![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by FredPotter on June 24, 2007, at 18:54:46
This site
http://www.psychotropical.com/maois_full.shtml
states that B6 is put out of action by MAOIs. I thought therefore that supplementing it would be a good idea, but what if that gets put out of action too?
Posted by Larry Hoover on June 24, 2007, at 19:38:40
In reply to MAOIs and vitamin B6, posted by FredPotter on June 24, 2007, at 18:54:46
> This site
>
> http://www.psychotropical.com/maois_full.shtml
>
> states that B6 is put out of action by MAOIs. I thought therefore that supplementing it would be a good idea, but what if that gets put out of action too?My reading of the available literature suggests that B6 and phenelzine (Parnate) mutually destroy one another. Tranylcypromine (Nardil) does not have the same clear evidence of destruction of B6, but it is thought to do so.
Supplementation in the normally recommended range of doses for pyridoxine is the general consensus approach for managing this antagonistic interaction.
Lar
Posted by FredPotter on June 24, 2007, at 20:19:16
In reply to Re: MAOIs and vitamin B6 » FredPotter, posted by Larry Hoover on June 24, 2007, at 19:38:40
Thanks Larry (did you mean to call Phenelzine Nardil?). The logic would seem to be that enough B6 will kill off Nardil
Posted by Larry Hoover on June 25, 2007, at 6:27:50
In reply to Re: MAOIs and vitamin B6, posted by FredPotter on June 24, 2007, at 20:19:16
> Thanks Larry (did you mean to call Phenelzine Nardil?). The logic would seem to be that enough B6 will kill off Nardil
Did I mix the two trade names up? Sorry about that. I think in generic, so the correct information follows from phenelzine and tranylcypromine referenced.
My brain is not working well these days. I'm barely functioning.
Lar
Posted by Phillipa on June 25, 2007, at 11:54:32
In reply to Re: MAOIs and vitamin B6 » FredPotter, posted by Larry Hoover on June 25, 2007, at 6:27:50
Even though I'm not on an MAOI I take B6 as I was told it's a natural diuretic. Love Phillipa
Posted by GWA on June 27, 2007, at 8:46:33
In reply to MAOIs and vitamin B6, posted by FredPotter on June 24, 2007, at 18:54:46
B6 certainly destroys phenelzine/Nardil, even in small amounts. It brought me to relapse. Don't take more than 100% of the recommended daily amount, and even then only six hours after your last phenelzine of the day.
Posted by KayeBaby on June 27, 2007, at 12:26:03
In reply to Re: MAOIs and vitamin B6, posted by GWA on June 27, 2007, at 8:46:33
Interesting.
Does B6 effect EMSAM?
Posted by FredPotter on June 27, 2007, at 15:31:08
In reply to Re: MAOIs and vitamin B6, posted by GWA on June 27, 2007, at 8:46:33
Many thanks for the information. It's a puzzle knowing what to do as I don't want to be B6 deficient. What are the symptoms of B6 deficiency?
Posted by brooke484 on June 27, 2007, at 19:53:30
In reply to Re: MAOIs and vitamin B6, posted by GWA on June 27, 2007, at 8:46:33
I take Nardil and also take a B-Complex. It has 50 mgs of B6. So, what does this mean for me? SHould I stop taking it? I thought I read that you should take a B-Complex if you have anxiety. I'm confused.
brooke
Posted by GWA on June 27, 2007, at 20:21:18
In reply to B-Complex and Nardil, posted by brooke484 on June 27, 2007, at 19:53:30
You should certainly stop the B-complex. 50mg of B6 utterly destroyed me until I worked out what was doing it. It was of course an "expert" on whose recommendation I started taking B6.
> I take Nardil and also take a B-Complex. It has 50 mgs of B6. So, what does this mean for me? SHould I stop taking it? I thought I read that you should take a B-Complex if you have anxiety. I'm confused.
>
> brooke
Posted by FredPotter on June 27, 2007, at 20:26:46
In reply to Re: B-Complex and Nardil, posted by GWA on June 27, 2007, at 20:21:18
I'm confused too. How much B6 am I getting in my food? Do I have to give up eating? Also I have a strong AD response even though I'm taking B6 and a B complex pill every night.
Posted by GWA on June 27, 2007, at 20:30:08
In reply to Re: B-Complex and Nardil, posted by FredPotter on June 27, 2007, at 20:26:46
I imagine that Everybody's Different, but also that if you gave up the B6 you'd have more Nardil in your bloodstream. Eating, in extreme moderation, may be safe.
Posted by brooke484 on June 27, 2007, at 20:32:52
In reply to Re: B-Complex and Nardil, posted by GWA on June 27, 2007, at 20:21:18
So do you take any B6 at all now?
Brooke
Posted by GWA on June 27, 2007, at 20:37:20
In reply to Re: B-Complex and Nardil - GWA, posted by brooke484 on June 27, 2007, at 20:32:52
Only as much as is in a multivitamin (2mg), and long after Nardil.
Posted by brooke484 on June 27, 2007, at 20:41:57
In reply to Re: B-Complex and Nardil - GWA » brooke484, posted by GWA on June 27, 2007, at 20:37:20
.
Posted by Zyprexa on June 28, 2007, at 13:56:00
In reply to Re: B-Complex and Nardil, posted by GWA on June 27, 2007, at 20:21:18
Posted by GWA on June 28, 2007, at 15:15:18
In reply to Re: B-Complex - what happened? (nm) » GWA, posted by Zyprexa on June 28, 2007, at 13:56:00
I had the symptoms of coming off Nardil - nightmares, deep depression, agitation and nausea.
Posted by Zyprexa on June 28, 2007, at 18:32:29
In reply to Re: B-Complex - what happened? » Zyprexa, posted by GWA on June 28, 2007, at 15:15:18
Did the B-complex counteract the nardil. And do you know if it does this to other meds? My doctor tells me to take B-100.
Posted by Honore on June 28, 2007, at 18:42:48
In reply to Re: B-Complex - what happened? » GWA, posted by Zyprexa on June 28, 2007, at 18:32:29
Could someone give me a cite to an article or two that say vitamin b-6 destroys Nardil or any other MAOI? I've read the reverse-- ie that nardil and other MAOIs destroy vitamin B-6. And I've gotten recommendations to take B-6 when on parnate.
I'd like to see any information about the B6/ destroys Nardil connection.
Honore
Posted by GWA on June 28, 2007, at 19:48:44
In reply to Re: Could someone give me some cites on that, plea, posted by Honore on June 28, 2007, at 18:42:48
Irritatingly, I can't find the free abstract I originally read. However -
http://www.jbc.org/cgi/content/full/276/18/15107:
"carbonyl reactive reagents... react with the aldehyde group of PP [pyridoxal phosphate] and thereby block its coenzyme activity. These agents include hydrazines, which form hydrazones (examples are 1-amino-D-proline in linseed oil and several drugs, including the anti-tuberculous agent isoniazid, carbidopa, phenelzine, and hydralazine)"PDRHealth says of B6 that "Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound".
The abstract I'm thinking of said, essentially, not "may" but "does". Anyway, my experience of sharp decline with discontinuation symptoms, not at the time recognised as such, after taking B6, and then of recovery beginning about ten days after dropping it, is proof enough for me.
I don't know about Parnate, I'm afraid.
Posted by Honore on June 28, 2007, at 23:16:26
In reply to Re: Could someone give me some cites on that, plea » Honore, posted by GWA on June 28, 2007, at 19:48:44
Yes-- but this article is about vitamin B deficiency, and mentions nothing about depletion of Nardil, or any other MAOI.
The sentence you quote addresses the destruction of Vitamin B-6 by phenelzine, not vice versa.
"Vitamin B6 deficiency was an unexpected, incidental, finding.... There was no question of nutritional deficiency, and the explanation, therefore, had to be antagonism or de-activation of the vitamin. A range of antagonists is known...... and [the] third [antagonist of the vitamin is] carbonyl reactive reagents.....These agents include hydrazines...including the anti-tuberculous agent isoniazid, carbidopa, phenelzine, and hydralazine)..."
In other words, nardil and the other compounds named antagonize, or destroy, vitamin b. Nothing says that vitamin 6 destroys nardil. Nothing in this article or anywhere that I could find, at least.
I don't know what caused your reaction, but I feel pretty sure it had nothing to do with ingesting vitamin B. All the other articles I've seen repeat the same information about possible deficiency of Vitamin B--NOT nardil.
I really think you have made a mistake in inferring that any such relationship exists.
Honore
Posted by FredPotter on June 28, 2007, at 23:41:13
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 28, 2007, at 23:16:26
Honore The following does imply they "interact" but uses only the word "react". "Interact" would imply a nonlinear relationship that destroys B6 and phenelzine. On the other hand "react" could mean they destroy each other too eg
Pb+O=PbO
"PDRHealth says of B6 that "Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound"."
Sorry to labour the point, but I think we need to get this right. We not talking about blocking an enzyme. The other question is does phenelzine do its MAOI work before it hits B6 or afterwards?
Fred
Posted by Honore on June 28, 2007, at 23:55:35
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by FredPotter on June 28, 2007, at 23:41:13
The context makes it totally clear that the discussion is about Vitamin B-6 deficiency.
It simply is what that article is about. Whatever the imprecision of the sentence, in establishing the reversibility of the relationship, it's not what the sentence is about, or what anything in the article is about.
Have you looked at the articed cited, in GWA's post prior to mine? Look at it, and then tell me that you think the sentence could possibly be taken to mean that vitamin B6 in any way affects nardil.
We can discuss it better if you look at the beginning of the article, where the abstract and this sentence occur.
Honore
Posted by Honore on June 29, 2007, at 0:56:04
In reply to Re: Nothing suggests Vitamin b destroys Nardil » Honore, posted by FredPotter on June 28, 2007, at 23:41:13
Let me argue by inference also:
Vitamin B6 is a treatment for peripheral neuropathy associated with isoniazid, a tuberculous drug also the first MAOI. Isoniazid also causes vitamin B6 deficiency...
(EG:
"It is believed that isoniazid competes with pyridoxyl phosphate for the enzyme apotryptophanase which may lead to symptoms of pyridoxine (vitamin B6) deficiency. Pyridoxine administration can prevent and reverse peripheral neuropathy complicating isoniazid use. Prophylactic pyridoxine administration (e.g., 10 to 50 mg/day) should probably be given routinely in individuals predisposed to develop peripheral neuropathies secondary to isoniazid therapy (e.g., patients who are malnourished, pregnant, alcoholic, diabetic, HIV-infected, or patients receiving higher doses of isoniazid)."
If Vitamin b6 destroyed isoniazid, at least in anything like potentially problematic amounts, so as to render treatment with isozianid ineffective-- it wouldn't be prescribed. Nor would the descriptions of the drugs mention vitamin b6 deficiency caused by isozionid; they would mention that vitamin b6 makes isozianid inactive and therefore not a useful treatment.Thereupon, patients with the effect would have to be given some other drug to treat tuberculosis. Ie, the isoniazid just wouldn't work for them if they needed to take vitamin b6).
Since many sources also suggest that vitamin b6 be prescribed, or used, with phenelzine (nardil), to treat nardil-caused vitamin b6 deficiency, the same would likely be true, don't you think?
Let's assume that the competition for apotryptophanase is two-way, and that therefore some amount of isoniazid, or nardil, might also be rendered ineffective by vitamin b6. It stands to reason, that if treatment with vitamin b6 for the peripheral neuropathy or vitamin b6 deficiency caused by nardil were going to negate the effects of nardil, nardil would simply have to be withdrawn from those who showed symptoms of vitamin b6 deficiency. Plus, I would expect that to be noted in the regular PDR as a contraindication for nardil-- or as a problematic condition in its use.
There's nothing of that sort at all anywhere that I can find, including the PDR.
So, I'm going to assume that since vitamin b6 is a recommended treatment for vitamin b6 deficiency in patients using nardil, that the nardil remains effective in the presence of vitamin b6.
Nothing else stands to reason.
So, I honestly think that taking vitamin v6 with nardil is well within reason, although not necessarily required. (Not everyone who takes nardil will have vitamin b6 deficiency, although it is well-known to exist.)
Does that in any way convince you of at least the great unlikelihood that any danger or threat to nardil exists in taking vitamin b6 with it; and that, moreover, much good may very possibly be done?
Honore
Posted by Larry Hoover on June 29, 2007, at 6:47:41
In reply to Re: Nothing suggests Vitamin b destroys Nardil » GWA, posted by Honore on June 28, 2007, at 23:16:26
> In other words, nardil and the other compounds named antagonize, or destroy, vitamin b. Nothing says that vitamin 6 destroys nardil. Nothing in this article or anywhere that I could find, at least.
From GWA's post:
" PDRHealth says of B6 that 'Phenelzine may react with pyridoxal 5'-phosphate to yield a metabolically inactive hydrazone compound'."It is precisely this phrase that led me to state earlier in the thread that phenelzine concentration might also be reduced by B6. The sole functional group on phenelzine is the hydrazine moiety. If the chemical reaction with pyridoxine converts it to a hydrazone, it is no longer able to inactivate the reactive centre of monoamine oxidase. It is rendered physiologically inert.
Obviously, if true, this reaction must take place in all individuals taking phenelzine, as everybody has some amount of pyridoxine in their tissues. It would be a dynamic balance, dependent on reactant concentrations, and it could be shifted into disequilibrium in either direction.
The underlying assumption is that this mechanism explains the B6 deficiency in susceptible individuals. Individual differences in genetic (or environmental, e.g. dietary) factors might relegate it to an insignificant concern, or elevate it to a dominant regulatory position.
Lar
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.