![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by JohnSky on November 6, 2007, at 9:24:11
Hello.
I started Nardil 10 days ago at 45mg/day. A couple of days ago I noticed my anxiety level rising. Worries me as anxiety has come with about every AD I've tried. Yesterday I went up to 60mg as my doc wanted me to do. I took an extra 15mg pill at dinner. The anxiety really ramped up and it took a long time to get to sleep.
I am so frustrated after trying so many meds I want this to work as it did in the past.Questions:
1. Should this anxiety I am feeling taper away as my body gets use to Nardil? I took Nardil 20 years ago and I don't remember this anxiety... but I may not be remembering everything.
2. Have others experienced this starting anxiety and then a reduction?
3. Can I cut a pill in half to spread out the increased 15mg better through the day?
Thanks in adavance for the help
John
Posted by stargazer2 on November 6, 2007, at 13:37:37
In reply to Need Help from Nardil users, posted by JohnSky on November 6, 2007, at 9:24:11
John, did I hear you right in saying you started at 45 mg? The way to begin Nardil is slowly starting at 15 mg for a few days, then 30 mg for a few days, working up slowly to the target dose.
Your anxiety may be from this high dose to begin with. Not sure why you would have statred at 45. What does your pdoc say?
I too too Nardil 20 years ago and was on 15 mg twice a day. It worked beautifully on its own and if you don't know this the Nardil of today was reformulated and the outer coating dissolves more quickly than it should. Many people who were rock stable on the earlier version have decompensated on the version made by Pfizer which I think was rereleased in 2003. I may have that date wrong but no matter what, the current Nardil does not work as well as the original formula and many users had to get off of it becasue they crashed and burned.
That is all I can offer you as to why your anxiety might be through the roof.
Stargazer
Posted by mav27 on November 6, 2007, at 20:26:50
In reply to Re: Need Help from Nardil users, posted by stargazer2 on November 6, 2007, at 13:37:37
According to the drug company you start at 45 and work up as fast as you can, my doc also said the same thing.
Here's a snipet from the product info sheet
http://members.iinet.net.au/~jkaufman/nardil.jpgsource: http://www.linkpharma.com.au/util/doc.jsp?i=570&f=blob8&c=20
Posted by Justherself54 on November 6, 2007, at 22:24:11
In reply to Re: Need Help from Nardil users » stargazer2, posted by mav27 on November 6, 2007, at 20:26:50
I started at 15 mg for 4 days then went to 45 and I feel it was too fast..not feeling so great, but have been at 45 for 3 days so don't know what to think now..keep at 45 and hope I feel better or drop down to 30 for a few days..gad..someone let me off this med merry-go-round..
Posted by stargazer2 on November 7, 2007, at 7:47:13
In reply to Re: Need Help from Nardil users » stargazer2, posted by mav27 on November 6, 2007, at 20:26:50
Mav, that's interesting since when I used Nardil 20 years ago I took 15 mg twice a day. Now with Pfizer manufacturing it, the starting dose is considered 45. This is what so many users have said about the newer nardil after Pfizer became the manufacturer...if it is the same thing why is more Nardil necessary now? For drug sales?
What does it say for people that are having side effects at the starting dose? Does it say reduce the dosage and start at a lower dose?
Of all of the meds I've used, I always have started on the lowest dose, since I have alot of S/E's that cause me to have to discontinue meds too early (in the past).. My doc and I now know to start on the lowest dose and work up from there.
It's too bad the package insert says start at 45...many of us would have failed to tolerate nardil at this dosage. I will go back and look at the package insert again. I have read that you should start at 15 for a few days and increase to 30 as tolerated, so i wonder where I read that?
Stargazer
Posted by mav27 on November 7, 2007, at 9:09:41
In reply to Re: Need Help from Nardil users/mav27, posted by stargazer2 on November 7, 2007, at 7:47:13
Yeah well i've just had to re-start the Nardil due to a sudden hit in side effects. I started at 45 and increased it rapidly just like it said up to 60 which i actually didn't have trouble with (in about a weeks period)... then at the 3 week mark it was like being blasted with the side effects from hell. So i had to stop for a couple weeks and now i've re started on 15mg which i've been on for 2 weeks and will be increasing to 30 at the 3 week mark.
Posted by stargazer2 on November 9, 2007, at 13:06:12
In reply to Re: Need Help from Nardil users/mav27 » stargazer2, posted by mav27 on November 7, 2007, at 9:09:41
See what good was it to start at the recommended 45 mg to only end up with severe side effects and have to start all over again. Why can't these drug manufacturers make a recommendation to start at 15 mg, else why would the pill come in 15 mg if it should be started at 45 mg.
I'm not sure why they do this as so many users of AD's can have S/E's at any dose so it only makes sense to start at the lowest dose.
Nardil also has bad side effects related to hypotension and that side effect has to be adjusted to very slowly raising the dose only once you are not having severe dizziness.
Package inserts often times contain the wrong message and I believe this is the case with Nardil. Starting at 45 mg will cause many users to fail a trial of it due to severe, intolerable side effects.
Stargazer
Posted by JohnSky on November 9, 2007, at 13:15:20
In reply to Start slow despite package insert indications, posted by stargazer2 on November 9, 2007, at 13:06:12
Thanks for the input. I plan to see if the anxiety side effect comes down in a week. If it does not I need to move on. The impact on sleep insn't good either. I just wonder how long users of Nardil had these side effects before they tapered away? Using this forum I will only obviusly hear for .0001% of users so it is hard to guage what the average response is. Would love to chat with someone that had the start up side-effects.
John
Posted by stargazer2 on November 9, 2007, at 15:19:28
In reply to Re: Start slow despite package insert indications, posted by JohnSky on November 9, 2007, at 13:15:20
John, do you split the dose? I take the larger dose at bedtime because it made me sleepy. If it energizes you, take the larger dose in the AM...but anything 30 and above should be a split dose.
Stargazer
Posted by JohnSky on November 9, 2007, at 15:30:09
In reply to When do you take Nardil?/John, posted by stargazer2 on November 9, 2007, at 15:19:28
So are you saying if it is 30mg dose I should split it up to 15mg and spread it out? It does energize me and is messing with my sleep so maybe I should take it in the morning. Does the anxiety fade away with time. I took Nardil 20 years ago and I don't remember any problems with anxiety or sleep.
> John, do you split the dose? I take the larger dose at bedtime because it made me sleepy. If it energizes you, take the larger dose in the AM...but anything 30 and above should be a split dose.
> Stargazer
Posted by stargazer2 on November 9, 2007, at 19:44:52
In reply to Re: When do you take Nardil?/John, posted by JohnSky on November 9, 2007, at 15:30:09
John, you should split the dose. If it is very energizing you may want to take 15 in the am and 15 in the afternoon, but not too close to yur bed time.
The original Nardil from 20 years ago no longer exists. I took it then and was very well controlled on 30mg. Alot of users say the newer Pfizer version of Nardil does not work as well as the original version. Even though it is not considered a generic med, Pfizer reformulated Nardil in the last few years and it no longer is red with a hard outer shell. The reformulation did something to the medication causing it to breakdown more quickly and now you have to use higher doses and there are definately more side effects than the original Nardil.
It seems that this is happening more and more to medications as they are bought out by other pharma cos. and are reformulated to possibly save money by making a cheaper product with cheaper ingredients.
There's alot written about the reformulation of Nardil and the users who destabalized when it was released by Pfizer. Do a google search on Nardil, reformulation or consumer complaints and you will see what the argument is. The change in the med caused many users to end up in the hospital and relapse for the first time in many years. It is obvious to the end users that the refomulation of Nardil caused some change in the way the med works, enough so that stable users destabalized and their depression returned after many years of being well controlled.
The worse thing that can happen to a depressed patient is to have a medication that is working for them pulled from the market. I had this happen to me in 1994 with Marplan and I was never able to get another med to work as well as it did. When Marplan was released this past year, I rushed to try it again and of course, it never worked like the original did.
Pharmaceutical Companies do this constantly and also once a med becomes generic, the meds are not the same as the brand name product because the generic components are never the exact same thing so even though it says the active ingredients are the same, the inactive ingredients affect how the medication works.
It stinks to not know if the medication you have been taking is going to continue working once it becomes generic. Oftentimes it does not despite being told it is the same thing. Example: Buproprion vs Budeprion, generic of wellbutrin.
Sorry so much info, i got carried away...
stargazer
Posted by mav27 on November 9, 2007, at 21:11:53
In reply to Start slow despite package insert indications, posted by stargazer2 on November 9, 2007, at 13:06:12
> Nardil also has bad side effects related to hypotension and that side effect has to be adjusted to very slowly raising the dose only once you are not having severe dizziness.
>
> StargazerYeah the hypotension was the side effect that hit me bad when i followed the insert instructions. It was so bad i spent the day in hospital. My blood pressure dropped to the point of 70/60 and it was just impossible to function... i couldn't move around without just randomly blacking out and fainting. So that's why i've restarted on the 15mg and working up slowly.
Posted by stargazer2 on November 11, 2007, at 20:56:02
In reply to Re: Start slow despite package insert indications » stargazer2, posted by mav27 on November 9, 2007, at 21:11:53
If everyone that has taken Nardil has so much trouble with a high starting dose, at what point does Pfizer change the package insert to reflect the large number of SE's and to start out at 15 mg, not 45 mg.
Don't they know it is not the same med as the original Nardil that they messed with and no one had anywhere near the same number of SE's with the original formulation.
They changed a fantastic product by messing with the so called insipient ingredients and that made Nardil unlike the previous version, which had a hard red coating which allowed for a longer dissolution phase with minimal SE's.
They're going to lose many patients who cannot tolerate the side effects of this inferior replication of the 'Real' Nardil, circa 2002 and before.
They just tried to save money by making the product more cheaply and messed with the original formula.
google 'nardil Activism' for more details of this fiasco.
Stargazer
Posted by Nardilstarted2007 on November 14, 2007, at 21:00:29
In reply to Re: Start slow despite package insert indications, posted by JohnSky on November 9, 2007, at 13:15:20
Posted by Nardilstarted2007 on November 14, 2007, at 21:15:17
In reply to Re: Start slow despite package insert indications (nm) » JohnSky, posted by Nardilstarted2007 on November 14, 2007, at 21:00:29
Hi John more of the 0.0001 population here, I just joined, and everyone else on the maoi thread! Im new here but have been reading 100's, maybe even a thousand posts before I signed up. It will be great to share my expeariences with you guys as I've read sooo many post and knew it was time time sign up.. Anyway, I hope this thread is still alive! I started Nardil oct 10 2000 and was SO DESPERATE for it to kick in, in the soonest possible time that I took charge myslf (as I have for years because I, m sick of using meds that dont work, and I'm to the point that I will just about do anything) anyway I got my bottle of 100 Nardil and took 60mgs the fist day, then 75 the second day (1mg/kg) I figured that I would try hard and tolerate the side effects without titrating in hopes to get the full maoi inhibition as fast as possible and for results as fast as possible. Nardil doesn't really start to work for most people until 80% maoi inhibition, and then you have to wait the 2 - 8 weeks for it to kick in. so I wanted maoi inhibition right away! so I didnt have to wast my time titrationg, then waiting. Im trying to finish school this semester and if nardil doesn't kick in by 6 weeks a bit more , Im screwed. So thats why I srarted at 75 immediately (crazy? yes indeed, I know but I was, and still am desperate for a normal life and to finish school. Im definately not saying to start out at a high dose, not at all. I just want to tell you what happened.
- 1 st day at 60, nothin
- 2nd day at 75, tired, dizzy(different then ssri dizzy), arms and legs felt weak
- 3rd same
- day 5 somewhat blurred vision, but not much, still the same side effects as day two. I knew maoi inhibition was not yet very high as I could orgasm fine and eat anything on the restricted list.
-Day 7 I believe I hit 80% maoi inhibition because I couldn't orgasm, urinary retention, small hints of hypermania lasting only a few minutes a couple times a day, I felt my heart pound if I ate the wrong food, (I was trying the restricted food like raisins in small amounts and cheese in small amounts (i was testing my body to see where I was at, Not safe I dont suggest anyone do what I did)-week 2 Nothing changed except the introduction of very dizzy upon standing up, same other side effects as week 1.
-week 3 I noticed a small increase in mood and anti anxiety effcts, with all side effects still annoying me.
week 3.5 - I noticed a drastic decrease in anxiety and depression almost gone, with slight hypomania (talking on msn to 4 people at once really fast) So I knew it was kicking in because this was lasting all day and not just little bursts that I get with placebo induced thoughts from old times when ssri's worked a little. Side effects diminished alot. only had, urinary retention, and dizzyness upon standing up, Also I must follow the dietary restrictions pretty closely or I get a pounding heart, and one time a headache (this was ocurring from Raisin bran, if I took the big raisins out I was fine)
-week 4 Im feeling the same but with sever constipation(im on 2 stool softerners which help and get me by ok, some urinary retaention left, and I have insomnia, and dizzyness upon standing up. Anxiety in social places is almost completely gone YA! but I still cant give a presentation, but I did put up my hand and give an example without having a Panick Attack, Yep, pretyy positive so far at 4 weeks.
4.5 weeks (today) pretty sever insomnia at night(very actually, but I still lie there) but I can nap in the afternoon for 3 hrs. constipation would be present if I wasn't taking 2 differt kinds of stool softeners 2x a day (tolerable and quite common with Nardil), Dizzyness upon standing up(probably will never go away while on nardil), cant orgasm (tolerable but upsetting as I know that I wouldn't be able to have s*x with a girl without explaining something of why I cant finish, but erection are good and I still have a sex drive.So I believe after the maoi enzymes were inhibited in me by the first week at 75mg's/day devided 30 in morning, thirty in afternoon and 15 at evening it took 2 weeks after that to start working (making a total of 3 weeks, and 3.5 weeks to start working good) It could work better I am sure and within a couple more weeks I wonder if it will kick in even more, I will ask that on a new post soon. I didn't have any anxiety upon starting, except I could get embaressed that I was fatigued, slow, and dizzy, so I had to hide that.
Super sorry for such a long post but its my first one ever so I just gaver. anyway thats my experience starting right off the bat at 75mg's and im 170 lbs, and its working and I seem to have tolerable side effects, oh and I gaind 4 lbs, and I crave food and smokes even tho ive never smoked in my life and im 22. at 4.5 weeks.
Hope to hear back from someone. I'll post my story of how I got here on a new thread in a couple days. Im not a maniac for starting so high, But was so desperate, I had a pantic attick the week before that left me hiding in he woods. I would have failed everything if I didnt get this med working ASAP, so I did it, unsafely. But I will update you all soon to compare my life and how it was woth it to start this med unsafely for ME. Thankyou all.
Posted by UgottaHaveHope on November 15, 2007, at 2:00:16
In reply to Re: Start slow despite package insert indications » Nardilstarted2007, posted by Nardilstarted2007 on November 14, 2007, at 21:15:17
Glad to have you aboard, and seems you have a lot of experience on Nardil, which many of us are eager to hear. Please tell.
Posted by JohnSky on November 15, 2007, at 9:57:02
In reply to Re: Yes, please tell your story » Nardilstarted2007, posted by UgottaHaveHope on November 15, 2007, at 2:00:16
So what dose is the minimum needed to work? 45mg?
60mg? What do most people take?John
Posted by Nardilstarted2007 on November 15, 2007, at 18:00:42
In reply to Re: Yes, please tell your story, posted by JohnSky on November 15, 2007, at 9:57:02
Hi. WHoooops! I meant I started nardil Oct 10 2007, just like in my name.. my thread will make more sense now.. I said 2000, just a typing error. Good to meet you UgottaHaveHope, I have sure read a lot of messages by you on here, pretty cool to hear back from you, Im sure I'll be able to speak to other big contributers aswell pretty soon as I join in more.
John, The only way to find your minimum dose is to slowly titrate up and wait 1-3 weeks to see if the nardil starts kicking in ( eg. 1-3 weeks at 30mgs, 1-3 weeks at 45mgs, 1-4 weeks at 60mgs and so on up until you get the antidepressant/antianxiety effect to kick in. If you can tolerate the side effects, I would suggest titrating up to 60 mgs/day as fast as your body can tolerate it, then stay there for at least 4 weeks before going any higher. I bet that 45mg's/day is the lowest dose a person may feel positive benefits on the new nardil, but it could be less for a select few lucky people (I hear and have read that the old nardil could have great benefits at just 30mgs/day and 45mg/day).
-People usually take 1mg of Nardil per Kilogram of bodyweight. So Devide your weight in pounds by 2.2 and what ever that equals is your target dose to shoot for. I'm 170lbs so I devide that by 2.2 and I get approximately 77 so I take 75mg's of nardil/day. 30mgs in the morning and 30 in the afternoon and 15 during the evening. I hope that helps John, Its seems that is the way to do it after reading a 100 hours of info and posts and listening to my psychiatrist.
-Nardil could kick in at anytime between 2 and 8 weeks. It Kicked in for me abit at 3.5 weeks, then alot more at 5 weeks (today is 5 weeks for me! and I feel almost all my social phobia is gone and a good antidepressant effect without hypomania like I could get on ssri's)I will write my full story of how I got here soon!, but I gotta run because I've been at school all day. talk to you guys soon
Posted by Nardilstarted2007 on November 19, 2007, at 14:26:15
In reply to Re: Yes, please tell your story » Nardilstarted2007, posted by UgottaHaveHope on November 15, 2007, at 2:00:16
> Glad to have you aboard, and seems you have a lot of experience on Nardil, which many of us are eager to hear. Please tell.
Hi again YouGottaHaveHope, Yes I posted my story of how my life got me to Nardil 5 weeks ago, its got some interesting stuff maybe and is probably similar to the rest of the people here except that I started nardil at my target dose 2nd day!.. I know that was not safe or right but hey i did it and im doing ok, My post is near the bottom of the new threads board, Hope to talk to you soon and hear how your doing these days on/off nardil? working/not,
see you later bud
This is the end of the 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.