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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 brooke484 on November 12, 2007, at 10:11:04
I've been doing fine on 30 mgs as far as side effects go, but I haven't really noticed any benefit yet. So on Sat my doctor told me to go up to 40 mgs. Well, since then I'm so dizzy and lightheaded. Now I did have this on Nardil and it usually went away after about a week of increasing the dose, so I can only hope it goes away this time too.
My question is, do you think spacing out the dose would help? Like take 10 mgs 4 times a day instead of taking 20 mgs 2 times? I can handle a lot of side effects, but feeling like I'm going to pass out at any minute is not pleasant.
I'll probably call my doctor in a few days, but I always like to hear your opinions too.
Thanks so much.
Brooke
Posted by tecknohed on November 12, 2007, at 19:51:02
In reply to Marplan and lightheadedness, posted by brooke484 on November 12, 2007, at 10:11:04
Hi brooke!
3 weeks for me on Marplan. 2 weeks at 40mg. I've just started getting postural hypotension occasionally when I stand up, but only occaionally. I suspect it will get worse for me before it gets better, you too probably.
MAOI side effects seem to creep up on people very slowly, last for a few months but then they DO eventually fade away completely (usually). Postural hypotension is usually dose related & will probably happen each time you increase the dose.
A couple of remedies for it which I've read about (on here) are adding more sodium to your diet, or even adding a very small dose of amphetamines to the MAOI. Drinking more water (3 Liters + per day) is supposed to help too. If you already drink caffein regularly & tolerate it well, increasing your intake is another option to raise you blood pressure.
Getting a blood pressure monitor is a good idea to check your progress. You can get a really cheap (& good) one off ebay.
Posted by tecknohed on November 12, 2007, at 19:58:36
In reply to Marplan and lightheadedness, posted by brooke484 on November 12, 2007, at 10:11:04
Some more suggestions from http://en.wikipedia.org/wiki/Orthostatic_hypotension :
"Some drugs that are used in the treatment of orthostatic hypotension include fludrocortisone (Florinef), erythropoietin and midodrine.
Pyridostigmine bromide (Mestinon) is now also used to treat orthostatic hypotension."
"Some suggestions for minimizing the effects include:
* Checking blood pressure regularly with a home monitoring kit. Check when lying flat and when standing as well as when symptoms occur.
* Standing slowly rather than quickly, as the delay can give the blood vessels more time to constrict properly. This can help avoid incidents of syncope (fainting).
* Take a deep breath and flex your abdominal muscles while rising to maintain blood and oxygen in the brain. This, however, may be contraindicated in individuals with Stage 2 hypertension. Usually medical personnel have their patients "dangle" before rising from bed to decrease the likelihood of dizziness/falling due to orthostatic hypotension. The dangling is done by having the patient sit on the side of their bed for about a minute so they do not have the sudden dizziness.
* Maintaining an elevated salt intake, through sodium supplements or electrolyte-enriched drinks. A suggested value is 10 g per day; overuse can lead to hypertension and should be avoided.
* Maintaining a proper fluid intake to prevent the effects of dehydration.
* As eating lowers blood pressure, eat multiple smaller meals rather than fewer larger meals. Take extra care when standing after eating.
* When orthostatic hypotension is caused by hypovolemia due to medications, the disorder may be reversed by adjusting the dosage or by discontinuing the medication.
* When the condition is caused by prolonged bed rest, improvement may occur by sitting up with increasing frequency each day. In some cases, physical counterpressure such as elastic hose or whole-body inflatable suits may be required."teck
Posted by brooke484 on November 12, 2007, at 20:25:18
In reply to Re: Marplan and lightheadedness » brooke484, posted by tecknohed on November 12, 2007, at 19:51:02
I was hoping you would respond. Thank you for all of the great suggestions. This just started and I'm hoping it goes away soon. I felt so fortunate because I wasn't having any side effects and then BOOM it hits me today at the drug store and I thought I was going to pass out. Very scary. I'll definitely add some more salt (I eat very little) and increase the water.
Do you take all of your medication in the morning or do you split the dose? I might try taking it 4 times a day and see if that helps.
Hope you're still feeling good. You give me hope. :)
brooke
Posted by tecknohed on November 13, 2007, at 7:41:44
In reply to Re: Marplan and lightheadedness, posted by brooke484 on November 12, 2007, at 20:25:18
I take mine 4 times day. 10mg breakfast, lunch, dinner & bedtime. This time around Marplan seems to be causing drowsiness (last time it caused insomnia for a while). Maybe the Klonopin is adding to this. For example, I was taking 20mg in morning, 10 at lunch & 10 at dinner but the 20mg in the morning was starting to knock me out, hence why I split that dose & take the other 10mg at night.
I'll babblemail you with some more info.
teck
Posted by brooke484 on November 13, 2007, at 14:07:38
In reply to Re: Marplan and lightheadedness » brooke484, posted by tecknohed on November 13, 2007, at 7:41:44
I'm going to have to try taking it 4 times a day also. I feel so much worse since going to 40. Maybe I should have tried 35 for a week and then gone to 40. Ugh.
brooke
Posted by tecknohed on November 14, 2007, at 3:48:40
In reply to Re: Marplan and lightheadedness - tecknohed, posted by brooke484 on November 13, 2007, at 14:07:38
> I'm going to have to try taking it 4 times a day also. I feel so much worse since going to 40. Maybe I should have tried 35 for a week and then gone to 40. Ugh.
>
> brookeMaybe go down to 35mg for 5 days. Might trick your body/brain & bring you some relief. Then, when you increase again go strait to 45mg & wait for the side effects & as soon as they hit go down to 40mg. Make sense?
Posted by brooke484 on November 14, 2007, at 10:54:33
In reply to Re: Marplan and lightheadedness - tecknohed » brooke484, posted by tecknohed on November 14, 2007, at 3:48:40
I'm back to 30 again after having a horrible day yesterday. The lightheadedness is still with me. Shouldn't it have gone away by now? I don't know Marplan's half-life. Does it take a few days for my body to realize I'm back to 30? I took 30 yesterday also.
Still feeling horrible...
brooke
Posted by tecknohed on November 14, 2007, at 15:46:40
In reply to Re: Marplan and lightheadedness - tecknohed, posted by brooke484 on November 14, 2007, at 10:54:33
Unfortunitely my friend, you're gonna be stuck with this dizziness (low blood pressure) for a good while. But it WILL go eventually. When I took Nardil & reached 60mg+ I had this side effect for a good 3 months then it dissappeared, never to return.
I think Marplan has a very short half-life - just a few hours. But of course you've been on it for many weeks so it would have accumilated. But even if you stopped it completely these side effects would probably last a few days anyway.
If I were you I'd stick on 35mg & wait. Then increase maybe 5mg every 2 weeks. But then I'm not you.Have you increased your salt intake yet? Make sure its SODIUM salt & not a potassium substitute otherwise it wont work. And what about the other suggestions? It may take a while for these to work - the sodium may need to build up in your system. AND GET A BLOOD PRESSURE MONITOR - then you can see EXACTLY whats going on!
teck
Posted by brooke484 on November 14, 2007, at 20:38:26
In reply to Re: Marplan and lightheadedness - tecknohed » brooke484, posted by tecknohed on November 14, 2007, at 15:46:40
3 months??? How could you function? I've been staying at home since this started because I'm afraid I'm going to pass out in public. Just walking up my stairs makes me feel like I could pass out. But, I will hang in there and follow your suggestions. I just hope this passes soon.
Thanks for your support.
Brooke
Posted by tecknohed on November 15, 2007, at 5:30:18
In reply to Re: Marplan and lightheadedness - tecknohed, posted by brooke484 on November 14, 2007, at 20:38:26
> 3 months??? How could you function? I've been staying at home since this started because I'm afraid I'm going to pass out in public. Just walking up my stairs makes me feel like I could pass out. But, I will hang in there and follow your suggestions. I just hope this passes soon.
>
> Thanks for your support.
>
> BrookeSorry, that did sound a bit daunting. This dizziness should gradually fade before it goes completely. In other words, it'll be BAD for a couple of weeks, then less bad for a couple of weeks, and so on. Of course each time you increase the dose it may get worse temporarily.
But thats just my experience with NARDIL. I've only been on MARPLAN for just over 3 weeks so I'm ONLY GUESSING based on my experience with Nardil. This side effect may (HOPEFULLY) dissappear quicker than we both think.
Sorry if I scared you!
Did you know that some herbs can raise and/or 'normalize' blood pressure. http://www.itmonline.org/arts/hypertension.htm
I would definitely recommend giving Korean Ginseng a go, starting with a normal (not high) dose. Just read & follow the label.
Posted by tecknohed on November 15, 2007, at 5:33:06
In reply to Re: Marplan and lightheadedness - tecknohed, posted by brooke484 on November 14, 2007, at 20:38:26
Licorice might be even better!
Posted by brooke484 on November 15, 2007, at 10:58:51
In reply to Re: Marplan and lightheadedness - tecknohed » brooke484, posted by tecknohed on November 14, 2007, at 15:46:40
When I was on Nardil I bought some salt supplements called Thermotabs. It's sodium chloride and one pill is equal to 180 mgs. I also have sea salt where 1/4 teaspoon is equal to 1.5 grams. Guess I should go with the sea salt. I never really noticed a difference when I took the pills. Did you increase your salt and did that help?
Still dizzy,
brooke
Posted by tecknohed on November 15, 2007, at 11:25:42
In reply to salt - tecknohed, posted by brooke484 on November 15, 2007, at 10:58:51
> When I was on Nardil I bought some salt supplements called Thermotabs. It's sodium chloride and one pill is equal to 180 mgs. I also have sea salt where 1/4 teaspoon is equal to 1.5 grams. Guess I should go with the sea salt. I never really noticed a difference when I took the pills. Did you increase your salt and did that help?
>
> Still dizzy,
>
> brookeYes, sea salt would be better. Make sure you actually calculate the SODIUM content as 'salt' can mean anything in the product, even the anti-caking agent. And make sure its NOT balanced with potassium or it wont work.
I really would buy a blood pressure monitor first if I were you (a wrist monitor). A set of digital scales weighing in 0.01g divisions would also be a good idea so you can know EXACTLY how much sodium you are taking. Both can be purchased cheaply off ebay. Just check the seller's feedback score before purchase (I always make sure its 99%+).
Posted by brooke484 on November 15, 2007, at 20:01:07
In reply to Re: salt - tecknohed » brooke484, posted by tecknohed on November 15, 2007, at 11:25:42
Thank you for all your advice and support. I really appreciate it!
Brooke
Posted by Astounder on November 15, 2007, at 23:21:08
In reply to Marplan and lightheadedness, posted by brooke484 on November 12, 2007, at 10:11:04
> I've been doing fine on 30 mgs as far as side effects go, but I haven't really noticed any benefit yet. So on Sat my doctor told me to go up to 40 mgs. Well, since then I'm so dizzy and lightheaded. Now I did have this on Nardil and it usually went away after about a week of increasing the dose, so I can only hope it goes away this time too.
>
> My question is, do you think spacing out the dose would help? Like take 10 mgs 4 times a day instead of taking 20 mgs 2 times? I can handle a lot of side effects, but feeling like I'm going to pass out at any minute is not pleasant.
>
> I'll probably call my doctor in a few days, but I always like to hear your opinions too.
>
> Thanks so much.
>
> BrookeMarplan like Parnate and Nardil is an unselective, irreversible inhibitor of MAO. Irreversible meaning it forms a covalent bond with enzyme, permenantly inactivating it. You have to wait weeks for your body to produce another enzyme. Since the orthostatic/postural issue is a direct effect of inhibiting MAO, you can't fix this by spacing the dose. The hypotension is mediated by increased uptake of octopamine, a trace amine like tyramine, into noradrenergic terminals. Normally this transmitter is kept at low levels, but if you start inhibiting MAO, the levels go up.
What you could try doing is adding on a selective NRI, like desipramine. Not only will this increase noradrenaline levels, it'll prevent octopamine from entering the NA terminals. This also abolishes the pressor response to tyramine, so you can be less picky about what you eat.
Posted by tecknohed on November 16, 2007, at 4:50:58
In reply to Shouldn't matter when you take it » brooke484, posted by Astounder on November 15, 2007, at 23:21:08
> Marplan like Parnate and Nardil is an unselective, irreversible inhibitor of MAO. Irreversible meaning it forms a covalent bond with enzyme, permenantly inactivating it. You have to wait weeks for your body to produce another enzyme. Since the orthostatic/postural issue is a direct effect of inhibiting MAO, you can't fix this by spacing the dose. The hypotension is mediated by increased uptake of octopamine, a trace amine like tyramine, into noradrenergic terminals. Normally this transmitter is kept at low levels, but if you start inhibiting MAO, the levels go up.
>
> What you could try doing is adding on a selective NRI, like desipramine. Not only will this increase noradrenaline levels, it'll prevent octopamine from entering the NA terminals. This also abolishes the pressor response to tyramine, so you can be less picky about what you eat.Not too sure about the dose spreading being uneffective. When I took Nardil I was fine when I woke up in the mornings, then after my first dose I'd be virtually blind with dizziness.
Your right about an NRI blocking the tyramine effect. I know reboxetine has been studied well for this. But didn't you say that they "cause plastic NET downregulation after a few weeks, like all other NAergic antidepessants. An effect that remains after treatment ends." http://www.dr-bob.org/babble/20071115/msgs/795398.html
So are they good or bad?
I'm sure that if there is a way of getting around the low blood pressure effect without the use of more artificial drugs then that would be prefered?
Posted by Astounder on November 16, 2007, at 8:36:14
In reply to Re: Shouldn't matter when you take it » Astounder, posted by tecknohed on November 16, 2007, at 4:50:58
> > Marplan like Parnate and Nardil is an unselective, irreversible inhibitor of MAO. Irreversible meaning it forms a covalent bond with enzyme, permenantly inactivating it. You have to wait weeks for your body to produce another enzyme. Since the orthostatic/postural issue is a direct effect of inhibiting MAO, you can't fix this by spacing the dose. The hypotension is mediated by increased uptake of octopamine, a trace amine like tyramine, into noradrenergic terminals. Normally this transmitter is kept at low levels, but if you start inhibiting MAO, the levels go up.
> >
> > What you could try doing is adding on a selective NRI, like desipramine. Not only will this increase noradrenaline levels, it'll prevent octopamine from entering the NA terminals. This also abolishes the pressor response to tyramine, so you can be less picky about what you eat.
>
> Not too sure about the dose spreading being uneffective. When I took Nardil I was fine when I woke up in the mornings, then after my first dose I'd be virtually blind with dizziness.
>
> Your right about an NRI blocking the tyramine effect. I know reboxetine has been studied well for this. But didn't you say that they "cause plastic NET downregulation after a few weeks, like all other NAergic antidepessants. An effect that remains after treatment ends." http://www.dr-bob.org/babble/20071115/msgs/795398.html
> So are they good or bad?
> I'm sure that if there is a way of getting around the low blood pressure effect without the use of more artificial drugs then that would be prefered?Less NET pumps = Less NE/tyramine/octopamine/DA uptake into NA terminals. This is similar to the action of tertiary amine tricyclics and SSRIs on SERT. It's probably responsible for the plastic, curative (not palliative) effects of antidepressants, why you can often remove the drug after remission and still maintain their effects. Opposite, drugs you develop tolerance to, like DAT blockers, increase the number of DAT pumps, making them less effective over time.
Posted by tecknohed on November 18, 2007, at 8:51:44
In reply to It's a good thing!, posted by Astounder on November 16, 2007, at 8:36:14
> Less NET pumps = Less NE/tyramine/octopamine/DA uptake into NA terminals. This is similar to the action of tertiary amine tricyclics and SSRIs on SERT. It's probably responsible for the plastic, curative (not palliative) effects of antidepressants, why you can often remove the drug after remission and still maintain their effects. Opposite, drugs you develop tolerance to, like DAT blockers, increase the number of DAT pumps, making them less effective over time.
Makes sense, thanks.
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