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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by socialphobic on August 4, 2008, at 2:41:01
Well I was just prescribed some nardil and also purchased an automatic blood pressure machine on the way home.
I took my blood pressure reading BEFORE starting nardil and it was 142 / 84. Is this a good level for going on an MAOI? Is it better to be on the high end (like I am) or lower end of normal? My resting heart rate was like 113... but i'm very unfit. Is heart rate a problem while on MAOI's?
How much does nardil lower your blood pressure by usually?
I might be starting it tomorrow but at the moment i'm very anxious about it. I'll see if I can build up the courage tomorrow.
BTW, I recently heard that you shouldn't eat gravy while on MAOI's? Is this true? I never knew that. Oh and is yogurt ok?
Posted by socialphobic on August 4, 2008, at 7:49:14
In reply to Starting nardil soon, ideal BP?, posted by socialphobic on August 4, 2008, at 2:41:01
One more question... I eat a fair bit of packet mix pasta's which contain "yeast extract", is this safe to eat?
Posted by Justherself54 on August 4, 2008, at 8:16:20
In reply to Starting nardil soon, ideal BP?, posted by socialphobic on August 4, 2008, at 2:41:01
> Well I was just prescribed some nardil and also purchased an automatic blood pressure machine on the way home.
>
> I took my blood pressure reading BEFORE starting nardil and it was 142 / 84. Is this a good level for going on an MAOI? Is it better to be on the high end (like I am) or lower end of normal? My resting heart rate was like 113... but i'm very unfit. Is heart rate a problem while on MAOI's?
>
> How much does nardil lower your blood pressure by usually?
>
> I might be starting it tomorrow but at the moment i'm very anxious about it. I'll see if I can build up the courage tomorrow.
>
> BTW, I recently heard that you shouldn't eat gravy while on MAOI's? Is this true? I never knew that. Oh and is yogurt ok?
Nardil can lower BP quite a bit for some. I didn't have hypotension with Nardil, but a friend of mine's is really low. It can vary from individual.Real homemade gravy made just from the drippings is OK. Don't add Bovril or Oxo or anything like that. I eat yogurt every day. Yeast extract in packaged foods is a no-no. You'll be suprised as it seems to be in frozen dinners, canned soups...you'll get used to reading labels!! Best thing is to eat as fresh as you can.
I was scared to start MAOI's, but I was more scared of my depression. This is a great place to ask questions about Nardil as lots of informed people here. One thing to remember is I've found the maoi'S take a bit longer to work sometimes, so don't get discouraged...Nardil made me a social butterfly. I'm now on Parnate and am not very social at all..
Good luck to you. It took me three days of staring at the pill before I finally said OK here goes, so you're not alone in that.
Posted by dcruik518 on August 4, 2008, at 8:23:37
In reply to Re: Starting nardil soon, ideal BP?, posted by Justherself54 on August 4, 2008, at 8:16:20
Social phobic,
All this anxiety about your blood pressure may be more harmful to your health (and blood pressure) than the drug itself. You'll be fine.
~DRC
Posted by socialphobic on August 4, 2008, at 8:56:01
In reply to Re: Starting nardil soon, ideal BP?, posted by Justherself54 on August 4, 2008, at 8:16:20
>Yeast extract in packaged foods is a no-no. You'll be suprised as it seems to be in frozen dinners, canned soups...you'll get used to reading labels!! Best thing is to eat as fresh as you can.
You're joking right? I practically live off frozen meals and packet pasta mixes. Can I not eat them at all anymore? I seriously don't know what else i'll eat. Isn't yeast extract in pretty much every packaged foods these days?
Anyone else have experiences with frozen dinners and pasta packet mixes etc?
Posted by dcruik518 on August 4, 2008, at 9:05:08
In reply to Re: Starting nardil soon, ideal BP?, posted by socialphobic on August 4, 2008, at 8:56:01
Sheesh, man.
Posted by Phillipa on August 4, 2008, at 12:12:08
In reply to Re: Starting nardil soon, ideal BP?, posted by dcruik518 on August 4, 2008, at 9:05:08
Even things like healthy choice? And with the hypotension I'd think a slightly elevated on to start with would be better . Phillipa no personal experience.
Posted by Quintal on August 4, 2008, at 13:41:06
In reply to Re: Starting nardil soon, ideal BP?, posted by socialphobic on August 4, 2008, at 8:56:01
It is very hard to find any kind of ready prepared or fast food that contains no hidden cheese or yeast extract. I did find a few though, but mostly had to live of a very simple diet of bread, beans on toast, cereals etc. It had some advantages in that I had to switch to cooking things from scratch myself and switch to a healthier diet. Some people have reported being able to eat foodstuffs containing yeast extract though, so long as it's listed towards the end of the ingredients (meaning it's only present in small quantities). Others have claimed to be able to eat McDonalds without any problems, but I wouldn't want to do that myself.
A few Nardil users have used cheese to counteract the hypotension, but again that isn't something that anyone would recommend on a large scale. According to Dr. Ken Gillman it's the amount of tyramine that hits the stomach at once that dictates the risk of hypertensive crisis as much as the amount of tyramine consumed overall. This means that you might be able to get away with small amounts of tyramine rich foods so long as they're eaten as part of a large meal.
Q
Posted by Justherself54 on August 4, 2008, at 17:33:19
In reply to Re: Starting nardil soon, ideal BP?, posted by Quintal on August 4, 2008, at 13:41:06
I too used to live on Lean Cuisine and frozen meals..now I have to prepare..but being lazy I eat a lot of yogurt, cereals and lots of fruit.
I have eaten at McDonald's many times and have had no problem. Their cheese is processed, so it's OK.
I'll continue altering my dietary lifestyle in the hopes that my recent increase in Parnate will help.
There's a good beef tortellini and ravioli out there that has no cheese in it...I just use a spicy salad dressing as I tend to get sick of tomato sauces. I did run across some frozen dinners recently that did not have any yeast crap in them. When I pick some up I'll post the name of them.
You just have to keep looking...I was pretty excited to finally see a frozen meal I could nuke.
As for the BP monitor, I have one and was a little compulsive with it at first. I'm glad I have it as I did spend 3 hours in the ER. It didn't turn into a hypertensive crisis but my BP was high enough that they monitored it, plus hooked me up to an EKG. Now I only take it if I have a bad headache or feel light headed.
You have to think seriously whether you can handle the lifestyle changes that come with being on a MAOI. If giving up prepackaged food (and the yeast is in 99% of it), you may not be a good candidate for a trial on a MAOI.
Posted by Phillipa on August 4, 2008, at 20:30:48
In reply to Re: Starting nardil soon, ideal BP?, posted by Justherself54 on August 4, 2008, at 17:33:19
Excellent advise and post. Phillipa
Posted by socialphobic on August 4, 2008, at 22:55:42
In reply to Re: Starting nardil soon, ideal BP?, posted by Justherself54 on August 4, 2008, at 17:33:19
I have read contradicting information about the MAOI diet, its getting really confusing now.
Some say processed cheese is okay, while other websites say its not.
Some people say "yeast extract" is fine is processed/packaged/frozen foods, others say it isn't.
My pharmasist told me that all nasal sprays are fine, whereas someone on here reported a hypertensive crisis taking one.
When there is such contradicting information it really does make it confusing and scary. If you're on an MAOI then it really sounds like you're playing with fire.
It sounds like the only true safe way to be on an MAOI (with all the contradicting information out there) is to be hooked up to a drip instead of eating.
I have some nardil sitting here but i'm starting to think twice about taking it.
Posted by dcruik518 on August 5, 2008, at 8:14:11
In reply to Re: MAOI diet confusion, posted by socialphobic on August 4, 2008, at 22:55:42
There is an old diet list and a new one that is much less restrictive. The newest research indicates that Nardil and other MAOIs are much safer than previously thought. And as I told you before, I was able to eat just about anything on it for over six years without any problem. You are just allowing yourself to get extremely paranoid over this. The drug is safe! There have been many more deaths from Prozac than Nardil, btw.
~Dwight
Posted by mickapoo on August 5, 2008, at 10:49:13
In reply to Re: MAOI diet confusion, posted by socialphobic on August 4, 2008, at 22:55:42
> I have read contradicting information about the MAOI diet, its getting really confusing now.
>
> Some say processed cheese is okay, while other websites say its not.
>
> Some people say "yeast extract" is fine is processed/packaged/frozen foods, others say it isn't.
>
> My pharmasist told me that all nasal sprays are fine, whereas someone on here reported a hypertensive crisis taking one.
>
> When there is such contradicting information it really does make it confusing and scary. If you're on an MAOI then it really sounds like you're playing with fire.
>
> It sounds like the only true safe way to be on an MAOI (with all the contradicting information out there) is to be hooked up to a drip instead of eating.
>
> I have some nardil sitting here but i'm starting to think twice about taking it.I understand your confusion & frustration. I started Nardil a week ago and am going through the process of figuring out what I can & cannot have. BTW, I have a horrendous cold with a splitting headache. I called one pharmacy, and they looked up whether there was any interaction with Nardil & Fiorinal with Codeine (which is the only thing that helps for my headaches). The pharmacist told me he looked it up in the two databases they check for interactions- one database showed no interactions, and the other database listed it as having a severe interaction. I then decided to call the same chain of stores, but a different location. Apparently they only checked the one database and told me the medication was safe to take! Aaarghh! That obviously added to my frustration. What I do now is I call several pharmacies, and do research online.
Posted by gardenergirl on August 5, 2008, at 19:11:19
In reply to Re: MAOI diet confusion, posted by socialphobic on August 4, 2008, at 22:55:42
> I have read contradicting information about the MAOI diet, its getting really confusing now.
>
> Some say processed cheese is okay, while other websites say its not.It depends on whether it's aged cheese, not processed or not. I had to learn something about cheese-making to determine whether I could eat feta or goat. Feta is aged, goat cheese is not. Provolone and mozzarella are not aged. Ricotta is not. Cream cheese is not. But most others are, at least most common cheeses I'm familiar with.
>
> Some people say "yeast extract" is fine is processed/packaged/frozen foods, others say it isn't.Autolyzed yeast extract is something used to bind the flavors of seasoning and is used in a lot of prepackaged foods. It's generally safe in the amounts used in this type of food. Marmite and Vegemite, however, are mostly if not all yeast extract, and they are to be avoided as they can cause a crisis.
>
> My pharmasist told me that all nasal sprays are fine, whereas someone on here reported a hypertensive crisis taking one.It depends on what's in the nasal spray.
>
> When there is such contradicting information it really does make it confusing and scary. If you're on an MAOI then it really sounds like you're playing with fire.There is a lot, that's true. It's important to stay up with the latest research and take anecdotal information with a grain of salt. What works for one may not work for another, as we each have our own individual body chemistries. Try to assess how much tyramine is in what you are considering by looking at how aged it or ingredients in it are, and in what quantities. And always, better cautious imo.
Hope this helps.
gg
Posted by gardenergirl on August 5, 2008, at 19:13:12
In reply to Re: MAOI diet confusion, posted by mickapoo on August 5, 2008, at 10:49:13
> The pharmacist told me he looked it up in the two databases they check for interactions- one database showed no interactions, and the other database listed it as having a severe interaction. I then decided to call the same chain of stores, but a different location. Apparently they only checked the one database and told me the medication was safe to take! Aaarghh! That obviously added to my frustration. What I do now is I call several pharmacies, and do research online.
That is frustrating and scary. I tend to rely on Epocrates pretty extensively. That and the PDR. And my own doc, who is at least familiar with MAOIs, as it's not a widely used med anymore.
gg
Posted by Zeba on August 5, 2008, at 21:40:40
In reply to Re: MAOI diet confusion » socialphobic, posted by gardenergirl on August 5, 2008, at 19:11:19
my research shows that Provolene cheese is aged. Where do you see it is not? Thanks.
Zeba
Posted by socialphobic on August 5, 2008, at 21:48:02
In reply to Re: MAOI diet confusion, posted by mickapoo on August 5, 2008, at 10:49:13
> I understand your confusion & frustration. I started Nardil a week ago and am going through the process of figuring out what I can & cannot have. BTW, I have a horrendous cold with a splitting headache. I called one pharmacy, and they looked up whether there was any interaction with Nardil & Fiorinal with Codeine (which is the only thing that helps for my headaches). The pharmacist told me he looked it up in the two databases they check for interactions- one database showed no interactions, and the other database listed it as having a severe interaction. I then decided to call the same chain of stores, but a different location. Apparently they only checked the one database and told me the medication was safe to take! Aaarghh! That obviously added to my frustration. What I do now is I call several pharmacies, and do research online.
That is exactly why i'm so scared, there is a LOT of contradicting information out there.
My pharmacist told me that ALL nasal sprays are fine. If I took this to be true I could have purchased a nasal spray and had a hypertensive crisis.
It seems no-one seems to know for sure whats safe and what isn't. It sounds like a lot of it is "try it, pray, and hope for the best" type of thing. There is just too much trial and error involved with some foods, especially at restaurants.
To the person who said i'm paranoid, yes I am, but with this kind of information how could you not be? It seems that a lot of foods (especially when eating out) are a hit and miss affair. You don't know how long some meat has been sitting in their fridge, and you don't always know what sauces they put in.
I have decided to change my script for cymbalta because going on an MAOI is just making me too anxious in the first place.
Posted by Nadezda on August 6, 2008, at 19:37:03
In reply to Re: MAOI diet confusion, posted by socialphobic on August 5, 2008, at 21:48:02
There aren't actually that many restrictions on Maois-- although lots of places will give you a list of everything that anyone had a reaction to. Most of the things on those lists are not important.
The main things to look for is aged foods-- for example, soy sauce, aged cheese, red wines of certain kinds and food that has spoiled from being left out in the heat, especially foods mayonnaise based salads.
The other category is certain medications like nasal sprays, decongestants, long-acting novocaine and some other anti-depressants (like most tricyclics), and some others.
While it can be a bit unnerving at the beginning, when you need to check things once and a while, I can reassure you that, after using an maoi, you quickly learn what you need to avoid (it isn't that much). And then, you become quite used to it, even if it means being a bit careful at times-- and that's really it.
It's important to check your BP every day at the beginning, just to make sure that you aren't doing anything that's causing it to be elevated. Realistically until you get to very high doses of Maois, there's a fair amount of extra capacity before you get into trouble with foods or meds-- so you probably will catch it before anything much happens.
I never had a reaction that required me even to consider going to the hospital and I was on a very high dose. Once or twice I had mild serotonin reactions to normally safe ADs that my pdoc was trying out to help me sleep-- and that's only because I'm very sensitive to serotonin.
For a lot of things, my pdoc, who'se very experienced with Maois would tell me-- try a small amount and if it's okay, you can experiment with it. Of course, I was careful with those things-- but again-- it's not as if, if you have a sip of something, you'll be in trouble.
Of course, if you do turn out to be one of the few people who have to be especially careful, you can rethink the decision to take Maois. You'll figure this out without putting yourself in any danger.
What others have said about the dangers being overstated is certainly true. My pdoc, for example, told me to disregard most of the proscriptions, and stick with his limited rules--
Most importantly, I would consult your pdoc when you have questions, not with pharmacies, who are pretty uninformed about these things--
Nadezda
Posted by Zeba on August 6, 2008, at 23:36:45
In reply to Re: MAOI diet confusion » socialphobic, posted by Nadezda on August 6, 2008, at 19:37:03
I completely agree with Nadezda. Once on it awhile, you get used to it and know what to stay away from. I have a list somewhere from my old pdoc that rates things in terms of 1,2, or 3 being absolute no nos. I will try to find it as it told me I could eat a little of some things I thought were not okay, and I have been fine.
I cannot believe a doctor would say that decongestents are okay. On the box, they even say it is a no no for people on MAOI's. I once years ago perposefully od'd on Contac time release cold capsules, and I had such a horrible hypertensive crisis that I ended up in the cardiac intensive care unit of the hospital. It was an experience I will never forget and would never try to duplicate again either. The pain was worse than anything I have ever known.
Zeba
Posted by Crotale on August 8, 2008, at 6:22:55
In reply to Re: MAOI diet confusion » socialphobic, posted by Nadezda on August 6, 2008, at 19:37:03
Hi Nadezda. I agree with a lot of your advice (like listen to your pdoc rather than a pharmacist! I've occasionally known pharmacists who really know what they're talking about but in my experience they're rare). The one thing I disagree with is some of your recommendations re: specific foods.
> There aren't actually that many restrictions on Maois-- although lots of places will give you a list of everything that anyone had a reaction to. Most of the things on those lists are not important.
>
> The main things to look for is aged foods-- for example, soy sauce, aged cheese, red wines of certain kinds and food that has spoiled from being left out in the heat, especially foods mayonnaise based salads.I think most soy sauce, or at least, the typical bottled soy sauce that you get in your average grocery store, is fine in moderation.
Also, red wine is fine (although the party line is in general don't drink with antidepressants). Yes, that includes the infamous Chianti.
> The other category is certain medications like nasal sprays, decongestants, long-acting novocaine and some other anti-depressants (like most tricyclics), and some others.
Actually several of the tricyclics are okay. Desipramine, nortriptyline, amoxapine, and others that are fairly selective for NE reuptake (they do have some antagonist effects at various receptors - desipramine least so - but those aren't relevant to MAOI interactions) are fine. The ones you want to watch out for are amitriptyline, imipramine, doxepin, and others that also block serotonin retuptake.
Novocaine (with or without epinephrine) is fine. If you're worried, ask your dentist to monitor your blood pressure. In general, it's the indirect-acting sympathomimetic drugs, like pseudoephedrine and amphetamine, that you have to watch out for, not direct-acting ones like epinephrine. (although amphetamine can be used, and is, in low doses and with caution).
Also, not all nasal sprays are dangerous. It depends on the active ingredient, and also on whether it is absorbed into the bloodstream or whether it only acts locally.
> I never had a reaction that required me even to consider going to the hospital and I was on a very high dose. Once or twice I had mild serotonin reactions to normally safe ADs that my pdoc was trying out to help me sleep-- and that's only because I'm very sensitive to serotonin.
That's curious. Which ADs, and what sort of reactions did you have? I got full-blown serotonin syndrome on Cymbalta (no MAOI or anything).
I think that the supposed danger of MAOIs has been overstated a great deal. Especially since for a long time, TCAs (which are quite toxic, highly subject to pharmacokinetic interactions, and have such a low therapeutic index) were the only other ADs. Comparatively, MAOIs seem rather mild.
For a much more realistic guide to MAOI-food interactions, check out the Emsam package insert. I think it's pretty accurate, or at least, much closer than the monographs for Nardil, Parnate, etc. which say to avoid everything under the sun!
-Crotale
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