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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by uncouth on September 7, 2008, at 10:17:41
Hi, I'm taking parnate 30mg after switching from Nardli 90mg down to Parnate 40 overnight per my doctor's orders. Parnate has had a dramatic but incomplete effect on my mood (helped especially with drive, anhedonia, desire), but at 40 I immediately got very intense and debilitating orthostatic hypotension. Went down to 30, but it's still pretty bad. Can't exercise, get lightheaded everytime I stand up and it often doesn't go away for minutes, and I've had a few close calls where I've needed to get on the ground horizontal otherwise I'd pass out.
I'm wondering what to do. I don't want to ditch the parnate, does this side effect go away in time?
Also, are there any other antidepressants I can add at a low dose that might help? From my research this has something to do with the alpha receptors, can anyone clarify? And if so, what would I need to add to deal with this effectively?
Would a low dose of desipramine help? Adderall/Ritalin? Abilify? Amantadine?
I should note I'm also having anorgasmia and some urinary hesitation/constipation, but latter two have responded to the dose decrease to 30mg.
I also take Lithium 450mg at night and trazodone 50mg. Both I've taken for some time without adverse effects so I can't imagine they would be interacting with the Parnate to produce the orthostatic hypotension. I also started on n-acetyl-cysteine twice a day about a month ago.
I didn't have the intense orthostatic hypotension on Nardil 90, but was only on it for a week and wasn't responding, so we switched to parnate. I had other bad side effects on Nardil (anorgasmia/ED and hunger) but i'd consider trying Nardil again, we may have not given it enough time at 90 to work, but my doctor wasn't too confident it would work if I hadn't felt anything for 3 weeks at 60 and 1 week at 90.
Thanks for the insights....really appreciate it.
Posted by uncouth on September 9, 2008, at 13:48:09
In reply to Parnate + Orthostatic Hypotension, posted by uncouth on September 7, 2008, at 10:17:41
Anyone? Buelller? Please help?
Posted by Justherself54 on September 9, 2008, at 16:04:35
In reply to Parnate + Orthostatic Hypotension, posted by uncouth on September 7, 2008, at 10:17:41
Sorry no one is answering your post. I've read it a couple of times but I've never used add on meds with MAOI's, so I was hoping some of the more knowledgable posters would chime in.
On my first trial with parnate I had orthostatic hypotension pretty badly and had to go down on my hands and knees pretty often and wasn't able to go over 20 mg. as I was spending a lot of time crawling around on my hands and knees. On this trial things were different..I only had a few occasions of lightheadedness that were short lived. Unfortunately, I have received little to no benefit from it this time.
My Nardil trial ended due to a strange side effect. My pdoc was adamant that I do the 14 day washout before I started parnate. I wonder if you still are feeling some effects of going on Parnate without titrating down on the Nardil.
I had far more side effects on Nardil that I did on Parnate, but everyone reacts differently.
What are your blood pressure readings? If you are in danger of hurting yourself due to the severity of the hypotensive episodes, I think you need to put a call in to your doctor asap.
Also, the MAOI's seem to take a lot longer for full benefit than other classes of AD's. Perhaps your Nardil trial was discontinued too quickly.
I hope you don't mind, but I'm going to stick a big HELP on your subject line...sometimes that helps to stick out in the long list of threads. I hope you feel better soon.
Posted by uncouth on September 9, 2008, at 19:18:46
In reply to Re: Parnate + Orthostatic Hypotension - HELP!!, posted by Justherself54 on September 9, 2008, at 16:04:35
Hi, thanks for the resonse. Changing to 30mg has helped with the orthostatic hypotension, i'm still getting low BP readings (85/40) upon standing but not having lightheadedness as often. However my muscles are still very weak and sore all the time and I'm limited in the amount of exercise I can do.
THe constipation and urinary hesitation has reduced 50%, although I'm still 'backed up'. Unfortunately, I'm still anorgasmic, and I don't know what to do about this one. I'm hoping it goes away, as my mood has dropped significanty since going from 40mg to 30mg...I was hoping to go up to 50, not go DOWN, but side effects are side effects.
I really would hate to go back to Effexor :(
Posted by Justherself54 on September 9, 2008, at 20:25:30
In reply to Re: Parnate + Orthostatic Hypotension - HELP!!, posted by uncouth on September 9, 2008, at 19:18:46
Unfortunately I didn't get much out of the increase to 50 mg. It's hard to deal with the side effects. I eat a lot of fibre so I think that helped avoid the constipation. One other babbler who had extreme hypotension found that drinking small amounts of salt water seems to help. I've never tried it myself.
It's funny that you mention your muscles are weak and sore. I had weakness in my legs at times too. Plus, I have fibromyalgia and Parnate just didn't mix with it. I was doing some weird muscle clenching in my sleep that just flared it up constantly. I noticed as soon as I started titrating down my pain decreased.
You kinda get the feeling of being caught between a rock and a hard place...raising the dose to get benefit increases the side effects, lowering the dosage relieves some of the side effects, but isn't enough to handle the depression.
If I had achieved some partial response to 50 mg. I may have been able to tolerate the pain better, but it was to the point that I was having to hold onto my bed frame and walls to walk in the mornings and getting up from a sitting position was agony.
I know the feeling of dread with revisiting meds cause that's where I'm at too.
Hope things start to settle down for you and some of the side effects clear up or at least get manageable so you can start increasing. I've got my fingers crossed for you!
Posted by Zeba on September 10, 2008, at 23:55:11
In reply to Parnate + Orthostatic Hypotension, posted by uncouth on September 7, 2008, at 10:17:41
Sorry I just saw your post. I agree with Justherself54 that a wash out period would have been best. When I started back on Parnate, I started with 10 mg for a couple of days, then 20 mg for a few days, and then 30 mg. for a few days or a week before going to 40 mg.
Years ago I took 30 mg. Parnate, Lithium (amount I don't remember), and I also took Mellaril at night. I did not have the issues you describe, at least from Parnate and Lithium. I used Mellaril, a small amount as a sleep aide. Ultimately I quit the Lithium as I was getting acne pretty bad. My pdoc at the time was of the opinion that it served a useful purpose (the Lithium) for a time and that later it was not needed. I agreed.
So, I am not sure your meds gave you a problem but it would seem that switching just like that and then taking 40 mg. just like that may have been the problem. I have liked Parnate as it has an activating quality, but this also means one may have sleep problems if it is taken past around 2 p.m. I take my doses in the a.m. and at noon. Parnate for me does not cause any sexual problems. Neither did Parnate and Lithium. Can't speak to the other you take and that might be the culprit.
Zeba
Zeba
Posted by azalea on September 14, 2008, at 1:18:43
In reply to Parnate + Orthostatic Hypotension, posted by uncouth on September 7, 2008, at 10:17:41
How long have you been on Parnate 30mg? Is the orthostatic hypotension improving? Perhaps it is a side effect of the rapid immediate transition from Nardil to Parnate.
Below is copied and pasted information regarding how to manage hypotension as a side effect of other MAOIs. Not sure if this generalizes to Parnate as well.
From "Current Psychiatry" Vol. 1, No. 6 / June 2002
MAO inhibitors: An option worth trying in treatment-resistant cases
Orthostatic hypotension is the most common early side effect
of phenelzine and isocarboxazid. Clinically significant
hypotension is best managed via dosage adjustment. If that
fails, add Na Cl, 1 to 2 grams bid with increased fluids. If that
doesnt work, administer fludrocortisone, 0.1 to 0.4 mg/d. If
that fails, administer d-amphetamine, starting
with 2.5 to 5 mg/d, and observe carefully for
hypertension.
This is the end of the thread.
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