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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by George Romero on February 26, 2010, at 23:25:29
I had a spontaneous hypertensive crisis on Parnate--i hadn't eaten anything in at least 24 hours that could have contained tyramine, and i hadn't taken a dose of Parnate in about 6 hours. was only on 20 mg at the time.
now my doctor is saying we're going to have to try something else--that if it wasn't tyramine-induced, then there's no way i can prevent it. but i've already tried everything, and parnate is the only med that's worked well for me. this is the best i've felt in 10+ years (hypertensive episode notwithstanding, of course). is that really it? if i stay on parnate, am i destined to keep having these episodes spontaneously just b/c i had one once? can't i just carry around that sublingual med that rapidly lowers bp, or are doctors not doing that anymore?
i'm supposed to have already started tapering off parnate, but i just can't bring myself to do it--it's so hard to affirmatively take steps toward being horribly depressed, which i know is exactly what's waiting for me. on the other hand, being rushed to the e.r. on a stretcher with a sky-high bp was pretty horrifying too. i just keep hoping for a solution.
Posted by atypical on February 26, 2010, at 23:41:37
In reply to Spontaneous Hypertensive Crisis on MAOI, posted by George Romero on February 26, 2010, at 23:25:29
MAOI hypertensive crisis is scary. I've never read or heard about a spontaneous one. To answer your question, yes, there is still a medication that rapidly lowers blood pressure. My doctor gave me nifedipine capsules. I took one when I got a hypertensive crisis from cheese. It was scary. Sky high BP, like 190/110 or something. I bit into and swallowed the pill. Pressure went down gradually. I did go to the ER just in case though. Was home in a few hours.
>can't i just carry around that sublingual med that rapidly lowers bp, or are doctors not doing that anymore?
Posted by jedi on February 27, 2010, at 1:05:58
In reply to Spontaneous Hypertensive Crisis on MAOI, posted by George Romero on February 26, 2010, at 23:25:29
Hi George,
The same thing happened to me, which ended my last Parnate trial. I went back to my old standby Nardil, with all the side effects. I was really hoping Parnate would work for me, but I don't get headaches and this was an obvious spontaneous hypertensive episode.You have to be careful with nifedipine also. It can lower your blood pressure too quickly and for too long a time after the hypertensive episode is over. I ended up in the hospital on IV fluids overnight, because the hypertensive crisis ended and my BP kept dropping, after taking nifedipine. Really, low BP kills people too. This is why some docs won't prescribe the medication any longer.
Jedi
Reference:
Int J Clin Pract. 2004 May;58(5):517-9.
Adverse events associated with aggressive treatment of increased blood pressure.Yanturali S, Akay S, Ayrik C, Cevik AA.
Dokuz Eylul University Hospital, Department of Emergency Medicine, Izmir, Turkey. sedat.yanturali@deu.edu.tr
Patients with severely increased blood pressure often present to the emergency department. Rapid lowering of blood pressure can precipitate or worsen end organ damage. We report two cases that developed cerebrovascular and cardiovascular adverse events associated with aggressive treatment of increased blood pressure by the use of sublingual nifedipine capsule. The first patient had developed ischaemic stroke; the second patient actually had acute left ventricular failure causing deteriorated, and required positive inotropic treatment for persistent hypotension. These cases emphasise that the pseudoemergency may rapidly progress into a real emergency when blood pressure is rapidly and aggressively reduced.
PMID: 15206510 [PubMed - indexed for MEDLINE]
> I had a spontaneous hypertensive crisis on Parnate--i hadn't eaten anything in at least 24 hours that could have contained tyramine, and i hadn't taken a dose of Parnate in about 6 hours. was only on 20 mg at the time.
>
> now my doctor is saying we're going to have to try something else--that if it wasn't tyramine-induced, then there's no way i can prevent it. but i've already tried everything, and parnate is the only med that's worked well for me. this is the best i've felt in 10+ years (hypertensive episode notwithstanding, of course). is that really it? if i stay on parnate, am i destined to keep having these episodes spontaneously just b/c i had one once? can't i just carry around that sublingual med that rapidly lowers bp, or are doctors not doing that anymore?
>
> i'm supposed to have already started tapering off parnate, but i just can't bring myself to do it--it's so hard to affirmatively take steps toward being horribly depressed, which i know is exactly what's waiting for me. on the other hand, being rushed to the e.r. on a stretcher with a sky-high bp was pretty horrifying too. i just keep hoping for a solution.
Posted by Phillipa on February 27, 2010, at 11:07:59
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » George Romero, posted by jedi on February 27, 2010, at 1:05:58
Jedi what's the name of the brain damage that an old poster experienced with a parnate hypertensive crisis? Phoenix I I think? Phillipa
Posted by stargazer2 on February 27, 2010, at 15:18:28
In reply to Spontaneous Hypertensive Crisis on MAOI, posted by George Romero on February 26, 2010, at 23:25:29
Are you sure it wasn't from something you ate or drank (alcohol or caffeine) or another medication?
I was not aware of anything called spontaneous, not related to some other factor that could have been overlooked.
What dosage were you on?
I had a reaction on Nardil with a stimulant, a tiny dose but I did have Nifedepine and used it successfully. I dropped to the floor with my BP cuff on my arm. It was scarey but I got through it and continued on Nardil, so that didn't make me have to switch as that is devastating when you are stable on something.
I would try and convince my doc to give it another try and make sure you have Nifedipine, handy. I htink a second chance is worth it but that is me and my pdoc, so it is an individual call. MY doc knows me so well he knows I will not take any risks at all. I wouldn't be convinced that it was not something I hadn't eaten, drank or another medication in combination, like an OTC cold medication, those are big NO-Nos. Unfortunately when on a MAO, you forget what goes into your mouth until you have the dreaded reaction.
I've been on MAOs for years and only had a real reaction once, with a few mini ones, that showed me how careful you have to be with anything you put in your mouth and ingest. Many people can not be that disciplined. But if it means you could die, you have to be vigilant.
Good luck with whatever happens with this issue.
Posted by jedi on February 27, 2010, at 16:58:08
In reply to Re: Spontaneous Hypertensive Crisis on MAOI, posted by stargazer2 on February 27, 2010, at 15:18:28
Though they are rare, spontaneous hypertensive episodes on MAOIs have been documented. They are more common with Parnate than Nardil.
JediReference:
Biol Psychiatry. 1993 Aug 1;34(3):146-51.
Spontaneous hypertensive reactions with monoamine oxidase inhibitors.Lavin MR, Mendelowitz A, Kronig MH.
Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, NY.
Despite long-standing concerns over hypertensive reactions, monoamine oxidase inhibitors (MAOIs) have grown in popularity and are now used in a variety of psychiatric disorders. The risk of hypertensive episodes is less than 1%. This is most likely the result of careful dietary instructions and prudent prescribing of concomitant medications. The possibility exists of spontaneous or unprovoked hypertensive crises in patients receiving MAOIs. In this report, we review the literature on spontaneous hypertensive episodes and present a case report. There has been a total of 11 cases described in six separate reports. We discuss the possible mechanism, risk factors, treatment, and safety of rechallenging the patients with the MAOI. Further research is needed to clarify this reaction. For now, it remains a rare but worrisome phenomenon. It should stand as an additional source of concern for clinicians who are already well aware of the risk of hypertensive episodes in patients receiving MAOIs.
PMID: 8399806 [PubMed - indexed for MEDLINE]
> Are you sure it wasn't from something you ate or drank (alcohol or caffeine) or another medication?
>
> I was not aware of anything called spontaneous, not related to some other factor that could have been overlooked.
>
> What dosage were you on?
>
> I had a reaction on Nardil with a stimulant, a tiny dose but I did have Nifedepine and used it successfully. I dropped to the floor with my BP cuff on my arm. It was scarey but I got through it and continued on Nardil, so that didn't make me have to switch as that is devastating when you are stable on something.
>
> I would try and convince my doc to give it another try and make sure you have Nifedipine, handy. I htink a second chance is worth it but that is me and my pdoc, so it is an individual call. MY doc knows me so well he knows I will not take any risks at all. I wouldn't be convinced that it was not something I hadn't eaten, drank or another medication in combination, like an OTC cold medication, those are big NO-Nos. Unfortunately when on a MAO, you forget what goes into your mouth until you have the dreaded reaction.
>
> I've been on MAOs for years and only had a real reaction once, with a few mini ones, that showed me how careful you have to be with anything you put in your mouth and ingest. Many people can not be that disciplined. But if it means you could die, you have to be vigilant.
>
> Good luck with whatever happens with this issue.
Posted by George Romero on February 27, 2010, at 17:11:26
In reply to Re: Spontaneous Hypertensive Crisis on MAOI, posted by stargazer2 on February 27, 2010, at 15:18:28
> Are you sure it wasn't from something you ate or drank (alcohol or caffeine) or another medication?
>
> I was not aware of anything called spontaneous, not related to some other factor that could have been overlooked.
>
> What dosage were you on?
>
> I had a reaction on Nardil with a stimulant, a tiny dose but I did have Nifedepine and used it successfully. I dropped to the floor with my BP cuff on my arm. It was scarey but I got through it and continued on Nardil, so that didn't make me have to switch as that is devastating when you are stable on something.
>
> I would try and convince my doc to give it another try and make sure you have Nifedipine, handy. I htink a second chance is worth it but that is me and my pdoc, so it is an individual call. MY doc knows me so well he knows I will not take any risks at all. I wouldn't be convinced that it was not something I hadn't eaten, drank or another medication in combination, like an OTC cold medication, those are big NO-Nos. Unfortunately when on a MAO, you forget what goes into your mouth until you have the dreaded reaction.
>
> I've been on MAOs for years and only had a real reaction once, with a few mini ones, that showed me how careful you have to be with anything you put in your mouth and ingest. Many people can not be that disciplined. But if it means you could die, you have to be vigilant.
>
> Good luck with whatever happens with this issue.Thanks for your comments. I was on 20 mg at the time (10 mg twice per day). I thought about it a lot, and I can't think of anything I took or ate or drank that day except coffee, which i've been drinking everyday prior and since the episode with no problem. i hadn't taken any other meds (OTC or otherwise). i know i ate some food the day before that could have contained tyramine but doc says the reaction is much more immediate than that--no more than an hour or two after ingesting the a forbidden food--so it couldn't have been that. (admittedly, he doesn't know much about MAOIs or tyramine or spontaneous hypertensive episodes, so if you guys have different information, please let me know.)
Posted by Phillipa on February 27, 2010, at 20:05:08
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » stargazer2, posted by George Romero on February 27, 2010, at 17:11:26
It was called Pres something will try and find. Phillipa
Posted by jedi on February 27, 2010, at 22:59:48
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » George Romero, posted by Phillipa on February 27, 2010, at 20:05:08
> It was called Pres something will try and find. Phillipa
Sorry Phillipa, I can't remember. Must be a clonazepam moment!
Jedi
Posted by Phillipa on February 27, 2010, at 23:56:01
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » Phillipa, posted by jedi on February 27, 2010, at 22:59:48
Jedi seriously I've been looking. Got another place it could be. Love Phillipa
Posted by europerep on February 28, 2010, at 11:50:27
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » jedi, posted by Phillipa on February 27, 2010, at 11:07:59
> Jedi what's the name of the brain damage that an old poster experienced with a parnate hypertensive crisis? Phoenix I I think? Phillipa
are you serious? how awfully awful is that? I tried searchin' but didn't find anything, so if you happen to know more about that, please share..
this thread makes me very very scared of the perspective to switch to MAOIs..
Posted by Phillipa on February 28, 2010, at 12:19:47
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » Phillipa, posted by europerep on February 28, 2010, at 11:50:27
I didn't forget was up til 2am with google searches and couldn't find it. Checked files too. I know someone who knows the name. Not sure she's on this site anymore. I'm sorry I just know that it was a press something and that the poster could no longer take Maois. It was some sort of stroke. All my searches came up with serotonin syndrome???? Let me see if I can reach her on facebook but it also sunday. Such poor timing. Love Phillipa
Posted by jedi on February 28, 2010, at 12:31:48
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » Phillipa, posted by europerep on February 28, 2010, at 11:50:27
europerep, The dangers of the MAOIs are way overblown. Spontaneous hypertensive episodes are very, very rare. Even tyramine reactions are very rare. I have been taking Nardil for most of the past 12 years. My depression was serious and the medication has saved my life. Many times when no other meds work, a MAOI can stop the depression. When Nardil works it is like flipping a light switch. I have never experienced this kind of response from an antidepressant.All medications have their risks. Family doctors hand out the SSRIs like candy. Nardil has been around for over fifty years. For some kinds of depressions it works better than anything else. Particularly atypical depression with social anxiety. Don't let a few isolated problems stop you from taking something that can help. Depression can and does kill.
Jedi
> > Jedi what's the name of the brain damage that an old poster experienced with a parnate hypertensive crisis? Phoenix I I think? Phillipa
>
> are you serious? how awfully awful is that? I tried searchin' but didn't find anything, so if you happen to know more about that, please share..
> this thread makes me very very scared of the perspective to switch to MAOIs..
Posted by Justherself54 on February 28, 2010, at 13:34:53
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » europerep, posted by Phillipa on February 28, 2010, at 12:19:47
This is Phoenix1's post that explains it and gives a link about it also.
Posted by Phillipa on February 28, 2010, at 13:46:10
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » europerep, posted by Phillipa on February 28, 2010, at 12:19:47
Thanks Justherself good timing to find you in. Love Phillipa
Posted by evenintherain on March 1, 2010, at 17:04:26
In reply to Spontaneous Hypertensive Crisis on MAOI, posted by George Romero on February 26, 2010, at 23:25:29
> i'm supposed to have already started tapering off > parnate, but i just can't bring myself to do it
i totally understand this. i think i would feel the same reluctance. what did you decide to do?
sometimes it is had to tell if the doctors are just covering their *sses or if the danger just really isn't worth the risk.
i wonder if someone who has experienced one spontaneous hypertensive crisis is more likely to experience another (it seems like they would be, but that might not be the case? unfortunately i doubt there are studies on this). i also wonder if having the hypOtensive problems you had make going into a hypertensive crises more dangerous because the fluctuation is so severe?
Posted by George Romero on March 1, 2010, at 17:32:01
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » George Romero, posted by evenintherain on March 1, 2010, at 17:04:26
> > i'm supposed to have already started tapering off > parnate, but i just can't bring myself to do it
>
> i totally understand this. i think i would feel the same reluctance. what did you decide to do?
>
> sometimes it is had to tell if the doctors are just covering their *sses or if the danger just really isn't worth the risk.
>
> i wonder if someone who has experienced one spontaneous hypertensive crisis is more likely to experience another (it seems like they would be, but that might not be the case? unfortunately i doubt there are studies on this). i also wonder if having the hypOtensive problems you had make going into a hypertensive crises more dangerous because the fluctuation is so severe?i've wondered the same things--whether i'm more likely to have another episode b/c i've had one already, whether mine was worse b/c i started out with such a low bp (doctors/nurses at the hospital kept saying things to one another like "but it was 85/55 just this morning"). i don't know.
i guess i'm going to try something else. doctor gave me cymbalta (which i'm not excited about at all). i don't know what else to do. i've tried everything else.
Posted by evenintherain on March 1, 2010, at 19:03:26
In reply to Re: Spontaneous Hypertensive Crisis on MAOI, posted by George Romero on March 1, 2010, at 17:32:01
good luck with the Cymbalta.
wish i had some nice things to say about that drug, but some other people on here do?
Posted by Justherself54 on March 1, 2010, at 22:44:10
In reply to Re: Spontaneous Hypertensive Crisis on MAOI » stargazer2, posted by George Romero on February 27, 2010, at 17:11:26
I spent an evening in the ER with extremely high blood pressure while on Parnate, however, it wasn't a full-blown hypertensive crisis. I had no blood pressure problems on Nardil, however, I had to discontinue it due to other severe side effects.
For me, Nardil was by far superior for depression and especially social anxiety. I would probably give it another shot if there was something that could be done to control the particular side effects I had on it.
Who knows..right now I'm not on an AD and suffering pretty badly. I'm out of options at this point, so I may give Nardil a shot again and hope the side effects are different.
I wish I too could say something positive about Cymbalta. For me, it brought out anger/rage which was pretty scary.
Posted by George Romero on March 4, 2010, at 21:47:41
In reply to Re: Spontaneous Hypertensive Crisis on MAOI, posted by Justherself54 on March 1, 2010, at 22:44:10
> I spent an evening in the ER with extremely high blood pressure while on Parnate, however, it wasn't a full-blown hypertensive crisis. I had no blood pressure problems on Nardil, however, I had to discontinue it due to other severe side effects.
>
> For me, Nardil was by far superior for depression and especially social anxiety. I would probably give it another shot if there was something that could be done to control the particular side effects I had on it.
>
> Who knows..right now I'm not on an AD and suffering pretty badly. I'm out of options at this point, so I may give Nardil a shot again and hope the side effects are different.
>
> I wish I too could say something positive about Cymbalta. For me, it brought out anger/rage which was pretty scary.
>
>
>
>
>
>
>Do you mind sharing what the other Nardil symptoms were? Why did you like Nardil better?
Posted by Justherself54 on March 4, 2010, at 23:21:09
In reply to Re: Spontaneous Hypertensive Crisis on MAOI, posted by George Romero on March 4, 2010, at 21:47:41
Hi..other side effects of Nardil for me were vomiting in my sleep and some bad urinary problems. One night of extreme strange cycling..but only the one night.
I liked Nardil better as it pretty much killed my social anxiety and depression pretty quickly. I was able to go out and socialize easily and had a good time with others. I probably felt closer to full remission with it than any other med.
This is the end of the thread.
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