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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by angels78 on August 14, 2010, at 5:43:47
Is there a "wash out" period from switching from one MAOI to another MAOI? ie., Nardil to Parnate
Posted by ed_uk2010 on August 14, 2010, at 8:29:52
In reply to NARDIL / PARNATE Users Please Read, posted by angels78 on August 14, 2010, at 5:43:47
> Is there a "wash out" period from switching from one MAOI to another MAOI? ie., Nardil to Parnate
Yes, as posted in your thread above :) The reason for the washout period is that serious adverse reactions have been reported after abruptly switching between different MAOIs. Rarely, patients have had a stroke.
Isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate) have all been implicated.
Posted by Willful on August 14, 2010, at 10:29:06
In reply to NARDIL / PARNATE Users Please Read, posted by angels78 on August 14, 2010, at 5:43:47
Yes, two weeks.
Willful
Posted by angels78 on August 14, 2010, at 14:50:27
In reply to Re: NARDIL / PARNATE Users Please Read, posted by Willful on August 14, 2010, at 10:29:06
I was recently told this regarding washout periods from MAOI to MAOI:
"When you are switching from one MAOI to another, like with Nardil to Parnate, there is absolutely no need to taper, and there's especially no need for a wash-out period. You can safely switch INSTANTLY. That's what I did. If for some reason you DID need to stop taking Nardil for a wash-out period though, most sources say you can reasonably just STOP taking an MAOI. They don't have the same "discontinuation" issues that reuptake inhibitors have, and the whole idea of replacement occurring every day at a rate of 1/14th of the total inhibited enzymes (based on a 2-week "cycle") is pretty much a taper in its own right."
Posted by ed_uk2010 on August 14, 2010, at 16:15:53
In reply to Re: NARDIL / PARNATE Users Please Read » Willful, posted by angels78 on August 14, 2010, at 14:50:27
>"When you are switching from one MAOI to another, like with Nardil to Parnate, there is absolutely no need to taper, and there's especially no need for a wash-out period. You can safely switch INSTANTLY. That's what I did. If for some reason you DID need to stop taking Nardil for a wash-out period though, most sources say you can reasonably just STOP taking an MAOI. They don't have the same "discontinuation" issues that reuptake inhibitors have, and the whole idea of replacement occurring every day at a rate of 1/14th of the total inhibited enzymes (based on a 2-week "cycle") is pretty much a taper in its own right."
I don't know who this person is but they should not be telling people to do something which might be unsafe. The fact that one person was able to switch 'instantly' does not mean that it is safe for others to do so. The information about discontinuation symptoms is also inaccurate. Stopping MAOIs abruptly can cause discontinuation symptoms.
Also, enzymes are not replaced at the rate of 1/14th per day. This appears to be something which the writer has just invented.
The UK manufacturer of Nardil states: Phenelzine sulphate should not be administered at the same time as, or within 14 days of, treatment with other MAOIs.
Posted by emmanuel98 on August 14, 2010, at 19:57:43
In reply to Re: NARDIL / PARNATE Users Please Read, posted by ed_uk2010 on August 14, 2010, at 16:15:53
I don't know why this is, but I do know McLean required a two-week washout from ensam to parnate and my p-doc, who works a lot with MAOI's told me the day before I went in to stop the ensam immediately to reduce the washout time. This was not just being over cautious. I was suicidal and they were desperate to get my on something, anything, that would help during that two week period. At one point, I was up to 36mg perphenazine, which is very high dose, but they were hoping it helped since atypicals have helped in the past.
Posted by Willful on August 14, 2010, at 20:59:23
In reply to Re: NARDIL / PARNATE Users Please Read » Willful, posted by angels78 on August 14, 2010, at 14:50:27
Whoever told you this is mistaken. They're giving you bad advice. No matter how eager you are to take a shortcut, you need to wait.
I switched from one Maoi to another and was told by my pdoc that it's important to have the two week washout period between Maois.
My pdoc is an extremely reputable pdoc who doesn't have any desire to make patients wait for treatment, if it's not necessary. He is however careful and doesn't cut corners.
Willful
Posted by angels78 on August 15, 2010, at 0:09:40
In reply to Re: NARDIL / PARNATE Users Please Read, posted by ed_uk2010 on August 14, 2010, at 16:15:53
> Also, enzymes are not replaced at the rate of 1/14th per day. This appears to be something which the writer has just invented.
>He said he was correct regarding the 1/14th rate I disagreed, but he thought otherwise. Here's a snippit of our convo below. To each his own I guess.
For instance, the 1/14th rate is in fact accurate, but only in a rough sense, as I pointed out. It is not EXACT, because it is different for every person, but it is damn close enough, and serves the purpose just fine for the illustration I used it for. In fact, ANY number theoretically could have served the purpose just fine, but 1/14 actually has a basis in fact. It is widely accepted that the body replaces MAO enzymes on the order of ROUGHLY every two weeks, and it is a constant, continuous process. Since a complete turnover is reached within 14 days (which is, incidentally, why an MAOI needs to be washed out for 14 days!), it is nothing short of obvious that in any given 24-hour period, you can expect a turnover of roughly 1/14th of total MAO enzymes.
Posted by angels78 on August 15, 2010, at 2:07:10
In reply to Re: NARDIL / PARNATE Users Please Read, posted by emmanuel98 on August 14, 2010, at 19:57:43
Thank me later :)
Posted by Ron Hill on August 15, 2010, at 2:22:32
In reply to NARDIL / PARNATE Users Please Read, posted by angels78 on August 14, 2010, at 5:43:47
> Is there a "wash out" period from switching from one MAOI to another MAOI? ie., Nardil to Parnate
-----------------------------------------angels78,
Yes. The specifics are in the Parnate Prescribing Information document published by GlaxoSmithKline, the manufacturer of Parnate. See the bottom of page 2 and continuing onto the top of page 3.
http://us.gsk.com/products/assets/us_parnate.pdf
-- Ron
Posted by angels78 on August 15, 2010, at 3:39:42
In reply to Re: NARDIL / PARNATE Users Please Read, posted by Ron Hill on August 15, 2010, at 2:22:32
Thanks Ron.
Ron if you don't mind responding to this I had replied to you on a different thread.
Posted by ed_uk2010 on August 15, 2010, at 12:08:20
In reply to Re: NARDIL / PARNATE Users Please Read » ed_uk2010, posted by angels78 on August 15, 2010, at 0:09:40
>He said he was correct regarding the 1/14th rate
I assume he is a pharmacologist? :) If so, perhaps he has performed a study which demonstrates that switching from one MAOI to another without any washout period is safe? (since this is what he is advising you to do).
>(MAO replacement, after stopping phenelzine) is a constant, continuous process.
Perhaps he could provide a reference? What makes him think that the process of MAO replacement occurs at a constant rate? The synthesis of enzymes/proteins in the body is a controlled process. I doubt that MAO synthesis occurs at a constant rate no matter what. The brain does not function like a mechanical toy. For many enzymes, the rate of synthesis of new enzymes is controlled by the concentration of substances which are metabolised by the enzyme, or by the concentration of the end product produced by the enzyme.
>it is nothing short of obvious that in any given 24-hour period, you can expect a turnover of roughly 1/14th of total MAO enzymes.
Not necessarily.
To be honest Angel, I am having difficulty understanding why this person is advising you to go against standard medical advice. The recommendation seems to be based mainly on his own personal experience, n=1.
In order for something to be considered safe, it needs to be tested in a large number of people. One person's reaction is not sufficient. Not everyone suffers an adverse reaction, clearly, but that fact that some people have suffered serious reactions does suggest that abruptly switching from Nardil to Parnate is not a good idea.
Be safe.
Posted by Phillipa on August 15, 2010, at 13:28:14
In reply to The brain is not like a mechanical toy either, posted by ed_uk2010 on August 15, 2010, at 12:08:20
Angel I hope it wasn't on this site and please wait. Phillipa
This is the end of the thread.
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