![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Conundrum on September 9, 2010, at 21:22:43
Wouldn't nortriptyline + parnate cause an interraction because nortriptyline is an anti histamine and antihistmanergic drugs are contraindicated with MAOis?
Would it be the same for EMSAM?
Posted by Maxime on September 9, 2010, at 21:43:04
In reply to nortripytline + MAOi? anti histamine interraction, posted by Conundrum on September 9, 2010, at 21:22:43
I take Nortrip and Parnate together. I haven't had a problem with this interaction.
Posted by Conundrum on September 9, 2010, at 21:44:24
In reply to Re: nortripytline + MAOi? anti histamine interraction » Conundrum, posted by Maxime on September 9, 2010, at 21:43:04
Cool! Has it been of any benefit. I know you're taking dex as well, thats a pretty powerful combo.
Posted by Maxime on September 9, 2010, at 21:54:16
In reply to Re: nortripytline + MAOi? anti histamine interraction » Maxime, posted by Conundrum on September 9, 2010, at 21:44:24
> Cool! Has it been of any benefit. I know you're taking dex as well, thats a pretty powerful combo.
It helps make the Parnate work better. I am on a 100 mg of Parnate and 75 mg on Nortrip. I tried to stop the Nortrip a few months back and I felt awful. So I went back on it. The Dexedrine doesn't seem to be helping me very much because it actually make me sleep if that is possible. Sigh. I am so tired of finding the right combo.
Posted by morgan miller on September 9, 2010, at 22:11:26
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by Maxime on September 9, 2010, at 21:54:16
Maxime, how often do you take Parnate? How exactly did you feel awful off Nortriptyline? More depressed? Do you have any lasting side effects on Nortriptyline?
Posted by Tomatheus on September 9, 2010, at 22:24:24
In reply to nortripytline + MAOi? anti histamine interraction, posted by Conundrum on September 9, 2010, at 21:22:43
Conundrum,
For what it's worth, I took 25 mg of the antihistamine doxylamine succinate (Unisom) when I was on Nardil and never had a problem. If my understanding is correct, antihistamines are listed as contraindicated with MAOIs on some lists, but not others. Combining Nardil and doxylamine succinate was also ok with the psychiatrist I was seeing at the time. So, I would check with your doctor, but I don't think that the antihistamine-MAOI interactions are as absolute as they're sometimes made out to be.
Tomatheus
Posted by SLS on September 10, 2010, at 5:24:03
In reply to Re: nortripytline + MAOi? anti histamine interraction » Conundrum, posted by Tomatheus on September 9, 2010, at 22:24:24
You need to look out for antihistamines that contain decongestants like pseudoephedrine or phenylpropanolamine. Also, be careful of dextromethorphan.
- Scott
Posted by SLS on September 10, 2010, at 5:27:43
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by SLS on September 10, 2010, at 5:24:03
> You need to look out for antihistamines that contain decongestants like pseudoephedrine or phenylpropanolamine. Also, be careful of dextromethorphan.
Actually, some of the major antihistamines are reuptake inhibitors of serotonin. That's where Prozac came from. Ask Linkadge about the potential risk of taking diphenhydramine or chlorpheniramine. Serotonin toxicity might be a problem.
- Scott
Posted by SLS on September 10, 2010, at 5:29:18
In reply to Re: nortripytline + MAOi? anti histamine interraction » SLS, posted by SLS on September 10, 2010, at 5:27:43
> > You need to look out for antihistamines that contain decongestants like pseudoephedrine or phenylpropanolamine. Also, be careful of dextromethorphan.
>
> Actually, some of the major antihistamines are reuptake inhibitors of serotonin. That's where Prozac came from. Ask Linkadge about the potential risk of taking diphenhydramine or chlorpheniramine. Serotonin toxicity might be a problem.Now that I recall, I had no problem mixing Parnate with Benedryl. However, Nardil might be a different story as it is more serotonergic.
- Scott
Posted by linkadge on September 10, 2010, at 7:47:30
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by SLS on September 10, 2010, at 5:29:18
Yeah, SLS answered it. Some antihistamines have secondary serotonergic effects.
The histamine blocking effect (in general) does not contribute to serotonin syndrome.
Linkadge
Posted by Conundrum on September 10, 2010, at 7:50:00
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by linkadge on September 10, 2010, at 7:47:30
So it has to do with its serotonergic effects and not related to blood pressure.
I know nortriptyline has some SRI. Perhaps it mixes with parnate well since parnate works more on dopamine than NE and 5HT
Posted by SLS on September 10, 2010, at 8:06:43
In reply to Re: nortripytline + MAOi? anti histamine interraction » linkadge, posted by Conundrum on September 10, 2010, at 7:50:00
> I know nortriptyline has some SRI. Perhaps it mixes with parnate well since parnate works more on dopamine than NE and 5HT
This is logical. I have had more problems with serotonin toxicity when mixing Nardil with TCA than with mixing Parnate with TCA.
- Scott
Posted by Conundrum on September 10, 2010, at 8:13:41
In reply to Re: nortripytline + MAOi? anti histamine interraction » Conundrum, posted by SLS on September 10, 2010, at 8:06:43
Perhaps EMSAM with nortriptyline would be a safer combo. one could add zoloft if some SRI were needed. Damn that would be one sick combo. It would hit dopamine hard especially in the prefrontal cortex. NE would be boosted along with serotonin, but probably not enough to become blunted if the dose were low.
Posted by linkadge on September 10, 2010, at 10:18:00
In reply to Re: nortripytline + MAOi? anti histamine interraction » linkadge, posted by Conundrum on September 10, 2010, at 7:50:00
The problem occurs when your combine potent serotonin reuptake inhibition with MAO-A inhibition. As a result, the body cannot properly metabolize serotonin leading to excessive levels. This results in serotonin syndrome (a potentially life threateneing condition).
Since nortriptyline is much more potent a NRI, it has generally been used safely with MAOIs
Linkadge
Posted by linkadge on September 10, 2010, at 10:21:56
In reply to Re: nortripytline + MAOi? anti histamine interraction » Conundrum, posted by SLS on September 10, 2010, at 8:06:43
I don't really know of any evidence that nardil and parnate are substantially different in their MAO effect. Both drugs inhibit both MAOA/B roughly equally.
The difference may be due to secondary activities of the two agents. Nardil inhibits GABA metabolism leading to higher levels of GABA. This could counteract some of the stimulatory nature of the drug.
Perhaps nardil is more potent an MAOI i.e. more inhibition at lower doses?
Linkadge
Posted by linkadge on September 10, 2010, at 10:28:34
In reply to Re: nortripytline + MAOi? anti histamine interraction » SLS, posted by Conundrum on September 10, 2010, at 8:13:41
>Perhaps EMSAM with nortriptyline would be a >safer combo. one could add zoloft if some SRI >were needed.
>Damn that would be one sick combo. It would hit >dopamine hard especially in the prefrontal >cortex. NE would be boosted along with >serotonin, but probably not enough to become >blunted if the dose were low.
Meh, I've gone away from getting excited about the way a drug "should" feel on paper. Mice lacking both the NET transporter and MAO-B have greatly increased cardiac NE levels and blood pressure. Dopamine in the prefrontal cortex isn't the be all too. Some studies show that there is hypermetabolism in the prefrontal cortex in certain depressive states. In ketamine responders, for instance, there is a dramatic *decrease* in prefrontal metabolism. I think there are studies showing the same in SSRI responses.
Too much dopamine in the prefrontal cortex can make you irritable, obsessive, and unable to shut drives / thoughs off.
I combined nortriptyline with the herb Fo-ti (a herbal MAOI with relative selectivity towards MAO-B). It was the worst experience of my life. I totally flew off the handle.
Linkadge
Posted by Maxime on September 10, 2010, at 11:20:54
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by morgan miller on September 9, 2010, at 22:11:26
I take 75 mg of the Notrip. a day. I take it all at once at night. Although I know that I am supposed to take it in 3 doses but I would always forget the first two. My depression has been helped by the Nortip. I know it makes a lot of people sleep, but it doesn't help my sleep problems at all. I wish it did, Yesterday I feel asleep for two hours after taking 15 mg of Dexedrine.
Posted by Conundrum on September 10, 2010, at 15:18:51
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by linkadge on September 10, 2010, at 10:28:34
> Mice lacking both the NET transporter and MAO-B have greatly increased cardiac NE levels and blood pressure. Dopamine in the prefrontal cortex isn't the be all too. Some studies show that there is hypermetabolism in the prefrontal cortex in certain depressive states. In ketamine responders, for instance, there is a dramatic *decrease* in prefrontal metabolism. I think there are studies showing the same in SSRI responses.
>Nortriptyline doesn't block all transporters and MAO inhibitors can actually be used to lower blood pressure. They actually end up decreasing blood pressure I believe this works through something called octapine or something. So there is a difference between MAO B depleted h rats on paper and MAO inhibitors in vivo.
Posted by SLS on September 10, 2010, at 15:39:28
In reply to Re: nortripytline + MAOi? anti histamine interraction » SLS, posted by linkadge on September 10, 2010, at 10:21:56
> I don't really know of any evidence that nardil and parnate are substantially different in their MAO effect. Both drugs inhibit both MAOA/B roughly equally.
>
> The difference may be due to secondary activities of the two agents. Nardil inhibits GABA metabolism leading to higher levels of GABA. This could counteract some of the stimulatory nature of the drug.
>
> Perhaps nardil is more potent an MAOI i.e. more inhibition at lower doses?Darn. I read a nice article about it just the other day. I doubt I can find it again.
Anyway, for what it's worth - from Wiki:
http://en.wikipedia.org/wiki/Tranylcypromine
"Tranylcypromine acts as a nonselective and irreversible inhibitor of monoamine oxidase.[1][2] Regarding the isoforms of monoamine oxidase, it shows slight preference for the MAOB isoenzyme over MAOA."
- Scott
Posted by linkadge on September 10, 2010, at 16:58:08
In reply to Re: nortripytline + MAOi? anti histamine interraction, posted by Conundrum on September 10, 2010, at 15:18:51
>Nortriptyline doesn't block all transporters and >MAO inhibitors can actually be used to lower >blood pressure. They actually end up decreasing >blood pressure I believe this works through >something called octapine or something.
You mean octopamine. Sometimes MAOIs lower blood pressure, sometimes not. Both my blood presure and heart rate increased on parnate. The increase in heart rate was distrubing. Same thing with nortriptyline. I don't feel comfortable with my heart beating >100 bpm.
>So there
>is a difference between MAO B depleted h rats on >paper and MAO inhibitors in vivo.Every drug or combination has side effects. I wouldn't refer to any combination as being 'sic' without first taking it. The point I'm trying to make is a lot of combos might seem great in theory, but clinically they might not pan out.
Go ahead and take selegiline + nortriptyline, I really don't care. See what it does for you. Mood is a lot more complicated than just boosting serotonin norepinephrine and dopamine. I mean, reserpine used to be used for anxious depression.
Linkadge
Posted by linkadge on September 10, 2010, at 16:58:54
In reply to Re: nortripytline + MAOi? anti histamine interraction » linkadge, posted by SLS on September 10, 2010, at 15:39:28
"Tranylcypromine acts as a nonselective and irreversible inhibitor of monoamine oxidase.[1][2] Regarding the isoforms of monoamine oxidase, it shows slight preference for the MAOB isoenzyme over MAOA."
and phenelzine?
Posted by SLS on September 10, 2010, at 17:19:57
In reply to Re: nortripytline + MAOi? anti histamine interraction » SLS, posted by linkadge on September 10, 2010, at 16:58:54
> "Tranylcypromine acts as a nonselective and irreversible inhibitor of monoamine oxidase.[1][2] Regarding the isoforms of monoamine oxidase, it shows slight preference for the MAOB isoenzyme over MAOA."
>
>
> and phenelzine?
Ah. Good point.I am having trouble finding that paper I was referring to. It was the authors' contention that Nardil was more serotonergic than Parnate. Of course, it could be that Nardil has no preference at all.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.