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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 roscopeeco on August 29, 2011, at 21:19:28
Well...here I am again. I tried Parnate and while it worked fairly well, I became too anxious on the medication. I am now on my third fourth day of Nardil at 45mg. I will post my response. Thanks for your support.
Posted by Lepus on August 29, 2011, at 21:27:36
In reply to Second time around on MAOI, posted by roscopeeco on August 29, 2011, at 21:19:28
I'm starting up Nardil too. I'm on my first week at 30mg.
Good luck to you. I look forward to seeing your progress!
Posted by jono_in_adelaide on August 29, 2011, at 22:11:27
In reply to Re: Second time around on MAOI, posted by Lepus on August 29, 2011, at 21:27:36
A couple of things
1. The optimum dose of Nardil is around 1mg per kilo of bodyweight per day, so dont be afriad to work the dose upwards
2. Give it time, it can take upto 6 weeks after you reach a theraputic dose to see a response. Also, side effects tend to get better with time as well.
Very best of luck!
Posted by Phillipa on August 29, 2011, at 22:23:51
In reply to Re: Second time around on MAOI, posted by jono_in_adelaide on August 29, 2011, at 22:11:27
Best of luck. Phillipa
Posted by floatingbridge on August 30, 2011, at 2:29:06
In reply to Second time around on MAOI, posted by roscopeeco on August 29, 2011, at 21:19:28
Roscepeeco, very good luck. Look forward to reading updates.
fb
Posted by roscopeeco on August 30, 2011, at 14:52:45
In reply to Re: Second time around on MAOI, posted by Lepus on August 29, 2011, at 21:27:36
> I'm starting up Nardil too. I'm on my first week at 30mg.
>
> Good luck to you. I look forward to seeing your progress!
Hello Lepus,I was told to start out at 15mg three times a day for the initial week and work up from there as tolerated to a dose of approximately 1mg per kilogram of body weight. Since I weigh around 195, my goal is going to be 90mg.
I am only telling you what I am planning to do because all of us are different. I plan on going to 60mg after week one, 75mg after week 2, and 90mg after week three. Of course I might have to alter my plan according to my own reaction. The only thing that is going to stop me from going up as scheduled is hypotension. I can deal with other S/E's, but the postural hypotension that I encountered with Parnate was a nightmare. My experience with hypotension and Parnate is that is goes away with time. I am hoping that Nardil will be better at keeping anxiety at bay.
I look forward to hearing your progress Lepus. How much do you weigh?
Posted by Lepus on August 30, 2011, at 17:04:20
In reply to Re: Second time around on MAOI, posted by roscopeeco on August 30, 2011, at 14:52:45
I weigh about 135lbs. I'm supposed to increase to 45mgs tonight. My biggest fear is the hypotension as well. I already have POTS, which is a disorder that causes issues With hypotension when I change positions or stand for a long time. I really need this med to work but I'm concerned.
Posted by jono_in_adelaide on August 30, 2011, at 18:11:08
In reply to Re: Second time around on MAOI, posted by Lepus on August 30, 2011, at 17:04:20
If you're worried about hypotension, ask your doctor about Florinef - it makes the body retain salt and fluid and thus prevents the hypotension (basicly the opposite effect of diuretics, which are used to treat high blood pressure)
Posted by roscopeeco on August 30, 2011, at 18:16:35
In reply to Re: Second time around on MAOI, posted by Lepus on August 30, 2011, at 17:04:20
> I weigh about 135lbs. I'm supposed to increase to 45mgs tonight. My biggest fear is the hypotension as well. I already have POTS, which is a disorder that causes issues With hypotension when I change positions or stand for a long time. I really need this med to work but I'm concerned.
According to your weight, 60mg is your goal. I understand you need this medication to work. I was in your boat as well. Remember to make sure you are patient with yourself. They say a trial of 4 to 8 weeks at your target dose is what it usually takes. Don't get caught up in the fact that some respond very quickly and thus something is wrong if you are not responding at the same pace. I am here for any support you need. You can email me personally if you would like. Babblemail me and I can give you my personal email.
In regards to the hypotension, it went away completely for me when I was taking parnate. Thus far I have not had the same hypotensive feelings on Nardil. I have had some periods were my legs were a little unsteady, but when I was on Parnate I would literally blackout every time I would stand up. I thought it would never go away, but it did.
Posted by Lepus on August 30, 2011, at 18:44:16
In reply to Re: Second time around on MAOI))Lepus, posted by roscopeeco on August 30, 2011, at 18:16:35
Thank you, RP. Your words mean a lot to me, as does your offer to talk. Thank you so much!
How did you get through blacking out every time you stood up?!?
Posted by Lepus on August 30, 2011, at 18:45:53
In reply to Re: Second time around on MAOI, posted by jono_in_adelaide on August 30, 2011, at 18:11:08
> If you're worried about hypotension, ask your doctor about Florinef - it makes the body retain salt and fluid and thus prevents the hypotension (basicly the opposite effect of diuretics, which are used to treat high blood pressure)
I have asked my cardiologist about this but he seems to only want to prescribe beta-blockers. I can't even take those anymore so maybe now he will change his mind.
Thanks for the suggestion!
Posted by emmanuel98 on August 30, 2011, at 20:14:46
In reply to Re: Second time around on MAOI, posted by Lepus on August 30, 2011, at 18:45:53
I found on parnate that the hypotension goes away. When I first started it, I would fall down going from the bedroom to the bathroom in the middle of the night and the route is right by the stairs. My husband put a child safety gate over the top of the stairs so I wouldn't tumble down. Then I started sitting on the bed for a few minutes, then standing holding on to something for a few minutes before I left the bedroom. But after a few months, it went away. Now I can get up in the middle of the night, walk to the bathroom and be fine.
Posted by roscopeeco on August 30, 2011, at 20:53:40
In reply to Re: Second time around on MAOI))Lepus, posted by Lepus on August 30, 2011, at 18:44:16
> Thank you, RP. Your words mean a lot to me, as does your offer to talk. Thank you so much!
>
> How did you get through blacking out every time you stood up?!?
I did what emmanuel did when she was experiencing the same thing. When you standup your blood volume drops to your lower extremities. Your heart compensates this by a rapid increase in heart rate to counteract its perceived drop in blood volume.Your aorta and carotid arteries have baroreceptors that sense blood pressure. When they sense a drop in blood pressure it sends a signal to the heart to beat faster to accommodate this drop. That is what is considered "reflex tachycardia", or sudden acceleration of heart rate. It is a feedback mechanism in our body. To avoid this sudden drop in blood pressure and accompanying accelerated heart rate, you have to let your heart adjust at a slower pace. Sit up in the bed first. Start moving around while sitting. Stand up slowly, hold onto something. Give your heart time to accelerate gradually instead of suddenly. You are giving your heart the adequate time to catch up to lower blood pressure when you get up gradually. If you get up all of the sudden the heart cannot catch up quick enough and you black out.
Posted by jono_in_adelaide on August 30, 2011, at 21:04:58
In reply to Re: Second time around on MAOI, posted by Lepus on August 30, 2011, at 18:45:53
Might be worth asking your psychiatrist about it as well, s/he may have used it before on other Nardil patients
Posted by Lepus on August 30, 2011, at 21:54:56
In reply to Re: Second time around on MAOI))Lepus » Lepus, posted by roscopeeco on August 30, 2011, at 20:53:40
My cardiologist says to throw your legs over the side of the bed and wait at least two minutes before beginning to stand, which is what you guys are saying. I'm just giving you confirmation by an MD. :) (As if you needed one.)
I desperately hope I don't get such a drastic increase in hypotension. I hate that feeling and have dealt with it too much in my life.
Is there any way to avoid it with Nardil? Slower titrating? Anything besides another drug?
Posted by jono_in_adelaide on August 30, 2011, at 23:38:27
In reply to Re: Second time around on MAOI))Lepus, posted by Lepus on August 30, 2011, at 21:54:56
compression stockings might help, by stopping blood pooling in the legs..... the sort people with vericose veins wear
Posted by sigismund on August 31, 2011, at 2:27:35
In reply to Re: Second time around on MAOI))Lepus, posted by Lepus on August 30, 2011, at 21:54:56
I like the idea of slow titration.
Perhaps you could find an adequate response with fewer side effects on a slightly lower dose?
I just wonder.
Posted by Lepus on August 31, 2011, at 12:06:20
In reply to Re: Second time around on MAOI))Lepus, posted by sigismund on August 31, 2011, at 2:27:35
> I like the idea of slow titration.
>
> Perhaps you could find an adequate response with fewer side effects on a slightly lower dose?
>
> I just wonder.I think it is possible. I have already noticed changes on 30mgs. I generally respond to lower does of medicines anyway. So, hopefully 45mgs will turn the lights on for me.
Posted by Lepus on August 31, 2011, at 12:08:14
In reply to Re: Second time around on MAOI))Lepus, posted by jono_in_adelaide on August 30, 2011, at 23:38:27
> compression stockings might help, by stopping blood pooling in the legs..... the sort people with vericose veins wear
Yeah, I have considered picking up a pair. I don't know much about them in terms of how safe they are though. Can anyone use them to stop pooling or might there be consequences?
Posted by SLS on September 2, 2011, at 8:25:05
In reply to Re: Second time around on MAOI, posted by roscopeeco on August 30, 2011, at 14:52:45
> > I'm starting up Nardil too. I'm on my first week at 30mg.
> >
> > Good luck to you. I look forward to seeing your progress!
>
>
> Hello Lepus,
>
> I was told to start out at 15mg three times a day for the initial week and work up from there as tolerated to a dose of approximately 1mg per kilogram of body weight. Since I weigh around 195, my goal is going to be 90mg.
You have an enlightened doctor.You might need to be patient with Nardil, especially if you have been on and off another MAOI. With a little luck, you'll feel improved at 60mg. I would give this dosage three weeks to show results before increasing it. The faster you titrate the dosage of Nardil, the more likely you are of developing persistent side effects. This has been my experience.
- Scott
This is the end of the thread.
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