Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by reflecting on January 3, 2012, at 8:15:45
Hey folks,
I have a question for the Nardil experts here... I take 90mg of the Greenstone Nardil since some months now. It is helpful for my social anxiety, though not as drastically as I expected (or as I read it in other people's reports).
It took a very long time until I got the good effects, still they are inconsistent.
Moreover, I have untypical side effects concerning blood pressure:I do not have the orthostatic hypotension (that is, the drop in blood pressure when standing up), which worries me as it is typically stated to be a good sign on whether it is working sufficiently.
However, my blood pressure always increases for some time when taking a pill... in addition, I seem to be quite sensitive to food... I already had some minor reactions and yesterday a larger (blood pressure up to 220/110) one to marinated lamb. So all in all I am not completely happy with the results and frightened by the unusual blood pressure effects.
I do not really want to stop completely, as Nardil has better effects than anything I tried before. Should I try to change the brand maybe, to lower the dose or to go down with the dose and then up again to see if something is different then?Thanks for your help!!
Posted by Erewhonian on January 3, 2012, at 11:05:54
In reply to Nardil - should I change brand/stop/go down and up, posted by reflecting on January 3, 2012, at 8:15:45
> I have a question for the Nardil experts here...
I wouldn't say I'm one of those, since I've never taken it, but I'm interested since I'm heading the same direction soon...
>I take 90mg of the Greenstone Nardil since some months now. It is helpful for my social anxiety, though not as drastically as I expected (or as I read it in other people's reports).
> It took a very long time until I got the good effects, still they are inconsistent.You've been on 90mg for how long exactly? Is the anxiety what you're primarily taking the nardil for?
> I do not really want to stop completely, as Nardil has better effects than anything I tried before. Should I try to change the brand maybe, to lower the dose or to go down with the dose and then up again to see if something is different then?
Supposedly the gavis/novel nardil has better absorption. It's possible you'd get more drug actually delivered into your blood per mg if you switched. The idea of switching manufacturers kinda bothers me if you're having a response (even if partial), but in this case there's only one other maker and their product is widely thought to be more potent, so maybe it wouldn't be a terrible idea.
Maybe draw some blood? I don't think there's a test to easily allow your doctor to directly find the level of nardil in your blood, but I think they can test the level of MAO inhibition in your platelets, which is an indirect indication.
Do you weight significantly more than 90kg/200lbs? Maybe you need more than the typical max dose. It doesn't seem to cause you the usual blood pressure problems (which I'd be more thankful for than worried), so I wouldn't think going over 90mg would be reckless, but your doctor might feel otherwise.
Posted by reflecting on January 3, 2012, at 11:41:07
In reply to Re: Nardil - should I change brand/stop/go down and up » reflecting, posted by Erewhonian on January 3, 2012, at 11:05:54
Thanks for your answer!
[i]> Supposedly the gavis/novel nardil has better absorption. It's possible you'd get more drug actually delivered into your blood per mg if you switched. The idea of switching manufacturers kinda bothers me if you're having a response (even if partial), but in this case there's only one other maker and their product is widely thought to be more potent, so maybe it wouldn't be a terrible idea.[/i]
Is it really common knowledge that Gavis is more potent?
I hoped especially for it dissolving a bit slower, since I get this - moderate - blood pressure increase every time I take a dose of the Greenstone (if taking several tablets at once I even get a dangerous peak!)...> [i]
> Maybe draw some blood? I don't think there's a test to easily allow your doctor to directly find the level of nardil in your blood, but I think they can test the level of MAO inhibition in your platelets, which is an indirect indication.[/i]Maybe a good idea, I have to ask my doc concerning this.
[i]
> Do you weight significantly more than 90kg/200lbs? Maybe you need more than the typical max dose. It doesn't seem to cause you the usual blood pressure problems (which I'd be more thankful for than worried), so I wouldn't think going over 90mg would be reckless, but your doctor might feel otherwise.[/i]My doc is quite flexible and would probably be fine with going for 105mg. I weight a bit below 90kg though.
My worry is that I seem to be quite tyramine-reactive already, given that I got a reaction to marinated lamb... that's why I am not sure if going higher is safe (but probably you are right that I should be happy about the missing hypotension...)
Posted by Erewhonian on January 3, 2012, at 14:07:03
In reply to Re: Nardil - should I change brand/stop/go down and up, posted by reflecting on January 3, 2012, at 11:41:07
> Is it really common knowledge that Gavis is more potent?
That seems to be the opinion of the people that suffered through the 2003 nardil reformulation. I didn't follow the controversy too closely, but supposedly the new pfizer pills changed the excipients such that more of the drug breaks down in the stomach before ever reaching the small intestine. This caused nardil to stop working for many people. The gavis pill is supposed to be similar to nardil before the 2003 pfizer reformulation.
This normally shouldn't be an issue for new nardil users; if your body is naive you shouldn't have the resistance/potency issues that experienced users have. Even some old nardil users, returning to the drug after a number of years, report that the pfizer nardil works for them. But there's no predicting each person's idiosyncrasies.
> My worry is that I seem to be quite tyramine-reactive already, given that I got a reaction to marinated lamb... that's why I am not sure if going higher is safe
Sounds like something weird in the marinade? Or maybe something weird in you? ;) Again, no predicting each person's idiosyncrasies. In 2012, when you get to the point where you're taking an MAOI, it's necessary to deal with a certain amount of risk. The particular point where risk/benefit part ways is, again, idiosyncratic (word of the day!).
Posted by emmanuel98 on January 3, 2012, at 20:00:55
In reply to Re: Nardil - should I change brand/stop/go down and up, posted by reflecting on January 3, 2012, at 11:41:07
Marinated lamb? Was the lamb spoiled? Fresh lamb doesn't contain tyramine. Have you had your blood pressure checked just generally. Maybe you have high blood pressure.
Posted by reflecting on January 3, 2012, at 20:24:10
In reply to Re: Nardil - should I change brand/stop/go down and up, posted by Erewhonian on January 3, 2012, at 14:07:03
> That seems to be the opinion of the people that suffered through the 2003 nardil reformulation. I didn't follow the controversy too closely, but supposedly the new pfizer pills changed the excipients such that more of the drug breaks down in the stomach before ever reaching the small intestine. This caused nardil to stop working for many people. The gavis pill is supposed to be similar to nardil before the 2003 pfizer reformulation.
Good to know. I'll surely give it a try.> Sounds like something weird in the marinade? Or maybe something weird in you? ;) Again, no predicting each person's idiosyncrasies. In 2012, when you get to the point where you're taking an MAOI, it's necessary to deal with a certain amount of risk. The particular point where risk/benefit part ways is, again, idiosyncratic (word of the day!).
Dunno whether it was the lamb or the marinade... but was a quite frightening experience-for some hours I was sure to stop Nardil... but it really helps quite a bit with my social anxiety, which is my major problem - therefore, I really wanna proceed... the results could be a bit stronger and it could do more depression - I am still very lethargic, unactive, ahedonic and have little motivation to actually sozialise (even though the anxiety is clearly lessened/I am more self-confident and less rejection-sensitive).
I plan to get some Valium now such that I can use them sublingual in a hypertensive case...I read that this lowers blood pressure (and the anxiety of course which itself increases the blood pressure).Also I think about (though my doc willprobably not wanna do this) adding a NE-Reuptake-Inhibitor like Atomoxetine/Reboxetine/Ritalin/Nortryptline, as I read that this can lower the risk of a hypertensive crisis. This - in theory - works by blocking the channels, the tyramine needs to get through to release NE and so to rise BP.
But anyway, I will surely go on with Nardil - and maybe even try 105mg to see whether this gives full remission.
Posted by reflecting on January 3, 2012, at 20:25:57
In reply to Re: Nardil - should I change brand/stop/go down and up, posted by emmanuel98 on January 3, 2012, at 20:00:55
> Marinated lamb? Was the lamb spoiled? Fresh lamb doesn't contain tyramine. Have you had your blood pressure checked just generally. Maybe you have high blood pressure.
Normally it is fine (and even a bit below the optimum since Nardil) - but I was as well very shocked by the marinated lamb to have this effect, because I considered it to be totally fine... (it was bought already marinated... so I do not know what the ingredients were and how long it was marinated)
Posted by Erewhonian on January 4, 2012, at 11:17:41
In reply to Re: Nardil - should I change brand/stop/go down and up, posted by reflecting on January 3, 2012, at 20:24:10
I'm glad emmanuel brought up the possibility of spoiled lamb. I was afraid to, since I thought you might have made the lamb yourself, and I thought Am I supposed to accuse reflecting of intentionally preparing and eating spoiled meat? :D
But yeah, something weird in the marinade or spoiled meat. And no way of knowing, since you didn't make it, so I guess just cross buying that lamb off the list of things you can eat.
> I plan to get some Valium now such that I can use them sublingual in a hypertensive case...I read that this lowers blood pressure (and the anxiety of course which itself increases the blood pressure).
Gah, another pdoc afraid to give a patient an emergency hypertension pill! I'm afraid the valium won't cut it; it will help calm you down, but won't do much for the blood pressure in a serious tyramine hypertensive crisis.
Try suggesting chlorpromazine (aka Thorazine in the US), that's a popular choice now that all the doctors are afraid of nifedipine. The thorazine has pretty strong alpha-1 adrenergic receptor blocking action, which would be a major side-effect if you were taking it as an antipsychotic; but in the case of maoi tyramine hypertension, it's not a bug, it's a feature.
The pdocs are all afraid that if they give you a real anti-hypertension drug you'll take too much of it, or will take it in a panic when you don't actually have a hypertensive crisis. The thorazine is safe enough that it shouldn't put you into a serious case of hypotension, even if you take it when you're not in the middle of a real tryamine induced hypertensive episode.
Posted by reflecting on January 4, 2012, at 17:49:30
In reply to Re: Nardil - should I change brand/stop/go down and up, posted by Erewhonian on January 4, 2012, at 11:17:41
> Gah, another pdoc afraid to give a patient an emergency hypertension pill! I'm afraid the valium won't cut it; it will help calm you down, but won't do much for the blood pressure in a serious tyramine hypertensive crisis.
>
> Try suggesting chlorpromazine (aka Thorazine in the US), that's a popular choice now that all the doctors are afraid of nifedipine. The thorazine has pretty strong alpha-1 adrenergic receptor blocking action, which would be a major side-effect if you were taking it as an antipsychotic; but in the case of maoi tyramine hypertension, it's not a bug, it's a feature.
>
> The pdocs are all afraid that if they give you a real anti-hypertension drug you'll take too much of it, or will take it in a panic when you don't actually have a hypertensive crisis. The thorazine is safe enough that it shouldn't put you into a serious case of hypotension, even if you take it when you're not in the middle of a real tryamine induced hypertensive episode.Yeah, I read different things about this... that Nife is a bad choice seems to be consense now in the profession.
Ken Gillman (www.psychotropical.com) even writes that one should not do anything about high blood pressure (except for benzo) unless there is real evidence of ongoing endorgan-damage... I don't know, maybe a high dose like 20mg sublingual of Valium already reduces it to some degree (and if not enough one would have to go to the ER).But you are right that sth. like the thorazine may be a good idea for a case where there is no ER close by.
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