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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 deerock on November 28, 2013, at 21:17:35
i just started nardil im at 30 mg, dont notice much. at thanksgiving dinner a relative dropped dead from a heart attack mid sentence while talking with me. it was horrific.
now im obsessed with nardil causing sudden heart attack or damaging my heart. which may make no sense since im 30 years younger than the person who died...but its got me obsessing.
can nardil cause heart damage and how likely is it? i know about the food and med interactions...but is this something that is not likely to happen? i want to give the med a shot. but i also am a little paranoid now...and i was to begin with. it was a really sad and traumatic holiday.
Posted by SLS on November 28, 2013, at 22:17:03
In reply to nardil and heart, posted by deerock on November 28, 2013, at 21:17:35
> i just started nardil im at 30 mg, dont notice much. at thanksgiving dinner a relative dropped dead from a heart attack mid sentence while talking with me. it was horrific.
> now im obsessed with nardil causing sudden heart attack or damaging my heart. which may make no sense since im 30 years younger than the person who died...but its got me obsessing.
> can nardil cause heart damage and how likely is it? i know about the food and med interactions...but is this something that is not likely to happen? i want to give the med a shot. but i also am a little paranoid now...and i was to begin with. it was a really sad and traumatic holiday.I am profoundly sorry for the great tragedy and trauma you are experiencing. It is unimaginable.
Perhaps you should ask your questions of your doctor.
For me, Nardil produced occasional heart palpitations that were not indicative of a heart condition. I think they were just an example of "fight-or-flight" autonomic symptoms that are nothing to worry about and will pass with time. Having said that, I would suggest that think about getting a quick ECG (EKG) should palpitations arise. It would help to allay your fears.
By the way, heart palpitations can be a symptom of depression.
Good luck.
- Scott
Posted by stargazer2 on November 29, 2013, at 8:18:06
In reply to nardil and heart, posted by deerock on November 28, 2013, at 21:17:35
I am sorry for your loss, that would make most of us question our vulnerabilities.
I have taken Nardil multiple times and have never heard anything about Nardil's affect on the heart.
Other than the tyramine effect, MAOs improve hypertension, at least that is what one article I have saved says.
Have you been on MAOS before? I think if you tolerate if and it improves your depression, you will feel better about it.
Speaking with your pdoc or reading some articles on MAOS might be helpful to familiarize yourself with how they work and their side effects.
Stargazer
Posted by Phillipa on November 29, 2013, at 8:37:58
In reply to nardil and heart, posted by deerock on November 28, 2013, at 21:17:35
I was not home yesterday just read this and I can't imagine the horror of what happened. I am so sorry. Phillipa
Posted by deerock on November 29, 2013, at 18:30:04
In reply to Re: nardil and heart » deerock, posted by Phillipa on November 29, 2013, at 8:37:58
thanks for your support everyone. it was utterly traumatic.
Posted by Phillipa on November 29, 2013, at 20:15:38
In reply to Re: nardil and heart, posted by deerock on November 29, 2013, at 18:30:04
How are you today? I can't imagine. I'm so sorry this happened. Phillipa
Posted by Cee on November 30, 2013, at 0:52:41
In reply to Re: nardil and heart » deerock, posted by Phillipa on November 29, 2013, at 20:15:38
Philip a what the f do you now ai
Bout nardil
Posted by ed_uk2010 on November 30, 2013, at 6:16:23
In reply to Re: nardil and heart, posted by stargazer2 on November 29, 2013, at 8:18:06
Like Stargazer said, Nardil tends to reduce blood pressure (BP), provided that you stick to the correct diet of course. This could theoretically have some benefits for your heart and cardiovascular system.
An MAOI called pargyline was once used for patients with high blood pressure (mainly in the 1960s I believe). Of course, it was awkward to use due to the diet etc and was replaced by newer BP meds with milder side effects.
Nardil reduces blood pressure with little change in heart rate. It does not cause abnormal heart rhythms, unlike some antidepressants. Provided you educate yourself fully about the diet, you should be fine. Do take care as you increase the dose because drops in BP on standing up can cause dizziness and faintness eg. when getting out of bed. Always best to get up slowly rather that jumping out of bed/out of your chair/or whatever.
Do not buy any medicines to take while on Nardil without consulting the pharmacist, and do not take any additional prescribed medicines without double checking for interactions. A lot of cold/flu/cough meds interact seriously, as do most other antidepressants and some painkillers (eg. tramadol, meperidine). If you have any interacting meds around the house, it may be a good idea to get rid of them. Dietary and med restrictions must be continued for 2 weeks after stopping Nardil, if you do need to stop.
I hope this makes you feel a bit better. Nardil is a very effective medication, but education is key to its safe use. For further information on the diet, search the Dr. Bob archives for MAOI or Nardil, diet and Elizabeth. The former poster Elizabeth did a lot of great posts about the MAOI diet. Obviously, eating out can be awkward if you don't know what's gone into the food, especially the sauces. This is particular true of Chinese food due to Soy sauce.
There are various diet sheets online:
http://www.upmc.com/patients-visitors/education/nutrition/pages/maoi-diet-facts.aspx
Some points are a little controversial, for example, most patients on MAOIs do seem to tolerate caffeine. I would avoid it during initial treatment though, especially after noon, since Nardil can cause insomnia. Similarly, most people seem to tolerate chocolate. If you wish to introduce any new food on the 'limit' list, do so very gradually. The severity of the food interactions in highly dependent on how much you ate. With respect to things like cheese, tyramine content is very variable to it's best to avoid all except cottage cheese and highly processed American 'hamburger' cheese, which is barely even cheese! Tyramine content also varies between batches, which is why the 'limit' list exists.
Tyramine is a breakdown product of protein. Foods with little or no protein will not contain tyramine eg. most fruits.
With respect to meds...
Meds you CAN take with Nardil:
Acetaminophen aka. paracetamol (on its OWN - some tablets contain a variety of other drugs, some of which are not safe at all).
Ibuprofen - on its own. Check the box.
Non-sedating antihistamines, on their own (some contain decongestants). Safe antihistamines include cetirizine and loratadine.
All common over-the-counter laxatives. Nardil can cause constipation. MiraLax is a good choice in the US, Movicol if you're in the UK.
....................................................................................................................
Meds to AVOID in all cases:
All types of decongestants for nose/sinuses etc. Contained in many cold/flu treatments. Best to avoid decongestant nasal sprays too. If you have allergies, you can use a steroid nasal spray safely. Banned decongestants to look out for include pseudoephedrine (eg. Sudafed) and phenylephrine.
Certain painkillers: eg. tramadol (Ultram), meperidine (pethidine/Demerol). Check with the pharmacist for the safety of other prescription analgesics.
Some OTC cough meds: Dextromethorphan (eg. Robitussin Dry Cough and many other dry cough brands).
Most antidepressants: SSRIs and related (Paxil, Zoloft, Prozac, Celexa, Lexapro, Effexor, Cymbalta etc react extremely severely with Nardil). Remove them from your house. Some older ADs eg. clomipramine (Anafranil) and imipramine also react very badly.
If in doubt, check with a professional, and take care :) Nardil can be very safe in the right hands, and can work when nothing else has.
Posted by stargazer2 on November 30, 2013, at 14:19:31
In reply to Nardil, the heart and safe use., posted by ed_uk2010 on November 30, 2013, at 6:16:23
Nice summary on Nardil. So much information but presented in a very clear and organized way. I forget how much information is required with the MAO's, no wonder docs are reluctant to prescribe them even though they work so well. The liability is there and if a patient does not follow through with the restrictions they can be in big trouble. You can't emphasize enough the food and drug limitations. I thought I was aware of all of them but it helps to periodically review the lists of allowable foods and meds.
Stargazer
Posted by sigismund on November 30, 2013, at 17:24:32
In reply to Nardil, the heart and safe use., posted by ed_uk2010 on November 30, 2013, at 6:16:23
I had problems with dark chocolate or red wine (never was sure which) on Parnate.
Scott once said (if he doesn't mind me repeating it) that his response to pargyline was fantastic.
Posted by Phillipa on November 30, 2013, at 18:22:34
In reply to Re: nardil and heart, posted by Cee on November 30, 2013, at 0:52:41
I do know about empathy and what happened was a tragedy. Two things here a horrific death, and information needed about a med. Is this a problem?
Posted by corkskru on November 30, 2013, at 20:21:36
In reply to Re: nardil and heart, posted by Cee on November 30, 2013, at 0:52:41
> Philip a what the f do you now ai
> Bout nardilExcuse me, but this is a SUPPORT forum last time I checked and your post has nothing to do with OP thread and is doubly NOT supportive of OP or Phillipa. I know nothing about Nardil, but would also like to express my sympathy for the horrific incident experienced.
Posted by Phillipa on November 30, 2013, at 20:27:18
In reply to Re: nardil and heart » Cee, posted by corkskru on November 30, 2013, at 20:21:56
Deerock I do hope things are going better for you now. Phillipa
Posted by ed_uk2010 on December 1, 2013, at 6:39:03
In reply to Re: Nardil, the heart and safe use., posted by sigismund on November 30, 2013, at 17:24:32
Thanks Stargazer, I hope it was helpful :)
Sigi, I think red wine was more likely to be the culprit, but dark choc is suggested in moderation. Tyramine content various a lot even between batches of the same wine. Spirits such as vodka, contain no tyramine however! Not that I'm advocating them as a suitable replacement :)
I think Scott responded to clorgyline, but I'm unsure whether he took pargyline. Hmm.
Posted by deerock on December 1, 2013, at 11:02:52
In reply to Re: nardil and heart » deerock, posted by Phillipa on November 29, 2013, at 8:37:58
thanks phillipa.
Posted by sigismund on December 1, 2013, at 15:49:02
In reply to Re: Nardil, the heart and safe use.Stargazer,Sigi, posted by ed_uk2010 on December 1, 2013, at 6:39:03
> clorgyline, but I'm unsure whether he took pargyline
Right, somewhat similar names, hey?
Posted by ed_uk2010 on December 2, 2013, at 12:00:04
In reply to Re: Nardil, the heart and safe use.Stargazer,Sigi » ed_uk2010, posted by sigismund on December 1, 2013, at 15:49:02
> > clorgyline, but I'm unsure whether he took pargyline
>
> Right, somewhat similar names, hey?+ both MAOIs :)
Anyway, I hope deerock found my post useful. Other people had been supportive, so I decided to be informative :)
Posted by deerock on December 3, 2013, at 21:13:00
In reply to Re: Nardil, the heart and safe use.Stargazer,Sigi, posted by ed_uk2010 on December 2, 2013, at 12:00:04
useful indeed! thank you!
Posted by jedi on December 15, 2013, at 2:08:48
In reply to Re: Nardil, the heart and safe use.Stargazer,Sigi » ed_uk2010, posted by deerock on December 3, 2013, at 21:13:00
Hi,
I have been on Nardil for most of 15 years. It has never caused any heart problems for me. Like Ed mentioned, it will actually lower blood pressure in therapeutic doses for depression. My BP was always borderline high and 60mg of Nardil lowers it 10 to 15 points on both the systolic and diastolic readings.That said, I have had probably 30 or 40 instances over the years that have felt like heart attack symptoms. They were not! A real tightening of my chest and jaw. A really bad feeling that I surmised might be what a heart attack feels like. When I get these symptoms, I will usually lie down if I can. They have always passed in a few minutes time. Have any other Nardil users experienced this?
Ed was sure right, Elizabeth was a guru on treatment resistant depression. I hope she is doing well.
I have posted many times over the years of my experiences with Nardil. Feel free to Google them: https://www.google.com/#q=nardil+jedi+site:dr-bob.org Add some more qualifiers to narrow the search. Substitute Elizabeth for jedi if you want some really good info.
Be Well,
Jedi
Posted by kirkglen on March 30, 2014, at 10:34:58
In reply to nardil and heart, posted by deerock on November 28, 2013, at 21:17:35
Deerock
Do not worry about Nardil / heart issues. I've been taking Nardil since @ 1981. My cardio Doc tells me if I die it won't be my heart. The one thing I would check annually is your liver.
This is the end of the thread.
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