Psycho-Babble Medication Thread 1064530

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Parnate and angina

Posted by kirbyw on April 20, 2014, at 11:48:28

I am 66 years old, taking Parnate off and on for 30 years. I have heart disease (well controlled until now), but I have suddenly developed angina when exercising just mildly, but physician is not sure if this is angina or some other condition.

The best way to find out would be to use nitroglcerin and see if it stops the angina attack, but from everything I have read Nitro cannot be used with Parnate, in fact is highly contraindicated.

Physician suggests I stop the Parnate, so that he can try nitro, but I have seen what happens when I get off of Parnate.I quickly relapse into a more severe depression. Anyone have insights into this issue. It would be much appreciated.

(also worried about Parnate "masking" other symptoms of my heart problem, but I feel like I am between the devil and the deep blue sea. I never imagined I would still be on Parnate at age 66, but I tried to switch last year to Effexor and wound up with a major depressive episode and in the hospital until I got back on Parnate.

Drugs I take:
Zyprexa 2.5 daily at night.
Clonazapam 2 mg daily
Parnate 20 mg daily
Lipitor: (recent suspended to see if muscle pains are Lipitor related)
Lithium 600 mg daily
Pantoprozole 40 mg daily (for GERD)
cardioaspirin

Thanks. Rick in Costa Rica

 

Re: Parnate and angina

Posted by ed_uk2010 on April 20, 2014, at 15:10:50

In reply to Parnate and angina, posted by kirbyw on April 20, 2014, at 11:48:28

>The best way to find out would be to use nitroglycerin and see if it stops the angina attack, but from everything I have read Nitro cannot be used with Parnate, in fact is highly contraindicated.

Where have you read this? I am not aware of any major interaction.

 

Re: Parnate and angina » kirbyw

Posted by Phillipa on April 20, 2014, at 17:10:12

In reply to Parnate and angina, posted by kirbyw on April 20, 2014, at 11:48:28

Rick how is the medical care there. Not sure if asked before. Do you have a cardiologist? Here pretty sure a stress test would be ordered. Phillipa

 

Re: Parnate and angina

Posted by kirbyw on April 20, 2014, at 17:51:09

In reply to Re: Parnate and angina » kirbyw, posted by Phillipa on April 20, 2014, at 17:10:12

Rick how is the medical care there. Not sure if asked before. Do you have a cardiologist? Here pretty sure a stress test would be ordered. Phillipa

Yes, I will probably have a stress test this week, but I am so out of shape, they will probably have to do the chemically induced (adenosine) stress test. As for the interaction between MAOIs and Nitro, there are warnings everywhere about not using these drugs together. because of dangerously low blood pressure. I am not about to be the test case to see if it is true. Medical care here is good, but there are no MAOs in Costa Rica. So no physician knows anything about them. Which is becoming true in the U.S. as well, as I found out last summer. Only older physicians in the U.S. are really aware of MAOIs or thats how it seemed to me. When was the last time you saw a study published about MAOis. I think there was one that was being done at NIH, actually, but don't know the results. Other than that seems like nothing for years. Thanks for asking, Rick

 

Re: Parnate and angina » kirbyw

Posted by Phillipa on April 20, 2014, at 21:01:17

In reply to Re: Parnate and angina, posted by kirbyw on April 20, 2014, at 17:51:09

Not surprised to hear this as the docs look at you as if you have lost your mind if you mention the MAOI's. As for nitro the use when I was Nursing was that in the hospital if a patient said they had chest pain. Was take BP, administer one under tongue, 5 minutes later ask if pain gone and take BP & if not gone give another, repeat what I wrote and then one last try of nitro if pain still there. Not angina more serious and new orders given. Glad you are having the stress test. Phillipa

 

Re: Parnate and angina » kirbyw

Posted by ed_uk2010 on April 21, 2014, at 14:07:59

In reply to Re: Parnate and angina, posted by kirbyw on April 20, 2014, at 17:51:09

>As for the interaction between MAOIs and Nitro, there are warnings everywhere about not using these drugs together. because of dangerously low blood pressure.

There is no evidence of a specific interaction between MAOIs and nitroglycerin. Some people develop hypotension (low blood pressure) on MAOIs. This may be increased by nitroglycerin because it also reduces blood pressure. This isn't an interaction as such, it's an additive effect ie. both meds can reduce BP. Assuming your BP is normal on Parnate, I see no reason not to use nitroglycerin if medically necessary. If your BP is abnormally low already, don't use nitroglycerin.

The same warning of an 'interaction' is automatically applied to all drugs which can potentially reduce blood pressure. It's really important to consider what someone's BP is before giving nitroglycerin rather than assuming it's contraindicated. Nitroglycerin can reduce BP with or without MAOIs, so it would not be given if BP was too low to begin with.

Interestingly, and on another subject, back in the early 1960s some doctors prescribed MAOIs such as iproniazid, isocarboxazid (Marplan) and phenelzine (Nardil) to reduce the frequency of angina attacks. The mechanism of action wasn't clear, but they seemed to improve exercise tolerance and decrease pain in some patients.


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