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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on November 19, 2011, at 12:39:18
In reply to Re: 2nd MAOI after the first one failed? » ed_uk2010, posted by europerep on November 19, 2011, at 8:47:52
>it would make some sense if the same was true for fillers
Archimedes UK (the marketing authorisation holder) could choose to alter the excipients if they so desired, but they don't really have much incentive to do so. If they wanted to change the formulation so that it was the same as American Nardil, testing and MHRA approval would still be needed. I don't think they would view this as worthwhile, even if it meant that their product didn't need to be stored in the fridge anymore. I imagine that all the excipients used in American Nardil are readily available here but that's not the problem. I just don't think Archimedes would want to invest any money into a slow selling product.
Posted by europerep on November 20, 2011, at 14:17:34
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 19, 2011, at 12:39:18
>If they wanted to change the formulation so that it was the same as American Nardil, testing and MHRA approval would still be needed.
Ah, I think now I got it. I thought that regulatory bodies such as the MHRA or its counterparts in other countries (or the EMA) would basically say "here is box A with all the drugs that we have approved, and here is box B with all the fillers, excipiens etc. that we approved as well. Throw together any combination of those substances and you are free to sell it." I didn't know that preparations (and not just the active drugs they contain) had to be approved too. Good to know though, thanks for explaining it to me! :)
Posted by ed_uk2010 on November 20, 2011, at 14:42:58
In reply to Re: 2nd MAOI after the first one failed? » ed_uk2010, posted by europerep on November 20, 2011, at 14:17:34
>Throw together any combination of those substances and you are free to sell it.
That would not be good at all! The bioavailability could be changed if the composition of the tablet was altered.
>I didn't know that preparations (and not just the active drugs they contain) had to be approved too.
Yes, everything has to be approved. The composition of the tablet, the manufacturing site, the manufacturing process, the packaging etc. For example, if a company is launching a generic version of a product, they may choose to use some different ingredients (for example a different colouring). They will need to do tests to show that the drug is still absorbed from the tablet in the same way.
If Archimedes wanted to change the ingredients in Nardil, they would have to get approval for all of the changes. They would have to do studies to show that the tablets still dissolve the same way, that the new tablet manufacturing process is appropriate and that the phenelzine is still absorbed into the body at the same rate and in the same quantity. All this would cost money. For a low volume product which is only distributed to a few large wholesalers, why bother?
I noticed that Archimedes UK don't even mention Nardil on their website. Hmm, that's not too encouraging.
Posted by europerep on November 29, 2011, at 8:10:40
In reply to Re: 2nd MAOI after the first one failed? » europerep, posted by ed_uk2010 on November 20, 2011, at 14:42:58
Thanks for clarifying this, ed! *thumbsup*
Now that I think about it, it does make sense that drug preparations need to be assessed for bioavailability and all that... nice to have that question cleared up!
ER
Posted by kakalak on December 12, 2011, at 15:44:53
In reply to Re: 2nd MAOI after the first one failed? » Mark25, posted by jedi on November 12, 2011, at 12:22:43
> Nardil can and does work where Parnate fails. That is a S**tload of clonazepam! I used up to 5mg while I was waiting for Nardil to kick in the first time. Phenelzine is the "BOMB" for social anxiety and atypical depression. In my opinion it should be 2nd tier and not last resort for this diagnosis. It is a bloody crime that it is not available in your country. The stuff saved my life more than once! You can probably get all of the worthless SSRIs you want! Sorry! The MAOIs work where all others fail. I have been preaching about it on here for years. I did have 2 failed Parnate trials. Google some of my posts. This S**T works!
> Good Luck,
> Jedi
>Parnate did not work for me. Besides the first few days I took it and directly after a dosage increase, I never felt energized like many others. By late afternoon every day I was exhausted, my vision was blurry, and I struggled to keep up yet could never sleep. I tried altering the dosing times and the afternoon drag didn't improve. Ambien was the only thing that seemed to work for my insomnia and some nights it didn't work at all. The Ambien left me feeling groggy whenever I couldn't get 8 hours of consecutive sleep (which was often) and the memory loss was awful. Because I have an infant and need to be able to wake during the night if need be, I cannot continue taking Ambien or any similar sleep aid every single night. One of the other big problems was the Parnate didn't help my general anxiety and it seemed to increase my social anxiety.
Before abandoning MAOIs, my pdoc suggested I try Nardil even though insomnia is a main side effect. He said since my body is already used to an MAOI, I should know within a few weeks if the Nardil side effects are tolerable. While I don't want to waste any more time, I wonder if a few weeks is enough time.
I've spent years trying to find the right combo of meds that worked for me and the last few taking Effexor combined with Buspar. While the Effexor side effects were pretty crappy, I got used to them but after taking it for so long it pooped out on me and no longer worked. One of the main reasons my pdoc selected Parnate was to eradicate some of the side effects caused by Effexor. Unfortunately the side effects on Parnate were worse for me. I can't help but wonder if I should have stuck with the Effexor and tried adding different meds? (My insurance would not approve a higher dose.)
I feel like I have to choose between spending the rest of my life miserable with depression and anxiety or be happier yet have insomnia, weight gain, no libido, etc. It's a vicious cycle. If Nardil isn't the solution for me, where do I go from there? I've tried many SSRIs, many atypical antidepressants, & now 2 MAOIs. I've never tried a TCAs.
Any suggestions?
Thanks,
kakalak
Posted by enrtwo on May 28, 2014, at 12:14:33
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by ger man on October 4, 2011, at 6:26:14
Hello,
can someone please tell me where I might possibly get a prescription for Nardil in Germany? I'v tried from online pharmacies in the UK, but they cannot supply it at the moment, but since it worked so well for my social anxiety, I really need another prescription. Please help.Best regards
Posted by europerep on May 28, 2014, at 13:52:47
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on May 28, 2014, at 12:15:48
Hi,
Are you looking for a doctor who prescribes phenelzine (Nardil) or a pharmacy that sells it? Phenelzine is available in Belgium, under the brand name Nardelzine, and Belgian pharmacies accept German prescriptions. Does that help you?
ER
Posted by enrtwo on May 28, 2014, at 14:00:51
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » enrtwo, posted by europerep on May 28, 2014, at 13:52:47
I'm looking for a German doctor, preferably somewhere around Frankfurt, who might prescribe it, if I talk to them about my situation.
My current psychiatrist was actually going to prescribe it, but just before he did, his colleague came along and convinced him that it was illegal to prescribe and import this, which is of course bulls***, but now I guess he kinda thinks I was trying to trick him into doing something illegal. :/
Posted by europerep on May 28, 2014, at 14:35:50
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on May 28, 2014, at 14:00:51
In that case, I would suggest that you carefully try to educate your doctor on this. You can find importers of medical drugs in Germany via Google, maybe have them write you something to show your doc that it's perfectly fine and easy to import drugs, particularly ones from EU member states.
That would seem more promising than to go and see other docs who don't know you at all.
Posted by enrtwo on May 28, 2014, at 14:59:15
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » enrtwo, posted by europerep on May 28, 2014, at 14:35:50
Yeah, I tried that, though. His colleague was certain that those importers and pharmacies just tell you what you want to hear to make money and that they don't care about whether doctors could get into legal trouble for prescribing it. Then he looked it up on some list actually by some government institution where he told me it was marked "non-marketable". Since I had to do a lot of convincing my doctor in the first place, this stuff about it being illegal kinda reinforced his hesitations. Last time I saw him, after his colleague told him all this, he actually seemed quite angry and said I should "go somewhere else and get a prescription there", if I thought it was legal. So I don't really see a big chance there and have pills left for only few days, anyway. :/ This doctor is actually very "liberal" with meds and prescribes you most things you want, so if it was available here in Germany, he'd probably have prescribed me two dozens packages right away. lol But since he has no experience with imports and is too old to go google stuff, I guess I'm f***ed. :/
Posted by europerep on May 29, 2014, at 7:06:03
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on May 28, 2014, at 14:59:15
Hmm, in that case I would try to find an experienced psychiatrist who is comfortable with prescribing MAOIs and has a rational attitude concerning importing medication.
But if you only have a few tablets left, I would go to Frankfurt's university hospital, where they surely have something like "emergency" outpatient consultations for psychiatric patients and see whether they can help you.
Posted by enrtwo on May 29, 2014, at 15:17:08
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » enrtwo, posted by europerep on May 29, 2014, at 7:06:03
Thanks for your advice. :)
I would also have the option to try Parnate, but of course trying different doses and finding out if it works at all, would take itself a few months. I have also written to said government organization to please confirm that it is legal to import, so I might make a last attempt to convince my doctor, but after waiting for two weeks, no answer yet. Since Nardil stays in the blood for 2-3 weeks after stopping it, I'm thinking to wait for an answer a little longer and maybe use benzos in case of emergency. I guess I shouldn't start Parnate right after Nardil anyway, right?
Posted by europerep on May 29, 2014, at 16:44:07
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on May 29, 2014, at 15:17:08
Actually, the half-life of phenelzine is fairly short, but its mechanism of action doesn't depend on blood serum levels, so in that sense you will probably notice only a gradual loss of effect. But, personally, I wouldn't be happy with that.
You probably won't hear from the any government body because the law clearly states what is allowed. Maybe you could ask your pharmacist, who is obviously a trustworthy source on this issue, to talk to your doctor? That might help.
Posted by europerep on May 30, 2014, at 16:34:17
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on May 29, 2014, at 15:17:08
Oh and you're right, switching from one MAOI to another is kind of tricky. But I don't know whether one would need to have a full wash-out period of two weeks (until MAO inhibition has worn off) before starting a new MAOI.
Posted by enrtwo on June 1, 2014, at 8:06:49
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » enrtwo, posted by europerep on May 30, 2014, at 16:34:17
You are right, europerep, having a pharmacist talk to my doctor seems a good idea. Before doing that, I'll try to see if I can go to the outpatient clinic tomorrow at the university and explain my problem to a doctor there. If they would agree to write me just a one month script, I could show a copy to my doctor to show him that if they write a script for it, it sure can't be illegal. However, even if I happened to succeed tomorrow, I'd still be without pills for a good week, since it takes that long to import it. But in one week, it would surely keep most of its effect.
The big problem with Nardil here in Germany is that nobody seems to know it. Even my doctor, who is well over 60 (and that's probably the reason he would write me a script for Parnate) and has been a doctor already for some years back around 1980, when Nardil was still available here, has never heard of phenelzine. And as soon as a doc hears that a substance has to bee imported, it quickly becomes "suspect" to them, no matter how harmless.
Anyway, thanks for your replies, I'll let you know how it went.
Posted by europerep on June 1, 2014, at 15:40:30
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on June 1, 2014, at 8:06:49
Yeah, try that... be honest to the doctor and say right away that you're there for a prescription of a very particular drug blah blah import blah blah only drug that works for you blah blah...
And are you sure that phenelzine was available in Germany at some point in time? I thought that it never was, but it's totally possible I am wrong on that.
Well, good luck anyways, and yeah, post back how it went if you like...
Posted by enrtwo on June 2, 2014, at 12:05:55
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » enrtwo, posted by europerep on June 1, 2014, at 15:40:30
Well, kinda funny conversation with the doc: "What's the med's name?" "Nardil. It's an import from England." "I can't find that on my list of German meds here. What's the active ingredient's name?" "Phenelzine. It's from England." "I can't find that [on my list of German meds] either. Anyway, I can't prescribe you anything, you have never been here before."
So much for that, I guess I'll just try some Parnate then and see what happens. It's not like it's completely useless, it might actually have some advantages to it and work better than expected. And if it does, I can at least be sure to always get as much as I need. Because, after all, what use is the best med, if you can't even get it?
Posted by europerep on June 3, 2014, at 15:24:51
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on June 2, 2014, at 12:05:55
Sorry to hear that. I'm beginning to think university or academic hospitals are not really the place to look for "creative" and open-minded/well-informed doctors. Or rather, it depends on what type of "creativity" you are looking for. I could have much more easier been prescribed various atypical antipsychotics as an augmentation agent than an irreversible MAOI ("We haven't used those since twenty years ago."). I'm not sure whether that is rational.
Anyway, if phenelzine works for you, I would be careful not to "throw that away." Going off a drug and later back on it does usually, but not always, produce the same result. You could do the looking-for-a-doctor-that-prescribes-MAOIs thing. Many of us have been there. But if you already had it imported before, I think your pharmacist would be the most promising option right now. If he can't convince your doc, ask him whether he can help you find another one. That's what I would do in any case.
Good luck, with whatever you decide to do...
Posted by Lamdage22 on June 4, 2014, at 12:43:52
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on June 2, 2014, at 12:05:55
I speak english because German would be unkind. I took Nardil in Germany.
I know someone south of Munich wo would prescribe it.There are good Doctors here you just have to find them! Im not a big fan of that Dr but he would basically prescribe anything non narcotic.
Posted by Lamdage22 on June 4, 2014, at 12:46:19
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on June 2, 2014, at 12:05:55
Nardil is cool but makes you gain. Parnate is cool but overstimulating. Id prefer Nardil with Metformin.
And both have sent me into maniac psychosis, but that is just me.
Posted by enrtwo on June 5, 2014, at 4:54:48
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by Lamdage22 on June 4, 2014, at 12:46:19
Good to hear there is some hope. I don't know if I may ask for this here, but if you would mention the doctor's name over PM, if all else fails, that would be nice ...
After showing my doc the government's answer that came in just yesterday, he agreed to prescribe me one bottle so I can continue for about 20 days. At the same time, he referred me to the university emergency outpatient clinic, explicitly writing down for the doc there that I have had positive results with Nardil. Despite this being a university clinic, I have my doubts, though, that more people will know phenelzine there, but I'll certainly give it a try.
Posted by Lamdage22 on June 5, 2014, at 10:16:22
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on June 5, 2014, at 4:54:48
No problem.
Just turn babble mail on: http://www.dr-bob.org/babble/faq.html#babblemail
Posted by europerep on June 5, 2014, at 14:42:02
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by enrtwo on June 5, 2014, at 4:54:48
Good to hear that.
By the way, I'm curious: what does an imported box of UK Nardil cost you? I wouldn't be surprised if it was quite expensive, despite the fact that it has been off patent for ages. Drugs in the UK are, in my experience, very expensive...
Posted by Lamdage22 on June 6, 2014, at 4:44:33
In reply to Re: Questions on phenelzine/Nardil (@jedi and others) » enrtwo, posted by europerep on June 5, 2014, at 14:42:02
Im not 100% sure how much it costs. Contact your pharmacy, they can tell you.
You've got mail
Posted by Lamdage22 on June 6, 2014, at 4:46:48
In reply to Re: Questions on phenelzine/Nardil (@jedi and others), posted by Lamdage22 on June 6, 2014, at 4:44:33
If you can make a compelling argument together with your doctor about why you need exactly this medication, you can try to get it paid by medical insurance. Just contact them about it.
Me and my doc tried for Metformin. Didn't work, but Metformin is really cheap over here so i don't really care. I liked that my doc stood up for my needs though. Cool guy.
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