![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by MuseMemento on September 4, 2014, at 12:03:52
Hi, all. Just began parnate three days ago and I've become compulsive about checking my blood pressure. I also immediately dropped caffeinated coffee which I'd been drinking to the tune of a pot a day when I began parnate. Yesterday, even though I didn't have anything I can think of that was contraindicated (grilled cheese with kraft singles slices with ketchup, a muffin with almond butter, canned green beans that weren't in salted water, a pear and perhaps a yogurt, can't recall) my blood pressure went up to 138/93 shortly after smoking a cigarette. I felt a bit confused, nauseated, sweaty and I had a headache, but all of those could be the result of caffeine withdrawal. I monitored my blood pressure and it went down to approximately 120/80 a half hour later. Is this anything to be concerned about? What blood pressure would indicate that I should seek ER treatment? I only didn't go to the hospital because I'm trying not to engage my OCD thoughts by taking action when rationally there shouldn't be a problem, like not having eaten anything problematic. Thanks, all.
Posted by MuseMemento on September 4, 2014, at 12:38:10
In reply to What BP constitutes a hypertensive crisis?, posted by MuseMemento on September 4, 2014, at 12:03:52
If it's relevant, the headache was toward the front of my head, either the forehead or just above my eye, rather than at the base of my skull to the best of my recollection. Thanks.
Posted by pontormo on September 4, 2014, at 18:52:58
In reply to What BP constitutes a hypertensive crisis?, posted by MuseMemento on September 4, 2014, at 12:03:52
While I don't know that there's a BP cut off per se, I would at least somewhat key it to my normal BP. A small increase, like 120/80 to 138/93 doesn't sound to me like enough of a difference to send you to a hospital.
I occasionally have a reaction to emsam if I eat the wrong thing (my dose is higher than the doses that don't require monitoring of food), and my pdoc seemed to evaluate the increase in terms of my usual BP, which is lower than yours.
BTW, a headache is a well-known symptom of caffeine withdrawal. I can't say about the other things you experienced, but I sometimes feel that way for vague reasons--and you've cut down on caffeine a lot. Maybe tapering a bit would be easier. Plus you've expressed a fair amount of anxiety. You'll know when you need to get to the hospital-- I promise you.
It's not unusual to be hyper-vigilant in the immediate aftermath of starting an MAOI-- You'll get to know the range of your reactions over time.
Posted by baseball55 on September 4, 2014, at 19:22:19
In reply to What BP constitutes a hypertensive crisis?, posted by MuseMemento on September 4, 2014, at 12:03:52
I'm not sure what the cutoff is, but surely it's considerably higher than normal variation. Up to 140-150 is considered high-normal.
Taking your BP constantly is probably just causing anxiety, which, in itself, raises BP. BP fluctuates all the time, rises with exercise, alcohol and caffeine, anxiety, etc. If you want to get a baseline BP, take it every day at the same time and circumstances (say, upon awakening), keep track for a few weeks and see what your average BP is. This is what the doctor told my husband to do when his BP was high at the doctor's appointment.
Remember that a hypertensive crisis means BP is high enough to cause a blood vessel to burst in your brain -- so really, really high.
REmember also that MAOI's would not be prescribed if hypertensive crises were commonplace and easily set off.
A lot of people seem to needlessly worry themselves sick over MAOI's and diet and BP.
Posted by SLS on September 5, 2014, at 10:52:15
In reply to Re: What BP constitutes a hypertensive crisis?, posted by MuseMemento on September 4, 2014, at 12:38:10
Your concerns about the occurrence of a dangerous rise in blood pressure produced by Parnate (tranylcypromine) is not without merit. Parnate can cause a spontaneous hypertensive episode at any dosage, even in the absence of tyramine ingestion. However, this side effect is very uncommon, and usually occurs early in treatment. Nardil and Marplan seem to be less likely to cause reaction.
I don't think you have anything to worry about beyond two weeks of treatment as you titrate up to a therapeutic dosage. I don't know of any prescribed frequency at which one should take their blood pressure to monitor for a reaction. Again, a spontaneous hypertensive episode caused by Parnate is uncommon and not likely to occur with you. Perhaps you can take your blood pressure 2 - 3 times a day in order to allay your fears.
Good luck.
- Scott
Posted by Lamdage22 on September 7, 2014, at 13:46:21
In reply to Re: What BP constitutes a hypertensive crisis? » MuseMemento, posted by SLS on September 5, 2014, at 10:52:15
I had the same problem. I raised my BP way up because of anxiety.
In the hospital it went down again.
Posted by MuseMemento on September 7, 2014, at 13:49:21
In reply to Re: What BP constitutes a hypertensive crisis?, posted by Lamdage22 on September 7, 2014, at 13:46:21
Thanks for the reassuring replies, all. I'll do my best to relax about the blood pressure issue and, to some extent the diet, just letting the med do what it needs to do. Much appreciated.
Posted by ed_uk2010 on September 10, 2014, at 13:24:01
In reply to What BP constitutes a hypertensive crisis?, posted by MuseMemento on September 4, 2014, at 12:03:52
>my blood pressure went up to 138/93 shortly after smoking a cigarette. I felt a bit confused, nauseated, sweaty and I had a headache, but all of those could be the result of caffeine withdrawal. I monitored my blood pressure and it went down to approximately 120/80 a half hour later.
It's quite possible for BP to rise by that amount due to anxiety, or increased activity, but the increase will be temporary.
Posted by musememento on September 10, 2014, at 13:57:56
In reply to Re: What BP constitutes a hypertensive crisis? » MuseMemento, posted by ed_uk2010 on September 10, 2014, at 13:24:01
Yeah, I'm beginning to believe that it was either an anxiety or panic attack. Thanks, all!
Posted by Lamdage22 on September 14, 2014, at 14:40:46
In reply to Re: What BP constitutes a hypertensive crisis? » ed_uk2010, posted by musememento on September 10, 2014, at 13:57:56
Same thing happened to me.
Relax
Posted by MuseMemento on September 22, 2014, at 15:13:11
In reply to Re: What BP constitutes a hypertensive crisis?, posted by Lamdage22 on September 14, 2014, at 14:40:46
I've still only been on 20 mg/day for three weeks but I've become so paranoid about the blood pressure issue, including one trip to the ER when it rose to 169/106 that I can't help but think it's time to move on from Parnate already. I stay home all day after having improved my socializing so that I'm never far from my blood pressure monitor and check it at least three times a day, after every meal, and I've gone long periods of time (12 hours) throughout the day without eating because the fear of a hypertensive crisis is overwhelming to me. Perhaps more tricyclics or vortioxetine or vilazodone when they're released in Canada.
Posted by Lamdage22 on September 24, 2014, at 15:38:23
In reply to Re: What BP constitutes a hypertensive crisis?, posted by MuseMemento on September 22, 2014, at 15:13:11
Oh come on. Besides from that it is helping?
Maybe you can get over it with therapy.
If it makes you feel safer, you could carry emergency nifedipine.
IF you don't obsess about it. If you have a hypertensive crisis, you will feel it in your head, no need for a monitor.
Posted by musememento on September 24, 2014, at 15:53:18
In reply to Re: What BP constitutes a hypertensive crisis?, posted by Lamdage22 on September 24, 2014, at 15:38:23
No benefit whatsoever. Only further regression. And the obsessions are to thepoint of constant distraction. It's triggered some eating disorder difficulties and I feel completely trapped. It's simply untenable.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.