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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by cubbybear on November 17, 2004, at 22:54:29
Has anyone who's taking an MAOI (Parnate, Nardil, Marplan) ever had Ketamine as a pain killer or anaesthetic? Does anyone know if ketamine is safe with an MAOI?
And for ANYONE who has had ketamine as an anesthetic, what experience did you have? I've read that this drug can induce some really bizarre reactions--perhaps even halluciations or out-of-body experiences. Would really like to hear from anyone who's had experience with it in the hospital.
Posted by crazychickuk on November 18, 2004, at 2:30:45
In reply to Ketamine Experiences /Ketamine and MAOIs, posted by cubbybear on November 17, 2004, at 22:54:29
isnt this a horse tranquilizer?
Posted by SLS on November 18, 2004, at 9:05:22
In reply to Ketamine Experiences /Ketamine and MAOIs, posted by cubbybear on November 17, 2004, at 22:54:29
Hi.
I don't think you will find much definitive information regarding the combination of an MAOI and ketamine. I found only one citation on Medline describing the combination, and it reported no adverse interaction between the two drugs.
I also found the following:
Intravenous induction agents
"All the commonly used intravenous induction agents (thiopentone, propofol, etomidate and ketamine) have been used uneventfully in patients taking MAOIs.14,16 The classical MAOIs can cause a decrease in the hepatic metabolism of barbiturates which requires a reduction in dose.17"
http://www.rcoa.ac.uk/docs/b21_monoamine.pdf
Theoretically, a sympathomimetic drug like ketamine should not be combined with an MAOI, but it is well recognized that Ritalin, Dexedrine, and noradrenergic TCAs are safe to use.
What are you to use ketamine for?
- Scott
Posted by cubbybear on November 18, 2004, at 9:13:47
In reply to Re: Ketamine Experiences /Ketamine and MAOIs, posted by crazychickuk on November 18, 2004, at 2:30:45
> isnt this a horse tranquilizer?
I have no idea. And I resemble a small bear rather than a horse.
Posted by cubbybear on November 18, 2004, at 9:23:49
In reply to Re: Ketamine Experiences /Ketamine and MAOIs » cubbybear, posted by SLS on November 18, 2004, at 9:05:22
>
> What are you to use ketamine for?
>
Scott, your info was very helpful. I really didn't think there'd be anything out there. I'm looking down the road at having a colonoscopy done (exam of large intestine) and the anaesthesia that's commonly employed (I think propofol?) is definitely off limits. The doctor said I could probably be OK with just a heavy benzo sedative like midazolam but if there's any conventional anaesthetic out there that would be safe with the Parnate (for this procedure), I'd sure like to know. I don't want to have to phase out and stop the Parnate for the colonoscopy and then re-start it later.
I thought I had read that ketamine is OK but wanted confirmation.
On the other hand, I've read that this drug can induce a strange trip, and I'm not so sure I want to experience an aftermath of hallucinations.
Posted by ed_uk on November 18, 2004, at 15:17:27
In reply to Re: Ketamine Experiences /Ketamine and MAOIs » SLS, posted by cubbybear on November 18, 2004, at 9:23:49
Anaesthetics, general + Monoamine oxidase inhibitors (MAOIs)
It used to be thought that MAOIs should be withdrawn well before anaesthesia, but there is now evidence that this may be unnecessary in most patients, although individual cases of both hypo- and hypertension have been seen. The MAOIs can however interact with other drugs sometimes used during surgery.Clinical evidence and mechanism
The absence of problems during emergency general anaesthesia in 2 patients on MAOIs prompted further study in 6 others taking unnamed MAOIs chronically. All 6 were premedicated with 10–15 mg diazepam 2 h before surgery, induced with thiopental (thiopentone), given suxamethonium (succinylcholine) before intubation, and maintained with nitrous oxide/oxygen and either halothane or isoflurane. Pancuronium was used for muscle relaxation. Morphine was given postoperatively. One patient experienced hypotension that responded to repeated intravenous doses of 0.1 mg phenylephrine without hypertensive reactions. No other untoward events occurred either during or after the anaesthesia. 1No adverse reactions occurred in 27 other patients on MAOIs (tranylcypromine, phenelzine, isocarboxazid, pargyline) when anaesthetised. 2 No problems were seen in eight patients on unnamed MAOIs when anaesthetised, nor in dogs on tranylcypromine given enflurane and fentanyl. 3 Two single case reports describe the safe and uneventful use of propofol in a patient on phenelzine 4 and another on tranylcypromine. 5 The latter was also given alfentanil. No problems were seen in one patient on tranylcypromine when given ketamine 6 and in another on selegiline when given fentanyl, isoflurane and midazolam. 7 No problems were seen in another patient on phenelzine when anaesthetised firstly with sevoflurane in oxygen, followed by isoflurane, oxygen, air and an infusion of remifentanil. 8 Unexplained hypertension has been described in a patient taking tranylcypromine when etomidate and atracurium were used. 9 Moclobemide was stopped on the morning of surgery in a patient who was anaesthetised with propofol and later isoflurane in nitrous oxide and oxygen. Morphine and droperidol were also used. No adverse reactions occurred. 10 Ketorolac, propofol and midazolam were used uneventfully in one patient on phenelzine. 11
Importance and management
There seems to be little documentary evidence that the withdrawal of MAOI before anaesthesia is normally necessary. Scrutiny of reports 12 alleging an adverse reaction usually shows that what happened could be attributed to an interaction between other drugs used during the surgery (e.g. pethidine, sympathomimetics) rather than with the anaesthetics. The authors of the reports cited 1,2 here offer the opinion that . . general and regional anaesthesia may be provided safely without discontinuation of MAOI therapy, provided proper monitoring, adequate preparation, and prompt treatment of anticipated reactions are utilised. 1 This implies that the possible interactions between the MAOI and other drugs are fully recognised, but be alert for the rare unpredictable response.
Posted by crazychickuk on November 18, 2004, at 15:24:05
In reply to Re: Ketamine Experiences /Ketamine and MAOIs » SLS, posted by cubbybear on November 18, 2004, at 9:23:49
I had a colonoscopy 2 weeks ago i didnt go to sleep i wasawake they just put some hypnoval(sp) in my arm cus i was freaking out.. if your calm they may not need to use nothing, just numb your throut if they are going in that way which they did for me..
Posted by djmmm on November 18, 2004, at 17:28:21
In reply to Re: Ketamine Experiences /Ketamine and MAOIs, posted by crazychickuk on November 18, 2004, at 2:30:45
> isnt this a horse tranquilizer?
Not exactly..it is primarily used in veterinary offices to induce a "twilight" anesthesia, however, it is also used as an anesthetic for small children and the elderly, because it lacks the CNS depression effects that come with other anesthetics
Posted by Glydin on November 18, 2004, at 20:06:07
In reply to Re: Ketamine Experiences /Ketamine and MAOIs » SLS, posted by crazychickuk on November 18, 2004, at 15:24:05
> just numb your throut if they are going in that way which they did for me..
If they are taking a look at your colon, that's generally not the pathway they choose.
Posted by cubbybear on November 19, 2004, at 1:41:02
In reply to Re: Ketamine Experiences /Ketamine and MAOIs » SLS, posted by crazychickuk on November 18, 2004, at 15:24:05
> I had a colonoscopy 2 weeks ago i didnt go to sleep i wasawake they just put some hypnoval(sp) in my arm cus i was freaking out.. if your calm they may not need to use nothing, just numb your throut if they are going in that way which they did for me..
Very interesting--but I've never heard of a colonosopy in which they go in from your throat.
Posted by cubbybear on November 19, 2004, at 1:47:50
In reply to Re: Ketamine Experiences /Ketamine and MAOIs, posted by Glydin on November 18, 2004, at 20:06:07
Maybe I should have checked the websites first, but after reading some of the horror stories about people having bad trips after getting Ketamine AND reading one website which advises vs. using it with an MAOI, I'm going to nix my original idea entirely.
Posted by Tai Chi on December 4, 2004, at 7:53:23
In reply to Re: Ketamine Experiences /Ketamine and MAOIs » SLS, posted by ed_uk on November 18, 2004, at 15:17:27
> Anaesthetics, general + Monoamine oxidase inhibitors (MAOIs)
> It used to be thought that MAOIs should be withdrawn well before anaesthesia, but there is now evidence that this may be unnecessary in most patients, although individual cases of both hypo- and hypertension have been seen. The MAOIs can however interact with other drugs sometimes used during surgery.
>
> Clinical evidence and mechanism
> The absence of problems during emergency general anaesthesia in 2 patients on MAOIs prompted further study in 6 others taking unnamed MAOIs chronically. All 6 were premedicated with 10–15 mg diazepam 2 h before surgery, induced with thiopental (thiopentone), given suxamethonium (succinylcholine) before intubation, and maintained with nitrous oxide/oxygen and either halothane or isoflurane. Pancuronium was used for muscle relaxation. Morphine was given postoperatively. One patient experienced hypotension that responded to repeated intravenous doses of 0.1 mg phenylephrine without hypertensive reactions. No other untoward events occurred either during or after the anaesthesia. 1
>
> No adverse reactions occurred in 27 other patients on MAOIs (tranylcypromine, phenelzine, isocarboxazid, pargyline) when anaesthetised. 2 No problems were seen in eight patients on unnamed MAOIs when anaesthetised, nor in dogs on tranylcypromine given enflurane and fentanyl. 3 Two single case reports describe the safe and uneventful use of propofol in a patient on phenelzine 4 and another on tranylcypromine. 5 The latter was also given alfentanil. No problems were seen in one patient on tranylcypromine when given ketamine 6 and in another on selegiline when given fentanyl, isoflurane and midazolam. 7 No problems were seen in another patient on phenelzine when anaesthetised firstly with sevoflurane in oxygen, followed by isoflurane, oxygen, air and an infusion of remifentanil. 8 Unexplained hypertension has been described in a patient taking tranylcypromine when etomidate and atracurium were used. 9 Moclobemide was stopped on the morning of surgery in a patient who was anaesthetised with propofol and later isoflurane in nitrous oxide and oxygen. Morphine and droperidol were also used. No adverse reactions occurred. 10 Ketorolac, propofol and midazolam were used uneventfully in one patient on phenelzine. 11
>
> Importance and management
> There seems to be little documentary evidence that the withdrawal of MAOI before anaesthesia is normally necessary. Scrutiny of reports 12 alleging an adverse reaction usually shows that what happened could be attributed to an interaction between other drugs used during the surgery (e.g. pethidine, sympathomimetics) rather than with the anaesthetics. The authors of the reports cited 1,2 here offer the opinion that . . general and regional anaesthesia may be provided safely without discontinuation of MAOI therapy, provided proper monitoring, adequate preparation, and prompt treatment of anticipated reactions are utilised. 1 This implies that the possible interactions between the MAOI and other drugs are fully recognised, but be alert for the rare unpredictable response.
>
>
Ed, I appreciated your response. This looked like you might have cited a medical journal. If so, could you provide the reference? Thanks.
This is the end of the thread.
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