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Re: Nortriptyline dosing and other subjects (long). undopaminergic

Posted by SLS on August 22, 2021, at 20:23:27

In reply to Re: Nortriptyline dosing and other subjects (long). SLS, posted by undopaminergic on August 21, 2021, at 13:47:12

Hi, UD.

You ask great questions. I'll have to come back to this. I can see a book coming on...

:-)

As far as the difference between "selective" versus "specific" is concerned: With regard to MAO-A inhibition and MAO-B inhibition is concerned, a selective MAOI inhibits both enzymes, but to varying degrees at varying dosages. As an example, selegiline, at low dosages, is selective for MAO-B, but inhibits MAO-A to a small degree. At high dosages, selegiline loses its selectivity and inhibits both enzymes equally. A specific MAOI inhibits only one enzyme without affecting the other, regardless of dosage.

Right now, clorgyline is used only as a biological probe. The NIH stopped treating people with it when there were some reports of their patients having cardiac events during treatment in the 1990s. They had to withdraw it from people for whom it was the only drug that ever worked for them. This was also the scenario with nomifensine (Merital). Nomifensine had been played around with in the 1980s because it was a potent reuptake inhibitor of dopamine, and I think some NE, too. It was approved by the FDA as an antidepressant. However, there were a handful of reports coming from Germany that it produced fatal hemolytic anemia. Hoecht Roussel voluntarily took it off the market worldwide. The thing is, it was the only drug that ever worked for people. Because of my suspicions regarding dopamine, I had to cry in front of Baron Shopsin (MD) to beg him to treat me with it. He relented. When I went back to him two weeks later, it was the only time he ever saw me dramatically improved. Unfortunately, it lasted for less than a week. Par for the course with me. In actuality, the incidence of this reaction was rare.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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