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Re: MAOIs » ed_uk

Posted by Don_Bristol on May 11, 2006, at 7:58:13

In reply to Re: MAOIs » Don_Bristol, posted by ed_uk on May 10, 2006, at 18:41:27

Don wrote
>
>Nifedapine is contra-indicated for a hypertensive crisis
>

Ed UK wrote
>
> I think we discussed this once before, do you rememeber?
> And captopril too. I remember you posting some links.
>


Hey! Have you been here as long as all that? *grin*
It was something like two years ago.
I like Bob's Psychobabble but the message go slashing by so quickly into the archives that I found it was getting a hard job keeping up with what was being said. It kind of gets to be too obsessional for me and that's the last thing I need!

>
> Some psychiatrists consider nifedipine to be an appropriate treatment
> for an MAOI hypertensive crisis. The dose should be low, and the
> patient should still go to hospital.
>

I guess that a lot of medicine is an art and so I am sure there are a spectrum of views. I don't have a need to support nifedinine for captopril or whatever. I started by not know what the heck to take and just did some reading. The documents I linked to in oneof my postings here were some I came across and which I judged, as afr as I could tell (which wasn't a great deal!) seemed to be reasonably sound.

>
> As you rightly point out, immediate-release nifedipine is not
> suitable for most types of hypertensive crisis. Many (non-MAOI)
> hypertensive crises occur in people with chronic hypertension

Uh oh! That's definitely me! :-(

> and cardiovascular disease. Immediate-release nifedipine should
> not be prescribed to these patients. This does not mean that
> immediate-release nifedipine is contra-indicated in MAOI crises
> however, which occur in very different circumstances, in different
> types of patients, who do not, in general, suffer from chronic
> cardiovascular disease.

Well, I went for Captopril but I have never had to use it. I do recall readng posters here who did have to use their nifedipine. There was a very good account here by someone a couple of years ago on how the writer had taken nifedipine and understood the need to keep calm as he made his way to the ER (A&E to you and me in the UK ). ISTR that nifedipine was sedating (or was it another med he augemnted it with) and that that was a help in staying calm too.

I am still not too sure how I could tell a hypertensive crisis until it was too late and I got the mother and father of headaches in the back of my head. I used to think I would carry a small wrist based blood pressure monitor to help me know but in the end I stopped carrying it. The wrist ones are said not to be accurate despite all the many reassurances from manufacturers and indeed I found that the international blood pressure machine tests had found that. However I figured that 10 units either way was not going to matter as hypertension is pretty dramatic. But the resident Prof Grim http://www.ishib.org/AI_board_cgrim.asp at Yahoo group Bloodpressureline told me not to chance anything because I could be playing a stupid game of "berry aneurysm roulette". I figured he should know as he does stuff like being the director of a high blood pressure treatment center and has a special interest in blood pressure.

BTW can you say anything about which doc in the UK is prescribing you MAOIs? The one which started me was the consultant p-doc Doc Wildgrube who had come over from Germany and was working for the NHS in London. I suspect the Germans might use MAOIs more than the UK because every other doc has been wary. What about your MAOI doc? Email me if you prefer.

rgds Don


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URL: http://www.dr-bob.org/babble/20060510/msgs/642517.html