Posted by jaclinhyde on May 29, 2006, at 20:01:06
In reply to Questions for long term MAOI users, posted by nickguy on May 29, 2006, at 14:31:40
I have been on MAOI's for over 25 years and have only had one hypertensive reaction which was when I had some sour cream that was in the fridge too long and had went bad. I took a seroquel and was fine afterwards. The list is really easy to manage with aged cheeses being the top food culprit. As far as painkillers are concerned morphine is just fine while demerol is a huge no-no. When you get sick you can take the newer antihistamines like Claritin or Zyrtec. As far as decongestants are concerned you really can't take any. But you know what is funny? When I started taking MAOI's I felt so much better emotionally that I didn't get sick as often as when I was depressed and anxious. I swear I think that because I was feeling so much better I didn't get as sick as before I statted taking them. Obviously you will get sick sometime but it will past and you will survive. It is a more than fair trade off, believe me! As far as surgery is concerned there are many options for anesthesia as long as you get a knowledgable anesthesiologist. Here is some info plus a link to the safety of taking an MAOI and having anesthesia.
"Do MAOI interact with anesthetic drugs?
MAOI inhibit microsomal enzymes, theoretically potentiating barbituates and opioids.80 Three cases of excessive barbiturate/opioid effects were reported from 1960 to 1970.80,84 Since then, numerous reports have described uneventful anesthetics using barbiturates and various opioids: remifentanil,89 alfen-tanil,89,90 sufentanil,91 fentanyl,80,81 hydromorphone91 and morphine80,81,81,85,89 for patients continuing to take MAOI. Other agents including propofol,90,92 ket-amine,93 midazolam,92 ketorolac,92 vecuronium,92 and atracurium92 have also been used safely. Severe hypertension on induction with etomidate and atracurium has occurred, although the patient’s blood pressure was 200/90 immediately prior to induction.94 Regional anesthesia has been performed without incident when hypotension was treated appropriately with volume and direct-acting sympathomimetics.80,81,95,96 Normal responses to most anesthetic agents can be expected (grade C).Is the continuation of MAOI associated with adverse outcomes?
Much of our understanding of the interactions between MAOI and anesthetic drugs comes from reports of isolated events in individual patients. A controlled prospective evaluation of 27 patients chronically treated with MAOI undergoing 36 anesthetics reported no adverse cardiovascular responses.95 Changes in blood pressure and heart rate were not significantly different from control patients without prior MAOI exposure. Anesthetic agents included sodium thiopental, etomidate, diazepam, succinylcholine, nitrous oxide, volatiles, pancuronium, morphine, spinal tetracaine, epidural bupivacaine, and phenylephrine.95 Similarly a review of a series of 32 orthopedic patients on MAOI who underwent 46 general anesthetics and five regional anesthetics for elective surgery found no adverse hemodynamic events.96 Agents used in this series included sodium thiopental, ketamine, volatiles, morphine and meperidine. Aside from sporadic case reports, the continued use of MAOI/RIMA has not been associated with adverse perioperative events when meperidine and indirect acting catecholamines are avoided (grade B).Conclusion: MAOI
Case reports of sporadic MAOI-related drug interactions prompted many to advise discontinuation of classic MAOI two to three weeks before surgery.80,84,95 Withdrawal of MAOI is not without risks. Many patients have severe depression refractory to other treatment and are at risk for life-threatening psychiatric illness. Acute exacerbation of depression with suicidal ideation has been reported after discontinuation of MAOI prior to elective cardiac surgery.97 There is no literature specifically concerning MAOI and ambulatory anesthesia. MAOI-related drug interactions are possible and have been reported; however, patients continuing to take either classic or selective MAOI remain suitable candidates for ambulatory anesthesia if meperidine, cocaine and indirect-acting catecholamines are avoided."
The link is http://www.cja-jca.org/cgi/content/full/51/8/782#SEC16 near the bottom of the page.
Two two things you should have are a medical ID bracelet so that in case you cannot speak for yourself the doctors will know that you are on an MAOI, and a blood pressure monitor so that you can keep tabs on how the drug is affecting you. This is more important if you are taking Parnate because it can raise blood pressure even without eating the wrong foods (although not necessarily to dangerous levels.) Nardil and Marplan tend to lower blood pressure so it isn't as important to monitor it. Drinking is OK as long as you don't consume chianti wine or beer from a tap. But don't go to extreme! Moderation is the key.
Hope this helps! If you have any more questions feel free to pick my brain :-)
JH
> I'd a little hesistant about taking an MAOI. I know they're not as dangerous as they're played out to be if you follow the guidelines, but a few things bother me. For those of you who have taken or are taking maoi's over a long period of time (a few years atleast), how much do the restrictions bother you? Do any of you drink or did drink before you went on, and how has that effected you? What the heck do you do when you get sick (colds and coughs)? What are you supposed to do when you need surgery or go to the emergency room ( concerning painkillers) ?
>
> I'd really appreciate some feedback. thanks guys.
poster:jaclinhyde
thread:650144
URL: http://www.dr-bob.org/babble/20060525/msgs/650223.html