Posted by laima on February 25, 2007, at 8:58:15
In reply to Re: Master list of drugs to avoid while on MAOIs?, posted by Ken Blades on February 25, 2007, at 3:06:17
Thanks for the clarification about Phenelzyn being nardil, NOT parnate. I apologize for getting mixed up and posting an incorrect speculation- hope no one was confused or upset by it. And again, I don't know what book the pages came from, or if the pages were from a section about any PARTICULAR med, ie, is that why the extra emphasis on nardil? I too had an idea that parnate was the finickiest one. The only MAOI I've ever been prescribed is selegeline/Emsam, and my doctor quickly shuffled up those pages for me at the end of an appointment after I asked for specific info on drug interactions and what happens with them.
But yes- the dangers exist! I use Emsam myself, and am floored by how many medical personell and pharmacy staff, even three separate bona-fide pharmacists (not assistants- but real pharmacists), were unfamiliar with Emsam- ok- this was last summer- but also unfamiliar with selegeline??? I've had to spell it numerous times. I make a fuss about it and explicitly say, "It is an MAOI" whenever a situation arises.
I had an endoscopy- they used morphine- no problems-and made sure to check with psychiatrist in addition to hospital's anaesthetic people. Not sure if this was overkill, but I felt better this way. And no one involved minded or found it to be weird. "Better safe than sorry", they agreed. I mean, gastroenterologist who did my endoscopy was a perfectly competent one, but had to look up in her book about selegeline, had to have me spell it, didn't know it was an MAOI until I explained that- and if I hadn't fussed, I too might have ended up with a dangerous anaesthetic. Are MAOIs that uncommon?
When I mentioned to my psychiatrist that I'd be making some dental appointments soon, and that I was worried about the painkillers, I off-handedly said, "Well, at least novocaine will be alright" and he said "NO!!!!" And something about how it can act as something akin to a local stimulant (?? Not sure if I heard that right- sounds weird. Numb stimulant??) And since it's so local- how can it be trouble? Maybe the potential reaction isn't local? Thank goodness I mentioned it- I had been certain it would be fine. I'll by all means be careful with the dentist, but figured it couldn't hurt to clear things with the psychiatrist, too, just in case dentist isn't up on everything. But he said for the more major work I need, ie gums, I will probably have to go off Emsam for at least 2 weeks :( I'm quite anxious about that. I guess low dose morphine and relaxation tapes won't quite be enough.
Since when and why did they stop using novocane? I think my dentist is awsome and pretty with-it with her methods- and unless I'm mixed up, she uses novocane, (as well as nitrous for the truely squeemish.) And of course, relaxation tapes and all that business. I don't like novocane-or whatever those shots are- I'd be delighted to use an alternative.
Thanks again for all of your helpful information.
> >>>>>In addition, in conversation, he told me novocane, ie at the dentist, can be a problem. Weird, huh?<<<<
>
> Novocaine[the common term for local anesthetic but
> this one is not used much nowadays], and its
> more commonly used younger brother lidocaine[brand name Xylocaine] can be of concern used on MAO inhibitor-dosed people. The dental forms of lidocaine[as well as others used in medicine]
> contain epinephrine as a vasoconstrictor, keeping
> the lidocaine 'in place' longer. Epinephrine is also a normal substance in the body, one that the
> monoamine oxidase enzyme metabolizes. Without
> that process, the epinephrine can precipitate
> a hypertensive crisis.
>
> So you're supposed to tell the dentist that
> you're on a MAO inhibitor[and hope to hell he
> knows what that is!] before you get any local
> anesthetic. You should probably mention the
> epinephrine/MAO danger just to be safe.
>
> >>>>Phenelzyn- is that parnate? That one sure seems to have to most potential for interactions!<<<<
>
> Phenelzine is NARDIL. Actually, from what I've
> read, Parnate is more likely to precipitate
> interactions. But I wouldn't be complacent
> with either drug.
>
> Recently I had an upper GI endoscopy...I
> had written my MAOI status on everything,
> and even told it to one of the nurses.
> When the M.D doing the endoscopy started
> injecting something in the I.V., I asked
> what it was...he said 'Demerol'..I yelled
> 'I'm on a MAOI!'...he pulled on the
> syringe and removed what he had started
> to inject...
>
> Next time...I'm writing 'TAKING PARNATE
> -NO DEMEROL!' on my forehead
> with a marker!
>
> Moral of the story...keep telling them you're on a MAOI. Better safe than sorry.
>
> Most non-psychiatrists and non-anesthesiologists
> these days don't seem to be too aware of MAOIs.
>
>
poster:laima
thread:735398
URL: http://www.dr-bob.org/babble/20070224/msgs/735972.html