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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by wynn on February 25, 2001, at 17:35:17
I have a friend who is taking Nardil and is almost up to the maximim dosage. For most patients Nardil is sufficient to provide relief, but for him it is not enough. He asked me to try to find out if there are any possible drugs that could be taken with Nardil to enhance its effects. He is having difficulty finding anyone in our town who has expert knowledge about this. If you have any suggestions at all about antidepressants that could be helpful if taken in combination with Nardil, your comments would be most helpful. Thanks.
Posted by kazoo on February 26, 2001, at 0:49:54
In reply to nardil, posted by wynn on February 25, 2001, at 17:35:17
> I have a friend who is taking Nardil and is almost up to the maximim dosage. For most patients Nardil is sufficient to provide relief, but for him it is not enough. He asked me to try to find out if there are any possible drugs that could be taken with Nardil to enhance its effects. He is having difficulty finding anyone in our town who has expert knowledge about this. If you have any suggestions at all about antidepressants that could be helpful if taken in combination with Nardil, your comments would be most helpful. Thanks.
^^^^^^^^^^^^^^^^
Wynn: though I cannot answer your question re. enhancing the effects of NARDIL, I can tell you of a drug to avoid; i.e., DEMEROL (meperidine) which is a common enough pain killer that is used in most pain management situations. A NARDIL/DEMEROL mix is fatal, no question about this. I would have you suggest to your friend to carry a card, or some identification, that says he is on NARDIL in the event he's unable to speak.
A word to the wise is sufficient.
kazoo
Posted by kate9999 on February 26, 2001, at 3:59:40
In reply to Re: nardil * a warning, posted by kazoo on February 26, 2001, at 0:49:54
Better advice is to not just say on Nardil, but to also add "NO DEMEROL" onto the card or ID.
Truth is, my biggest fear about taking Nardil is not what I'll eat, it's that I'll ever have to go into the hospital. With medical professionals killing 100,000 a year by accident I don't think I'd last two days in a hospital on Nardil.
> Wynn: though I cannot answer your question re. enhancing the effects of NARDIL, I can tell you of a drug to avoid; i.e., DEMEROL (meperidine) which is a common enough pain killer that is used in most pain management situations. A NARDIL/DEMEROL mix is fatal, no question about this. I would have you suggest to your friend to carry a card, or some identification, that says he is on NARDIL in the event he's unable to speak.
>
> A word to the wise is sufficient.
>
> kazoo
Posted by kate9999 on February 26, 2001, at 4:45:34
In reply to nardil, posted by wynn on February 25, 2001, at 17:35:17
There are smarter people to answer this, but I'll start throwing some ideas out.
I'd be thinking Lithium or Thyroid. These are both commonly used relatively effective augmenting agents. I know lithium can be added to an MAOI. And I'm pretty sure thyroid can, but since I'm not a walking PDR I'll hedge and say look it up to find out for sure.
There are other augmenters too - e.g. I took Neurontin with Nardil and it helped a lot (though I had to dump it recently because of hypertension). I'm sure other people can give you lots of other ideas.
I'd say adding other antidepressants is OUT. Especially given the fact that there aren't first rate psychopharmacologists in your area. SSRI's (Prozac, Zoloft, etc.) are ALWAYS out with MAOIs, as are other MAOIS. Tricyclics are risky - but some say some do it (I've never known anybody that has). I don't know about the novel antidepressants (eg. Wellbutrin, Effexor) but I'd expect they're at least as risky as tricylics and maybe as risky as SSRI's.
Also, if he's had some good effects with Nardil, he could try switching to Parnate, which is another MAOI. And if he's not tried cognitive behavioral therapy he should. Exercise also has an antidepressant effect.
There's also the issue of time. If he's had some effect, and he's not at the maximum dosage he should go there and stay there for at least a month, see what happens.
> I have a friend who is taking Nardil and is almost up to the maximim dosage. For most patients Nardil is sufficient to provide relief, but for him it is not enough. He asked me to try to find out if there are any possible drugs that could be taken with Nardil to enhance its effects. He is having difficulty finding anyone in our town who has expert knowledge about this. If you have any suggestions at all about antidepressants that could be helpful if taken in combination with Nardil, your comments would be most helpful. Thanks.
Posted by ShelliR on February 26, 2001, at 10:17:58
In reply to nardil, posted by wynn on February 25, 2001, at 17:35:17
Wynn. I have taken stimulents with Nardil (even though the PDR says not to mix them.) My pdoc mixes them alot. But they didn't do much for me. I have also tried topomax and lamical (mood stabilizers) with Nardil, and so far Lamictal has been the only drug that has been partly successful for me with Nardil. Some people have added the new antipsychotics with success, (e.g. resperidal). Your doctor needs to do a lot of reading on what drugs are now used as augmentors to Nardil, since they have changed substantially in the past three years; or at least have a consultation with another, more informed pdoc.
Posted by smdd on February 27, 2001, at 7:07:42
In reply to Re: nardil » wynn, posted by ShelliR on February 26, 2001, at 10:17:58
I agree with the statement that Nardil will not kill me, a medical professional will. I have had too many arguments with doctors on what I can take and what I cannot. After I leave the doctor, I go to my pharmacist and he just shakes his head and refuses to fill my rx. I know I cannot take many things they give me, but I feel by giving the rx to the pharmacist, it might help 'my case' someday. Witnesses so to speak.
Regarding a drug to augment Nardil. Several years ago, the psych that first gave me Nardil, suggested adding 10mg of desipramine. I refused out of fear, but he said he did this quite often. You might want to have your friend check with his psych about this, of course doing careful research to see if has ever really been done and documented.
smdd
Posted by kate9999 on February 28, 2001, at 0:27:36
In reply to Re: nardil, posted by smdd on February 27, 2001, at 7:07:42
There's actually a Law and Order episode about a doctor that kills a patient on Nardil by injecting her accidentally with, I think, an antihistamine or a cough supressant.
I found the episode unrealistic, though, because the mistake was presumably made just because he was drunk, and all of the doctors around him picked up on it and tried to stop him.
In real life, it'd have been a stone cold sober doctor and nobody would have caught it.
Wake up call for me - I go for migraines to a neurologist at a fairly prestigious hospital in Boston. We talk about how Nardil might be affecting my migraines at length, and the risks of stroke from migraine and from Nardil. He gives me 2 scripts. As an afterthought, as I'm leaving holding the scripts I say - these are both okay with Nardil, right? He says "oh, let me check." Turns out one is contraindicated in the PDR.
For God's sake. I can almost understand if my GP occasionally "forgets", but this guy had no excuse at all.
Like you, now I run every med I take by the pharmacist. They actually seem to carefully check like responsible professionals.
Other thing I do is, when I fill out the form saying what meds I'm on I put exclamation marks and underline Nardil to draw attention to it.
Maybe it's tilting at windmills, but I figure it can't hurt.
> I agree with the statement that Nardil will not kill me, a medical professional will. I have had too many arguments with doctors on what I can take and what I cannot. After I leave the doctor, I go to my pharmacist and he just shakes his head and refuses to fill my rx. I know I cannot take many things they give me, but I feel by giving the rx to the pharmacist, it might help 'my case' someday. Witnesses so to speak.> Regarding a drug to augment Nardil. Several years ago, the psych that first gave me Nardil, suggested adding 10mg of desipramine. I refused out of fear, but he said he did this quite often. You might want to have your friend check with his psych about this, of course doing careful research to see if has ever really been done and documented.
>
> smdd
Posted by smdd on February 28, 2001, at 23:41:22
In reply to nardil and deadly docs, posted by kate9999 on February 28, 2001, at 0:27:36
I was floored when you told me there was a tv episode about Nardil and drug interactions. Kind of makes one think that someone that contributes to the show, knows of an incident like that.
You are so right. Stone cold sober and no one noticing in real life.
I have a huge argument with an emergency room doctor (an internist) last year. I asked him several times if he was sure about the rx he was giving me and reminded him several times it was Nardil and Nardil was an MAO. He just smiled at me in an all knowing way and said "Sure it is okay, don't worry." Well I knew it wasn't okay as it was an inhaler for severe bronchitis. I had my husband take it to the pharmacy so he could see what happens trying to get these filled. The pharmacist caught it and said this happens all the time. My husband was so angry with the doctor for this. I told him I had been going through this for years and I was used to it. Even if the pharmacist says it is okay, I still check it out thoroughly before using anything prescribed, or OTC.
My doc doesn't understand my fear relating to this. I told him that I feel as if the assistant to my dentist will one day give me ephinephine just to see if it causes a reaction, or if I am just a whiner. I have had some dental work lately and that fear comes over me every single time.
I have been taking Nardil for almost six years now and I still have this fear. Food doesn't worry me much. It is the actions of others that bother me the most.
I have had the same thing happen with the pharmacist as you have and it is not the GP all the time either. As a matter of fact, I have highlighted my records just as you have. I even put MAO beside Nardil in big letter and circle it with the notation, SEVERE HYPERTENSIVE CRISIS POSSIBLE WITH DRUG INTERACTION. But..., they often forget to read that book we write them when we see a new doc. I think that is mostly for the clerk to put in for billing purposes.
I am starting to wonder if the warnings against using Nardil aren't more for the docs that don't pay attention in order to avoid malpractice claims and not really for the patient taking the drug.
All my psych says is you are your own consumer, Buyer Beware!!!
Thanks for your reply,
smdd
BTW-For the physicians out there that do pay attention, my comments obviously don't apply to you.
******************************************
> There's actually a Law and Order episode about a doctor that kills a patient on Nardil by injecting her accidentally with, I think, an antihistamine or a cough supressant.
>
> I found the episode unrealistic, though, because the mistake was presumably made just because he was drunk, and all of the doctors around him picked up on it and tried to stop him.
>
> In real life, it'd have been a stone cold sober doctor and nobody would have caught it.
>
> Wake up call for me - I go for migraines to a neurologist at a fairly prestigious hospital in Boston. We talk about how Nardil might be affecting my migraines at length, and the risks of stroke from migraine and from Nardil. He gives me 2 scripts. As an afterthought, as I'm leaving holding the scripts I say - these are both okay with Nardil, right? He says "oh, let me check." Turns out one is contraindicated in the PDR.
>
> For God's sake. I can almost understand if my GP occasionally "forgets", but this guy had no excuse at all.
>
> Like you, now I run every med I take by the pharmacist. They actually seem to carefully check like responsible professionals.
>
> Other thing I do is, when I fill out the form saying what meds I'm on I put exclamation marks and underline Nardil to draw attention to it.
> Maybe it's tilting at windmills, but I figure it can't hurt.
>
>
> > I agree with the statement that Nardil will not kill me, a medical professional will. I have had too many arguments with doctors on what I can take and what I cannot. After I leave the doctor, I go to my pharmacist and he just shakes his head and refuses to fill my rx. I know I cannot take many things they give me, but I feel by giving the rx to the pharmacist, it might help 'my case' someday. Witnesses so to speak.
>
> > Regarding a drug to augment Nardil. Several years ago, the psych that first gave me Nardil, suggested adding 10mg of desipramine. I refused out of fear, but he said he did this quite often. You might want to have your friend check with his psych about this, of course doing careful research to see if has ever really been done and documented.
> >
> > smdd
Posted by Sunnely on March 1, 2001, at 17:47:44
In reply to nardil and deadly docs, posted by kate9999 on February 28, 2001, at 0:27:36
Hi smdd,
Actually a few years ago, in a NY Hospital ER, a deadly interaction occurred between a MAOI and Demerol (I think). The woman died. The ER doctor did not know then that about this deadly drug-drug interaction. The father of the patient sued the hospital and the doctor. I think the father lost the case due to his daughter's complicated medical and significant drug abuse. I believe her name is Libby. May be those from NY will remember this case.
> There's actually a Law and Order episode about a doctor that kills a patient on Nardil by injecting her accidentally with, I think, an antihistamine or a cough supressant.
>
>
> In real life, it'd have been a stone cold sober doctor and nobody would have caught it.
>+++++++++++++++++++++++++++++++++++++++++++++++++
I think it's wise to avoid the combination of a MAOI with any of the triptans (for migraine headaches). Danger of serotonin syndrome.
> Wake up call for me - I go for migraines to a neurologist at a fairly prestigious hospital in Boston. We talk about how Nardil might be affecting my migraines at length, and the risks of stroke from migraine and from Nardil. He gives me 2 scripts. As an afterthought, as I'm leaving holding the scripts I say - these are both okay with Nardil, right? He says "oh, let me check." Turns out one is contraindicated in the PDR.
>
>
> Like you, now I run every med I take by the pharmacist. They actually seem to carefully check like responsible professionals.
>
> Other thing I do is, when I fill out the form saying what meds I'm on I put exclamation marks and underline Nardil to draw attention to it.
> Maybe it's tilting at windmills, but I figure it can't hurt.
>
>
> > I agree with the statement that Nardil will not kill me, a medical professional will. I have had too many arguments with doctors on what I can take and what I cannot. After I leave the doctor, I go to my pharmacist and he just shakes his head and refuses to fill my rx. I know I cannot take many things they give me, but I feel by giving the rx to the pharmacist, it might help 'my case' someday. Witnesses so to speak.
>
> > Regarding a drug to augment Nardil. Several years ago, the psych that first gave me Nardil, suggested adding 10mg of desipramine. I refused out of fear, but he said he did this quite often. You might want to have your friend check with his psych about this, of course doing careful research to see if has ever really been done and documented.
> >
> > smdd
Posted by smdd on March 1, 2001, at 18:37:25
In reply to Re: nardil and deadly docs » kate9999, posted by Sunnely on March 1, 2001, at 17:47:44
Hi Sunnely,
That was another one of my fears. I don't understand however, why the doctor did not have her vitals monitored to see this. This is very sad.
Thanks again,
smdd
> Hi smdd,
>
> Actually a few years ago, in a NY Hospital ER, a deadly interaction occurred between a MAOI and Demerol (I think). The woman died. The ER doctor did not know then that about this deadly drug-drug interaction. The father of the patient sued the hospital and the doctor. I think the father lost the case due to his daughter's complicated medical and significant drug abuse. I believe her name is Libby. May be those from NY will remember this case.
>
> > There's actually a Law and Order episode about a doctor that kills a patient on Nardil by injecting her accidentally with, I think, an antihistamine or a cough supressant.
> >
> >
> > In real life, it'd have been a stone cold sober doctor and nobody would have caught it.
> >
>
> +++++++++++++++++++++++++++++++++++++++++++++++++
>
> I think it's wise to avoid the combination of a MAOI with any of the triptans (for migraine headaches). Danger of serotonin syndrome.
>
> > Wake up call for me - I go for migraines to a neurologist at a fairly prestigious hospital in Boston. We talk about how Nardil might be affecting my migraines at length, and the risks of stroke from migraine and from Nardil. He gives me 2 scripts. As an afterthought, as I'm leaving holding the scripts I say - these are both okay with Nardil, right? He says "oh, let me check." Turns out one is contraindicated in the PDR.
> >
> >
> > Like you, now I run every med I take by the pharmacist. They actually seem to carefully check like responsible professionals.
> >
> > Other thing I do is, when I fill out the form saying what meds I'm on I put exclamation marks and underline Nardil to draw attention to it.
> > Maybe it's tilting at windmills, but I figure it can't hurt.
> >
> >
> > > I agree with the statement that Nardil will not kill me, a medical professional will. I have had too many arguments with doctors on what I can take and what I cannot. After I leave the doctor, I go to my pharmacist and he just shakes his head and refuses to fill my rx. I know I cannot take many things they give me, but I feel by giving the rx to the pharmacist, it might help 'my case' someday. Witnesses so to speak.
> >
> > > Regarding a drug to augment Nardil. Several years ago, the psych that first gave me Nardil, suggested adding 10mg of desipramine. I refused out of fear, but he said he did this quite often. You might want to have your friend check with his psych about this, of course doing careful research to see if has ever really been done and documented.
> > >
> > > smdd
Posted by kate9999 on March 4, 2001, at 4:09:03
In reply to Re: nardil and deadly docs » kate9999, posted by Sunnely on March 1, 2001, at 17:47:44
He shouldn't have lost the case. There's nothing complicated about that interaction. Interesting post, though, thanks.
> Actually a few years ago, in a NY Hospital ER, a deadly interaction occurred between a MAOI and Demerol (I think). The woman died. The ER doctor did not know then that about this deadly drug-drug interaction. The father of the patient sued the hospital and the doctor. I think the father lost the case due to his daughter's complicated medical and significant drug abuse. I believe her name is Libby. May be those from NY will remember this case.
> > There's actually a Law and Order episode about a doctor that kills a patient on Nardil by injecting her accidentally with, I think, an antihistamine or a cough supressant.
> >
> >
> > In real life, it'd have been a stone cold sober doctor and nobody would have caught it.
> >
>
> +++++++++++++++++++++++++++++++++++++++++++++++++
>
> I think it's wise to avoid the combination of a MAOI with any of the triptans (for migraine headaches). Danger of serotonin syndrome.
>
> > Wake up call for me - I go for migraines to a neurologist at a fairly prestigious hospital in Boston. We talk about how Nardil might be affecting my migraines at length, and the risks of stroke from migraine and from Nardil. He gives me 2 scripts. As an afterthought, as I'm leaving holding the scripts I say - these are both okay with Nardil, right? He says "oh, let me check." Turns out one is contraindicated in the PDR.
> >
> >
> > Like you, now I run every med I take by the pharmacist. They actually seem to carefully check like responsible professionals.
> >
> > Other thing I do is, when I fill out the form saying what meds I'm on I put exclamation marks and underline Nardil to draw attention to it.
> > Maybe it's tilting at windmills, but I figure it can't hurt.
> >
> >
> > > I agree with the statement that Nardil will not kill me, a medical professional will. I have had too many arguments with doctors on what I can take and what I cannot. After I leave the doctor, I go to my pharmacist and he just shakes his head and refuses to fill my rx. I know I cannot take many things they give me, but I feel by giving the rx to the pharmacist, it might help 'my case' someday. Witnesses so to speak.
> >
> > > Regarding a drug to augment Nardil. Several years ago, the psych that first gave me Nardil, suggested adding 10mg of desipramine. I refused out of fear, but he said he did this quite often. You might want to have your friend check with his psych about this, of course doing careful research to see if has ever really been done and documented.
> > >
> > > smdd
Posted by blackjack on March 4, 2001, at 14:32:42
In reply to Re: nardil and deadly docs » Sunnely, posted by kate9999 on March 4, 2001, at 4:09:03
> He shouldn't have lost the case. There's nothing complicated about that interaction. Interesting post, though, thanks.
As I recall, this was before the specific interaction between Demerol and Nardil was well doumented. Also, the woman was doing a ton of cocaine, which could easily have done her in in combination with the Nardil.
When I was on Parnate, I found the best rule of thumb was not to take anything that ended in -amine or -amide, whether it's listed as contraindicated or not. I even got a weird interaction from OTC diarrhea medicine.
Posted by ShelliR on March 4, 2001, at 17:49:50
In reply to Re: nardil and deadly docs, posted by blackjack on March 4, 2001, at 14:32:42
Amazingly few people die per year of nardil interactions. I rarely elimate anything from my diet and OTC drugs which said don't take with Nardil. Even my pdoc mixes nardil with stimulents, as do many other pdocs these days. The only reaction I've ever had was to nardil and a european med, my pdoc warned me not to take. And still I didn't come close to a stroke--BP up to 160 (usual, 90-110). I'm not saying don't be aware of possible interactions, so you can jump on them if they happen, but this post is sort of sounding a bit hypervigilent to me.
MAIOs are really good drugs for lots of folks and I'd hate to have people pass them by because they are afraid, or think they have to restrict everything. Shelli
Posted by blackjack on March 4, 2001, at 18:17:26
In reply to Re: nardil and deadly docs, posted by ShelliR on March 4, 2001, at 17:49:50
MAOI's are the only AD's that ever got me to 100% for any length of time. The side effects are more than tolerable if it means you get to be a functional human being again. Heck, orthstatic hypotension is kinda fun, like free whip-its!
Posted by smdd on March 4, 2001, at 19:25:42
In reply to Re: nardil and deadly docs, posted by blackjack on March 4, 2001, at 18:17:26
Great follow ups. I laughed out loud at the whip-its. Nardil is the only thing that has helped both my son and I. I think I have tried them all. I ended up begging my doc to please let me try just once. The change in me was dramatic.... almost overnight. I would still like to give Selegiline a try. I have been taking Nardil for almost 6 years now and the weight gain is the only that that stays consistent.
I have to say the dentist will remain my fear. I know he will be cautious, I just fear a slip up by his assistant on that second or third shot I am too numb to remind them of.
All considered, Nardil is still worth it for me. I don't think I would have done so well, if I had not had the chance to try this AD.
I would definitely recommend this A.D. for anyone that cannot seem to find the right one. In addition, it also helps block pain I have from an accident a few months AFTER I started taking it. I notice this because some days you can just feel your Nardil is not quite working 100%. These are the days I can feel every injury I had. I would recommend for pain management as long as you are very careful with any additional pain pills. I feel the Nardil makes pain medication a little more powerful than it would be for those not taking Nardil.
It is good to know I am such a large group of Nardil users. It is greek to most people I talk with here.
Best Wishes,
smdd
This is the end of the thread.
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