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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Mischief on August 30, 2002, at 2:00:41
Could someone tell me what is the minimum to the maximum dosage of parnate at a theraputic level.
Thanks.
Posted by Jonathan on August 30, 2002, at 20:54:46
In reply to Parnate-Dosage, posted by Mischief on August 30, 2002, at 2:00:41
... it seems to depend which country you live in!
Here in the UK the British National Formulary (BNF) recommends a starting dose of 10 mg twice daily, increasing the second daily dose to 20 mg after a week if necessary (a total of 30 mg/day), and cutting back to a maintenance dose of only 10 mg/day after a few weeks; "doses above 30 mg daily under close supervision only" which usually means only for hospital in-patients.
http://www.bnf.vhn.net/bnf/documents/bnf.868.html#BNFID_3346
The US Physician's Desk Reference (PDR), however, recommends almost double the UK dose: a 'usual' dose of 30 mg/day (the UK maximum) increasing in 10 mg increments to 60 mg/day if needed. You can find the same figures online at RxList:
http://www.rxlist.com/cgi/generic2/tranylcypromine_ids.htm
I'd place more reliance on the US figures - I suspect that a significant number of British patients who would have benefitted from 40 to 60 mg/day never have an opportunity to try such a high dose because their doctor decides that tranylcypromine doesn't work for them when 30 mg/day proves too little.
A much larger proportion never get to try it at all because doctors don't like to prescribe irreversible MAOIs: "You have to adhere to a strict diet and Parnate is the worst of all - it's also a stimulant!"
I like strong, mature, blue cheeses like Stilton and warm, cloudy, cruddy "real ale" even more than most Brits, but any doctor who believes I'd hesitate to give them up in order to get out of this hell hasn't a clue how depression feels.
I hope the pdocs in your country are more enlightened than mine, Mischief.
Jonathan.
Posted by jsarirose on August 31, 2002, at 3:17:05
In reply to About 20 to 60 mg/day, but ..., posted by Jonathan on August 30, 2002, at 20:54:46
> ... it seems to depend which country you live in!
>The official information from the pharmaceutical company that makes Parnate is that the maximum dose is 60mg. That means when they were testing, that's the dose they determined helped the maximum number of people with the fewest adverse effects.
From scouring the internet, I found that benefit can be derived from a dose up to 130mg. There have been people that took higher doses, but there is no conclusive evidence that it did them any good and was worth the risk.
Personally I took 100mg. I got the maximum benefit and could handle the side effects at that level. If I went higher I was too dizzy. But as I increased to that amount I continued to have more positive results. I found the easiest way to handle the higher dose was to split the dose into three per day. I would take 30mg when I woke, 40mg three hours later, and 30mg three hours after that. Unless I missed the first dose by a while (in which case I would feel dizzy and tired), I did just fine and the second and third doses didn't have to be 100% on time.
-Jessica
Posted by missliz on August 31, 2002, at 3:50:19
In reply to Re: About 20 to 60 mg/day, but ..., posted by jsarirose on August 31, 2002, at 3:17:05
I did extremely well at a low dose, 20 mg. Every body is different. You have to try it to know what you need. Too much Parnate will mess you up pretty badly if you're a lower dose person.
Not every Pdoc is qualified to treat with Parnate. When the SSRIs came out a lot of docs weren't trained in MAOIs and can look them up, but you want a doctor who understands the subject. A good psychopharmacologist gets his info from better sources than the PDR or a national formulary.
Start with one pill for at least a week, see how it goes. Apparently some people can just gobble the stuff but a lot of us need to titrate up slowly to avoid trouble. Besides, the first eight weeks can be rough with insomnia and other side effects as your body gets used to the drug. You don't need to pile it on all at once. Don't be put off by this though- it's a great drug. Well worth the trouble.Miss Liz
Posted by jsarirose on August 31, 2002, at 14:05:09
In reply to Re: About 20 to 60 mg/day, but ..., posted by missliz on August 31, 2002, at 3:50:19
> Start with one pill for at least a week, see how it goes. Apparently some people can just gobble the stuff but a lot of us need to titrate up slowly to avoid trouble. Besides, the first eight weeks can be rough with insomnia and other side effects as your body gets used to the drug. You don't need to pile it on all at once. Don't be put off by this though- it's a great drug. Well worth the trouble.
>I completely agree. Go slow. If the insomnia is intolerable there are some drugs you can take to help like Klonopin and Trazodone (and others, but those are the two I've tried). Not everyone needs the same dose my any means. I've talked to a ton of people and it's different for everyone!
-Jessica
Posted by Dave001 on September 5, 2002, at 18:29:07
In reply to Re: About 20 to 60 mg/day, but ..., posted by jsarirose on August 31, 2002, at 14:05:09
Something I've wondered, but have not taken the time to research, is the degree of MAO inhibition achieved at varying dosages. I'd love to see a graph of that. I find it odd that the dosing schedule can make such a big difference to people in terms of side-effects, given the affinity and irreversibility of binding to MAO. Is the enzyme synthesized so fast that the effect can begin to wear off in a matter of hours?
Also, while dietary and drug interactions are obviously something that ought to be taken very seriously, I'm wondering why hypertensive crises tend to occur without a nearly 100% inhibition of MAO; or is it that such a high degree of inhibition is necessary for therapeutic effectiveness? For instance, suppose one has a level of 70% MAO inhibition; does that not leave enough MAO to metabolize the paltry amounts of tyramine found in the restricted foods??
Dave
This is the end of the thread.
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