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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by JadeKelly on November 6, 2008, at 17:46:05
Week and 1/2 with quick great response to Parnate30mg, then subsequent hypertensive crisis. Restart Parnate couple days later with daily Nifedipine 10mg (only way to stop BP spikes). Another week 1/2, now feel worse than before. Any Parnate experts/users,etc. have a couple minutes to answer these questions? Note: had great response on Emsam at 6mg patch for week or so, also, then switched to Parnate.
1. Is parnate known for early response then gone?
2. Do MAOI's just have early stim effect? Thought they ruled that out. Didn't feel like stim.
3. Is it likely just a need for dose adjustment?
4. I know 30mg to be standard for Parnate trial, I'm small and fairly sensitive to drugs too. Is it likely that Nifedipine is whats causing lack of response?
5. Do most people who respond well in 5-7 days on MAOI tend to respond for long time, given right dose?
6. Is it a general rule, that most have to go up in dose to keep original response?
Thanks to anyone who can answer these questions for me. I'm getting anxious to figure all this out as I feel lethargic and back to depressed state. See PDoc Monday. Atyp/tr MDD.
Thanks All-Jade
Posted by Phillipa on November 6, 2008, at 17:58:22
In reply to PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE?, posted by JadeKelly on November 6, 2008, at 17:46:05
Jade I'm sorry. Wish I had info for you. Are you thinking of patch again? It's expensive any way to get assistance drug companies etc. Love Phillipa
Posted by JadeKelly on November 6, 2008, at 18:29:52
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » JadeKelly, posted by Phillipa on November 6, 2008, at 17:58:22
> Jade I'm sorry. Wish I had info for you. Are you thinking of patch again? It's expensive any way to get assistance drug companies etc. Love Phillipa
Hi Phillipa, yeah, I'm thinking of all MAOI's except Parnate cause this crazy Nifedipine, according to a medline search I did, can cause depression and all kinda nasty effects.
What I'm not sure of, is Nifedipine negating benefits of Parnate, or will all MAOI's poop-out on me. Emsam did at 6mg, after a week, no response to 9mg, then went to Parnate. Not sure if insurance would cover patch or not. Azaela suggested Seleligine (oral), then there's Nardil, and that other one, starts with an M. I'm suspecting I'm either doomed to any early, brief response on all, or I just need to titrate to higher doses. And get off this calcium channel blocker.
Jade
Posted by Phillipa on November 6, 2008, at 19:42:49
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » Phillipa, posted by JadeKelly on November 6, 2008, at 18:29:52
Jade maybe I need to search more for you. But know how through you are. Love Phillipa
Posted by JadeKelly on November 6, 2008, at 20:35:31
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » JadeKelly, posted by Phillipa on November 6, 2008, at 19:42:49
Thanks Phillipa,
I think I'm good with the search, what I want now are some first hand experiences. Hope I get them.
Posted by azalea on November 6, 2008, at 20:58:25
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » Phillipa, posted by JadeKelly on November 6, 2008, at 20:35:31
If you decide to go back to Emsam, here's the link to The Bristol-Myers Squibb Patient Assistance Foundation . . .
http://www.bmspaf.org/program0.htmlThe other MAOI is Marplan (isocarboxazid), which also has a patient assistance program.
http://marplan.com/patient_assistance.asp> Thanks Phillipa,
>
> I think I'm good with the search, what I want now are some first hand experiences. Hope I get them.
Posted by JadeKelly on November 6, 2008, at 21:54:20
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » JadeKelly, posted by azalea on November 6, 2008, at 20:58:25
> If you decide to go back to Emsam, here's the link to The Bristol-Myers Squibb Patient Assistance Foundation . . .
> http://www.bmspaf.org/program0.html
>
> The other MAOI is Marplan (isocarboxazid), which also has a patient assistance program.
> http://marplan.com/patient_assistance.asp
Thanks Azalea, I will def check those out, I've been on Emsam but maybe its time for another look. I'll be reporting back on Monday with a script for MAOI. Which one is the question! Now Scott has me thinking maybe add to it to knock out this dep for good.I'll ask PDoc. Thanks for all your help!!Jade
Posted by SLS on November 7, 2008, at 0:03:35
In reply to PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE?, posted by JadeKelly on November 6, 2008, at 17:46:05
> Week and 1/2 with quick great response to Parnate30mg, then subsequent hypertensive crisis. Restart Parnate couple days later with daily Nifedipine 10mg (only way to stop BP spikes). Another week 1/2, now feel worse than before. Any Parnate experts/users,etc. have a couple minutes to answer these questions? Note: had great response on Emsam at 6mg patch for week or so, also, then switched to Parnate.
>
> 1. Is parnate known for early response then gone?No. However, that is how I react to Parnate when it is used as monotherapy. Actually, this pattern of response has been my main problem for 25 years.
> 2. Do MAOI's just have early stim effect?
Parnate does.
> Thought they ruled that out. Didn't feel like stim.
You know your body best.
> 3. Is it likely just a need for dose adjustment?
Some people who experience spontaneous hypertensive reactions to Parnate upon treatment startup have it be only transient. You might want to try slowly lowering the nifedipine if you feel confident that you can monitor your blood pressure accurately. You might want to work with your doctor on this.
> 4. I know 30mg to be standard for Parnate trial, I'm small and fairly sensitive to drugs too. Is it likely that Nifedipine is whats causing lack of response?I wouldn't think so. It is likely that 30mg of Parnate is not enough. Most people need a minimum of 40mg when treating more severe depressions.
> 5. Do most people who respond well in 5-7 days on MAOI tend to respond for long time, given right dose?
I don't know. Sometimes slower is better when it comes to responding long-term. It may depend on how your system may have been "primed" by previous treatment. Your brain is not "drug-naive". In the short-term, it might be more responsive rather than less responsive because of this.
> 6. Is it a general rule, that most have to go up in dose to keep original response?Not with Parnate.
> Thanks to anyone who can answer these questions for me. I'm getting anxious to figure all this out as I feel lethargic and back to depressed state. See PDoc Monday. Atyp/tr MDD.
I bet you need to increase the dosage to >= 40mg. It is my experience that 40-80mg is the effective range, not 30-60mg.
Some people do feel lethargic on Parnate early in treatment. Since I haven't been on nifedipine, I can't attest to its propensity to produce sedation. Maybe a Google search will answer this part of your question.
Why people react to psychotropic drugs in "paradoxical" or "atypical" ways is still a mystery, although I am sure that these questions will eventually be answered.
If I were you, I would first try to taper the nifedipine before increasing the dosage of Parnate, hoping that the hypertensive reaction to Parnate is only transient. If hypertension emerges again, and if you have not yet tried Nardil, I would probably make the switch if I were you. I would be afraid that my system on Parnate is too volatile to rely on nifedipine alone as a fail-safe.
- Scott
Posted by shasling on November 7, 2008, at 14:47:03
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » JadeKelly, posted by SLS on November 7, 2008, at 0:03:35
I agree parnate monotherapy is usualy seen at onset of a users trial,then slowly fades.
Parnate for me as well as sls is a PAIN IN THE -
med,however until i see a newer one like the few
ssndri that have been denied come out,i simply dont see a alternative primary med.So i spend my time searching for augmentation cocktails,dosing patterns and the like.
My biggest fear is that my doc will suddenly feel he has me on to high a dose and lower it,im on a 100 per doc now,50/50.
I would be first in line to stop taking these little red m&ms but i am not going to stop to simply go back to ssris which for me are burned in my head.Others may have forgotten what ssris did to me since it has been a while,but i never will,so i will just continue to read and search around parnate for augmentations and hopefully replacment.I had high hopes on the patch knowing of it much prior to its mention,i truly thought that was gonna be a new avenue for me,oh well im hearing a lot about these selective serotonin,norardrenaline,dopamine,re-uptake inhibitors in the works,these sound promising.
Posted by bulldog2 on November 7, 2008, at 18:40:36
In reply to PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE?, posted by JadeKelly on November 6, 2008, at 17:46:05
> Week and 1/2 with quick great response to Parnate30mg, then subsequent hypertensive crisis. Restart Parnate couple days later with daily Nifedipine 10mg (only way to stop BP spikes). Another week 1/2, now feel worse than before. Any Parnate experts/users,etc. have a couple minutes to answer these questions? Note: had great response on Emsam at 6mg patch for week or so, also, then switched to Parnate.
>
> 1. Is parnate known for early response then gone?
>
> 2. Do MAOI's just have early stim effect? Thought they ruled that out. Didn't feel like stim.
>
> 3. Is it likely just a need for dose adjustment?
>
> 4. I know 30mg to be standard for Parnate trial, I'm small and fairly sensitive to drugs too. Is it likely that Nifedipine is whats causing lack of response?
>
> 5. Do most people who respond well in 5-7 days on MAOI tend to respond for long time, given right dose?
>
> 6. Is it a general rule, that most have to go up in dose to keep original response?
>
> Thanks to anyone who can answer these questions for me. I'm getting anxious to figure all this out as I feel lethargic and back to depressed state. See PDoc Monday. Atyp/tr MDD.
>
> Thanks All-Jade
>
>
>
>
>Could be the Nifedipine. Consider augmenting with a tca as that does give some protection from hypertensive crisis.
Posted by Phillipa on November 7, 2008, at 19:32:20
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE?, posted by bulldog2 on November 7, 2008, at 18:40:36
How Bulldog can you explain as I don't know and would love to learn. Phillipa
Posted by bulldog2 on November 8, 2008, at 9:41:23
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » bulldog2, posted by Phillipa on November 7, 2008, at 19:32:20
> How Bulldog can you explain as I don't know and would love to learn. Phillipa
put parnate+amitriptyline in google at the bottom. Think tca blocks reuptake of norepinephrine so it can't be displaced and raise blood pressure.
Posted by Phillipa on November 8, 2008, at 12:15:51
In reply to PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE?, posted by JadeKelly on November 6, 2008, at 17:46:05
Jade you disappeared. Where did you go? Let us know what happens after you see pdoc. Love Phillipa
Posted by JadeKelly on November 8, 2008, at 18:38:01
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » JadeKelly, posted by Phillipa on November 8, 2008, at 12:15:51
Hi Phillipa, nope, I'm here! Parnate insomnia finally caught up to me and I slept in till an embarrassing late hour. (Now I'll prob be up till an ebarrassing late/early hour as well!) Also, been conversing with fantastic son of mine, hah! And how are you?
~Jade
Posted by Phillipa on November 8, 2008, at 22:29:25
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » Phillipa, posted by JadeKelly on November 8, 2008, at 18:38:01
Spending all kinds of plastic money. Got a money tree? Need a fast growing one. Love Phillipa
Posted by JadeKelly on November 9, 2008, at 0:01:09
In reply to Re: PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE? » JadeKelly, posted by Phillipa on November 8, 2008, at 22:29:25
> Spending all kinds of plastic money. Got a money tree? Need a fast growing one. Love Phillipa
Tree? I need a forest. If your nice to me I'll think about giving you a tree tho. What are you buying, was it worth the spending spree?
~jade
This is the end of the thread.
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