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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by medweirdo on November 20, 2007, at 13:18:45
Do I need to take the pills on an empty stomach or with food?
Thank you in advance.
Posted by Justherself54 on November 20, 2007, at 18:22:11
In reply to Initiating Nardil therapy tomorrow, posted by medweirdo on November 20, 2007, at 13:18:45
I have taken it on an empty stomach with no problem.
Posted by Nardilstarted2007 on November 20, 2007, at 20:43:04
In reply to Initiating Nardil therapy tomorrow, posted by medweirdo on November 20, 2007, at 13:18:45
> Do I need to take the pills on an empty stomach or with food?
>
> Thank you in advance.No, you can take it with or without food, it doesn't make a difference. If the Nardil gives you nausea on an empty stomach then take it with food. So are you going to start at 7.5mgs/day or 15mgs/day?
NardilSatated
Posted by medweirdo on November 21, 2007, at 1:05:37
In reply to Re: Initiating Nardil therapy tomorrow » medweirdo, posted by Nardilstarted2007 on November 20, 2007, at 20:43:04
Started with 15 mg this morning, I intend to go up to 30mg after a week and then will wait for 2 more weeks for higher dose.
Posted by medweirdo on November 21, 2007, at 7:25:10
In reply to Initiating Nardil therapy tomorrow, posted by medweirdo on November 20, 2007, at 13:18:45
I'm afraid of having it because I don't know if it's anxiety attack or reaction of the med to what i eat?
How can I be sure?Another thing is bothering me is about foods that come with soy lecithin, is it allow?
Is that just the soy sauce or all what derives of it?
thank you.
Posted by stargazer2 on November 21, 2007, at 7:49:34
In reply to How can I recognize a hypertesive crisis?, posted by medweirdo on November 21, 2007, at 7:25:10
Had a reaction when I combined Nardil with a generic form of adderall at 10 mg, 5 mg was fine, but will not risk doing this "experiment" again.
The reaction is really unmistakable. You feel funny and your head starts to develop a headache-like pain or tightening around your head. This was my reaction anyway, others may differ. The pain is just really different than a "normal" headache. Take your pressure immediately.
I have a BP cuff which I would advise anyone on a MAO to get. It may not be totally accurate but it will give you some indication of where your BP is going, i.e. up or down. Mine is normally very low, around 90/50. My BP when the "reaction" occurred, was 230/130. I laid down on the BR floor and took a medication my pdoc had given me if this should ever occur (Nifedipine) and although others here have disagreed with this as a treatment for hypertension (as it sometimes works too well and might crash your pressure) it brought mine down within an hour as I calmly (?) laid on the BR floor.
I had advised my husband what was going on and advised him to call 911 should my pressure not come down or my symptoms would get worse, i.e. loss of consciousness.
Best to avoid anything that can cause this, I have only had a mild reaction to an occasional cheese or food item. Med reactions can be more immediate and more severe, IMHO.
Stargazer
Posted by medweirdo on November 21, 2007, at 8:24:24
In reply to Re: How can I recognize a hypertesive crisis?, posted by stargazer2 on November 21, 2007, at 7:49:34
> Had a reaction when I combined Nardil with a generic form of adderall at 10 mg, 5 mg was fine, but will not risk doing this "experiment" again.
>
> The reaction is really unmistakable. You feel funny and your head starts to develop a headache-like pain or tightening around your head. This was my reaction anyway, others may differ. The pain is just really different than a "normal" headache. Take your pressure immediately.
>
> I have a BP cuff which I would advise anyone on a MAO to get. It may not be totally accurate but it will give you some indication of where your BP is going, i.e. up or down. Mine is normally very low, around 90/50. My BP when the "reaction" occurred, was 230/130. I laid down on the BR floor and took a medication my pdoc had given me if this should ever occur (Nifedipine) and although others here have disagreed with this as a treatment for hypertension (as it sometimes works too well and might crash your pressure) it brought mine down within an hour as I calmly (?) laid on the BR floor.
>
> I had advised my husband what was going on and advised him to call 911 should my pressure not come down or my symptoms would get worse, i.e. loss of consciousness.
>
> Best to avoid anything that can cause this, I have only had a mild reaction to an occasional cheese or food item. Med reactions can be more immediate and more severe, IMHO.
>
> StargazerSounds very scary, I would better ask my GP to give me perhaps alpha blocker, I know that it helps in this case very fast and doesn't interact with Nardil.
But can anyone help me with the soy thing? it's just the soy sause or anything which derives of it? and what about soy oil, is it ok to take foods contain soy oil?
Posted by tecknohed on November 21, 2007, at 20:17:49
In reply to Re: How can I recognize a hypertesive crisis? » stargazer2, posted by medweirdo on November 21, 2007, at 8:24:24
About the soy thing - I'd avoid if I were you. You dont NEED it do you?
This might help: http://www.dr-bob.org/tips/maoi.html
Just as Stargazer said, a hypertensive reaction to tyramine or certain drugs is UNMISTAKABLE!
I've had 2, both on Nardil. First was when I ate Lamb's liver. It started with tingles on the scalp & spine but quickly turned into a POUNDING headache like my head would pop! Also an excruciating burning pain in my stomache like I had swollowed molten lava! No vomiting though, just burning. I had nothing to take for it. I rang for an ambulance which promptly arrived & took me to hospital. I cant remember what my blood pressure was but they gave me NOTHING for it! I kept moaning & yelling in agony until eventually it all faded away & I simply discharged myself, just like that!
The second time was when I took a 'herbal high' (called Road Runner) bought legally from a stall in a night club. After about an hour I had the same pounding headache as before but without the stomache burning. I took myself promptly to the A&E ward & was made to sit & wait to be seen. I waited for a good hour constantly moaning in agony, then the effect wore off & I walked home without even being seen by a doc. After searching the net I soon discovered that the 'herbal high' I'd taken actually contained ephedrine, from a concentrated standerdised Sida cordifolia extract.
Posted by brooke484 on November 21, 2007, at 21:08:39
In reply to Re: How can I recognize a hypertesive crisis? » stargazer2, posted by medweirdo on November 21, 2007, at 8:24:24
I don't know about soy oil (what food is it in?), but I drink a lot of soy milk and eat granola bars with soy protein in them. I never had a problem.
brooke
Posted by quasiloco on November 21, 2007, at 21:44:51
In reply to Re: How can I recognize a hypertesive crisis? » stargazer2, posted by medweirdo on November 21, 2007, at 8:24:24
the food guidelines are ancient. moderation is unlikely to cause crisis. soy oil definitely not a factor.
aged, fermented, and poorly stored meats & cheeses in excess and regularly, poorly stored micro-brew beers and redwines are possilbe likely candidates.my p-doc perscribed clonidine for HT crisis
Posted by Molitor on November 21, 2007, at 23:34:30
In reply to Re: How can I recognize a hypertesive crisis? » medweirdo, posted by tecknohed on November 21, 2007, at 20:17:49
> I've had 2, both on Nardil. First was when I ate Lamb's liver. It started with tingles on the scalp & spine but quickly turned into a POUNDING headache like my head would pop! Also an excruciating burning pain in my stomache like I had swollowed molten lava! No vomiting though, just burning. I had nothing to take for it. I rang for an ambulance which promptly arrived & took me to hospital. I cant remember what my blood pressure was but they gave me NOTHING for it! I kept moaning & yelling in agony until eventually it all faded away & I simply discharged myself, just like that!
>It's curious you mentioned the Molten Lava, I had the exact same reaction.
I had a reaction to Parnate plus Provigil -- although I've never had a reaction to Parnate/Nardil/Cylert/Adderall/Ritalin/anything over the years (not all at the same time of course). My first symptom was indigestion which rapidly turned to Molten Lava in the Stomach. Usually I have stomach of iron, so this unusual. My heart was beating hard, although nothing too bad, but I had this overwhelming feeling "something's wrong". At this point, I didn't have a headache, but I took my blood pressure with an inflatable wrist thing, and it couldn't inflate high enough and I kept getting an error. I tried with another manual inflatable one, and it was giving me erratic readings over 200 systolic.
I decided I should go the emergency room, and got someone to drive me, because I was having trouble thinking. In the car, I was cradling my burning stomach (but not bent over or anything), and started getting a bad headache. The headache was bad, but it wasn't anything outside the realm of a really bad "normal" headache. However, I felt absolutely horrible all over, like I had some megaflu.
I got to the hospital, tried to explain what was going on, and couldn't remember my birthdate, phone number, etc. I felt pretty incoherent at that point, and had the person with me explain things while I sat down and waited.
They gave me a bed and an IV, but no medication. And I just sat there in bed for a couple hours while they monitored my blood pressure, heart rate, and took urine samples (I guess a HC can damage the kindeys). Eventually, my blood pressure went down by itself, promptly giving me a migraine... They offered me some painkillers, but I just took some $10 hospital Advil. They gave me a pill to keep my blood pressure stable for a couple days (don't remember what it was, I was pretty out of) and discharged. With the migraine, I couldn't see to sign the discharge papers, I had to have help positioning my hand. Then I went home and felt like I had the flu, a hangover, been beaten by the Russian Mafia, then stuffed into a tumble dryer full of painful things. This lasted for the better part of an entire month.
Truly one of the most unpleasant things I've ever experienced, and the after affects lasted far longer than I would have imagined.
So I guess there may be variations in how a HC manifests itselfs, but the way it feels, you just KNOW something is going wrong in your body.
Posted by tecknohed on November 22, 2007, at 6:11:46
In reply to How can I recognize a hypertesive crisis?, posted by medweirdo on November 21, 2007, at 7:25:10
Sorry, I always associate the word 'soy' with 'soy sauce' which is contraindicated. Here in the UK 'soy' is usually reffered to as 'soya'. Lecithin is FINE, so is soy/soya milk & even soy/soya 'live' yogurt (e.g. Yofu). Not sure about Tofu though - might be best to avoid that. Basically, ALL foods that have been fermented, including soy/soya fermented products, are best avoided. It is the fermenting process which creates the Tyramine content of foods.
And its not just Tyramine to avoid - other chemicals in food can trigger hypertensitivity too. Some foods contain L-dopa - Fava beans & Broad bean pods are examples & should be avoided. Not sure about the broad beans themselves though, might be best to avoid - hardly a dent in ones diet!
Posted by tecknohed on November 22, 2007, at 6:30:35
In reply to Re: How can I recognize a hypertesive crisis?, posted by Molitor on November 21, 2007, at 23:34:30
I would imagine that the stomache burning is caused by the same mechanism which happens in the brain, as the digestive system (esp. stomache) is full of neurotransmitter receptors including norepinephrine/noradrenalin receptors, which is the main resulting culprit for causing the hypertensive crises symptoms. The stomache actually contains MANY more such receptor sites that does the brain.
Hence the Molten Lava feeling.
Provigil is a potent noradrenergic drug & so is Parnate. I took Provigil without any problems with Nardil, even in excess of 600mg/day. Just shows that, like all groups of meds, MAOIs are NOT all the same. Of course WE'RE not all the same either!
take care,
teck
Posted by Molitor on November 23, 2007, at 3:48:19
In reply to Re: How can I recognize a hypertesive crisis? » Molitor, posted by tecknohed on November 22, 2007, at 6:30:35
The ironic part about Provigil is that it's not considered a classic "stimulant", and supposedly doesn't have any of the "bad" qualities of amphetamines, et al. This is why I was using it, because it should be safer than the alternatives.
Well, I'm calling shenanigans on that! I consider Provigil to be a stimulant just like any other, and it should be used with as much caution in combo with MAOIs as anything else. Perhaps MORE caution, since nobody knows exactly why it works.
Back to the Hypertensive Crises and the Molten Lava feeling. Whatever causes it, MAOI users need to be made aware of it. I probably had a lag of between 10-30 minutes between the Molten Lead and the headache, so if someone is getting this symptom, they should immediately think about getting to the emergency room. Having a BP monitor nearby is also a good idea. Even a cheap one is useful in determining if your blood pressure is soaring.
Also, another symptom I had that isn't mentioned much, was disorientation and confusion. MAOI users should carry a med alert card to hand the emergency wrokers, or better yet, have someone take them to the hospital to explain the situation. Lest you be treated as a bad drug trip, and sent to the back of the line.
Even with all that, when I was in the bed with all the monitors hooked up, I'd have a nurse come in and ask me stuff like what "ACE Inhibitor" I was taking, and who the doctor was that treated my hypertension (I have normal BP). She also kept telling me to lay down, but I swear I remember reading that I should NOT lay down, and it hurt MUCH more if I wasn't sitting up, so I kept sitting up even though the back of the hospital bed was reclined, which caused pain and cramping in my back/shoulder/arms. I never actually saw a doctor (although I think he was monitoring my vitals remotely), and to this day I don't believe they really understood what was going on. That's about the scariest part of the whole thing.
Posted by yxibow on November 23, 2007, at 12:56:57
In reply to Re: Initiating Nardil therapy tomorrow » Nardilstarted2007, posted by medweirdo on November 21, 2007, at 1:05:37
I understand we all have choices in life and I may make an euqally difficult one with Clozaril eventually but do people on here who have arrived at that point really arrive at Nardil and Marplan, etc, after trying only a few antidepressants or is it a a last case scenario?
I know that people who do take the class of medications have a good result but I just can't imagine carrying around the equivalent of a nitroglycerin container with nifedipine or clonidine or other HBP medications just because they ate some unknown ingredient at a restaurant.
With a worst case scenario, since MAOIs should be flushed out for 14 days, I'm imagining at least $31,200 to $52,000 in a combination of ER triage, rooms and possibly psych wards for that entire period to determine a better game plan.There is no warning, it just happens, immediately, a hypertensive crisis.
I must say Clozaril is not without its risks and expense but a body conscious person like myself could detect "not feeling well" and monitoring programs are very frequent.
Posted by Molitor on November 23, 2007, at 17:41:30
In reply to soy, posted by brooke484 on November 21, 2007, at 21:08:39
According to the dietary guidelines for Marplan, which has the most liberal guidelines of Marplan/Nardil/Parnate, it says about soy:
"Foods you cannot eat: Most Soybean products, including soy sauce and tofu"
"Foods you can eat: Soy Milk"
I avoid everything soy except for soybean oil, which I figure is the highly refined fat part of soy, and doesn't contain any proteins to cause problems. Too bad, because I don't really like meat, and I had to give up Garden Burgers and Boca Weenies and the like.
You can see it here:
http://validuspharma.com/dev/MarplanDietCard.pdfSince there's only a couple of thing on that chart, I'd take the soy recommendation very seriously. Also note that this is the chart for MARPLAN, not Nardil. Nardil has a stricter list, and when in doubt, I'd err on the side of safety and follow the list for the specific medication I'm taking.
Posted by tepi on November 25, 2007, at 12:54:02
In reply to Avoid Most Soybean Products, including Tofu., posted by Molitor on November 23, 2007, at 17:41:30
I have had only 1 HP crisys when I ate and spoiled big piece of chicken that was in the refrigerator for 2 weeks . Not sure It was spoiled because it tasted well, anyway I knew I should have not ate it.
For me was like a normal dinner , then I started to feel my heart beating a little quickly, fast breathing; time passed and I started to feel a big presure in the back side on my head that became worst every minute. All this happened like 1 hr an a half after my dinner .
I end up at the ER with a blood pressure of (150/200) .
Dr did not know MAOIS (not a surprise for me) so I told them to give me nifedipine.
I left the hospital 2 hrs left.
I have always been wondering if we could eat anything , and when we start to have the HP crisis just control it with nnifedipine. Sounds risky but just wonderingTepi
Posted by tecknohed on November 25, 2007, at 17:26:21
In reply to Re: How can I recognize a hypertesive crisis? » tecknohed, posted by Molitor on November 23, 2007, at 3:48:19
> The ironic part about Provigil is that it's not considered a classic "stimulant", and supposedly doesn't have any of the "bad" qualities of amphetamines, et al. This is why I was using it, because it should be safer than the alternatives.
>
> Well, I'm calling shenanigans on that! I consider Provigil to be a stimulant just like any other, and it should be used with as much caution in combo with MAOIs as anything else. Perhaps MORE caution, since nobody knows exactly why it works.I'm with you on this one. I definitely consider Provigil a stimulant too. It definitely has a 'kick' to it, especially during the first few days of usage. It also builded tolerance very quickly for me, just like any stim I've taken before. When I stopped I switched strait to bupropion but I've no doubt I'd have suffered withdrawal fatigue had I not made that switch so quickly.
> Also, another symptom I had that isn't mentioned much, was disorientation and confusion. MAOI users should carry a med alert card to hand the emergency wrokers, or better yet, have someone take them to the hospital to explain the situation. Lest you be treated as a bad drug trip, and sent to the back of the line.
>
> Even with all that, when I was in the bed with all the monitors hooked up, I'd have a nurse come in and ask me stuff like what "ACE Inhibitor" I was taking, and who the doctor was that treated my hypertension (I have normal BP). She also kept telling me to lay down, but I swear I remember reading that I should NOT lay down, and it hurt MUCH more if I wasn't sitting up, so I kept sitting up even though the back of the hospital bed was reclined, which caused pain and cramping in my back/shoulder/arms. I never actually saw a doctor (although I think he was monitoring my vitals remotely), and to this day I don't believe they really understood what was going on. That's about the scariest part of the whole thing.
I was treated very rudely when I went to the A&E. Was told to "HUSH" a few times when I was yelling in agony, as if they thought I was putting it on for attention or something, or maybe they thought I was a drug addict craving for a fix. VERY unpleasant & made me very angry! Like in your situation they obviously had little clue in what to do, even though I made it very clear what was going on & even made a few suggestions like giving me nifedepine.
Posted by stargazer2 on November 25, 2007, at 18:34:47
In reply to Re: HP crisis., posted by tepi on November 25, 2007, at 12:54:02
Tepi,
Would NEVER do to that as Nifedipine can drop your pressure the other way rather quickly and has to be monitored very closely. I was lucky in that I had my BP cuff ready to go, started at 230/130, laid on the BR floor to minimize any activity and just kept taking my BP and pulse every few minutes. Eventually it came down to 130/80 and I really felt relatively OK for what had happened.I have extremely low BP so the escalation to 230/130 made me fear a stroke if I couldn't get it under control.
BTW, your BP was more likely 200/150 since the bottom number is never larger than the top number.
I'm lucky in that most of the No-No food are ones I don't really like except for cheese. Occasionally I will have a slice of pizza and be OK, but that is it, no aged cheese ever, so cream cheese is one of my biggest treats.
Stargazer
Posted by yxibow on November 26, 2007, at 4:51:11
In reply to Re: HP crisis./Tepi, posted by stargazer2 on November 25, 2007, at 18:34:47
> BTW, your BP was more likely 200/150 since the bottom number is never larger than the top number.
There are peculiar situations, mostly it seems for women, hormones, pregnancy when it can be purely high diastolic. This is rare though.
Posted by Nardilstarted2007 on November 28, 2007, at 17:11:55
In reply to Initiating Nardil therapy tomorrow, posted by medweirdo on November 20, 2007, at 13:18:45
> Do I need to take the pills on an empty stomach or with food?
>
> Thank you in advance.
Hi Medweirdo, Hows your advancement with Nardil? Have you upped your dose? How do you feel? any side effects?Let us know >NardilStarted2007
Posted by medweirdo on November 29, 2007, at 11:19:28
In reply to Re: Initiating Nardil therapy tomorrow » medweirdo, posted by Nardilstarted2007 on November 28, 2007, at 17:11:55
Hi, I'd uped my dose to 30mg after 4 days initiating Nardil and today after 8 days I increased the dose again to 45mg. I know I'm very impatient but my case is very severe right now. I'm having panick attacks that interfere me from studying. the only SE I feel is sleepiness (after 2 or 3 hours of consumption) so I think it would be better to take it before bed time?.
I pray for it to start already working, I feel really dead (not b/c nardil) and can't even think how I can survive for one more day.
:[
Posted by stargazer2 on November 29, 2007, at 12:29:45
In reply to Re: Initiating Nardil therapy tomorrow » Nardilstarted2007, posted by medweirdo on November 29, 2007, at 11:19:28
I would reommend you take 15 in the morning and 30 at night since a twice a day dosing is recommended. That is what I had to do when I started to decrease sleepiness. Hang in there,it will work...I started in May taking 40, then had a bit of a relapse in October and had to go up to 60, where I'm at now. It is working rather well for me and many others.
Stargazer
Posted by stargazer2 on November 29, 2007, at 12:31:57
In reply to Re: HP crisis./Tepi » stargazer2, posted by yxibow on November 26, 2007, at 4:51:11
Xyibow, what do you mean by "purely high diastolic", I never heard of that term...
SG
Posted by medweirdo on November 29, 2007, at 13:06:05
In reply to Re: Initiating Nardil therapy tomorrow/MedWierdo, posted by stargazer2 on November 29, 2007, at 12:29:45
> I would reommend you take 15 in the morning and 30 at night since a twice a day dosing is recommended. That is what I had to do when I started to decrease sleepiness. Hang in there,it will work...I started in May taking 40, then had a bit of a relapse in October and had to go up to 60, where I'm at now. It is working rather well for me and many others.
>
> StargazerThank you Stargazer. what you suggest is a good advice for me. I took all the three pills at once this morning (the p.d told me to take it early once a day) so I'll start to stick with it next time perhaps it might also help me sleep better.
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