Posted by proudfoot on August 27, 2010, at 21:28:14
OK, so I'm most of the way through my first week taking Nardil, and so far so good with regards to the blood pressure (BP). I'm doing my best to adhere to a low tyramine diet (see my other recent food-related posts here), but worry about dealing with a surge in my BP from something I unknowingly ingest that contains too much tyramine.
My shrink gave me an Rx for nifedipine (generic for Procardia), but the pharmacy gave me hard pills, not the liquid-filled gelcaps that I think he intended for me to squeeze under my tongue should the need arise. I'm guessing I'd have to chew these suckers and say a prayer waiting for them to got absorbed from my gut.
I'm now reading that using nifedipine for treating a hypertensive crisis is not the standard of care anyhow, as it may interfere with some IV treatments used in the ER. Plus, it could worsen perfusion in parts of the brain by reducing blood flow that's available there, and thus potentially worsen any brain injury that's already happened.
What has your doc prescribed for you to use in an emergency? I'm really intrigued by the use of chlorpromazine (Thorazine) 50 mg, as I understand it can lower BP as well as treat the migraine-like headache symptoms that occur with an MAOI-caused hypertensive crisis. Sounds like a logical and useful choice.
I read too about sublingual nitroglycerin (NTG) being very effective and safer than nifedipine, but the limiting thing there would be the need to get a new bottle of the tablets to keep on hand every month, as NTG is not very stable and can thus not be kept for long periods of time.
I also read one anecdote of a nurse who self-treated during an episode of a food-induced headache/increased BP with the use of clonidine 0.1 mg under the tongue on a repeated basis until her BP normalized again.
I'm not sure I would have the balls to not go to the ER if something like this were to happen, but I also know how insensitive and inappropriate ER staff can be to patients with mental health diagnoses, so having a reliable means of at least initiating treatment without screwing things up for further management in the ER would be nice.
What feedback should I give my doc about how we should manage any episodes I might have? I'm thinking I'm going to ask for some chlorpromazine to keep on hand, but I'd like to hear from more of you about your experiences in this regard.
Thanks so much!
Doug
poster:proudfoot
thread:960231
URL: http://www.dr-bob.org/babble/20100821/msgs/960231.html