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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 Judy on October 26, 2000, at 15:51:44
Scott,
I left a message for you in the "High Doses of Parnate" thread and I had also hoped you'd 'sense' that I wanted your input on the "Nardil Patch" question that I squeaked into the "Selegiline Patch Update" thread.
As soon as you tell me what I did to offend you, I promise never to do it again! : )
Judy
Posted by SLS on October 27, 2000, at 9:06:51
In reply to SLS - Was it Something I Said?, posted by Judy on October 26, 2000, at 15:51:44
Dear Judy,
You are being silly now.
NO WAY !!!!!!!!!!!!!!!!!!!!!!!!!!!
Please, the only thing I am right now is upset that I somehow gave you the idea that you have offended me. NO WAY!
"Sense"? The only sense you can count on me as having is non-sense.
Actually, I was hoping to read follow-posts myself! I have never heard of a Nardil patch. Where can I go to find out more about it?
Offhand, I don't know what advantages there would be with a patch transdermal delivery. I doubt it would make much difference in side effects, hypotension in particular, or metabolism in the liver. I'm not sure, but my guess is that the reason why a gradual delivery of selegiline may be advantageous is because less of it would be converted to other active compounds like l-amphetamine and methamphetamine. This might make a significant difference in the overall behavior of selegiline in the body and the concentrations of the unwanted metabolites in the brain. (Perhaps amphetamines cause a depletion of dopamine).
"PHARMACOKINETICS: Selegiline is administered orally and is readily absorbed from the GI tract and crosses the blood/brain barrier. Peak serum concentrations are found in 0.5-2 hours. The drug is rapidly and completely metabolized to three active derivatives with the following half-lives: N-desmethyldeprenyl, 2 hours; 1-amphetamine, 17.7 hours; and 1-methamphetamine, 20.5 hours. Selegiline is eliminated slowly by the kidneys; about 45% of a single 10 mg dose is eliminated in the urine as the three active metabolites in 48 hours."
- Scott"
> Adam (I wonder if he still lurks?)
I was wondering the same thing, Noa. Adam was much more successful on the patch than the oral doses.I'm still waiting for a Nardil patch. I know for a fact that they were being tested at McLean Hospital here in MA, but I can't find any info about it. I have my fingers crossed that one will eventually be approved and it will provide me the benefits without the side effects that made it necessary for me to give it up.
> Judy
"
> Scott,
>
> I left a message for you in the "High Doses of Parnate" thread and I had also hoped you'd 'sense' that I wanted your input on the "Nardil Patch" question that I squeaked into the "Selegiline Patch Update" thread.
>
> As soon as you tell me what I did to offend you, I promise never to do it again! : )
>
> Judy
Posted by Judy on October 28, 2000, at 9:22:17
In reply to Re: SLS - Was it Something I Said? » Judy, posted by SLS on October 27, 2000, at 9:06:51
Thanks Scott,
Just hoping you might have encountered something about a Nardil patch somewhere along the way.
My reasoning (and it's probably faulty) was that Nardil works wonderfully for me mentally, but physically it is intolerable - outrageous edema, near shut-down of my bladder and bowel functions - I could go on...but if the tyramine reaction doesn't come into play when MAOI are administered transdermally, my hope is that some of the other physical side effects wouldn't either.
As I said, my doctor told me they were definitely doing studies on the Nardil patch at MacLean; and I even called there but was told they don't give out that type of information to mere mortals - so I wait in the limbo of Parnate-induced apathy and anhedonia.
Judy
Posted by SLS on October 28, 2000, at 11:20:43
In reply to Re: SLS - Was it Something I Said?, posted by Judy on October 28, 2000, at 9:22:17
> Thanks Scott,
>
> Just hoping you might have encountered something about a Nardil patch somewhere along the way.
>
> My reasoning (and it's probably faulty) was that Nardil works wonderfully for me mentally, but physically it is intolerable - outrageous edema, near shut-down of my bladder and bowel functions - I could go on...but if the tyramine reaction doesn't come into play when MAOI are administered transdermally, my hope is that some of the other physical side effects wouldn't either.
>
> As I said, my doctor told me they were definitely doing studies on the Nardil patch at MacLean; and I even called there but was told they don't give out that type of information to mere mortals - so I wait in the limbo of Parnate-induced apathy and anhedonia.
>
> Judy
Hi Judy.I am sort of in the same position you are regarding Parnate and Nardil, only with nowhere near the seriousness of what you experience. I chose Parnate more recently because I am also sensitive to the side effects of Nardil, particularly hypotension and fainting and the inability to urinate with a full bladder. On several occasions, I was scared I would have to go to the hospital for a catheterization. Although this is not too much of a problem when I use Nardil by itself, I have had the need to combine it with tricyclics that potentiate the side effects.
I like the way I feel on Nardil better. Your description of apathy and anhedonia with Panate is familiar.
It's great that you have a doctor who is part of the "loop" to know about the Nardil patch. Is the purpose of the patch to minimize side effects or increase efficacy?
I don't have a clue as to the mechanisms behind Nardil-induced edema. Do you? I imagine it could be related to the hypotension and a lack of vascular tone/volume. Don't know. I guess increasing salt doesn't help you much.
Have you been evaluated for some sort of idiopathic renal insufficiency? Is your bladder condition considered atonic?
Perhaps the drug bethanecol (Urecholine) would be helpful.Also, hypothyroid conditions can contribute to edema
Have you tried Marplan? Marplan is generally thought of as "a weak Nardil". However, I don't know if the term "weaker" is really accurate. I don't think it gets as many people well as does Nardil, but when it works, it can be a miracle. I have read of a few people here who failed to respond to Nardil who went on to experience a robust response to Marplan. Although the two drugs are related chemically (hydrazines), I don't think one can generalize side-effects between the two. It doesn't seem that Marplan is as liable to produce edema as Nardil.
Like I said, I am clueless regarding how Nardil causes edema. Treatment of edema is determined by first identifying the cause as it seems opposite approaches are used depending on the cause. In some cases, I think using a diuretic is exactly the wrong thing to do, as it allows too much salt to exit the blood-stream.
I saw something that recommended dosing Nardil more frequently with smaller amounts to mitigate edema. I guess the Nardil patch would be good for you. Probably me too.
Please post if you learn anything more about it. I wish I could have helped out more.
- Scott
Posted by Deborah14 on October 28, 2000, at 13:43:04
In reply to Re: SLS - Was it Something I Said?, posted by SLS on October 28, 2000, at 11:20:43
Judy
FYI, a fabulous laxative to counter bowel shut down is Miralax Powder. I used to gag on Chronulac and X-Lax is too dangerous to take on a continuous basis for any length of time.
The Miralax was prescribed by my GI doc (It is only sold in the US by prescription. It is relatively inexpensive.) I use it to counter a side effect of Eldypryl, which is the complete shutdown of the peritalsis of my colon.
Miralax is completely tasteless. I put a heaping capful in a glass of warm water before bedtime (it dissolves better and is more palatable to swallow.) I'm allergic to orange juice but I'm sure you could put it in any liquid. For me, it is the only safe laxative that works and one can drink easily without gaging.Hope this info is helpful.
P.S. The selegeline patch is supposedly more effective with less side effects. I don't know why it is more effective but I do know that it has less side effects because it does not have to be metabolized in the liver to the extent a pill does.
Posted by Judy on October 31, 2000, at 8:26:07
In reply to Re: SLS - Was it Something I Said?, posted by Deborah14 on October 28, 2000, at 13:43:04
Thanks to both of you for the input. I'm not looking for increased efficacy from a Nardil patch - I couldn't possibly feel any better than I do when taking it orally. I was just hoping that bypassing the digestive phase might lessen some of the side effects.
Under any other circumstances, my bladder and bowel functions are perfectly normal. Parnate affects them slightly, but both Nardil and Marplan almost shut them down. I did try urecholine but it didn't make an appreciable difference. As for the edema, no one had any clue. By the end of the day, my feet would be spilling over the sides of my shoes and my legs were unrecognizable as mine. When I'd wake up in the morning, my face was so swollen, I couldn't see past my puffed up eyelids. Marplan, by the way, also caused very frightening myoclonus at night - one jerk after the other about five seconds apart.
I have no idea if a Nardil patch would alleviate these symptoms or not but, as we all do, I'm grasping at any straw that floats by. I'll post if I find any information.
Judy
This is the end of the thread.
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