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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by PhoenixGirl on June 6, 2004, at 12:08:19
I'm going to start Parnate in a week, and I want to know if anyone has had a bad experience with it. Seems like a lot of people on here have had good experiences with it, but I want to know all possibilities. Thanks!
Posted by don_bristol on June 7, 2004, at 7:06:28
In reply to Anyone have a *BAD* experience with Parnate?, posted by PhoenixGirl on June 6, 2004, at 12:08:19
> I'm going to start Parnate in a week, and I want to know if anyone has had a bad experience with it. Seems like a lot of people on here have had good experiences with it, but I want to know all possibilities. Thanks!<
I have just started it. I am pleased with it so far.
Check out this forum http://groups.yahoo.com/group/maois
Posted by harryp on June 8, 2004, at 20:27:44
In reply to Anyone have a *BAD* experience with Parnate?, posted by PhoenixGirl on June 6, 2004, at 12:08:19
Worst things I have heard about Parnate:
1. Some people experience tachycardia (rapid pulse). Usually this can be avoided by breaking up dosages and avoiding caffine until you know how you will respond to it. I have heard of at least one person on this board who had to stop the drug because of this effect--no harm done.
2. Orthostatic hypotension, where a person gets a sudden loss in bp when standing up. It ususally goes away--breaking up dosages helps, as does getting up slowly.
3. Physical fatigue--this was noticeable when I went on the drug and increased the dosages. This SE went away completely for me, though.
4. Sensitivity to cold--very weird effect. I was constantly wearing sweaters and piling blankets on my bed. I think this has gone away, but since it's summer I'm not sure!
5. Insomnia--this can be relieved by Trazodone (which IS safe at low dosages w/Parnate according to the best MAOI literature). I use half a 50mg pill at night and sleep very well.
6. Most users love the stimulant effect of this AD--some find it overstimulating though.
7. I have heard of people who didn't like the strong emotions they felt on Parnate (unlike every other AD I've taken--Parnate DOES NOT blunt emotions; you can feel wonderful or miserable (in a normal way).
In short--watch the diet and read up on EVERY drug you think of taking with it, and you will probably have no problems. I'm amazed that this much-maligned MAOI seems (in general) to have the best SE profile of ANY AD, in addition to being one of the most effective.
Posted by cybercafe on June 9, 2004, at 1:31:58
In reply to Re: Anyone have a *BAD* experience with Parnate?, posted by harryp on June 8, 2004, at 20:27:44
> Worst things I have heard about Parnate:
>
> 1. Some people experience tachycardia (rapid pulse). Usually this can be avoided by breaking up dosages and avoiding caffine until you know how you will respond to it. I have heard of at least one person on this board who had to stop the drug because of this effect--no harm done.
>
> 2. Orthostatic hypotension, where a person gets a sudden loss in bp when standing up. It ususally goes away--breaking up dosages helps, as does getting up slowly.
>
> 3. Physical fatigue--this was noticeable when I went on the drug and increased the dosages. This SE went away completely for me, though.
>
> 4. Sensitivity to cold--very weird effect. I was constantly wearing sweaters and piling blankets on my bed. I think this has gone away, but since it's summer I'm not sure!
>
> 5. Insomnia--this can be relieved by Trazodone (which IS safe at low dosages w/Parnate according to the best MAOI literature). I use half a 50mg pill at night and sleep very well.
>
> 6. Most users love the stimulant effect of this AD--some find it overstimulating though.
>
> 7. I have heard of people who didn't like the strong emotions they felt on Parnate (unlike every other AD I've taken--Parnate DOES NOT blunt emotions; you can feel wonderful or miserable (in a normal way).
>
> In short--watch the diet and read up on EVERY drug you think of taking with it, and you will probably have no problems. I'm amazed that this much-maligned MAOI seems (in general) to have the best SE profile of ANY AD, in addition to being one of the most effective.combining abilify with parnate seems to give me a little orthostatic hypotension when i do martial arts (otherwise unnoticeable) and worsened my acne (already had high testosterone/bad acne though)
Posted by Keith Talent on June 9, 2004, at 8:20:17
In reply to Anyone have a *BAD* experience with Parnate?, posted by PhoenixGirl on June 6, 2004, at 12:08:19
I had a hypertensive crisis after taking it for only seven days, and even then only at 10 mg twice daily. The culprit seemed to be lasagne, which was fine when I had a small amount for dinner, but bad news when I had a lot of it the next day for lunch.
Posted by don_bristol on June 9, 2004, at 11:53:15
In reply to Re: Anyone have a *BAD* experience with Parnate? » PhoenixGirl, posted by Keith Talent on June 9, 2004, at 8:20:17
Keith Talent wrote
> I had a hypertensive crisis after taking it for
> only seven days, and even then only at 10 mg twice
> daily. The culprit seemed to be lasagne, which was
> fine when I had a small amount for dinner, but bad
> news when I had a lot of it the next day for lunch.I too am currently on 10mg Parnate twice daily and I must say I am worried that I might be too careless about my food. I try to be careful but I seem absent minded. And that is a worry. Can I ask you some questions.
What sort of blood pressure did your hypertensive crisis reach?
Did you go to ER?
If so then how long did they keep you for?
Did they use anything to reduce your hypertension?Next week I am in Italy and I like my pasta. If you don't mind, I would like to ask you some questions about the food you ate.
Was your lasagne from a restaurant or the supermarket?
Was it particularly cheesy?
When you say you had a lot of lasagna, can you quantify it in some way.
And when you say you had a small amount, can you quantify that too.Thanks for any info.
Don
Posted by PhoenixGirl on June 9, 2004, at 19:33:04
In reply to Re: Anyone have a *BAD* experience with Parnate? » PhoenixGirl, posted by Keith Talent on June 9, 2004, at 8:20:17
It's my understanding that even the foods you aren't "supposed" to eat, probably won't harm you if you eat only a *small* amount, and let enough time go by between servings. The tyramine effect sort of "builds up" if you eat a lot of it and/or eat it multiple times in a short time frame. I think the bottom line with these foods is keep it small and infrequent.
Posted by Keith Talent on June 10, 2004, at 8:44:03
In reply to Re: Anyone have a *BAD* experience with Parnate? » Keith Talent, posted by don_bristol on June 9, 2004, at 11:53:15
> I must say I am worried that I might be too careless about my food. I try to be careful but I seem absent minded. And that is a worry.
Everyone is "absent-minded" every now and then. The problem is that it takes just one boo-boo to set off the nasty chain of events that both of us are discussing.
After this horrible experience (at the start of this year) I came to the conclusion that in our multicultural societies (all the developed countries - I live in Australia and at a guess I'd say you live in the United States), a fun part of life is to try different types of cuisine. This almost inevitably involves ingesting SOMETHING containing one or more monoamines, whether it be in soy sauce or sauerkraut or fermented cheese. It's one of the benefits of living in multiracial, multicultural, multireligious communities. For example, I love Japanese food, but I was too nervous to eat any whilst on tranylcypromine.
> Can I ask you some questions?
Feel free.
> What sort of blood pressure did your hypertensive crisis reach?
About 240 mm Hg/130 mm Hg
> Did you go to ER?
Definitely. Those events are burned into my memory for ever: it was a Saturday afternoon, about 14:00 when I had lunch. I was relaxing, reading a book, when I noticed (over about half an hour) that my heart rate had become very slow and very strong (as in contractility of the heart). My pulse was what physicians know as a "water hammer" pulse. Even as I remained lying down, I noticed the gradual onset of a severe headache. I tried to shrug it off, put it down to a migraine and go to sleep. It did not go away - it steadily got worse.
I got up, with the thought of a hypertensive crisis in the back of my mind. I gathered my wallet and car keys and went downstairs. By this time I was feeling really weak. My parents were there and I said what I thought was happening. I tried to measure my blood pressure with one of those digital finger-cuff-inflating devices, but kept getting an error message (not reassuring!). I told my parents that I was going to drive to the Emergency Department of a hospital about five minutes drive from my place. Looking back, this was foolish and dangerous - I should have called an ambulance.
When I got to the ED, I said exactly what was going on, but was made to wait, even to see a nurse. The nurse put me on a bed, took my blood pressure and said that she would get a physician soon. Thoughts of having a stroke and dying or being paralysed were rushing through my head, at the same time as I had the worst headache of my life (throbbing, from occipital to frontal regions).
This particular hospital is one I won't be going back to - the ED is staffed by primary care physicians. When one finally took a history and examined me, he did not seem confident to take action to reduce the blood pressure. All he did was conduct an electrocardiogram, take blood samples and arrange a CT brain scan. He deferred (by phone) to an on-call cardiologist, who took an hour or two to arrive.
This guy and I formed an instant mutual dislike - I kept saying "Please, can you give me an alpha-1 antagonist to reduce the blood pressure and (hence) reduce the pain and risk of stroke?", which was even listed in the patient information dispensed with the drug. He dismissively said that my blood pressure was not that high for a young person (I'm 28) and that during weight training exercises, blood presure can go over 300 mm Hg systolic without harm. I have to say that I love that type of exercise, but I have never had any headaches while doing it (even long and intense workouts). He stated that following my suggestion could lead to "cardiovascular instability" - as if having bradycardia alternating with tachycardia plus malignant hypertension did not constitute same. As an aside, it took enormous effort not to vomit in the car. As soon as I arrived, I started vomiting regularly, which went on for six hours.
The CT scanner copped a huge load of vomit when I was insdie it. The radiologist's report said that there was neither any cerebrovascular events nor damage. The pain and vomiting persisted. All the arrogant cardiologist would do was offer two milligrams of morphine (with metoclopramide for the nausea), even though I weigh 110 kilograms. Now, I happen to know that patients who come into the ED with heart attacks are given ten milligrams TO START WITH. He also offered some uselessly low dose of diazepam to calm me down, though I wasn't inappropriately anxious, just extremely ill and weak. He left the hospital ASAP, obviously not wanting to be there on a Saturday night.
I was transferred to a ward. My Mum and girlfriend visited that night. My girlfriend was extremely upset at seeing me like this. My Mum had never wanted me to commence this medication, knowing the dangers. I got virtually no sleep all night, with an electrocardiogram and recorder fitted and hourly nursing observations. In the morning, it was discovered that, due to some mistake, the ECG machine hadn't recorded anything!
Needless to say, my psychiatrist, when I consulted him again a couple of weeks later, agreed with me that a drug should have been administered to lower my blood pressure. He said that every Psychiatry Registrar (trainee) knows this and what to do. After two weeks, I was able to recommence sertraline. When I next saw my primary care physician, I told her about the unpleasant cardiologist, and she said that she has had many similar complaints about him.
> If so then how long did they keep you for?
Overnight
> Did they use anything to reduce your hypertension?No
> Was your lasagne from a restaurant or the supermarket?
Neither, it was home-made.
> Was it particularly cheesy?
Yeah, I guess it was, but I also thought that perhaps the cheese had been broken down a bit overnight, resulting in greater concentrations of tyramine and other amines.
> When you say you had a lot of lasagna, can you quantify it in some way?
From memory, I had about 250 mm long by 150 mm wide by 40 mm deep (cut from a baking dish).
> And when you say you had a small amount, can you quantify that too?
Probably only about 50 mm by 50 mm by 40 mm.
Hope this is of benefit to others, including yourself, Don.
Posted by don_bristol on June 10, 2004, at 14:41:19
In reply to Re: Anyone have a *BAD* experience with Parnate? » don_bristol, posted by Keith Talent on June 10, 2004, at 8:44:03
Keith, that is a great account of what it feels like when having an MAOI hypertensiove crisis. I am very pleased you posted it because I have not come across anything which describes what might happen as well as you have done. Thank you.
I guess there are several lessons to be drawn. One is how hospital ER staff are not sure how to handle an MAOI crisis. Probably because such a thing is not common. There are other useful things in your account too.
Can I ask you about something you wrote. You said to use an 'alpha-1 antagonist' to reduce the blood pressure. I have not heard of that term before. My patient information leaflet in the Uk doesn't contain any information on what to do if there is a hypertensive crisis but it seem that yours does.
What are alpha-1 antagonist normally used for? I would be interested to hear more about these.
BTW not long ago I posted something here about using ther ACE-inhibitor Captopril for a hypertensive crisis. You might want to browse it. http://www.dr-bob.org/babble/20040527/msgs/352527.html
Hope to hear from you.
Don
Posted by Questionmark on June 10, 2004, at 18:25:53
In reply to Anyone have a *BAD* experience with Parnate?, posted by PhoenixGirl on June 6, 2004, at 12:08:19
> I'm going to start Parnate in a week, and I want to know if anyone has had a bad experience with it. Seems like a lot of people on here have had good experiences with it, but I want to know all possibilities. Thanks!
i had a bad experience with Parnate. Actually many of the the things that harryp mentioned hearing, i experienced, among others.
i experienced fluctuations in blood pressure (usually low, with postural hypotension and moderate general dizziness), mild to moderate tachycardia (which did not bother me that much except when in social situations because it made my anxiety worse), physical weakness and fatigue, sensitivity to cold (& yet occasional diaphoresis as well), severe insomnia, nervousness & anxiety (usually but not always), extreme aggravation of my obsessive-compulsiveness (e.g., ruminating, over-focusing, & perfectionism), and extreme emotional sensitivity. This last effect made my depression significantly WORSE instead of better-- it made everything so horribly sad, regretful, painful, depressing, negative and emotional, most of the time. It was not for me.
Also, be very careful with the dietary restrictions-- Parnate is much more liable than Nardil to cause a hypertensive crisis. i had one with a small amount of mac & cheese after only a month or so of being on Parnate, and i have never had a hypertensive reaction from food after 9 months on Nardil (and quite a bit of cheating). But you need not worry as long as you take the necessary precautions.Finally, don't let this discourage you, of course. Many people have benefitted tremendously from Parnate-- oftentimes when nothing else would benefit them. Good luck.
Posted by don_bristol on June 12, 2004, at 8:07:18
In reply to Re: Anyone have a *BAD* experience with Parnate? » PhoenixGirl, posted by Questionmark on June 10, 2004, at 18:25:53
PhoenixGirl wrote:
> be very careful with the dietary restrictions-- Parnate
> is much more liable than Nardil to cause a hypertensive
> crisis. i had one with a small amount of mac & cheese
> after only a month or so of being on Parnate, and i have
> never had a hypertensive reaction from food after 9 months
> on Nardil (and quite a bit of cheating).
PhoenixGirl, how much Parnate were you taking?Do you know what your blood pressure was?
Did you have to go to ER?
Thanks for any info.
Posted by harryp on June 12, 2004, at 13:35:36
In reply to Re: Anyone have a *BAD* experience with Parnate? » don_bristol, posted by Keith Talent on June 10, 2004, at 8:44:03
My God, that makes me sick...I'm really sorry about your experience...
I posted a bunch of stuff on treating MAOI induced HP crises a while back. It's my 5/27/04 post "Nardil Food Reaction." The whole thread is very good.
Posted by Questionmark on June 13, 2004, at 5:10:54
In reply to Re: Anyone have a *BAD* experience with Parnate? » Questionmark, posted by don_bristol on June 12, 2004, at 8:07:18
> PhoenixGirl wrote:
>
> > be very careful with the dietary restrictions-- Parnate
> > is much more liable than Nardil to cause a hypertensive
> > crisis. i had one with a small amount of mac & cheese
> > after only a month or so of being on Parnate, and i have
> > never had a hypertensive reaction from food after 9 months
> > on Nardil (and quite a bit of cheating).
>
>
> PhoenixGirl, how much Parnate were you taking?i'm not PhoenixGirl. i was only on 20mg at the time i think. It may have been 30mg though.
> Do you know what your blood pressure was?
i did not go to the emergency room or have my blood pressure taken. Sorry.
> Did you have to go to ER?
>
> Thanks for any info.i wrote a post about it after it happened (i think May of 2003). i took a few propranolol, a little Klonopin, and some Risperdal, and then after about 40 minutes maybe, i fell asleep for awhile (about a few hours i think). That was not by any means an appropriate treatment for a dangerous hypertensive reaction, but i did not want (my parents) to pay several hundred dollars or so for me to go to the E.R., so i took the risk. The Risperdal helped a good deal i think, though i wouldn't recommend it unless you have nothing else on hand. Also, i didn't really think of this at the time, but it might not have been the smartest thing to stay lying down as i did (instead of keeping my head straight up).
It was definitely a bad experience, and very painful, but it did not compare to the only other time i've had a hypertensive reaction (and the only time on Nardil)-- when i took two 25mg tablets of ephedrine, being comPLETEly idiotic and forgetful (i still have no idea how i could have been that stupid & didn't think about the fact that ephedrine is one of the worst things you can take with an MAOI, as far as hypertensive reactions go). That time i DID go to the E.R., and endured at least two hours of shear agony before finally being treated. i can't remember for sure, but my blood pressure went up to about 180/111 i think. (i posted about that here as well-- sometime in March or April 2004). So anyway my b.p. from the Parnate induced hypertension had to have been at least somewhat less than 180/111. It was still terrible though.
Sorry if this was more information than you wanted.
Posted by blnch on June 13, 2004, at 14:42:38
In reply to Re: Anyone have a *BAD* experience with Parnate? » PhoenixGirl, posted by Questionmark on June 10, 2004, at 18:25:53
> i had a bad experience with Parnate. Actually many of the the things that harryp mentioned hearing, i experienced, among others.
> i experienced fluctuations in blood pressure (usually low, with postural hypotension and moderate general dizziness), mild to moderate tachycardia (which did not bother me that much except when in social situations because it made my anxiety worse), physical weakness and fatigue, sensitivity to cold (& yet occasional diaphoresis as well), severe insomnia, nervousness & anxiety (usually but not always), extreme aggravation of my obsessive-compulsiveness (e.g., ruminating, over-focusing, & perfectionism), and extreme emotional sensitivity. This last effect made my depression significantly WORSE instead of better-- it made everything so horribly sad, regretful, painful, depressing, negative and emotional, most of the time. It was not for me.
> Also, be very careful with the dietary restrictions-- Parnate is much more liable than Nardil to cause a hypertensive crisis. i had one with a small amount of mac & cheese after only a month or so of being on Parnate, and i have never had a hypertensive reaction from food after 9 months on Nardil (and quite a bit of cheating). But you need not worry as long as you take the necessary precautions.
>
> Finally, don't let this discourage you, of course. Many people have benefitted tremendously from Parnate-- oftentimes when nothing else would benefit them. Good luck.I also had a bad experience with Parnate.
I experienced all the symptoms quoted above, with an emphasis on my BP going critically LOW.In addition, I became so irritably depressed that instead of the suicidal thoughts of killing myself by running headlong into a truck that I've been known to experience while NOT medicated, with Parnate I found myself wildly disinhibited - as in taking MANY driving risks and just not caring what happened. I definitely developed a death wish. And, no, it has been confirmed that I am not Bipolar. I have recurrent Major Depessive Illness.
Also, I had much GI distress on Parnate.
I had SO hoped that Parnate would be effective for me! I HAD to discontinue - absolutely no choice.
Seems bad experiences other than diet- restrictions related are rare, but I would feel remiss if I did not post mine, "just in case."
Good luck.
This is the end of the thread.
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