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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by KaraS on December 19, 2004, at 19:29:41
Can maprotiline be taken with an MAOI?
I've been thinking of taking a small amount of maprotiline (or trimipramine) for anxiety problems until I can start on an MAOI or something else after I talk to my doctor early next year. The Rx lists I've seen all say that you can't take it with an MAOI but they say the same thing for all TCAs and I know that Surmontil can be taken with them in limited amounts.
Also, on the Rx list for maprotiline (and not for trimipramine) it said do not take this if you're on thyroid medication. They had a separate line for hyperthyroid. The Surmontil listing only said don't take if you're hyperthyroid. I am hypothyroid and take medication for that. I have taken maprotiline for years and I'm pretty sure I took it while I was also taking thyroid medication. I only took a small amount of it though. Anyone know why they have that warning on the MAP? Should I be concerned about it?
K
Posted by SLS on December 20, 2004, at 7:16:18
In reply to Maprotiline + MAOI?, posted by KaraS on December 19, 2004, at 19:29:41
Hi Kara.
> Can maprotiline be taken with an MAOI?
I don't know for sure, but I would guess that you can. I'm sure you are aware that it is a relatively selective inhibitor of NE reuptake relative to 5-HT. However, I would be more inclined to go with nortriptyline or trimipramine or even desipramine if you are intent on using a TCA for anxiety and are looking for compatability with an MAOI.
What other treatments have you considered for anxiety? Do you have these medications on hand? Zyprexa would be effective I bet, and would probably add some AD effects. It is also compatable with MAOI.
My guess is that the contraindications for hyperthyroid patients of TCAs and maprotiline involves NE reuptake inhibition, anticholinergic effects, and the consequences these actions have on an already accelerated heart-rate, palpitations, and arrythmias. Remember, however, that thyroid hormone is often given in supratherapeutic dosages to augment TCAs. I wouldn't worry too much about it.
If you are going to choose Parnate, it would be a good idea to monitor for a hypertensive reaction upon initiating treatment. This sometimes occurs as a startup effect, and is not dosage dependant. Symptoms of a reaction would include:
• occipital headache which may radiate frontally
• palpitation
• neck stiffness or soreness
• nausea or vomiting
• sweating (sometimes with fever and sometimes with cold, clammy skin)
• photophobia
• either tachycardia or bradycardia
• constricting chest pain
• dilated pupils
- Scott
Posted by darkhorse on December 20, 2004, at 8:26:31
In reply to Maprotiline + MAOI?, posted by KaraS on December 19, 2004, at 19:29:41
Yes you can.
Maprotiline is the most selective AD with regards to NE inhibition more than Nort,Desip,Proto,and rebox. It has no activity on the 5ht...I've tried it with Parnate with no side effects.
Posted by KaraS on December 21, 2004, at 23:03:10
In reply to Re: Maprotiline + MAOI?, posted by darkhorse on December 20, 2004, at 8:26:31
Posted by KaraS on December 21, 2004, at 23:45:18
In reply to Re: Maprotiline + MAOI? » KaraS, posted by SLS on December 20, 2004, at 7:16:18
> Hi Kara.
>
> > Can maprotiline be taken with an MAOI?
>
> I don't know for sure, but I would guess that you can. I'm sure you are aware that it is a relatively selective inhibitor of NE reuptake relative to 5-HT. However, I would be more inclined to go with nortriptyline or trimipramine or even desipramine if you are intent on using a TCA for anxiety and are looking for compatability with an MAOI.I would prefer nort. or desipramine bu they cause tachycardia for me so that wouldn't be great for the anxiety now. Trimipramine would probably be a good bet. I have mixed feelings about going to an atypical AP if I have other options though.
> What other treatments have you considered for anxiety? Do you have these medications on hand? Zyprexa would be effective I bet, and would probably add some AD effects. It is also compatable with MAOI.
>Doxepin and maprotiline and the SSRIs have all worked really well for me for anxiety. Right now all I'm taking is niacinamide. It acts like a strong benzo for me only it's not as clean feeling (strong antihistaminic effects) but since I develop tolerance almost immediately to benzos, this has been an unbelievable help. It's allowed me to function somewhat until I can talk to my doctor and get on something else. Today I felt almost normal once I had taken my morning dose.
> My guess is that the contraindications for hyperthyroid patients of TCAs and maprotiline involves NE reuptake inhibition, anticholinergic effects, and the consequences these actions have on an already accelerated heart-rate, palpitations, and arrythmias. Remember, however, that thyroid hormone is often given in supratherapeutic dosages to augment TCAs. I wouldn't worry too much about it.
>That was my guess too and I understood why they would say don't take if you are hyperthyroid. I just didn't understand why they'd say don't take if you're taking thyroid meds period. Maybe it's another one of those times where they're covering their butts.
> If you are going to choose Parnate, it would be a good idea to monitor for a hypertensive reaction upon initiating treatment. This sometimes occurs as a startup effect, and is not dosage dependant. Symptoms of a reaction would include:
>
> • occipital headache which may radiate frontally
> • palpitation
> • neck stiffness or soreness
> • nausea or vomiting
> • sweating (sometimes with fever and sometimes with cold, clammy skin)
> • photophobia
> • either tachycardia or bradycardia
> • constricting chest pain
> • dilated pupils
>
>
> - Scott
How common is it to have one of these start up effects from Parnate? That list is enough to scare anyone to death. What we go through just to feel normal! I have my doubts whether I'll be able to tolerate Parnate or Nardil. When I take dopaminergics, they put me to sleep at first and then in time they make me feel sick. My head starts to feel like it's going to explode. Or, maybe I'll just have to go really slowly and I'll have the same kind of experience that Todd had only probably more intense.Anway, thanks for all of the information and advice.
Kara
Posted by SLS on December 22, 2004, at 0:56:53
In reply to Re: Maprotiline + MAOI? » SLS, posted by KaraS on December 21, 2004, at 23:45:18
> > If you are going to choose Parnate, it would be a good idea to monitor for a hypertensive reaction upon initiating treatment. This sometimes occurs as a startup effect, and is not dosage dependant. Symptoms of a reaction would include:
> >
> > • occipital headache which may radiate frontally
> > • palpitation
> > • neck stiffness or soreness
> > • nausea or vomiting
> > • sweating (sometimes with fever and sometimes with cold, clammy skin)
> > • photophobia
> > • either tachycardia or bradycardia
> > • constricting chest pain
> > • dilated pupils
> >
> >
> > - Scott
>
> How common is it to have one of these start up effects from Parnate?Extremely uncommon. Maybe just short of rare?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8399806
> That list is enough to scare anyone to death.
I know. However, I'm sure you've read enough drug monographs to understand that listings of side effects are always scary viewed with perspective.
> What we go through just to feel normal!
No sheet.
> I have my doubts whether I'll be able to tolerate Parnate or Nardil. When I take dopaminergics, they put me to sleep at first and then in time they make me feel sick.
I would not consider MAOIs as being "dopaminergic". They do not cause an artificial massive release of dopamine or inhibit its reuptake the way amphetamine and methylphenidate do respectively. Parnate, of course, can be stimulating. I don't know if the mechanism behind this effect has been fully elucidated, but it does not appear that there are any amphetamine like metabolites that would be responsible for it.
> My head starts to feel like it's going to explode.
That's just because you have packed too much information in your skull from all of the reading you have been doing. I wouldn't be surprised if it's leaking out your ears.
> Or, maybe I'll just have to go really slowly and I'll have the same kind of experience that Todd had only probably more intense.
What was this?
- Scott
Posted by KaraS on December 24, 2004, at 14:39:02
In reply to Re: Maprotiline + MAOI? » KaraS, posted by SLS on December 22, 2004, at 0:56:53
> > > If you are going to choose Parnate, it would be a good idea to monitor for a hypertensive reaction upon initiating treatment. This sometimes occurs as a startup effect, and is not dosage dependant. Symptoms of a reaction would include:
> > >
> > > • occipital headache which may radiate frontally
> > > • palpitation
> > > • neck stiffness or soreness
> > > • nausea or vomiting
> > > • sweating (sometimes with fever and sometimes with cold, clammy skin)
> > > • photophobia
> > > • either tachycardia or bradycardia
> > > • constricting chest pain
> > > • dilated pupils
> > >
> > >
> > > - Scott
> >
> > How common is it to have one of these start up effects from Parnate?
>
> Extremely uncommon. Maybe just short of rare?
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8399806
>
Thanks. I'd like to get ahold of that whole article. I'll have to do more research into it - though maybe this is one of those times where I'd be better off not doing any more research.
> > That list is enough to scare anyone to death.
>
> I know. However, I'm sure you've read enough drug monographs to understand that listings of side effects are always scary viewed with perspective.
Very true. (Why should the MAOIs be any different?)
> > What we go through just to feel normal!
>
> No sheet.
>
> > I have my doubts whether I'll be able to tolerate Parnate or Nardil. When I take dopaminergics, they put me to sleep at first and then in time they make me feel sick.
>
> I would not consider MAOIs as being "dopaminergic". They do not cause an artificial massive release of dopamine or inhibit its reuptake the way amphetamine and methylphenidate do respectively. Parnate, of course, can be stimulating. I don't know if the mechanism behind this effect has been fully elucidated, but it does not appear that there are any amphetamine like metabolites that would be responsible for it.Yes but it does make more dopamine available in the synapses (along with other neurotransmitters), no? I wonder if the stimulant effect isn't more similar to what the stimulating noradrenergic TCAs do? If that were the case, then I'd probably get tachycardia from it. (But then there's only one way to find that out.)
> > My head starts to feel like it's going to explode.
>
> That's just because you have packed too much information in your skull from all of the reading you have been doing. I wouldn't be surprised if it's leaking out your ears.:-)))
> > Or, maybe I'll just have to go really slowly and I'll have the same kind of experience that Todd had only probably more intense.
>
> What was this?
Todd felt tired and more depressed (don't know if there was any headache or feeling of increased pressure) at each dosage increase of Parnate for at least a week. He attributed this to the possible downregulating of dopamine autoreceptors.Kara
This is the end of the thread.
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