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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by girlnterrupted78 on April 28, 2007, at 19:11:33
I'm going to be starting Nardil in a few weeks, so I'm starting to think about all the risks associated with MAOIs.
So my question is the following:
If for any reason I had some kind of accident, and/or required surgery, would Nardil make it impossible for me to be given any kind of anesthesia? I read that local or full anesthesia are contraindicated with MAOIs, so what would happen in such a situation? Would I have to be operated without anesthesia?
A similar question is that I am having some dental procedures done, which also require local anesthesia. How would one proceed in such a situation?
And after surgery, I would also need pain-killers to minimize the pain. Are there any substitutes for the ones contraindicated with MAOIs?
Thanx in advance for any info
Posted by Phillipa on April 28, 2007, at 20:18:49
In reply to Important Question About Nardil, posted by girlnterrupted78 on April 28, 2007, at 19:11:33
Important questions. I know there are. Someone will pop in and answer I'm sure. Love Phillipa
Posted by Racer on April 28, 2007, at 20:43:54
In reply to Important Question About Nardil, posted by girlnterrupted78 on April 28, 2007, at 19:11:33
My understanding is that if the doctors know you're taking an MAOI, they can be prepared to address interactions if they have to give you anesthesia. Whether that means using alternate anesthetics, or mitigating the hypertensive reaction to standard anesthetics, I don't know. I don't think there's a doctor alive today who would perform surgery without anesthetic, though, even in an emergency.
As for dental work, I suspect the answer is that, for planned procedures, you stop the MAOI for a period before the procedure, and after. That's only a guess, though.
I very strongly urge you, though, to get some sort of MedAlert bracelet. Something that tells the world of emergency medicine professionals that you are taking an MAOI.
I hope that helps. I'm hardly an expert, so I hope someone with more knowledge will jump in, too.
Posted by UgottaHaveHope on April 28, 2007, at 22:38:51
In reply to Re: Important Question About Nardil » girlnterrupted78, posted by Racer on April 28, 2007, at 20:43:54
Posted by naughtypuppy on April 29, 2007, at 9:01:56
In reply to Re: Important Question About Nardil » girlnterrupted78, posted by Racer on April 28, 2007, at 20:43:54
> My understanding is that if the doctors know you're taking an MAOI, they can be prepared to address interactions if they have to give you anesthesia. Whether that means using alternate anesthetics, or mitigating the hypertensive reaction to standard anesthetics, I don't know. I don't think there's a doctor alive today who would perform surgery without anesthetic, though, even in an emergency.
>
> As for dental work, I suspect the answer is that, for planned procedures, you stop the MAOI for a period before the procedure, and after. That's only a guess, though.
>
It's ok to have dental work as long as they dont add epiniphrine to the novacaine. Just tell the dentist hat you are on an MAOI and they can give you pure novacaine. Post op demerol is ok as well.
> I very strongly urge you, though, to get some sort of MedAlert bracelet. Something that tells the world of emergency medicine professionals that you are taking an MAOI.Definatly!
>
> I hope that helps. I'm hardly an expert, so I hope someone with more knowledge will jump in, too.
Posted by Girlnterrupted on April 30, 2007, at 19:57:26
In reply to Re: Important Question About Nardil » girlnterrupted78, posted by Phillipa on April 28, 2007, at 20:18:49
> Important questions. I know there are. Someone will pop in and answer I'm sure. Love Phillipa
How is your post supposed to help me, Phillipa? Sorry, I'm just confused about what is the message you're trying to convey here or why you felt the need to post that. Thanks.
Posted by Phillipa on April 30, 2007, at 20:47:55
In reply to Re: Important Question About Nardil, posted by Girlnterrupted on April 30, 2007, at 19:57:26
Maybe I don't have the answer to your questions but someone will be with you shortly that does and they did. Encouragment. Don't like to see answers ingnored totally. Does this make sense? Love Phillipa
Posted by Phillipa on April 30, 2007, at 20:49:22
In reply to Re: Important Question About Nardil » girlnterrupted78, posted by Racer on April 28, 2007, at 20:43:54
Kind of the same as Racers but she knew more than me. Love Phillipa
Posted by Jedi on May 1, 2007, at 2:59:14
In reply to Re: Important Question About Nardil, posted by naughtypuppy on April 29, 2007, at 9:01:56
> "It's ok to have dental work as long as they dont add epiniphrine to the novacaine. Just tell the dentist that you are on an MAOI and they can give you pure novacaine. Post op demerol is ok as well."
Hi,
I have to jump in on this one. It is never OK to give Demerol(meperidine) with a MAOI. In fact this is one med that you should list on your bracelet.Meperidine and a MAOI given together can cause a fatal reaction! I've had general surgery for a broken leg while on Nardil. The anesthesiologist must know you are on a MAOI. Some narcotic pain relievers are fine with MAOIs. Just be careful.
Be Well,
Jedi
Posted by UgottaHaveHope on May 1, 2007, at 3:47:11
In reply to Re: Important Question About Nardil, posted by naughtypuppy on April 29, 2007, at 9:01:56
An ex-spouse or angry business partner? Thats a deadly combo. Please dont take it.
Posted by notfred on May 1, 2007, at 15:40:20
In reply to Re: Important Question About Nardil, posted by naughtypuppy on April 29, 2007, at 9:01:56
No synthetic opioid is ever OK with a MAOI.
Posted by Declan on May 1, 2007, at 16:13:59
In reply to Demerol is NOT OK !!!!, posted by notfred on May 1, 2007, at 15:40:20
I knew someone collapse (in public) from Demerol and Parnate.
He did survive, but it was serious.
Posted by Jedi on May 1, 2007, at 20:01:49
In reply to Re: Demerol is NOT OK !!!!, posted by Declan on May 1, 2007, at 16:13:59
This Dr. Ken Gillman sure seems to know his MAOIs. - Jedi
Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity
P. K. Gillman E-mail: kg@matilda.net.auPioneer Valley Private Hospital, Mackay, Queensland 4740, Australia
Link to Full Text
http://bja.oxfordjournals.org/cgi/content/full/95/4/434Abstract:
Toxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by clonus, hyper-reflexia, hyperthermia and agitation. Serotonergic side-effects occur with serotonergic drugs, and overdoses of serotonin re-uptake inhibitors (SRIs) frequently produce marked serotonergic side-effects, and in 15% of cases, moderate serotonergic toxicity, but not to a severe degree, which produces hyperthermia and risk of death. It is only combinations of serotonergic drugs acting by different mechanisms that are capable of raising intra-synaptic serotonin to a level that is life threatening. The combination that most commonly does this is a monoamine oxidase inhibitor (MAOI) drug combined with any SRI. There are a number of lesser-known drugs that are MAOIs, such as linezolid and moclobemide; and some opioid analgesics have serotonergic activity. These properties when combined can precipitate life threatening serotonin toxicity. Possibly preventable deaths are still occurring. Knowledge of the properties of these drugs will therefore help to ensure that problems can be avoided in most clinical situations, and treated appropriately (with 5-HT2A antagonists for severe cases) if they occur. The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.
This is the end of the thread.
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