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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by delna on October 20, 2009, at 23:27:50
Ok,
Since my doctor is so clueless I wrote to Dr Ivan Goldberg with some questions about Parnate.My questions are in normal caps- his replies are in full caps.
Hope this is helpful to other Parnate- newbies tooMy questions are as follows:
1)Which side effects are transient and which aren't?
IT IS IMPOSSIBLE TO STATE TO WHICH SIDE EFFECTS PEOPLE MAY DEVELOP TOLERANCE.
- Hypotension (not only orthostatic and despite dose splitting)
-Afternoon sedation despite the addition of a stimulating drug (Provigil 200mg in my case and normal sleep at night)
2)I am on 30mg/day so far and plan to increase to a much higher dose. Does the drug become more stimulating as the dose is escalated because right now I feel more exhausted and apathetic than usual?
WHILE SOME PEOPLE BECOME MORE STIMULATED WITH HIGHER DOSES OTHER BECOME MORE LETHARGIC
3)Is it true that a combination of Parnate and a stimulant can precipitate dyskinesias? Is Provigil considered to be a stimulant in that respect.
THE COMBINATION OF PARNATE AND ONE OF THE STIMULANTS IS OFTEN A USEFUL ONE. WHILE MANIA, HYPERTENSION, AND DYSKINETIC MOVEMENTS ARE ALL POSSIBLE, I HAVE SELDOM SEEN THEM IN PATIENTS ON THE COMBINATION. PROVIGIL IS A PSYCHOSTIMULANT.
4)How high a dose of Provigil could one take with Parnate (I understand if you do not want to comment on this one as there is no safety guidelines available - but a rough guess would do)
200 MG/DAY IS THE HIGHEST DOSE I HAVE USED . . . IT IS WELL ABOVE THE FDA APPROVED LABELING.
5)How long is a fair trail for Parnate? I believe it is longer than for most drugs. I am specially concerned about how long symptoms like the innate exhaustion of BP depression generally take to lift. (In fact I was led to believe that Parnate is highly stimulating which so far has not been so)
I ASK MY PATIENTS TO TOLERATE AN 8-WEEK TRIAL AT THE MAXIMALLY TOLERATED DOSE OF PARNATE.
----------
That's it!
So, this means that it is not true that in all people the side-effects will pass. Nor will they improve at a higher dose for some. I think this will influence my decision whether or not to continue.Take care everyone,
Hope Parnate is helping you and that your side effects will pass. I'm not so sure mine will- once a drug sedates me, it always sedates me.... :(Love D
Posted by MAxime on October 20, 2009, at 23:45:54
In reply to Parnate-Sharing Dr Ivan Goldberg's A's to my Q's, posted by delna on October 20, 2009, at 23:27:50
Thanks for sharing that. The thing is, it's impossible to know if the side effects will continue or not. The only way to find out is to stick with the med. :-) Maybe the side effects will change when you get to a higher dose. You just never know. I hope that you will stick with it.
Posted by ColoradoSnowflake on October 21, 2009, at 1:33:40
In reply to Parnate-Sharing Dr Ivan Goldberg's A's to my Q's, posted by delna on October 20, 2009, at 23:27:50
Hi Delna:
That's really great you wrote to Dr. Goldberg! No messing around. Go right to the expert! I love it!
Thanks!
Gayle
Posted by Phillipa on October 21, 2009, at 10:27:41
In reply to Parnate-Sharing Dr Ivan Goldberg's A's to my Q's, posted by delna on October 20, 2009, at 23:27:50
Delna I admire you for going to the direct source. So much misinformation out there. Just shows what helps some doesn't help all. Any idea what your next trial will be? Love Phillipa
Posted by bulldog2 on October 21, 2009, at 10:35:46
In reply to Parnate-Sharing Dr Ivan Goldberg's A's to my Q's, posted by delna on October 20, 2009, at 23:27:50
> Ok,
> Since my doctor is so clueless I wrote to Dr Ivan Goldberg with some questions about Parnate.My questions are in normal caps- his replies are in full caps.
> Hope this is helpful to other Parnate- newbies too
>
>
>
> My questions are as follows:
>
> 1)Which side effects are transient and which aren't?
>
> IT IS IMPOSSIBLE TO STATE TO WHICH SIDE EFFECTS PEOPLE MAY DEVELOP TOLERANCE.
>
> - Hypotension (not only orthostatic and despite dose splitting)
>
> -Afternoon sedation despite the addition of a stimulating drug (Provigil 200mg in my case and normal sleep at night)
>
> 2)I am on 30mg/day so far and plan to increase to a much higher dose. Does the drug become more stimulating as the dose is escalated because right now I feel more exhausted and apathetic than usual?
>
> WHILE SOME PEOPLE BECOME MORE STIMULATED WITH HIGHER DOSES OTHER BECOME MORE LETHARGIC
>
> 3)Is it true that a combination of Parnate and a stimulant can precipitate dyskinesias? Is Provigil considered to be a stimulant in that respect.
>
> THE COMBINATION OF PARNATE AND ONE OF THE STIMULANTS IS OFTEN A USEFUL ONE. WHILE MANIA, HYPERTENSION, AND DYSKINETIC MOVEMENTS ARE ALL POSSIBLE, I HAVE SELDOM SEEN THEM IN PATIENTS ON THE COMBINATION. PROVIGIL IS A PSYCHOSTIMULANT.
>
> 4)How high a dose of Provigil could one take with Parnate (I understand if you do not want to comment on this one as there is no safety guidelines available - but a rough guess would do)
>
> 200 MG/DAY IS THE HIGHEST DOSE I HAVE USED . . . IT IS WELL ABOVE THE FDA APPROVED LABELING.
>
> 5)How long is a fair trail for Parnate? I believe it is longer than for most drugs. I am specially concerned about how long symptoms like the innate exhaustion of BP depression generally take to lift. (In fact I was led to believe that Parnate is highly stimulating which so far has not been so)
>
> I ASK MY PATIENTS TO TOLERATE AN 8-WEEK TRIAL AT THE MAXIMALLY TOLERATED DOSE OF PARNATE.
>
> ----------
> That's it!
>
>
>
>
> So, this means that it is not true that in all people the side-effects will pass. Nor will they improve at a higher dose for some. I think this will influence my decision whether or not to continue.
>
> Take care everyone,
> Hope Parnate is helping you and that your side effects will pass. I'm not so sure mine will- once a drug sedates me, it always sedates me.... :(
>
> Love DA question about how long to stay on parnate? Does Dr. Goldberg mean a total trial of 8 weeks? Or eight weeks at the highest dose you have achieved?
Posted by bulldog2 on October 21, 2009, at 12:21:28
In reply to Parnate-Sharing Dr Ivan Goldberg's A's to my Q's, posted by delna on October 20, 2009, at 23:27:50
> Ok,
> Since my doctor is so clueless I wrote to Dr Ivan Goldberg with some questions about Parnate.My questions are in normal caps- his replies are in full caps.
> Hope this is helpful to other Parnate- newbies too
>
>
>
> My questions are as follows:
>
> 1)Which side effects are transient and which aren't?
>
> IT IS IMPOSSIBLE TO STATE TO WHICH SIDE EFFECTS PEOPLE MAY DEVELOP TOLERANCE.
>
> - Hypotension (not only orthostatic and despite dose splitting)
>
> -Afternoon sedation despite the addition of a stimulating drug (Provigil 200mg in my case and normal sleep at night)
>
> 2)I am on 30mg/day so far and plan to increase to a much higher dose. Does the drug become more stimulating as the dose is escalated because right now I feel more exhausted and apathetic than usual?
>
> WHILE SOME PEOPLE BECOME MORE STIMULATED WITH HIGHER DOSES OTHER BECOME MORE LETHARGIC
>
> 3)Is it true that a combination of Parnate and a stimulant can precipitate dyskinesias? Is Provigil considered to be a stimulant in that respect.
>
> THE COMBINATION OF PARNATE AND ONE OF THE STIMULANTS IS OFTEN A USEFUL ONE. WHILE MANIA, HYPERTENSION, AND DYSKINETIC MOVEMENTS ARE ALL POSSIBLE, I HAVE SELDOM SEEN THEM IN PATIENTS ON THE COMBINATION. PROVIGIL IS A PSYCHOSTIMULANT.
>
> 4)How high a dose of Provigil could one take with Parnate (I understand if you do not want to comment on this one as there is no safety guidelines available - but a rough guess would do)
>
> 200 MG/DAY IS THE HIGHEST DOSE I HAVE USED . . . IT IS WELL ABOVE THE FDA APPROVED LABELING.
>
> 5)How long is a fair trail for Parnate? I believe it is longer than for most drugs. I am specially concerned about how long symptoms like the innate exhaustion of BP depression generally take to lift. (In fact I was led to believe that Parnate is highly stimulating which so far has not been so)
>
> I ASK MY PATIENTS TO TOLERATE AN 8-WEEK TRIAL AT THE MAXIMALLY TOLERATED DOSE OF PARNATE.
>
> ----------
> That's it!
>
>
>
>
> So, this means that it is not true that in all people the side-effects will pass. Nor will they improve at a higher dose for some. I think this will influence my decision whether or not to continue.
>
> Take care everyone,
> Hope Parnate is helping you and that your side effects will pass. I'm not so sure mine will- once a drug sedates me, it always sedates me.... :(
>
> Love DI was on a site askaptient where you can see how a drug is rated. The ssris came in with ratings in the 3 area. By the way the system was 1 -5 with 5 being the best. Nardil and parnate had ratings over 4 so the maois had the best ratings.So maybe give parnate more time as it may be a better ad than the newer ads.
Posted by delna on October 21, 2009, at 12:35:56
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's, posted by bulldog2 on October 21, 2009, at 12:21:28
> I was on a site askaptient where you can see how a drug is rated. The ssris came in with ratings in the 3 area. By the way the system was 1 -5 with 5 being the best. Nardil and parnate had ratings over 4 so the maois had the best ratings.So maybe give parnate more time as it may be a better ad than the newer ads.Yes, I have visited that site and people really rave about Parnate. I'm sure it is better than the newer AD's, its considered the ultimate AD by many people (apart from the dangerous side effects)
I am continuing taking my dose but plan to titrate up faster and then make a decision about it.
But I am so glad I asked Dr Goldberg especially about the Provigil. He said 200mg max (and if you read his tips on the drug tips page you will see that he is not a doctor who is scared to augment freely).
My doctor told me that I can take 600mg + of Provigil (which frankly I was dubious about in the first place)! Glad I double checked.
TC
D
Posted by delna on October 21, 2009, at 12:37:54
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » delna, posted by Phillipa on October 21, 2009, at 10:27:41
> Delna I admire you for going to the direct source.
Thanks Phillipa but desperate times call for desperate measures... :-)
>So much misinformation out there. Just shows what helps some doesn't help all.
You know that's what I like about certain doctors - they tell it like it is (even if it's not what you want to hear). Unlike my doctor who has been making grand but false promises about Parnate.
>Any idea what your next trial will be?I think an SNRI that's heavily augmented...
Thanks for asking, Phillipalove
D
Posted by Phillipa on October 21, 2009, at 20:15:06
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » Phillipa, posted by delna on October 21, 2009, at 12:37:54
Delna your're welcome think your're making a wise choice. You say heavily augmented any idea what the augmentation will be or thoughts on it? Curious to see as need to know others ideas. Love Phillipa
Posted by Maxime on October 21, 2009, at 20:41:19
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » delna, posted by Phillipa on October 21, 2009, at 20:15:06
I don't think Delna has given up on the Parnate yet ....
Posted by delna on October 21, 2009, at 20:52:26
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » Phillipa, posted by Maxime on October 21, 2009, at 20:41:19
Posted by Phillipa on October 21, 2009, at 22:10:21
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » Phillipa, posted by Maxime on October 21, 2009, at 20:41:19
I see. Good luck to you both and continue posting. Love Phillipa
Posted by Sunbath on October 22, 2009, at 6:47:35
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » Maxime, posted by Phillipa on October 21, 2009, at 22:10:21
Posted by jane d on October 23, 2009, at 19:17:55
In reply to Re: Parnate-Sharing Dr Ivan Goldberg's A's to my Q's » bulldog2, posted by delna on October 21, 2009, at 12:35:56
> But I am so glad I asked Dr Goldberg especially about the Provigil. He said 200mg max (and if you read his tips on the drug tips page you will see that he is not a doctor who is scared to augment freely).
> My doctor told me that I can take 600mg + of Provigil (which frankly I was dubious about in the first place)! Glad I double checked.
> TC
> D
>
Are you sure he was talking about the Provigil and not the Parnate? You quote him as saying 200 mg is above the FDA labeling which just isn't true for Provigil. Provigil actually comes in 200mg tablets and that is a standard dose. It would be a high dose for Parnate however. Or perhaps it is just a typo.I have no idea whether 600 mg is a reasonable dose of Provigil. I've never taken more than 200 myself although I've heard other people do. Cost alone would be enough to keep me from trying larger amounts.
Jane
Posted by delna on October 23, 2009, at 23:40:59
In reply to Provigil dose » delna, posted by jane d on October 23, 2009, at 19:17:55
Hi
I think he means with the Parnate although there isn't any actually any FDA recommendation about the combination. So yes, that is confusing. The other bit that confused me was that in a thread (in pbabble tips, he says he gives around 60mg of Ritalin to Parnate patients. There is no way 200mg Provigil is equivalent to 60mg of Ritalin. 60mg Ritalin is high.About the 600mg, when I was in NYC I was seeing a pdoc. He wasn't happy to give me more than 400mg (with Geodon + Lexapro +Lamictal). So he sent me to his senior colleague ( a very learned pdoc) who said, in my case, with my history I could take 600mg max. He also warned me of the risks of increasing the dose to this level.
So 600mg is an okay dose but with the Parnate, who's to know. My pdoc here, in India, is happy to take risks (which is what I like about him in, a way) but sometimes he's just rash and makes things up with no medical backing or experience. There's absolutely no legal protection for patients here which means doctors can get away with anything! So I take everything he says with a pinch of salt and look things up.
Here's the link to Dr Goldberg's answer. I too was surprised....
http://en.allexperts.com/q/Bipolar-Disorder-2192/2009/10/Parnate.htm
Take care
D
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