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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 pedr on October 9, 2010, at 23:05:16
Hi babblers,
last week I suffered a hypertensive crisis seemingly after drinking one pint of draft beer. A quite frightening and excruciatingly painful experience.It appears to have happened again tonight after drinking a single bottle of lager (my head is still hurting). Oddly I've been drinking this bottled lager the whole time I've been on Nardil and never even had a hint of headache even after four or five of them. Same with white wine.
I'm trying to work out what's changed. The main thing that springs to mind about tonight is that I took my 12mg of Zelnorm (for IBS) along with my 6pm dose of Nardil. Normally I take the Zelnorm in the morning.
Now, I know of no interaction between Nardil and Zelnorm and Google comes up dry too. Neither are reported to be contraindicated by the other on their PDR's. AFAICR Zelnorm cannot cross the blood-brain barrier and exclusively acts on serotonergic receptors in the gut. Therefore pharmacologically, this cannot be the cause. But I'm no p-doc of course.
Has anyone heard of any Zelnorm-Nardil interplay? Does anyone have any other suggestions as to why I've suddenly had 2 strong reactions to beer? Here are the symptoms:
--last week: 1 minute after finishing first pint got neck pain, then strong headache at base of skull. Constantly increasing in intensity and moving forwards towards forehead. Within 5 minutes it was unbearable. After 30 minutes the pain settled around right eye for about 2 hours, slowly decreasing as did my blood pressure (sounds like http://en.wikipedia.org/wiki/Papilledema#Signs_and_symptoms ). For the following three days I had intermittent, strong headaches but bottled lager was OK.
--tonight: sipped first bottle, headache came on very rapidly after about 5 minutes. Immediately settled around right eye primarily, but whole right-side of skull very sore to touch. Right eye bloodshot and painful to see with, especially light. Ended up taking hot bath with lights out to combat vasoconstriction and lower BP which helped. +4 hours still have quite strong headache (and am typing with makeshift patch over right eye!).
I'd really appreciate some ideas because I am fairly concerned. Not just about these episodes but of the prospect of giving up beer... o_0
Pete
Posted by Phillipa on October 9, 2010, at 23:27:01
In reply to Zelnorm + Nardil = Hypertensive episode?, posted by pedr on October 9, 2010, at 23:05:16
Beer has to go for now at least. How horrible for you. Phillipa
Posted by emmanuel98 on October 10, 2010, at 0:03:27
In reply to Zelnorm + Nardil = Hypertensive episode?, posted by pedr on October 9, 2010, at 23:05:16
One of the things they say to never use while on nardil is draft beer. Bottled beer can be okay but is not recommended. Red wine is out. White wine is okay in moderate quantities. There are never use alcohols -- draft beer, vermouth, chianti, a few others. If I had drunk a draft beer and had a severe occipital headache, I'd have gone straight to the ER.
Posted by angels78 on October 10, 2010, at 3:08:39
In reply to Zelnorm + Nardil = Hypertensive episode?, posted by pedr on October 9, 2010, at 23:05:16
If the maoi diet says dont drink alky
DONT DRINK ALKY
its not that difficult. i cant stand when people push and push the limits.
Posted by pedr on October 10, 2010, at 9:40:03
In reply to Re: Zelnorm + Nardil = Hypertensive episode?, posted by emmanuel98 on October 10, 2010, at 0:03:27
>>> One of the things they say to never use while on nardil is draft beer.
Yeah I know. Such is human nature I guess that some of us get tempted - I just love draft beer. Especially since I was visiting London at the time. My usual regimen when in a pub/bar was always 1 draught pint then bottles. Never even had so much as a hint of a headache. I'm not going to say that I've "learnt my lesson" since I've always known there was a risk but I can say that I'm never, EVER having a draught pint again...>>> Bottled beer can be okay but is not recommended. Red wine is out. White wine is okay in moderate quantities. There are never use alcohols -- draft beer, vermouth, chianti, a few others.
I drink white wine all the time at home and have had no problems. I feel that if you stick to a few select brands, you're probably going to be alright.
>>> If I had drunk a draft beer and had a severe occipital headache, I'd have gone straight to the ER.
I didn't want to create a fuss (stupidly). I wanted to see if it wasn't very transient before calling in an ambulance. However after 10 minutes of solid excruciating pain I could stand no more and called 999. All they did was monitor my BP since they carry no meds. Then after waiting about 1.5 hours in A&E a doc checked me out for stroke symptoms and that was it. I guess that's what you get for free...
However this is all incidental to my question: why the sudden occurrences? Is it anything to do with taking Zelnorm+Nardil at the same time?
Cheers,
Pete
Posted by pedr on October 10, 2010, at 10:08:39
In reply to Re: Zelnorm + Nardil = Hypertensive episode? » pedr, posted by angels78 on October 10, 2010, at 3:08:39
> If the maoi diet says dont drink alky
>
> DONT DRINK ALKY
>
> its not that difficult. i cant stand when people push and push the limits.Hi,
if you'd get down from your soapbox one second, perhaps you'd begin to see the inaccuracy and obnoxiousness of your post.1/ you are wrong about the MAOI diet. See http://www.dr-bob.org/babble/20010804/msgs/73614.html. See http://home.caregroup.org/clinical/altmed/interactions/Nutrients/Tyramine-Contai.htm. See http://www.dr-bob.org/babble/20010814/msgs/75408.html. See http://www.dr-bob.org/tips/maoi.html.
No source I can find says to avoid "ALKY" period. Perhaps you should get your facts straight before you consider lecturing and admonishing someone - you may well appear less foolish.2/ Do you think that all MAOI users avoid all deli meats? all deli sandwiches ever? According to your logic they should because they can't be sure if that meat has been correctly handled nor how long it has been on display.
And you yourself - you've never broken the rules? in any aspect of your life? Are you perfect? If you are then that's both incredible and wonderful but I suggest you give us mere mortals a break. You will appear less obnoxious and self-righteous. If you're not perfect then you're being hypocritical.
I can't stand it when people are being hypocritical.
Posted by Maxime on October 10, 2010, at 15:38:05
In reply to Zelnorm + Nardil = Hypertensive episode?, posted by pedr on October 9, 2010, at 23:05:16
I have heard of people drinking beer with Nardil ... but not 4-5 of them. Try things in moderation with an MAOI. For instance I love cheese! Love it! But we are not supposed to eat it. So I tried a 2 x 2 piece and nothing happened. I did the same the next week and I was able to eat a bit more with no reaction. But I am not going to push it now.
I don't think it was Zelnorm, but the beer.
It's scary that you are still having problems with headaches. I would stop the med and see your doctor because what you describe sounds like a heart attack ir stroke looming in the background.I am sure he will be able to help you.
I take Parnate and my pdcoc says that if I am having headaches at the back of my head to stop the Parnate and see him. Back of the head seems to be key.
I hope you can sort everything out.
Posted by emmanuel98 on October 10, 2010, at 20:06:04
In reply to Re: Zelnorm + Nardil = Hypertensive episode? » pedr, posted by Maxime on October 10, 2010, at 15:38:05
Deli meats are fine except for aged meats like salami. Also old or rotting meats must be avoided, but they should be avoided anyway, for lots of reasons. Alcohol is okay, especially white wine, if used in moderation.
Beers are dangerous, especially drafts. I don't think it was the zelnorm but the draft. The reason drafts are more dangerous than bottled beer is that the tubes aren't always cleaned and this causes a build-up of tyramine. So you can have a draft in one place and be fine and then go to another pub and have a problem.
By the way, if you went to a hospital in the US, they would do the same thing. Keep you in the ER, monitor BP, watch for signs of stroke or dangerous BP levels, then send you home. It's just that I'd rather hang around the ER for a few hours than hang around at home if I had a severe occipital headache (back of head).
Like Maxine, I have cheese sometimes in small amounts. I am careful though and don't want to push the envelope. My p-doc told me that these food restrictions are tendencies, not certainties. If the were certainties (pepperoni cheese and chianti = death) no one would ever precribe an MAOI.
Posted by angels78 on October 11, 2010, at 2:41:33
In reply to Re: Zelnorm + Nardil = Hypertensive episode?, posted by pedr on October 10, 2010, at 10:08:39
im just watching your back since we go back 3 days
Posted by pedr on October 11, 2010, at 12:22:06
In reply to Re: Zelnorm + Nardil = Hypertensive episode? » pedr, posted by Maxime on October 10, 2010, at 15:38:05
>>> I have heard of people drinking beer with Nardil ... but not 4-5 of them. Try things in moderation with an MAOI. For instance I love cheese! Love it! But we are not supposed to eat it. So I tried a 2 x 2 piece and nothing happened. I did the same the next week and I was able to eat a bit more with no reaction. But I am not going to push it now.
really? I've conversed with plenty of folk who drink several draught beers on a regular basis. I'm not that reckless, I only used to have 1 before switching to bottled beer. You did read the links I posted yes? All of them say that bottled beer is pretty much safe. Therefore I see no reason not to drink bottled beer.
BTW you be careful too! I've read several sources that say that the following can happen :
- have some tyramine-containing food (e.g. aged cheese). No reaction.
- have same amount 14 times more. No reaction.
- 16th time - bang - reaction.
I've not read why this can happen, just that it's been observed.What's a 2x2 piece? BTW you are also aware that American and Mozarella cheese are also OK to eat? They have very low levels of tyramine. Probably why they have no taste :/ I eat turkey&American cheese sandwiches every day at work (boring, I know but I have IBS also).
>
> I don't think it was Zelnorm, but the beer.
>But on what basis? And how does this explain the headache I got on Friday after not even 1 bottle of Heineken, of which I've drank literally 100's during the last year on Nardil? Makes no sense.
> It's scary that you are still having problems with headaches. I would stop the med and see your doctor because what you describe sounds like a heart attack ir stroke looming in the background.I am sure he will be able to help you.
Respectfully but No way! I'll stop alcohol or anything else before I stop Nardil. It gave me life. Without it I'd rather be dead anyway.
>
> I take Parnate and my pdcoc says that if I am having headaches at the back of my head to stop the Parnate and see him. Back of the head seems to be key.
>
> I hope you can sort everything out.Thanks for your kind regards. So far today (fingers crossed) my headache has gone. I also happen to have a stinking cold and that's laid off a little too which is a relief!
Cheers,
Pete
Posted by pedr on October 11, 2010, at 12:30:15
In reply to Re: Zelnorm + Nardil = Hypertensive episode?, posted by emmanuel98 on October 10, 2010, at 20:06:04
>>> Deli meats are fine except for aged meats like salami. Also old or rotting meats must be avoided, but they should be avoided anyway, for lots of reasons. Alcohol is okay, especially white wine, if used in moderation.
with all due respect, what is the purpose of regurgitating this summary? Did you not see all the links that were posted? Also, how do you know how long deli meat has been on display? You can't. If it's been out for 2-3 days and not appropriately refrigerated, it could have high levels of tyramine. For this reason I only buy sealed deli meats from decent stores.
>>> Beers are dangerous, especially drafts.
Not true. Bottled beer is not dangerous. Please read the bucketload of links I posted.
>>> I don't think it was the zelnorm but the draft. The reason drafts are more dangerous than bottled beer is that the tubes aren't always cleaned and this causes a build-up of tyramine. So you can have a draft in one place and be fine and then go to another pub and have a problem.
Again, that does not explain my second reaction to a sole bottle of Heineken.
>>> By the way, if you went to a hospital in the US, they would do the same thing. Keep you in the ER, monitor BP, watch for signs of stroke or dangerous BP levels, then send you home. It's just that I'd rather hang around the ER for a few hours than hang around at home if I had a severe occipital headache (back of head).
I see. Would they have some pain management solutions though? I was in absolute agony and they just idly chatted with my drunk friends for 20 minutes before I thought to ask! Even then all they could give was a gas that is administered to women in labour. All it did was make me nauseous as well as in agony lol.
>>> Like Maxine, I have cheese sometimes in small amounts. I am careful though and don't want to push the envelope. My p-doc told me that these food restrictions are tendencies, not certainties. If the were certainties (pepperoni cheese and chianti = death) no one would ever precribe an MAOI.
Agreed. I think as humans we occasionally give in to temptation and even part of us wants to see for ourselves what our limit is. I've learnt my lesson, that's for sure. Even though I didn't die (unless this is all a dream, like Dallas...) the sheer pain is enough to put me off draught beer forever.
Pete
Posted by pedr on October 11, 2010, at 12:32:00
In reply to Re: Zelnorm + Nardil = Hypertensive episode? » pedr, posted by angels78 on October 11, 2010, at 2:41:33
> im just watching your back since we go back 3 days
for real man, true dat. I got yours too. Just stop sniffing the glue, OK? (jus kiddin)
Posted by Dr. Bob on October 12, 2010, at 14:30:55
In reply to Re: Zelnorm + Nardil = Hypertensive episode?, posted by pedr on October 10, 2010, at 10:08:39
> the inaccuracy and obnoxiousness of your post.
Please don't post anything that could lead others to feel accused or put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person, and I'm sorry if this hurts you.
More information about posting policies and tips on alternative ways to express yourself, including a link to a nice post by Dinah on I-statements, are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
This is the end of the thread.
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