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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by nix on November 21, 2013, at 0:13:08
Hi longtime lurker, first post.
Me in a nutshell:
Highly refractory atypical depression (occasional catatonic episodes) plus the usual collection of other diagnoses accumulated over the years. Been on just about everything in the book.Current situation: Recently switched from a (to use Dr. Stephen Stahl's terminology) heroic combo "California Rocket Fuel" [450mg Effexor (venlafaxine) + 60mg Remeron (mirtazepiene)], + 90mg Dexedrine (dextroamphetamine sulfate) to EMSAM (selegiline "transdermal system"). This was instigated at my own request, because a) there's was really no more room to add anything with my cocktail, and b), to paraphrase Dr. Stahl again, the goal of treatment is remission, not merely response.
Having to come off off everything first to switch to an MAOI was indescribably awful. But significant response, within two days! If anyone's interested in hearing more about this I'd be happy to share, but otherwise, staying on topic:
First followup after starting EMSAM, my psychiatrist, who until now I have held in very high regard, prescribed nifedipine and instructed to it take it PRN for suspected hypertensive crises.
Wen't home, made a sandwich, casually typed 'nifedipine' into my browser and settled in for some light reading. Found:
http://en.wikipedia.org/wiki/Nifedipine#Uses
http://www.dr-bob.org/tips/split/Nifed-MAOI-hypertension.html
http://www.dr-bob.org/babble/20110822/msgs/994751.htmlI know one is not supposed to flush meds down the toilet. I have never done so before.
I have also never been prescribed medication which, when used for the very indication for which it has been prescribed, apparently has a >30% likelihood of inducing heart attack and a >10% likelihood of inducing DEATH.
First time for everything I guess. Sorry, fishy friends.
A couple of ativan and deep breaths later: obviously, I'm going to have to reach my own decision here, and everyone is different, so I'm not asking what I should do.
But what would you do?
Go to your psychiatrist, inform them of what you've found, and try to 'work it out'?Or start looking for a new one?
I'm leaning toward the latter, but I HATE having to switch psychiatrists. But this seems like a huge and really dangerous error to me. This practice was supposed to abandoned 15+ years ago. On the other hand, MAOI's are still rarely prescribed, and I guess she could have just, I don't know, missed the memo?
Ugh. Thoughts?
Posted by atypical on November 21, 2013, at 0:34:05
In reply to Prescribed nifedipine with MAOI! Find a new p-doc?, posted by nix on November 21, 2013, at 0:15:09
Nix,
It is fairly customary for pdocs to prescribe nifedipine with an MAOi. My pdocs have done so. I have only had a tyramine reaction once. The "danger" is in nifedipine making blood pressure too low. Knowing this, when I had the reaction, I bit into a nifedipine cspsule and consumed only half of the contents. My blood pressure eventually reached normal.
Anyway, don't count out your doctor just yet!
Atypical
Posted by Phillipa on November 21, 2013, at 9:01:23
In reply to Re: Prescribed nifedipine with MAOI! Find a new p-doc?, posted by atypical on November 21, 2013, at 0:34:05
Haven't taken the Maoi's but seems like a good number of those that have on here do have nifedipine prescribed for them. Phillipa
Posted by stargazer2 on November 21, 2013, at 22:23:50
In reply to Re: Prescribed nifedipine with MAOI! Find a new p-doc?, posted by Phillipa on November 21, 2013, at 9:01:23
I took Nifedipine after I had a hypertensive reaction but my doc never prescribes it anymore. I think they just want you to go to the ER if you have a hypertensive reaction. Most peopl are not prepared to know what to do for this reaction since unless you have a BP cuff the only sign you might be having a reaction is a severe headache.
I had enough training and experience to feel I could handle something like this but your average person would not be able to know what to do so taking Nifedipine is proably not a good thing to give a patient unless they're in the medical field.
Stargzer
This is the end of the thread.
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