Psycho-Babble Medication Thread 1056037

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Parnate help: drug interaction

Posted by kirbyw on December 12, 2013, at 20:04:39

I have been on Parnate nearly 30 years. It still seems to work. Trials on Remeron and Effexor have failed miserably.
But now I have a new problem. I have been having attacks of shortness of breath, but my cardiac exams are ok. And both medicines suggested by my cardiologist (here in Costa Rica) are contraindicated with MAOs. (Salbutamol and trimetazidine) So does anyone know of anything that can help attacks of shortness of breath that are MAO compatible? these attacks are very unpleasant and last up to two hours. Thanks so much. Rick in Costa Rica.

 

Re: Parnate help: drug interaction » kirbyw

Posted by ed_uk2010 on December 13, 2013, at 14:54:36

In reply to Parnate help: drug interaction, posted by kirbyw on December 12, 2013, at 20:04:39

Hi Rick.

>I have been having attacks of shortness of breath, but my cardiac exams are ok.

What is the cause of these attacks? Do you think they are anxiety related? Do you feel a sense of panic? Also, have you ever suffered from asthma? Please can you list your medical problems/history and any other medication you take apart from Parnate. It may be appropriate to see a lung specialist. Does your chest feel tight when you have these attacks? What does it feel like?

>And both medicines suggested by my cardiologist (here in Costa Rica) are contraindicated with MAOs. (Salbutamol and trimetazidine) So does anyone know of anything that can help attacks of shortness of breath that are MAO compatible?

Trimetazidine is normally used to prevent angina. Do you suffer from chest pains? Why are you seeing a cardiologist specifically?

Salbutamol is a bronchodilator which relieves asthma attacks and COPD. There is very little evidence or logic behind the idea that standard doses of salbutamol are unsafe for patients on MAOIs. There appears to be a single case report of a man on an MAOI who felt rather anxious and suffered increased heart rate after using a salbutamol inhaler, but these are common side effects of salbutamol anyway. Salbutamol is a short-acting drug, so the effects will wear off fairly quickly if it doesn't suit you. It does tend to increase heart rate and cause a fine tremor of the hands. On the other hand, it can certainly relieve breathlessness caused by bronchospasm. It should be used with caution if you have coronary heart disease.

Salbutamol does not cause hypertension when combined with MAOIs. It should not be confused with related drug which do eg. ephedrine, pseudoephedrine. These drugs have a different mechanism of action to salbutamol.

Salbutamol by mouth causes far more side effects. Only the inhaler is recommended for asthma.

Take care.


 

Re: Parnate help: drug interaction

Posted by kirbyw on December 15, 2013, at 3:30:18

In reply to Re: Parnate help: drug interaction » kirbyw, posted by ed_uk2010 on December 13, 2013, at 14:54:36

From one of many websites regarding salbutamol which is also known as albuterol: What can I say?

***********************************************

What may interact with this medicine?

Do not take this medicine with any of the following medications:
MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate

This medicine may also interact with the following medications:
diuretics
medicines for depression, anxiety, or psychotic disturbances
medicines for irregular heartbeat
medicines for weight loss including some herbal products
methadone
pimozide
some medicines for blood pressure or the heart
sertindole

Read more: http://www.answers.com/topic/albuterol-sulfate-ipratropium-bromide-nebulizer-solution#ixzz2nXAGGaqJ

Rick

 

Re: Parnate help: drug interaction » kirbyw

Posted by SLS on December 15, 2013, at 6:40:34

In reply to Re: Parnate help: drug interaction, posted by kirbyw on December 15, 2013, at 3:30:18

Hi Rick.

Ed will probably double check his sources, but I have always found his input to be amazingly broad and accurate. He is fallable, but his track record is quite good - better than mine, anyway.

Just as with the advice coming from Babblers, one must scrutinize the writings of others to be found elsewhere. Almost every drug manufacturer will stay away from endorsing the use of their products in combination with MAOIs, even if no untoward events have been reported. Of course, it is better to err on the side of caution with MAOIs. My *guess* is that some of the side effects of albuterol might increase, but that the combination otherwise safe.

My recent treatments have included a combination of Parnate (tranylcypromine), nortriptyline, and Focalin (dexmethylphenidate). I was able to discontinue the Focalin once my dosage of Parnate was increased to 100 mg/day.

What about trying a beclomethazone inhaler? It is a corticosteroid that does not interact with MAOIs.


- Scott

 

Re: Parnate help: drug interaction » kirbyw

Posted by ed_uk2010 on December 15, 2013, at 10:19:05

In reply to Re: Parnate help: drug interaction, posted by kirbyw on December 15, 2013, at 3:30:18

>From one of many websites regarding salbutamol which is also known as albuterol: What can I say?

Like Scott said, manufacturers are very keen to protect themselves by claiming that their medicines are safe with MAOIs. I looked into a possible interaction with salbutamol but you find virtually nothing apart from a case report of someone who experienced what appear to be normal side effects of salbutamol eg. tremor etc.

MAOIs interact with indirect-acting sympathomimetics such as ephedrine, phenylpropanolamine and pseudoephedrine because the combination leads to large amounts of sympathomimetic amines being released, which causes hypertension. MAOIs do not appear to interact with direct-acting selective beta-2 agonists, such as salbutamol and terbutaline. I checked a few sources. The UK BNF, which does not list an interaction. The UK product information for salbutamol and Parnate, which does not list an interaction. And I checked a specialist drug interactions textbook, which just lists the case report of someone who had 'side effects' after the combination, as mentioned above. Couldn't find anything online either, apart from vague warnings to avoid sympathomimetics, apparently written by people who do not realise there are different kinds of sympathomimetics. Salbutamol just seems to get lumped together with related drugs which do interact. Frankly, internet drug interaction checkers are often of very poor quality.

Just in case of potentiation, you'd want to start with one puff of the 100mcg salbutamol inhaler and then one more after about 10 minutes if needed. Doses can then by used every few hours, but only during attacks, salbutamol is not a good preventive. You may experience side effects, but they are unlikely to be severe unless you inhale too many doses. Salbutamol relieves bronchospasm eg. in asthma but will not relieve breathlessness causes by panic attacks - which may be aggravated.

If you have indeed developed asthma, a regular steroid inhaler should be used. Have you been tested for asthma?

In asthma (except severe chronic asthma), attacks of breathlessness and chest tightness are usually intermittent. They are sometimes brought on by exercise (normally in children) or things being sprayed into the air eg. perfumes.

Breathlessness in panic attacks in always intermittent.

Breathlessness in heart disease is usually quite long term but with exacerbations. It is worse on lying down, especially at night,

Breathlessness in COPD is always chronic, but with exacerbations brought on by infection.

 

Re: Parnate help: drug interaction » SLS

Posted by ed_uk2010 on December 15, 2013, at 12:00:25

In reply to Re: Parnate help: drug interaction » kirbyw, posted by SLS on December 15, 2013, at 6:40:34

>He is fallable

:)

 

Re: Parnate help: drug interaction

Posted by jono_in_adelaide on December 15, 2013, at 22:24:18

In reply to Parnate help: drug interaction, posted by kirbyw on December 12, 2013, at 20:04:39

I have used salbutamol via an inhaler (albuterol to the Americans) with MAOI's with no dangerous side effects

Not sure about oral salbutamol though

If you need an oral drug. theophyline or one of its derivatives should be safe

 

Re: Parnate help: drug interaction

Posted by kirbyw on December 30, 2013, at 5:34:04

In reply to Re: Parnate help: drug interaction » kirbyw, posted by ed_uk2010 on December 15, 2013, at 10:19:05

Thanks for all the advice. I am going to see a lung specialist this week, and hopefully will get some guidelines. Based on the experiences referred to in the postings, it seems safe to try salbutamol. Physicians here in Costa Rica know nothing of MAOIs so I can't get any help there.
Also it would appear from what I have read that cortosteroid based medications for shortness of breath (mainly for asthma, apparently) have no MAO interactions, and can be used preventatively, but will not relieve an episode once it starts while salbutamol will.

I do have heart disease. I had bypass surgery six years ago, and I just went through extensive testing just before Christmas including an ecocardiogram and a nuclear stress test (in which I was not on the treadmill-instead they used a chemical called adenosine to replicate exercise). In both tests I came out ok, so they are saying that there is no cardiac related explanation for the shortness of breath. By the way, I have not gone to the hospital for these episodes of shortness of breath They are mild (although very uncomfortable at the same time) but I have an oxygen saturation device and my oxygen saturation level is always around 94 or so during the episodes, a figure which does not require hospital based intervention. After one or two hours, the problem clears up. Thanks again for the advice. Rick

 

Re: Parnate help: drug interaction » kirbyw

Posted by ed_uk2010 on December 30, 2013, at 13:49:59

In reply to Re: Parnate help: drug interaction, posted by kirbyw on December 30, 2013, at 5:34:04

>Based on the experiences referred to in the postings, it seems safe to try salbutamol.

It should be OK but you may experience the usual side effects eg. tremor. Just try one inhalation and repeat after 10 mins if needed, and if tolerated.

>Also it would appear from what I have read that cortosteroid based medications for shortness of breath (mainly for asthma, apparently) have no MAO interactions, and can be used preventatively, but will not relieve an episode once it starts while salbutamol will.

That is all correct.

>I do have heart disease.

Salbutamol is widely used in patients with heart disease, but can at times be a problem because it increases heart rate at high doses. This may provoke angina, but given your recent stress test results, this seems unlikely to be a problem. Unfortunately, some meds used in heart disease eg. beta blockers, can sometimes cause breathlessness.

You really need a diagnosis from your lung specialist, in order to determine the cause of your symptoms and formulate an appropriate treatment plan.


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