Posted by Suiram on February 7, 2007, at 0:22:01
In reply to Re: Got some thru a dif. pharmacy...relieved! :) » NYCguy, posted by Crazy Horse on February 3, 2007, at 11:36:41
Hi. This is my first post here, I think (I've used similar forums before, but can't recall having used this one, though I've read it for a while).
I used the Goldshield Tranylcypromine generic from the UK for a few months at a dose of 2.3mg/kg/day. Tried it in combination with several other drugs, all properly prescribed, including Edronax (reboxetine), Dexedrine (d-amphetamine) and Subutex (buprenorphine), with the latter being the most effective, and to date the only thing that made me feel like a human again (in fact, I soon felt remarkably like my old self, which others commented on).
However, at one point, I had to switch to another generic, called Jatrosom, from Germany. Where I live, medical care is public, and you are required to accept a generic substitute if it is cheaper, or pay the difference yourself, which I couldn't afford.
Soon thereafter, I developed acne, rashes (not S-J) and sleep abnormalities (even relative to what I had, and not just insomnia; vivid nightmares; four-level deep dream-within-a-dream waking-up sequences; periodic extreme hypersomnia, etc.).
After a few days, I started compulsively popping the acne, to the point where large areas of skin would be left a bloody mess; I still have scars from this.
After about a week, I got hypocondriac tendencies that by the end of that week bordered on psychosis.
Then I developed hallucinations, and the hypocondriac issue developed into a full-blow psychosis, including delusional parasitosis that didn't exactly help the skin issue.
After about a month (I can't believe I made it that far without someone recognizing that this stuff was really screwing me up; I'm usually a very composed person, to the point that I knew that I realized I was psychotic and had to do conscious reality testing to try to "hang on"), things got really bad blood-pressure-wise...
Now, I'm not talking about a hypertensive crisis, though I have had one of those several months later (250/180 when I administered the nifedipine on my way to the medical ward). I'm talking about the exact opposite: hypotension bordering on circulatory collapse. Fortunately, my dependant was elsewhere, and my parents could take me in and care for me.
The first measurement I have is from a visit to the medical ward (subsequent to fainting and having a brief seizure with cramping without full loss of consciousness, though I certainly wasn't truly there either) where they had to wheelchair me in so I wouldn't faint again. The doctor blinked and rechecked manually. Twice. It was 50 over 30 while sitting relaxed.
Noone had any idea what they should do, since I wasn't hypovolemic, and administering adrenaline or other pressor agents to someone on parnate... well, at least they realized they shouldn't do *that*.
I finally convinced them to make a new Rx for the Goldshield brand (we don't have to pay the extra if a doctor states that a specific brand must be used for medical reasons) and let me check back in in 3 days, rather than administering me to the hospital. My experiences with docs and pdocs have been less than satisfactory, so I didn't want to risk (in my view) that.
3 days later, I was no longer psychotic (after weeks), and the low blood pressure was slowly reversing, as were the other complications.
It took me months to recover to 90%, at which point my recovery was cut short by the second anecdote.
You see, my S.O. was also using tranylcypromine, although at doses around 30mg/day, and had to switch brands a little after I did.
She started out with rashes too (although she didn't get the "bleeding wounds" level of rash), and developed what might be called subclinical psychosis ("hysteric" would be the colloquial term for the main problem) as well, although it all developed more slowly for her, and reversed much more quickly.
When I had my hypotension problem, she was at her mother's place, which is good. However, her mother got ill from the stress of caring for her (she was going through a rough patch, and the creeping onset of the Jatrosom-induced problems wasn't helping any). Instead of trying to sort out a way to deal with this situation, her mother had a doctor (who never met her) forcefully commit her (picked up by 3 police officers) to the secure observation facility at a psychiatric hospital 3 hours away.
Now, for some, this wouldn't be a problem. For an Asperger with a history of bad run-ins with pdocs and strong issues about loosing control etc., it was rape. Pure and simple; and she has some grounds for comparison in that regard.
So I had to abort my bed rest, and band-aid myself with stimulants to the point where I could get on a plane, a taxi, two buses and another taxi (8 hours in all) and pick her up. The psychiatrist on duty had straight away confirmed that she had no need of even observation, but couldn't sign her out, as only the head pdoc can do that in the secure ward, and he wouldn't be there until the next day. Of course, they can't ship her anywhere, and no way would she trust her mother to pick her up after that incident, so I was the only one that could do it. As bad as she got from the experience she had there, I can honestly say it was the right thing to do, despite the risk to myself.
Of course, after this experience, life was walking on eggshells for months, and I was nowhere near functional yet ("broken" would be the term, as in "broken toy" or something).
A couple of days after picking her up, I got the hypertensive episode, seemingly unprovoked, though tranylcypromine has always lowered my usually slightly-elevated-but-stable blood pressure. I won't go into what that was like. If you've had one, you know what it's like, if you haven't, you don't, and should avoid finding out at any cost.
The fact that two people got similar problems from the same switch in drugs in such a way would seem to strongly support the notion that this most likely is linked to the switch, particularly since we switched at somewhat different times and both had a dose-dependant increase per unit time in the problems, and different ceiling levels.
The requirements for FDA approval for a generic are far less than for the parent drug (I seem to recall 24 patients, as opposed to 2400, being the minimum subject group, with the same inclusion criteria as the parent drug; i.e. ones rarely seen in clinical practice).
In short, switching brands may not always be harmless, although it will work fine in *most* cases. Heck, they wouldn't be producing that brand if it didn't have happy customers...
It certainly f*cked up my life and health, though, which were both really crap already, because of some idiot that refused to listen when I explained that I'm hypersensitive to antipsychotics...
Sorry for the lengthy and excessively detailed post, but it's hard not to rant with something like this.
I'm not going to suggest staying away from the generics (my original brand *was* generic), but I'd recommend sticking with whatever brand you get, just in case.
When you start low and go slow, as one usually does with tranylcypromine (parnate/jatrosom/...) to avoid the problems with transient blood pressure elevation, you'll pick up any problems early on, and can switch.
Switching when you're at 1mg/kg/dy or more is a *lot* more likely to give complications, I think. For instance, oral bioavailability can probably vary a bit between brands. Probably not enough to cause problems at the doses used in generic equivalency trials (usually 30mg or less), but it adds up at the higher doses.
poster:Suiram
thread:729121
URL: http://www.dr-bob.org/babble/20070201/msgs/730665.html