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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Melanie on October 4, 1999, at 9:28:30
Hi,
Anyone with experience with conteracting the negative side effects of nardil - particularly weight gain and sexual dysfunction. I realize that most experienced psychopharmacologists with cautiously combine other drugs with MAOI's. Less experienced psychdocs and, in particular, family physicians, tend to avoid MAOI's altogether.
Specifically, has anyone ever been prescribed both Wellbutron and Nardil? Or, low dose selegiline and Nardil? Again, these combinations are contraindicated, but experienced psychopharmacologists seem to be able to cautiously manage these.
Thanks.
Posted by anita on October 5, 1999, at 17:36:45
In reply to Offsetting side effects of Nardil?, posted by Melanie on October 4, 1999, at 9:28:30
I used a relatively low dose of Wellbutrin with Nardil
with no problems. Experienced pdocs are not uncomfortable prescribing the two
together as long as the patient had no prior problems with serotonin/norep syndrome.
It did seem to help with the sexual dysfunction and increased my energy, but did nothing
for weight gain. I definitely would not combine selegiline at any dose with Nardil -- way
too risky. Nardil can also be combined with Ritalin, Adderall, and reboxetine, but I don't know if
they would affect sexual stuff or weight.anita
> Hi,
>
> Anyone with experience with conteracting the negative side effects of nardil - particularly weight gain and sexual dysfunction. I realize that most experienced psychopharmacologists with cautiously combine other drugs with MAOI's. Less experienced psychdocs and, in particular, family physicians, tend to avoid MAOI's altogether.
>
> Specifically, has anyone ever been prescribed both Wellbutron and Nardil? Or, low dose selegiline and Nardil? Again, these combinations are contraindicated, but experienced psychopharmacologists seem to be able to cautiously manage these.
>
> Thanks.
Posted by Rick on October 5, 1999, at 18:53:04
In reply to Re: Offsetting side effects of Nardil?, posted by anita on October 5, 1999, at 17:36:45
My MAOI-fan pdoc switched me to Selegiline the same day I took my last Nardil (after about 4 days winding down from 75mg to 15mg). I started at 5mg Selegiline, and gradually increased to 15. Well, orgasms did not return until almost FOUR WEEKS after the switch, so even IF the augmentation is safe, it may not help out sexually. Of course, I may be atypical: I started Nardil just as I was embarking on the first concerted diet in my life -- and I lost 30 pounds with *less* effort than I expected. I"m glad I hadn't read the weight-gain stories at that point, or it might have psyched me out (oops...is that phrase verboten in this forum?)
But *many* other Nardil side effects hit me big time. Besides the sexual effects, for example, it turned me from moderately hypertensive into consistently hypotensive! So I don't know if I was the most typical patient to use in judging your own possible responses. The only side effect I LOVED was the lack of dreaming (my dreams tend to annoy me). No food-related problems, even though all I really avoided was tap beer and anything more than a few small nibbles of aged cheese.
(CAUTION: YMMV foodwise!!!!)BTW, once the orgasms finally returned, Selegiline's aphrodaisical qualities were very much (perhaps too much) in evidence. It may have had some other nice qualities, too (energy, cognitive enhancement), but it certainly did not help with anxiety (at that dose, anyways), and the entire reason for my treatment was Social Anxiety.
Rick
--------------------------------------
I used a relatively low dose of Wellbutrin with Nardil
with no problems. Experienced pdocs are not uncomfortable prescribing the two
together as long as the patient had no prior problems with serotonin/norep syndrome.
It did seem to help with the sexual dysfunction and increased my energy, but did nothing
for weight gain. I definitely would not combine selegiline at any dose with Nardil -- way
too risky. Nardil can also be combined with Ritalin, Adderall, and reboxetine, but I don't know if
they would affect sexual stuff or weight.anita
>Hi,
>
>Anyone with experience with conteracting the negative side effects of nardil - particularly weight gain and sexual dysfunction. I realize that most experienced psychopharmacologists with cautiously combine other drugs with MAOI's. Less experienced psychdocs and, in particular, family physicians, tend to avoid MAOI's altogether.
>
>Specifically, has anyone ever been prescribed both Wellbutron and Nardil? Or, low dose selegiline and Nardil? Again, these combinations are contraindicated, but experienced psychopharmacologists seem to be able to cautiously manage these.
>
>Thanks
Posted by Rick on October 5, 1999, at 19:17:49
In reply to Re: Offsetting side effects of Nardil?, posted by Rick on October 5, 1999, at 18:53:04
Wait...now I remember a few more details which may be significant on the safety front:
My pdoc actually started me on 5mg Selegeline about a week BEFORE I finished with Nardil. (I still can't recall if this was an attempt to help sexual dysfunction; an attempt to augment Nardil's fading anxiety-fighting efffects; or a weaning process.) I DO recall him saying "you're really not supposed to mix these but..."
In any event, after taking Nardil and Selegiline together the first time, I took my blood pressure about one-half hour later, and instead of the usual Nardil-induced 90/60, it read 220/120!! But I felt fine, save for a mild but painless coolness in the top of my head. I thought maybe some of my breakfast fruit had been overripe (a few of the tyramine lists warn against over-ripe fruit potentially causing hypertensive crises with MAOI's). Well, within 1/2 hour, I was back down to 120/75. Maybe the BP machine was broken? NOPE!
Next three mornings, exactly the same thing: Take Nardil + 5mg. Selegiline...1/2 hour later have BP of about 200/115 + mild, painless, cool sensation on top of head...and back to normal readings within 1/2 hour. The pdoc said he never heard of such a thing. Weird!Rick
-------------------
> My MAOI-fan pdoc switched me to Selegiline the same day I took my last Nardil (after about 4 days winding down from 75mg to 15mg). I started at 5mg Selegiline, and gradually increased to 15. Well, orgasms did not return until almost FOUR WEEKS after the switch, so even IF the augmentation is safe, it may not help out sexually. Of course, I may be atypical: I started Nardil just as I was embarking on the first concerted diet in my life -- and I lost 30 pounds with *less* effort than I expected. I"m glad I hadn't read the weight-gain stories at that point, or it might have psyched me out (oops...is that phrase verboten in this forum?)
>
> But *many* other Nardil side effects hit me big time. Besides the sexual effects, for example, it turned me from moderately hypertensive into consistently hypotensive! So I don't know if I was the most typical patient to use in judging your own possible responses. The only side effect I LOVED was the lack of dreaming (my dreams tend to annoy me). No food-related problems, even though all I really avoided was tap beer and anything more than a few small nibbles of aged cheese.
> (CAUTION: YMMV foodwise!!!!)
>
> BTW, once the orgasms finally returned, Selegiline's aphrodaisical qualities were very much (perhaps too much) in evidence. It may have had some other nice qualities, too (energy, cognitive enhancement), but it certainly did not help with anxiety (at that dose, anyways), and the entire reason for my treatment was Social Anxiety.
> Rick
> --------------------------------------
>
>
> I used a relatively low dose of Wellbutrin with Nardil
> with no problems. Experienced pdocs are not uncomfortable prescribing the two
> together as long as the patient had no prior problems with serotonin/norep syndrome.
> It did seem to help with the sexual dysfunction and increased my energy, but did nothing
> for weight gain. I definitely would not combine selegiline at any dose with Nardil -- way
> too risky. Nardil can also be combined with Ritalin, Adderall, and reboxetine, but I don't know if
> they would affect sexual stuff or weight.
>
> anita
>
> >Hi,
> >
> >Anyone with experience with conteracting the negative side effects of nardil - particularly weight gain and sexual dysfunction. I realize that most experienced psychopharmacologists with cautiously combine other drugs with MAOI's. Less experienced psychdocs and, in particular, family physicians, tend to avoid MAOI's altogether.
> >
> >Specifically, has anyone ever been prescribed both Wellbutron and Nardil? Or, low dose selegiline and Nardil? Again, these combinations are contraindicated, but experienced psychopharmacologists seem to be able to cautiously manage these.
> >
> >Thanks
Posted by Elizabeth on October 9, 1999, at 3:34:24
In reply to OOPS, I forgot...Nardil+Seleg. Wierdness!, posted by Rick on October 5, 1999, at 19:17:49
Rick,
My BP was only a little higher than yours had been -- 240/140, I think -- the time I had a pulmonary hemorrhage while on Nardil (no selegiline or overripe fruit, but some weird falafel). MAOI-associated hypertension does go down spontaneously even if not treated, but it's better to get thee to an ER!
Posted by Rick on October 10, 1999, at 1:22:42
In reply to Re: OOPS, I forgot...Nardil+Seleg. Wierdness!, posted by Elizabeth on October 9, 1999, at 3:34:24
> Rick,
>
> My BP was only a little higher than yours had been -- 240/140, I think -- the time I had a pulmonary hemorrhage while on Nardil (no selegiline or overripe fruit, but some weird falafel). MAOI-associated hypertension does go down spontaneously even if not treated, but it's better to get thee to an ER!Elizabeth --
After that happened the first time, I did a lot of reading and found that "hypertensive crisis" is a highly personal thing. A reading that could cause severe symptoms for one person produces none for another, and no immediate physical danger. I have a friend who had repeated readings of 200/120 in a routine doctor's visit, and he felt fine. Obviously they stepped up his blood pressure med regimen, and later tested for secondary causes (there were none, nor has there been any evidence of organ damage).
Before Nardil, I would somtimes get as high as a resting 160/110, so my own body is no stranger to high BP. (BTW, my BP is consistently normal-to-low-normal now after weight loss, and with: 5mg Pindolol, 1.5-2.0mg Klonopin, and 15mg Buspar daily. BTW, my pdoc, who has been an MAOI expert for 20 years (so he claims, anyways), was surprised by the Nardil+low-dose Selegiline reaction, but not alarmed.
Posted by Elizabeth on October 12, 1999, at 1:16:13
In reply to Re: OOPS, I forgot...Nardil+Seleg. Wierdness!, posted by Rick on October 10, 1999, at 1:22:42
Hi Rick. Congrats on getting your baseline BP down. Especially the weight loss - that's never easy (except right after you start taking Nardil, and get really depressed without the buffer of Nardil-induced sugar cravings - not that I would know).
You're definitely right that it's an individual thing. I can definitely feel it if my BP goes up to 160 - diastolic hardly ever has been as high as 110, but it went up to like 160/95 when I tried taking Dexedrine [5mg] with Parnate. My resting BP is around 100/60, typically, so 160/95 represents a significant increase.
>I had a friend who had readings of 200/120 in a routine doctor's visit, and he felt fine.
Hmm...he wasn't nervous, was he? ("White-coat hypertension.")
>BTW, my pdoc, who has been an MAOI expert for 20 years (so he claims, anyways), was surprised by the Nardil+low-dose Selegiline reaction, but not alarmed.
Whereas I was alarmed but not surprised? (How does one become an MAOI expert, anyway? Wonder if he's ever taken any of them? )
This is the end of the thread.
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