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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by dbc on June 3, 2008, at 19:09:22
I take atenolol (100mg) and EMSAM taunts me almost daily. God what i would do for an MAO-B inhibitor. What is the possibility that low to medium dose EMSAM will play nice with a beta blocker? Or is this just absolutely not a possibility? The only reason im asking is because im not sure what causes the BP to drop in MAOIs.
Just some theoretics for experienced people.
Posted by Amigan on June 4, 2008, at 14:57:36
In reply to Is emsam and beta blocker possible?, posted by dbc on June 3, 2008, at 19:09:22
I have also asked in here why MAOIs are causing hypotention a few weeks ago, but nobody gave me an answer...
If i'm not mistaken, selective MAOIs (either MAO-A or MAO-B) doesn't tend to cause this side effect. Only non-selective MAOIs like Parnate and Nardil does.
If i am correct on this, i can only SPECULATE that it is the excessive dopamine responsible... If you think of it, dopamine is destroyed by both the MAO-A and MAO-B subtypes of the enzyme.
Posted by Roslynn on June 4, 2008, at 16:50:45
In reply to Re: Is emsam and beta blocker possible?, posted by Amigan on June 4, 2008, at 14:57:36
I am due to start Emsam next week and my internist said something about high blood pressure too. She wants me to come in after 3 weeks on the med to check my blood pressure.
??????
I do take asthma meds but they are not supposed to interact with Emsam, other than my albuterol which is my "rescue inhaler" used only infrequently.
Posted by undopaminergic on June 5, 2008, at 5:04:00
In reply to Re: Is emsam and beta blocker possible?, posted by Roslynn on June 4, 2008, at 16:50:45
>
> I do take asthma meds but they are not supposed to interact with Emsam, other than my albuterol which is my "rescue inhaler" used only infrequently.
>The MAO enzyme, which is destroyed by EMSAM, may participate in breaking down albuterol (salbutamol), so the duration of action of albuterol may be prolonged - however, that may be regarded as a benefit.
Posted by undopaminergic on June 5, 2008, at 5:34:11
In reply to Re: Is emsam and beta blocker possible?, posted by Amigan on June 4, 2008, at 14:57:36
> I have also asked in here why MAOIs are causing hypotention a few weeks ago, but nobody gave me an answer...
>
> If i'm not mistaken, selective MAOIs (either MAO-A or MAO-B) doesn't tend to cause this side effect. Only non-selective MAOIs like Parnate and Nardil does.
> If i am correct on this, i can only SPECULATE that it is the excessive dopamine responsible...
>The mechanisms underlying MAOI-induced hypertension are not well understood.
Dopamine may contribute, and so may desensitation of vascular alpha1-adrenoceptors. Another possible cause is false neurotransmission by trace amines that are normally metabolised by MAO, and that accumulate after inhibition of the enzyme, possibly displacing noradrenaline (NA) from storage vesicles in sympathetic nerve terminals. False neurotransmission would result if these trace amines were to be released in place of NA, due to their lack of potency as agonists at postsynaptic alpha1-adrenoceptors. In other words, loss of noradrenergic, or sympathetic, tone due to false neurotransmission is one hypothetical cause of MAOI-induced hypotension. Another factor that might contribute is enhanced stimulation of alpha2-adrenoceptors in the CNS, as this also results in reduced sympathetic acitivity. It is also known that a high extent of MAO inhibition - above 80% - results in a pronounced reduction of the rate of neurotransmitter synthesis, and this may be another contributory factor, although it would be expected to reduce any hypotension that is dependent on dopamine.
Posted by Amigan on June 5, 2008, at 10:45:19
In reply to Re: Is emsam and beta blocker possible?, posted by undopaminergic on June 5, 2008, at 5:34:11
That was a good post. Thank you!
This is the end of the thread.
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