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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 zelda on December 12, 2000, at 10:07:31
hi. i'm curious to know if anyone has had problems with fainting or dizziness due to low blood pressure while taking an maoi drug.
also, what can be done about insomnia and restlessness as a result of maoi drugs? i've tried ambian and xanax for sleep, but they only work for five hours or so.
i recently switched to selegiline (eldapryl) because i was passing out too much on nardil and parnate.
suggestions and anecdotes are welcome! thank you very much.
Posted by SLS on December 12, 2000, at 11:05:11
In reply to maoi drugs, insomnia, and fainting, posted by zelda on December 12, 2000, at 10:07:31
> hi. i'm curious to know if anyone has had problems with fainting or dizziness due to low blood pressure while taking an maoi drug.
>
> also, what can be done about insomnia and restlessness as a result of maoi drugs? i've tried ambian and xanax for sleep, but they only work for five hours or so.
>
> i recently switched to selegiline (eldapryl) because i was passing out too much on nardil and parnate.
>
> suggestions and anecdotes are welcome! thank you very much.
I have had problems with both fainting due to low blood pressure and the inability to urinate while taking Nardil. The fainting (orthostatic hypotension) can be addressed using a drug called Floranef (fludrocortisone). This drug is usually effective to remedy the low blood pressure. If you find it difficult to initiate urination, bethanacol works pretty well. For me, these side effects were amplified because I was taking desipramine or imipramine (tricyclic antidepressants) at the same time. I found that after a month or so, the low blood pressure got much better without further need of using Fluranef.For insomnia, you will need to use a drug that lasts longer than Ambien and is a stronger sleep medication than Xanax. Trazodone (Desyrel) has become popular for use with MAOIs. You may also opt for using Ambien and adding another sleep medication to it. Ambien is strong and will do a good job to put you to sleep. The problem is keeping you to sleep. You may want to ask your doctor about taking the longer acting drugs like Ativan (lorazepam), Restoril (temazepam), trazodone (Desyrel), or possibly Klonopin (clonazepam).
I am sure there are other good suggestions that will be offered by others here.
Good luck.
- Scott
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DRUG TREATMENT for Orthostatic Hypotension
Certain medications may be helpful, usually as a combination. Most useful drugs are Florinef, erythropoetin and Midodrine.Two strong cups of coffee in the morning
Florinef (forces more salt into the bloodstream, 0.1 mg daily starting dose). Blood pressure raises gradually over several days with maximum effect at 1-2 weeks. Alter doses at weekly or biweekly intervals. Hypokalemia (low potassium) occurs in 50%, and hypomagnesemia in 5%. These may need to be corrected with supplements. Florinef should not be used in persons with CHF (congestive heart failure). Headache is a common side effect.
Effexor (an antidepressant which raises blood pressure as a side effect).
Inderal and other beta-blockers (small doses are used for positional-orthostatic-tachycardia syndrome (POTS), start inderal at 10 mg/d, increase to 30-60 mg/d over 2-3 weeks. Other useful agents are Nadolol (10 mg qd), and atenolol (25).
Motrin or Indocin (blocks blood-pressure lowering effects of prostaglandins).
Midodrine. An alpha-1 agonist. Causes increased blood pressure, vasoconstriction, pupil dilation, and "hair standing on end". Other common side effects are paresthesia of the scalp or itching. Usual doses are 2.5 mg at breakfast and lunch or three times daily. Doses are increased quickly until a response occurs or a dose of 30 mg/day is attained (Wright et al, 1998). Midodrine does not cross the blood-brain barrier and it is thus not associated with CNS effects. Most patients on Midodrine also take Florinef (see above).
Erythropoietin. This agent is used if there is also anemia and other measures have failed. Doses of 25 to 75 U/kg TIW are used, by injection.
Phenobarbital may improve POTS.
Posted by Ted on December 12, 2000, at 13:34:25
In reply to Re: maoi drugs, insomnia, and fainting, posted by SLS on December 12, 2000, at 11:05:11
What I have used when I *really* have trouble sleeping is a combo of 10 mg ambien with 0.5 mg ativan. Makes me dead to the world for 10 hours. :-) I have no experience with the MAOIs, so I don't know if this will help or not. Also, be careful of the addictive affects of this combo and of ativan.
Ted
Posted by SLS on December 12, 2000, at 18:25:30
In reply to Re: maoi drugs, insomnia, and fainting, posted by Ted on December 12, 2000, at 13:34:25
> What I have used when I *really* have trouble sleeping is a combo of 10 mg ambien with 0.5 mg ativan. Makes me dead to the world for 10 hours. :-) I have no experience with the MAOIs, so I don't know if this will help or not. Also, be careful of the addictive affects of this combo and of ativan.
>
> Ted
Hi Ted.Has this combination ever produced problems with memory? How long have you been using it?
Thanks.
- Scott
Posted by zelda on December 12, 2000, at 22:32:30
In reply to Re: maoi drugs, insomnia, and fainting, posted by SLS on December 12, 2000, at 18:25:30
> > What I have used when I *really* have trouble sleeping is a combo of 10 mg ambien with 0.5 mg ativan. Makes me dead to the world for 10 hours. :-) I have no experience with the MAOIs, so I don't know if this will help or not. Also, be careful of the addictive affects of this combo and of ativan.
> >
> > Ted
>
>
> Hi Ted.
>
> Has this combination ever produced problems with memory? How long have you been using it?
>
> Thanks.
>
>
> - Scott
scott,thanks for the info on the blood pressure and sleeping meds.
as for your question to ted about memory problems - i have been taking ambien for sleep for over a year and have experienced temporary amnesia several times.
if i take the pills (10-20 mg) and then go to bed straight away, everything is ok.
however, if i stay awake i sometimes don't remember events following taking the pills. i've had late night phone conversations and interactions that i don't recall at all the next morning.
i've read that you are only supposed to take 5-10mg of ambien, and only for 1-2 weeks. i don't know why my doctor suggested that i stay on it long term, but i definitly feel that i have developed a dependence on the drug and now need more and more of it to fall asleep.
ambien works well, but i feel it should be used with caution. i plan to ween myself off of it when i get my other mental health problems under control.
i'm curious to know if others have dealt with these issues.
-z
Posted by Ted on December 13, 2000, at 10:34:15
In reply to Re: maoi drugs, insomnia, and fainting, posted by SLS on December 12, 2000, at 18:25:30
Hi Scott,
I have not had memory problems I can attribute to the ambien/ativan combo, but since my last mania/depression/mania cycle, I have had a terrible memory anyway. :-) I think if you take the meds and go straight to bed, you should be fine. NEVER, EVER try to drive or consume alcohol while on this combo -- if you live, you will regret it.
Ativan IS addictive, and some people think ambien is too, so I think you should probably start with 5 mg ambien and 0.25 mg ativan (half a 0.5 mg tablet) and work your way up as needed. Just be careful. As always, consult your physician first.
Ted
> Hi Ted.
>
> Has this combination ever produced problems with memory? How long have you been using it?
This is the end of the thread.
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