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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Sammybabe on July 17, 2005, at 15:36:11
hi. i've been on the combo of nortriptyline AND nardil -- my doctor informed me that he prescribed it in the order so that it is not dangerous.
however, i am getting bad dizzy spells and am very sleepy in the morning. does anyone know if these side effects are from the nardil OR the nortriptyline? or are the effects caused by both and therefore compounded in strength?
all advice welcome.
thanks.
Posted by ed_uk on July 17, 2005, at 16:08:32
In reply to nortriptyline AND nardil, posted by Sammybabe on July 17, 2005, at 15:36:11
Hi,
Both drugs can cause dizziness. They can reduce the blood pressure when you stand up: postural hypotension. If your blood pressure is too low, increasing your dietary salt intake might help.
~ed
Posted by SLS on July 17, 2005, at 19:51:25
In reply to Re: nortriptyline AND nardil » Sammybabe, posted by ed_uk on July 17, 2005, at 16:08:32
Hi.
I am not so quick to recommend the combination of Nardil with any tricyclic other than desipramine. Even nortriptyline is not without some degree of serotonin reuptake inhibition. Do you feel at all "intoxicated"?
Orthostatic hypotension would occur with desipramine, but would not result in a continual state of low blood pressure such that you can't stand up. I had this happen with Nardil + imipramine and Nardil + nortriptyline. The nortriptyline was significantly less problematic than imipramine, but the feeling of being intoxicated and having difficulty with dizziness while trying to remain standing (not just upon rising from a supine position) were tip-offs to me that serotonin syndrome had been induced. Other symptoms included muscle stiffness and cramping of torso muscles.
Like I said, I wouldn't go out of my way to recommend the combination, but I wouldn't try to dissuade someone from trying it if it is their doctor's claim that the combination is practicable. I think the dizziness and dystonia I experienced was dosage dependent. What dosages are you going to be taking?
I am currently taking Parnate 80mg + nortriptyline 100mg.
- Scott
Posted by Sammybabe on July 24, 2005, at 13:24:54
In reply to Re: nortriptyline AND nardil, posted by SLS on July 17, 2005, at 19:51:25
Hi Scott. Thanks for writing.
Wow - you pinpointed exactly what's going on with me: stiffness in my neck and shoulders every morning, dizziness, feeling flu-ish/achy, etc. I've also had some major twitches which my dr. said could be leading to a myochardial xxx?
so, he is rushing me off the nortriptyline. i was on 100, now i'm on 80, and next week i'll go down to 60. he said i may experience some depression as he takes me off of this so fast, but i think he was really concerned about the imminent danger of my side effects.
what i ask is, why did he put me on both in the first place knowing how dangerous it could be?
have you ever been on an maoi by itself? if so, does it work? i'm still on nardil 60 which he'll keep me on.
thanks for your advice and candor.
> Hi.
>
> I am not so quick to recommend the combination of Nardil with any tricyclic other than desipramine. Even nortriptyline is not without some degree of serotonin reuptake inhibition. Do you feel at all "intoxicated"?
>
> Orthostatic hypotension would occur with desipramine, but would not result in a continual state of low blood pressure such that you can't stand up. I had this happen with Nardil + imipramine and Nardil + nortriptyline. The nortriptyline was significantly less problematic than imipramine, but the feeling of being intoxicated and having difficulty with dizziness while trying to remain standing (not just upon rising from a supine position) were tip-offs to me that serotonin syndrome had been induced. Other symptoms included muscle stiffness and cramping of torso muscles.
>
> Like I said, I wouldn't go out of my way to recommend the combination, but I wouldn't try to dissuade someone from trying it if it is their doctor's claim that the combination is practicable. I think the dizziness and dystonia I experienced was dosage dependent. What dosages are you going to be taking?
>
> I am currently taking Parnate 80mg + nortriptyline 100mg.
>
>
> - Scott
Posted by SLS on July 24, 2005, at 14:08:23
In reply to Re: nortriptyline AND nardil, posted by Sammybabe on July 24, 2005, at 13:24:54
Hi.
I have tried Nardil by itself at dosages as high as 120mg. It helps a little bit, but not enough to justify my staying on it.
Coming off of nortriptyline, you might experience what is known as a rebound improvement. After you stop the nortriptyline and continue with the Nardil you might experience a temporary improvement that can feel pretty damned good. My guess is that this can last for a week or two. I think it tends to occur more often when the drug is discontinued quickly rather than gradually. Either way, the result will be the same. Either Nardil will work or it won't.
I wouldn't be to angry at your doctor regarding his choice of combining Nardil + nortriptyline. It is an aggressive treatment, to be sure, but his choice of nortriptyline was a pretty good one in that there is only one other TCA that would be less problematic than nortriptyline, and that would be desipramine. Now, I am having absolutely no trouble combining Parnate 80mg + nortriptyline 100mg. I believe that Nardil is significantly more serotonergic than Parnate. This is why the nortriptyline mixes better with the Parnate. I would not hold your doctor accountable for knowing something that you won't find in any textbook or journal. Perhaps he has had success with the combination with other people who never developed serotonin syndrome. It is hard to say, but I think it is fortunate that you have a doctor who is willing to try exotic treatments.
- Scott
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