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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by jedi on August 24, 2011, at 13:12:58
To All MAOI users:
I've mentioned this before on here but thought I would again. There seems to be an increase in use of MAOIs for treatment resistant depression. I believe this is a good thing, and the dangers from the medications are highly overstated and misunderstood. Since there is such a lack of knowledge about these medications, I fear that someone could be seriously hurt using self administered nifedipine for a self limiting hypertensive episode.The use of self administered sublingual nifedipine is contraindicated for hypertensive reactions.
The only time I've been in the hospital from MAOIs is when I broke all the rules and had a mild hypertensive episode. I took the nifedipine provided by my P-Doc and went to the ER. Problem is the tyramine reaction ended and the BP reducing effect of the nifedipine continued. My BP became dangerously low and I spent the night in the hospital with IV fluids to make sure my BP didn't tank.
To think that I almost took another sublingual capsule before going to the ER, when I got the splitting headache! I could have easily died. As I remember, and this was over 10 years ago, the nifedipine given me was 10mg. Should have been 5mg. Actually, should not of been in my possession!
Be very careful with this stuff guys!
Jedi
(Reference)
Medical Treatment of High BP Resulting from Tyramine Ingestion
Dr. Ken Gillman
http://psychotropical.com/pdfs/maois_diet_full_v2.2.1.doc.pdf...
If excessive tyramine is ingested in cheese etc. blood pressure starts
to increase from about half an hour after ingestion, and remains
elevated for 1 2 hours. Current evidence suggests that elevated BP
without signs or symptoms of end organ damage does not require
treatment, and should not be treated. This is because rapid BP reduction
may do more harm than the short term BP elevation (usually less
than 2 hours) caused by tyramine. Rapid control (i.e. within 1-2
hours) of hypertension that does not also exhibit definite end organ
damage does sometimes result in serious adverse effects (12, 159,
160). Generally, treatment should only be initiated when there is
definite evidence of acute and rapidly evolving end organ damage. Several
recent reviews make strong statements about premature treatment in
the absence of end organ damage: e.g. Flanigan Often the urgency is
more in the mind of the treating physician than in the body of the patient The
compulsive need to treat reaches the pathological in some physicians, especially
during the early years in their careers.
It is generally inadvisable for treatment to be initiated by
psychiatrists: on the rare occasions where treatment is required it is
best initiated after admission to a critical care setting (1).
It is noteworthy that pain and anxiety both exacerbate hypertension,
so remaining calm and using a benzodiazepine (which usually lowers
BP to a significant extent (161)), whilst instituting measures to *ss*s
any possible developing end organ damage, is probably the most
important step. The most appropriate hypotensive agent will depend
on the particular end organ affected (brain, heart, lungs, kidneys).Note: sub-lingual nifedipine is now generally considered contraindicated
because it has an unpredictable effect: it should not be
given to patients to self-administer (11, 160).These observations exemplify why psychiatrists are strongly
advised to refer such cases (see Transfer Of Care protocols)
and not to attempt management themselves.
...
Posted by Phillipa on August 24, 2011, at 20:01:40
In reply to ALL MAOI USERS: Hypertensive Crisis and Nifedipine, posted by jedi on August 24, 2011, at 13:12:58
Jedi you are always there. Glad you posted this vital info. Phillipa
Posted by floatingbridge on August 24, 2011, at 22:04:46
In reply to ALL MAOI USERS: Hypertensive Crisis and Nifedipine, posted by jedi on August 24, 2011, at 13:12:58
The use of a benzo to remain calm and also lower blood pressure is a helpful tip. I would not have thought of that.
Thank you.
Posted by pedr on August 25, 2011, at 7:21:12
In reply to ALL MAOI USERS: Hypertensive Crisis and Nifedipine, posted by jedi on August 24, 2011, at 13:12:58
Thanks for the info Jedi, I was still wondering about this. I have also ended up in hospital from an HC. Most painful experience (as in raw, physical pain) I've ever had. Lasted about 5 hours too!
Pedr
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