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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on April 3, 2006, at 14:18:29
In reply to Re: Depression Can Be Fatal! » yxibow, posted by SLS on April 3, 2006, at 7:15:09
Hi Scott
>What would work to alleviate the nausea associated with opioids?
The nausea usually disappears after the first few days. During that time, lying down can do a lot to relieve the nausea.
Useful antiemetics for opioid-induced nausea include......
Metoclopramide 10mg tid
Prochlorperazine 5mg tid
Cyclizine 50mg tidIf you initiate the opioid at a low dose you probably won't need an antiemetic - which is good because antiemetics have their own side effects.
Regards
Ed
Posted by SLS on April 3, 2006, at 15:01:17
In reply to Re: Depression Can Be Fatal! » SLS, posted by ed_uk on April 3, 2006, at 14:18:29
:-)
Posted by yxibow on April 3, 2006, at 15:13:39
In reply to Re: Depression Can Be Fatal! » yxibow, posted by SLS on April 3, 2006, at 7:15:09
> Hi.
>
> > Yes -- percocet is wonderful stuff ... :) For a week or two. Then tolerance sets in and you can't go to the bathroom -- which is why Imodium is such a good drug because it is an opiate that cant cross the blood brain barrier.
>
> What would work to alleviate the nausea associated with opioids?
>
>
> - Scott
>Meclizine is similar to Cyclizine and is OTC as Dramamine II (and generic), and you can use it "off label" -- with the side effects like Cogentin if you get to a full dose.
If you can stand it, and I dont particularly mind, a lot of macerated raw ginger does partially block 5HT3 (I had to do that the other week for a virus in my inner ear -- so we think)
And then there's Tigan, which has some but not all the pitfalls of Compazine, and does carry some but not all the risks of TD. But as ed says, its worse than a stiff upper lip, so the people across the pond say.
Some people are very sensitive to nausea with opiates -- myself I fortunately haven't had that. Its a problem with pain mediation.-- Jay
Posted by SLS on April 3, 2006, at 15:25:41
In reply to Re: Depression Can Be Fatal!, posted by yxibow on April 3, 2006, at 15:13:39
:-)
Posted by Phillipa on April 3, 2006, at 20:25:39
In reply to Re: Depression Can Be Fatal! » yxibow, posted by SLS on April 3, 2006, at 7:15:09
Scott what nausea I didn't have any nausea? Love phillipa
Posted by SLS on April 3, 2006, at 20:30:43
In reply to Re: Depression Can Be Fatal! » SLS, posted by Phillipa on April 3, 2006, at 20:25:39
> Scott what nausea I didn't have any nausea? Love phillipa
My grandmother developed nausea from taking Vicoden. It seems to have passed over the course of a few days.
- Scott
Posted by CEK on April 4, 2006, at 10:07:22
In reply to Re: Depression Can Be Fatal!, posted by SLS on April 3, 2006, at 20:30:43
I had to take Percocet and Loratab before after having teeth pulled and after my c-sections and it made me feel wonderful. Not talking about how it helped my pain, it was how it helped my head! Nothing bothered me! My depression, things at work, my husband ranting, it was all like it didn't exist anymore. I could really see how people could get addicted to this stuff! Nausia was a promblem at first unless I was laying down and slept, but once I got use to it the nausia was gone. Oh what I would give to feel that way again!
Posted by JaclinHyde on April 5, 2006, at 9:35:06
In reply to Re: Depression Can Be Fatal! » Phillipa, posted by TylerJ on April 3, 2006, at 9:02:58
I'm sorry but I have to bring this up. There are so many people out there suffering so badly...close to suicide or house bound because of anxiety who will not even consider an MAOI. Why? Cause if you are not careful it could kill you. Does anyone else see the twisted logic here?
JH
Posted by TylerJ on April 5, 2006, at 10:56:38
In reply to Re: Depression Can Be Fatal!, posted by JaclinHyde on April 5, 2006, at 9:35:06
> I'm sorry but I have to bring this up. There are so many people out there suffering so badly...close to suicide or house bound because of anxiety who will not even consider an MAOI. Why? Cause if you are not careful it could kill you. Does anyone else see the twisted logic here?
>
> JHI definitley do. I really wish Parnate would have been my pdocs first choice when I was 22 years old and bed bound, I saw absolutely no future in my life. My doc put me on Imipramine, and it took me about a year to finally make some progress. With Parnate, I'm sure I wouldn't have been in bed for 2 mos., maybe 2 wks until it kicked in.
People don't be afraid of MAOI's. The chances of a hypertensive episode is not high, and the diet really isn't difficult to follow at all. Most importantly, if your not doing well with other meds., please don't wait 25 years like I did. An MAOI like Parnate, Nardil and maybe even EMSAM, just might change your life from barely hanging on, to feeling really good and enjoying each day.Tyler
Posted by Caedmon on April 5, 2006, at 12:22:59
In reply to Re: Depression Can Be Fatal! » yxibow, posted by SLS on April 3, 2006, at 7:15:09
> What would work to alleviate the nausea associated with opioids?
Just to add, I find that promethazine works really well, probably due to its antihistamine and phenothiazine characteristics.
- C
Posted by yxibow on April 6, 2006, at 1:27:26
In reply to Re: Depression Can Be Fatal!, posted by JaclinHyde on April 5, 2006, at 9:35:06
> I'm sorry but I have to bring this up. There are so many people out there suffering so badly...close to suicide or house bound because of anxiety who will not even consider an MAOI. Why? Cause if you are not careful it could kill you. Does anyone else see the twisted logic here?
>
> JHBecause most suicidal people really do not want to kill themselves in the end. They just want relief from their problems. Its the ones who don't say anything about it that bring real worry. But that's just my opinion.
I would consider ECT over an MAOI. They're just so rife with an eating plan that defies logic. RIMAs are slightly better on that aspect but not available in the US. EMSAM -- still not the panacea that it is, because beyond the little dose patch, there are still bold warnings about hypertensive crisis, which is pretty serious.
I understand your opinion, but I stand to disagree. Yes, there are a number of people on this board who have managed to survive on an MAOI, but there are just so many things, I mean, surviving spring allergies with OTC medication or taking cough syrup or lots of things can mean death to people who really don't actually want that in the end.
Posted by ed_uk on April 6, 2006, at 14:49:39
In reply to Re: Depression Can Be Fatal! » JaclinHyde, posted by yxibow on April 6, 2006, at 1:27:26
Hi Yxi
>I would consider ECT over an MAOI. They're just so rife with an eating plan that defies logic.
MAOIs are relatively safe provided that the appropriate precautions are taken. The eating plan does not defy logic.
>RIMAs are slightly better on that aspect but not available in the US
Dietary restrictions are rarely necessary with RIMAs. Unfortunately, RIMAs do not appear to share the high efficacy of the classical MAOIs.
>I mean, surviving spring allergies with OTC medication or taking cough syrup or lots of things can mean death to people who really don't actually want that in the end.
Oral decongestants are contra-indicated with MAOIs. None of the oral decongestants are particularly effective though. Having to avoid such drugs is hardly a great loss. Steroid nasal sprays and non-sedating antihistamines do not interact with MAOIs.
In general, none of the OTC cough syrups are worth buying. If pneumonia is present, antibiotics with be necessary. Otherwise, the cough will go away on its own.
Regards
Ed
Posted by TylerJ on April 6, 2006, at 18:01:40
In reply to Re: Depression Can Be Fatal! » yxibow, posted by ed_uk on April 6, 2006, at 14:49:39
> Hi Yxi
>
> >I would consider ECT over an MAOI. They're just so rife with an eating plan that defies logic.
>
> MAOIs are relatively safe provided that the appropriate precautions are taken. The eating plan does not defy logic.
>
> >RIMAs are slightly better on that aspect but not available in the US
>
> Dietary restrictions are rarely necessary with RIMAs. Unfortunately, RIMAs do not appear to share the high efficacy of the classical MAOIs.
>
> >I mean, surviving spring allergies with OTC medication or taking cough syrup or lots of things can mean death to people who really don't actually want that in the end.
>
> Oral decongestants are contra-indicated with MAOIs. None of the oral decongestants are particularly effective though. Having to avoid such drugs is hardly a great loss. Steroid nasal sprays and non-sedating antihistamines do not interact with MAOIs.
>
> In general, none of the OTC cough syrups are worth buying. If pneumonia is present, antibiotics with be necessary. Otherwise, the cough will go away on its own.
>
> Regards
>
> EdI totally agree with everything Ed said here. The eating plan does not defy logic. Most good pdocs would consider MAOI's before ECT. Lack of education continues to give maoi's a bad reputation, docs as well as patients are guilt of this.
Tyler
Posted by Caedmon on April 6, 2006, at 18:52:14
In reply to Re: Depression Can Be Fatal! » JaclinHyde, posted by yxibow on April 6, 2006, at 1:27:26
> I would consider ECT over an MAOI.
Interesting. I have strongly considered ECT many times, and if I had the money I would probably give it a go. Although I have no problem trying out MAOIs. The diet is okay, it requires a certain degree of vigilance and mindfulness, but that's something most of us could use anyway.
>EMSAM -- still not the panacea that it is, because beyond the little dose patch, there are still bold warnings about hypertensive crisis, which is pretty serious.
I know. I'm finding EMSAM a disappointing prospect, but I'm trying not to be too cynical. I understand oral selegiline to be somewhat less effective than other nonreversible MAOIs like phenelzine.
- C
Posted by TylerJ on April 6, 2006, at 19:47:31
In reply to Re: Depression Can Be Fatal! » yxibow, posted by Caedmon on April 6, 2006, at 18:52:14
> > I would consider ECT over an MAOI.
>
> Interesting. I have strongly considered ECT many times, and if I had the money I would probably give it a go. Although I have no problem trying out MAOIs. The diet is okay, it requires a certain degree of vigilance and mindfulness, but that's something most of us could use anyway.
>
> >EMSAM -- still not the panacea that it is, because beyond the little dose patch, there are still bold warnings about hypertensive crisis, which is pretty serious.
>
> I know. I'm finding EMSAM a disappointing prospect, but I'm trying not to be too cynical. I understand oral selegiline to be somewhat less effective than other nonreversible MAOIs like phenelzine.
>
> - CThe biggest problem with ECT is that it doesn't last. And believe me, it's not as easy and comfortable as "they" say it is. I had 24 treatments in 1997. The treatment itself is painless, but afterwords you feel like you've been hit by a truck, severe headache and flu like syptoms. And memory loss is worse than most pdocs say it'll be. I've lost for good everything 3 mos. before my treatments. And, oh yea, they want you to keep going back for maintenance treatments. I know I'll never do it again...I seriously think it's way over rated.
Tyler
Posted by JaclinHyde on April 6, 2006, at 22:09:08
In reply to Re: Depression Can Be Fatal! » JaclinHyde, posted by yxibow on April 6, 2006, at 1:27:26
<<I mean, surviving spring allergies with OTC medication or taking cough syrup or lots of things can mean death to people who really don't actually want that in the end.>>
Touching on allergies clariton & zyrtec are fine with MAOI's. And....
"Cough medications containing decongestants, dextromethorphan or Demerol are not to be taken but plain **plain Robitussin is OK**"
The list really isn't all that extensive when you really read it. Aged cheeses, Demerol, aged meats and sour cream are the biggest culprits. What makes it look long are the 'goofy' foods (or at least in my life they seem odd)...cavier, liver pate, pickled herring, over rip banannas and avocados, tofu, miso, saurkraut, marmite, bovril....
And damn, I can't have any cocaine...grrrrrrrrr ;-)
I am not saying that no one eats this stuff, I am just saying that the foods are not all that hard to control if take an MAOI. I have lived without these foods or drugs for over 25 years, been sedated for surgery etc. and I wouldn't trade any of those years for all the cheddar cheese in the world.
JH
Posted by yxibow on April 7, 2006, at 2:13:55
In reply to Re: Depression Can Be Fatal!, posted by JaclinHyde on April 6, 2006, at 22:09:08
> <<I mean, surviving spring allergies with OTC medication or taking cough syrup or lots of things can mean death to people who really don't actually want that in the end.>>
>
> Touching on allergies clariton & zyrtec are fine with MAOI's. And....But not clorpheneramine maleate, benadryl, I'm not sure of various antihistamines like meclizine for anti-emesis. Yes, pseudoephedrine hydrochloride is not the most effective thing on this planet but it at least for me clears my head on a really stuffy day (and then I have to take extra anxiety medicine usually, depends. I don't touch the 12/24 hour stuff, because that means you have to wait 12/24 hours if it messes with your body.)
>
> "Cough medications containing decongestants, dextromethorphan or Demerol are not to be taken but plain **plain Robitussin is OK**"Plain Robitussin is guaifenesin, which really isnt all that great a medication except as an expectorant in combination with a cough suppressant. Dextromethorphan is really the only effective thing here in the US, since we can't go and get a little bit of codeine like in Canada (unless the changed that.) Of course that is also contraindicated.
>
> The list really isn't all that extensive when you really read it. Aged cheeses, Demerol, aged meats and sour cream are the biggest culprits. What makes it look long are the 'goofy' foods (or at least in my life they seem odd)...cavier, liver pate, pickled herring, over rip banannas and avocados, tofu, miso, saurkraut, marmite, bovril....
Well I'm a vegetarian ... so a MAOI would be out, since it includes most soy products. Brewers yeast is added to vegetarian products because it is rich with vitamins and has some protein. I eat bananas at all stages -- avoiding a banana because its one day too old and having a hypertensive crisis --- good lord. They're not goofy, they supply a day's worth of potassium to your diet. And well, I'm a Californian so I'm brought up on avocados. That means no trips to Taco Bell or whatever chain in your state has it since trace amounts could show up.
>
> And damn, I can't have any cocaine...grrrrrrrrr ;-)
>
> I am not saying that no one eats this stuff, I am just saying that the foods are not all that hard to control if take an MAOI. I have lived without these foods or drugs for over 25 years, been sedated for surgery etc. and I wouldn't trade any of those years for all the cheddar cheese in the world.Well I wish you the best on it.
TidingsJay
Posted by naughtypuppy on April 7, 2006, at 8:55:30
In reply to Re: Depression Can Be Fatal!, posted by JaclinHyde on April 6, 2006, at 22:09:08
Don't forget banana peels. Monkeys don't even eat the peels so that just shows how far fetched a lot of these restrictions are.
Posted by Caedmon on April 7, 2006, at 10:49:00
In reply to Re: Depression Can Be Fatal! » JaclinHyde, posted by yxibow on April 7, 2006, at 2:13:55
I thought that diphenhydramine and chlorpheniramine (antihistamines) were okay with an MAOI. Just not in combination w/ a decongestant (obviously). Any idea why they would be contraindicated?
- C
Posted by yxibow on April 7, 2006, at 12:51:00
In reply to Re: Depression Can Be Fatal! » yxibow, posted by Caedmon on April 7, 2006, at 10:49:00
> I thought that diphenhydramine and chlorpheniramine (antihistamines) were okay with an MAOI. Just not in combination w/ a decongestant (obviously). Any idea why they would be contraindicated?
>
> - CI believe you're right on that at drugs.com, actually, however I seem to recall overcautious packaging.
Posted by JaclinHyde on April 7, 2006, at 16:43:17
In reply to Re: Depression Can Be Fatal! » JaclinHyde, posted by yxibow on April 7, 2006, at 2:13:55
> Well I'm a vegetarian ... so a MAOI would be out, since it includes most soy products. Brewers yeast is added to vegetarian products because it is rich with vitamins and has some protein. I eat bananas at all stages -- avoiding a banana because its one day too old and having a hypertensive crisis --- good lord. They're not goofy, they supply a day's worth of potassium to your diet. And well, I'm a Californian so I'm brought up on avocados. That means no trips to Taco Bell or whatever chain in your state has it since trace amounts could show up.>>
Just a quick note to say that it is OVER RIPE banana's (the kind that are black skinned) and OVER RIPE avocados. Ripe banana's and ripe avocado's are just fine.
Terri
> >
> > And damn, I can't have any cocaine...grrrrrrrrr ;-)
> >
> > I am not saying that no one eats this stuff, I am just saying that the foods are not all that hard to control if take an MAOI. I have lived without these foods or drugs for over 25 years, been sedated for surgery etc. and I wouldn't trade any of those years for all the cheddar cheese in the world.
>
> Well I wish you the best on it.
>
>
> Tidings
>
> Jay
Posted by JaclinHyde on April 7, 2006, at 16:50:25
In reply to Re: Depression Can Be Fatal! » yxibow, posted by Caedmon on April 7, 2006, at 10:49:00
> I thought that diphenhydramine and chlorpheniramine (antihistamines) were okay with an MAOI. Just not in combination w/ a decongestant (obviously). Any idea why they would be contraindicated?
>
> - CI just did a med interaction check on medscape which found no problems between Nardil and chlorpheniramine.
JH
Posted by ed_uk on April 7, 2006, at 16:55:18
In reply to Re: Depression Can Be Fatal! » JaclinHyde, posted by yxibow on April 7, 2006, at 2:13:55
>But not clorpheneramine maleate, benadryl
Most people on MAOIs take Benadryl with no problems. Even so, I wouldn't particularly recommend it. There are plenty of other antihistamines to choose from.
>Yes, pseudoephedrine hydrochloride is not the most effective thing on this planet but it at least for me clears my head on a really stuffy day (and then I have to take extra anxiety medicine usually, depends. I don't touch the 12/24 hour stuff, because that means you have to wait 12/24 hours if it messes with your body.)
A stuffy head is hardly comparable in importance to intense depression or anxiety. Having to avoid pseudoephedrine may be inconvenient, but it's really not that important. Have you tried a steroid nasal spray?
>Dextromethorphan is really the only effective thing here
There isn't much evidence to support the efficacy of dextromethorphan. I wouldn't generally recommend it. If a cough is present, the underlying cause should be treated. Mild coughs don't usually last long anyway.
>we can't go and get a little bit of codeine like in Canada (unless the changed that.) Of course that is also contraindicated.
I have only heard of one anecdotal case report of an interaction between an MAOI and codeine. Most people find that codeine does not interact with MAOIs. Nevertheless, taking codeine for a cough is not usually necessary.
>Well I'm a vegetarian ... so a MAOI would be out, since it includes most soy products
Fermented soy products, not all soy products.
>I eat bananas at all stages -- avoiding a banana because its one day too old and having a hypertensive crisis --- good lord
That would be extremely improbable. Fruit contains only tiny amounts of tyramine. You don't need to worry unless you're eating the banana peels as well.
>Avocadoes
They is a single case report of an alleged interaction. It is not of general importance.
>That means no trips to Taco Bell or whatever chain in your state has it since trace amounts could show up.
Trace amounts are irrelevent. Hypertension will only occur following a large 'dose' of tyramine. Even cheddar cheese would be safe in trace amounts.
Posted by ed_uk on April 7, 2006, at 16:57:06
In reply to Re: Depression Can Be Fatal!, posted by JaclinHyde on April 7, 2006, at 16:43:17
>Just a quick note to say that it is OVER RIPE banana's (the kind that are black skinned) and OVER RIPE avocados. Ripe banana's and ripe avocado's are just fine.
That's right. Rotten bananas would not be ok. Normal bananas are just fine :)
Ed
Posted by TylerJ on April 7, 2006, at 18:21:40
In reply to Re: Depression Can Be Fatal! » yxibow, posted by ed_uk on April 7, 2006, at 16:55:18
> >But not clorpheneramine maleate, benadryl
>
> Most people on MAOIs take Benadryl with no problems. Even so, I wouldn't particularly recommend it. There are plenty of other antihistamines to choose from.
>
> >Yes, pseudoephedrine hydrochloride is not the most effective thing on this planet but it at least for me clears my head on a really stuffy day (and then I have to take extra anxiety medicine usually, depends. I don't touch the 12/24 hour stuff, because that means you have to wait 12/24 hours if it messes with your body.)
>
> A stuffy head is hardly comparable in importance to intense depression or anxiety. Having to avoid pseudoephedrine may be inconvenient, but it's really not that important. Have you tried a steroid nasal spray?
>
> >Dextromethorphan is really the only effective thing here
>
> There isn't much evidence to support the efficacy of dextromethorphan. I wouldn't generally recommend it. If a cough is present, the underlying cause should be treated. Mild coughs don't usually last long anyway.
>
> >we can't go and get a little bit of codeine like in Canada (unless the changed that.) Of course that is also contraindicated.
>
> I have only heard of one anecdotal case report of an interaction between an MAOI and codeine. Most people find that codeine does not interact with MAOIs. Nevertheless, taking codeine for a cough is not usually necessary.
>
> >Well I'm a vegetarian ... so a MAOI would be out, since it includes most soy products
>
> Fermented soy products, not all soy products.
>
> >I eat bananas at all stages -- avoiding a banana because its one day too old and having a hypertensive crisis --- good lord
>
> That would be extremely improbable. Fruit contains only tiny amounts of tyramine. You don't need to worry unless you're eating the banana peels as well.
>
> >Avocadoes
>
> They is a single case report of an alleged interaction. It is not of general importance.
>
> >That means no trips to Taco Bell or whatever chain in your state has it since trace amounts could show up.
>
> Trace amounts are irrelevent. Hypertension will only occur following a large 'dose' of tyramine. Even cheddar cheese would be safe in trace amounts.
>
>
>
> Ed,
I currently take tylenol with codiene as needed for my back. It's the pain med my pdoc recommended. So far, so good, no problems at all.Also, do you know if Parnate has an effect on blood sugar? I'm a diabetic and am on glucophage and lately I've noticed more variations in my blood sugar when I test. It might just be my diabetes is getting worse..I was diagnosed with it 4 years ago. Thanks Ed.
Ty
>
>
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Dr. Bob is Robert Hsiung, MD,
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