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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by proudfoot on August 27, 2010, at 21:28:14
OK, so I'm most of the way through my first week taking Nardil, and so far so good with regards to the blood pressure (BP). I'm doing my best to adhere to a low tyramine diet (see my other recent food-related posts here), but worry about dealing with a surge in my BP from something I unknowingly ingest that contains too much tyramine.
My shrink gave me an Rx for nifedipine (generic for Procardia), but the pharmacy gave me hard pills, not the liquid-filled gelcaps that I think he intended for me to squeeze under my tongue should the need arise. I'm guessing I'd have to chew these suckers and say a prayer waiting for them to got absorbed from my gut.
I'm now reading that using nifedipine for treating a hypertensive crisis is not the standard of care anyhow, as it may interfere with some IV treatments used in the ER. Plus, it could worsen perfusion in parts of the brain by reducing blood flow that's available there, and thus potentially worsen any brain injury that's already happened.
What has your doc prescribed for you to use in an emergency? I'm really intrigued by the use of chlorpromazine (Thorazine) 50 mg, as I understand it can lower BP as well as treat the migraine-like headache symptoms that occur with an MAOI-caused hypertensive crisis. Sounds like a logical and useful choice.
I read too about sublingual nitroglycerin (NTG) being very effective and safer than nifedipine, but the limiting thing there would be the need to get a new bottle of the tablets to keep on hand every month, as NTG is not very stable and can thus not be kept for long periods of time.
I also read one anecdote of a nurse who self-treated during an episode of a food-induced headache/increased BP with the use of clonidine 0.1 mg under the tongue on a repeated basis until her BP normalized again.
I'm not sure I would have the balls to not go to the ER if something like this were to happen, but I also know how insensitive and inappropriate ER staff can be to patients with mental health diagnoses, so having a reliable means of at least initiating treatment without screwing things up for further management in the ER would be nice.
What feedback should I give my doc about how we should manage any episodes I might have? I'm thinking I'm going to ask for some chlorpromazine to keep on hand, but I'd like to hear from more of you about your experiences in this regard.
Thanks so much!
Doug
Posted by Maxime on August 27, 2010, at 22:42:22
In reply to Managing BP bombshells, posted by proudfoot on August 27, 2010, at 21:28:14
I use 100 mg of Thorazine/Largactil if I have a hypertensive crisis. I have only had 2 - one from home made wine, and the second was from something that I ate at a vegetarian asian restaurant (maybe a combination of things or many just the soy sauce.
I took the 100 mg and layed down in bed and I as fine in about an hour. I now use Thorazine for when I get headaches at the back of my head.
Maxime
Posted by ed_uk2010 on August 28, 2010, at 14:30:02
In reply to Managing BP bombshells, posted by proudfoot on August 27, 2010, at 21:28:14
Contrary to popular belief, nifedipine is not well absorbed sublingually. Just swallow it!
Posted by violette on August 29, 2010, at 23:22:48
In reply to Managing BP bombshells, posted by proudfoot on August 27, 2010, at 21:28:14
Hi Doug,
i don't have any information for your situation but wondered if I could ask you a question.
"Plus, it could worsen perfusion in parts of the brain by reducing blood flow that's available there, and thus potentially worsen any brain injury that's already happened"
I always wondered what the adverse effects of untreated chronic anxiety/panic attacks were. Is it possible they could cause damage in reducing flow to the brain, similar to what you mentioned here? Anxiety, from what I understands, redirects your blood towards the muscles. And many people here complain about chronic memory/concentration problems. Could cognitive problems be a result, in part, of chronic untreated anxiety related to the concept you mentioned above? You seem to have quite a bit knowledge of this concept...so I hoping you might know something I don't.
Thanks
Posted by proudfoot on August 30, 2010, at 9:22:59
In reply to Re: Managing BP bombshells » proudfoot, posted by violette on August 29, 2010, at 23:22:48
> Hi Doug,
>
> i don't have any information for your situation but wondered if I could ask you a question.
>
> "Plus, it could worsen perfusion in parts of the brain by reducing blood flow that's available there, and thus potentially worsen any brain injury that's already happened"
>
> I always wondered what the adverse effects of untreated chronic anxiety/panic attacks were. Is it possible they could cause damage in reducing flow to the brain, similar to what you mentioned here? Anxiety, from what I understands, redirects your blood towards the muscles. And many people here complain about chronic memory/concentration problems. Could cognitive problems be a result, in part, of chronic untreated anxiety related to the concept you mentioned above? You seem to have quite a bit knowledge of this concept...so I hoping you might know something I don't.
>
> Thanks
>
>Hi violette,
Alas, I must plead total ignorance of any knowledge with regards to anxiety/panic attacks and related cerebral blood flow.
The situation to which I refer is one where a stroke has already happened in the brain, whether from a burst blood vessel due to an aneurysm or from super-high blood pressure (which is the ultimate bad outcome for eating the wrong thing when taking an MAOI), or from a blocked blood vessel due to a piece of plaque that somehow got into the brain from the lower part of the body, your usual garden-variety stroke. My understanding is that when such a cerebrovascular accident (CVA) has occurred, the usual self-regulation of blood flow to the affected area is history, and the local blood flow to the area is thus dependent on the amount of blood flowing into your brain from below.
The nifedipine brings down one's blood pressure outside of the brain by dilating small blood vessels, but in doing so reduces the amount of blood available to flow into the brain, and if the brain doesn't have enough blood flowing into it (with both oxygen and glucose, which are crucial for your brain cells to survive), further cell injury will result, worsening the existing CVA. This is why when a person has had a stroke, the docs want to bring down the elevated blood pressure SLOWLY and in a controlled fashion, not right away, in order to maintain the iffy blood flow to the injured area. Bring the pressure down too fast, the blood flow to the brain decreases, and boom, the stroke gets worse.
The whole question of altered blood flow with a chronic state of anxiety and resultant cognitive deficits is an intriguing one. If I learn more about this in further research online, I'll post it here. Thanks for asking!
Doug
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