"noradrenergic syndrome;" effects of calcium antagonists 
Author Message
 "noradrenergic syndrome;" effects of calcium antagonists

Hi everyone.  To use my favourite overused phrase, "I have a question."

I'm a 22-year-old healthy F.  My normal resting vital signs are BP 110/70; pulse

I take Parnate (nonselective irreversible/semireversible MAO inhibitor).  Today I
had an episode of hypertension (I will refer to this as "noradrenergic syndrome"
since it didn't blow up into full hypertensive crisis).  (I have been instructed
to check my {*filter*} pressure if symptoms of hypertension, such as occipital
headache, tingling scalp, chest pain, stiff neck, sweating, etc. occur.)

I had directions from my doctor to take 10mg of nifedipine (by the "bite and
swallow" method) if my BP went over 140/85 and then to go to an ER.  I went to
Beth Israel/Deaconess (partly because it's a good hospital, mainly because last
time I was there they were very competent about dealing with my (out-of-state)
HMO :-).

After I took the nifedipine, my BP rapidly decreased to slightly below normal
(100/60 or so).  However, my pulse, which had been around 65, jumped to 120 and
remained there for several hours.  I felt like my heart was pounding...I was able
to take my pulse accurately without actually palpating, but just by feeling my
heart pound.  I also felt physically exhausted (still do), like I'd run a
marathon or three.  (My only exercise today consisted of backtracking after I
missed the BI bus stop.)

While I was at BI I had a brief reelevation of {*filter*} pressure (though not as
high) and a second subsequent "crash" (hypotension + tachycardia).

Right now - 12 hours after this all started! - I'm feeling kind of spacey, still
quite physically exhausted but mentally alert (perhaps even hyperalert), and
shakey/jittery.  My BP is back to normal and my pulse is only moderately elevated
at around 90.  I feel quite hyper and don't expect to be sleeping anytime soon.
I'm wondering, in fact, if I've been a little hypomanic; I've had some "pressured
speech" and I've been unusually socially uninhibited (usually I am kind of shy).
Also, my pupils are dilated as sin.

Okay, so my questions are:

1) What might have precipitated the NE syndrome?  I hadn't taken any other {*filter*},
or eaten any "forbidden foods," and I wasn't feeling anxious or under stress.  It
was not a panic attack.

2) What accounts for the weird feelings I've had today?  Which are due to the
effects of excess NE, which to the calcium channel blocker, etc.?  Are there
other factors I should be considering?

2.5) Can someone tell me about the effects (including psychiatric effects) of Ca
channel blockers?  This is the first time I have used one and it was kind of
unpleasant for me.

3) Any suggestions for how I could relax/calm down?

4) I'm nervous that my (overly conservative, IMHO) psychiatrist will consider
this a reason to d/c the Parnate (which has been working quite well with few
side effects until today).  He's currently on vacation and I'm afraid that I will
end up ruminating about this possibility until he gets back.  Any ideas as to how
to deal with this?  I'm really rather terrified of becoming depressed again (not
to mention the horrible experience of MAOI withdrawal/rebound).


 "a great teaching case"

Fri, 25 May 2001 03:00:00 GMT
 "noradrenergic syndrome;" effects of calcium antagonists
Hi; thanks for responding.


> 1) What might have precipitated the NE syndrome?  I hadn't taken any other
> {*filter*},  or eaten any "forbidden foods," and I wasn't feeling anxious or under
> stress. It was not a panic attack.

> A forbidden cooking.net">food that has not yet been labelled as such?

All I ate that day was a very small amount of tea (low-caffeine, and I drink it
all the time with no such problems).

> Seizure?

Novel idea, but what makes you say that?

> Undiagnosed condition that releases NE? (e.g. pheochromocytoma)

I'd think that would have created rather serious problems already, seeing as I've
been taking Parnate for 3 months or so!

> These spontaneous HTN crises happen more with Parnate than deprenyl, another

Familiar with it (though it's usually called selegiline around here).  Didn't
work for me, though.

> > 2.5) Can someone tell me about the effects (including psychiatric effects) of
> > Ca channel blockers?  This is the first time I have used one and it was kind
> > of unpleasant for me.

> each one is different.  check out www.healthgate.com

Didn't find anything of interest there, but I was referring specifically to

>i have not seen any literature, though, on psychiatric effects.

They're used for mania (verapamil has been studied the most), but I was wondering
about adverse effects.

> Have you had a neurologic workup?  It seems to me that psychiatrists miss alot
> of physical causes for symptoms, mostly because their interests lie in the
> non-physical causes.  I would get that done, then try another "antidote" than
> nifedipine for such episodes in the future, rather than discontinuing the
> Parnate.

Yes, I have; there was no evidence of any problem (although my psych still thinks
I might have some sort of epilepsy).

I think "non-physical" is misleading; today, the "causes" of psych problems are
not regarded as being somehow nonbiological (Descartes was a few centuries ago,
after all) but rather as things that we can't yet detect physically.

>Other suggestions for managing any further HTN crises include nitroglycerin -
>which would likely have the same effect as the nifedipine if you are volume
>depleted - or chlorpromazine.  Some physicians put their patients on
>amitryptaline as well as MAOI to reduce the incidence of HTN crises.  For a good
>discussion of the problem, see Biological Psychiatry 34(3):146 (93)

OK, will take a look at that.

Adding a TCA to an MAOI is rather dangerous; if you're going to use the
combination at all it should be done the other way around (and I'm not willing to
quit the Parnate, even temporarily, for this; I'd rather try another PRN
antihypertensive, or just try taking fluids to see if that helps if it happens
again).  Plus, I didn't tolerate TCAs (which is how I came to be taking Parnate).


Sun, 27 May 2001 03:00:00 GMT
 [ 5 post ] 

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