Expert: Ivan Goldberg, M.D. - 7/25/2011

Question
Good Morning Dr Goldberg,

I have found Marplan at 80mg/day to be less than effective than I and my Dr. had hoped... and my prescription benefits ran out, so $650 a month out of pocket is not feasible, and we had planned on making a switch anyway, BUT I just don't want to get "hit by a bus" during discontinuation and waiting weeks on new Maoi to become therapuetic.

My Dr. (a Generalist Psychiatrist...) has been practicing a long time (he's in his late 70's) and has been using Maoi's forever...
Before my Wed. appt... I just wanted to get your experience/suggestions/dosage on Rapid Switching to either Parnate or back to my 5 year use Nardil at 60mg which was decently effective but not great.

Thank you for your time, and we all appreciate your depth of knowledge.

Regards,Wm

Answer
Hi . . .

It is dangerous to rapidly switch from Marplan to either Nardil or Parnate. There is a real risk of severe hypertension. A 14-day interval between stopping the Marplan and starting another MAOI makes good sense.

Best regards . . .

Ivan
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