Hey everyone, I have been researching MAOIs a little bit and was looking for experiences between MAOI's and SSRI's on bluelight (most of which are negative, or risky to say the least).
But this one story caught my attention, because it just seemed so bizzare to me that a doctor wouldn't know that administering Demerol to a patient taking MAOIs is a bad idea. I mean, they did they have to give him Demerol? Seems like they could have given him Dilaudid instead...but maybe it was some backcountry clinic with some crazy doctor, who knows...maybe Johnnyzero will find this thread and tell us more.
But this one story caught my attention, because it just seemed so bizzare to me that a doctor wouldn't know that administering Demerol to a patient taking MAOIs is a bad idea. I mean, they did they have to give him Demerol? Seems like they could have given him Dilaudid instead...but maybe it was some backcountry clinic with some crazy doctor, who knows...maybe Johnnyzero will find this thread and tell us more.
Last Saturday night I had to pay a visit to my local hospital's emergency room because of severe muscle spasm's as a result of a lower back injury.
During the usual intake procedure, I gave the nurse a list of the medications I was currently taking. Of course I mentioned Emsam, and even stated that it was Selegeline, an MAOI.
After describing my symptoms to the doctor, he proceeded to administer an IM injection of Demerol+Vistral to ease the muscle spasms. Needless to say, within 4 or 5 minutes I started to feel really bad - profuse cold sweat w/ dripping face and soaked t-shirt, feeling shaky & faint like the bottom was dropping out of my soul, and extreme nausea. My wife said my color was sort of a greenish-grey!
I said to my wife, "Oh sh**, I think I now remember that Demerol is an MAOI no-no, and I'm having a reaction to it. Please go get the doctor or somebody right now!"
After describing things to the nurse, he was rather non-chalant and said that it was probably just a normal reaction to the Demerol. I explained the MAOI issue and requested that he please get the doctor. The only thing he did was give me a "hurl bucket" at my request - he didn't offer to check my BP, pulse, or temp.
The doctor himself was very dismissive and pretty much echoed the nurse: Demerol is a strong medication and this is probably a normal reaction. I further explained the possibilty of an MAOI interaction (as best I could, considering the condition I was in). I even said that, now that I think about it, I believe I remember seeing Demerol listed in the Emsam monograph as one of the "must avoid" drugs. I urged him to please double-check, at least to make sure that I wasn't going to die or have a stroke or something.
After a few minutes, he returned to say that he had checked the literature and that there was no such known interaction between Demerol and Emsam!
After about 15 minutes, the acute reaction seemed to subside & I started feeling better. At my urging, I had that the doctor take my BP & pulse. By this time, it was evidently pretty much normal. After another 5 minutes, I was told that I was fine and could go home.
Needless to say, the next morning I checked the Emsam lit & discovered just how potentially serious the interaction could have been. On Monday morning I called my prescribing doc & explained the whole story - he was livid. According to him, the reaction could have been much more serious, or even fatal, were it not for the fact that I take the lowest possible dose of Emsam (the 6mg/24-hr patch), and that I only use 1 patch every other day. If my Selegeline level had been any higher, I might well be pushing up daisies right now!
For me, here is perhaps the most troubling aspest of this whole incident: after I specifically urged the ER doctor to please double-check, he came back and stated that there was no such known drug interaction! That means one of several things, all of which indicate gross incompetence on his part:
1) Either he was so dismissive and arrogant that he didn't even bother to actually look it up. Or...
2) He did look it up and came across the interaction warning, but decided to lie to me about it to cover his a**. Or...
3) He searched the existing literature incorrectly and never came across the necessary information.
I have filed a complaint with the hospital itself, and I've also filed an incident report with the NY State Department of Health. Mainly, I want to make sure that the hospital changes their existing procedures so that this same type of thing doesn't happen to someone else in the future (with more dire consequences).
As I said to the hospital rep: if things had transpired a little differently, you would be hearing from my lawyer right now - or my widow!
best,
JohnB
ps: My back is feeling much better. If it doesn't kill you, Demerol is great!
