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John, this is a very interesting question. (Haven�t seen Dr. Brian�s paper
yet).
Hypertensive crisis is the most common and deadly effect of combining
monoamine oxidase inhibitors MAOIs with certain foods and meds (including
OTC drugs). Seizures commonly accompany hypertensive crisis and, under
water, will cause drowning.
Off the top of my head (from clinical experience): The MAOIs rank among the
oldest classes of antidepressant drugs and work by inhibiting the enzyme
monoamine oxidase (as the drug class name indicates). They are still used
clinically because they often work for patients whose depression is
refractory to newer and �cleaner� antidepressants (Prozac et al). However,
MAOIs can interact in dangerous ways when combined with certain foods,
medications, or are used in people with some clinical conditions---and they
are highly lethal when used for overdose attempts.
This is a sketchy list of MAOI/food/drug/disease interactions. Divers who
may be taking these (or any drugs, particularly any medications that act
upon the central nervous system [CNS] *must* consult a
psychiatrist---preferably one who is knowledgeable in dive medicine--before
diving). These MDs are rare; call DAN. Be aware, though, that very little
data are available regarding the effects of most medications at depth. If
you�re taking an MAOI, seek expert opinion before diving, particularly in
cold, deep, overhead, and other stressful environments.
MAOIs are notorious for their interactions with other medications, foods,
and diseases (this is a *short* list):
DRUGS:
* (�newer� antidepressants such as Prozac, Paxil and other SSRIs; also
Buspar;
* older tricyclic antidepressants ( Elavil, Nortriptiline, Pamelor and
others),
* some antihypertensives,
* some narcotics (Demerol, codeine, morphine, most likely others)
* Other CNS depressants
* Stimulants (Sudafed, cocaine, presumably Dexedrine and similar drugs)
* OTC drugs (cough medicine containing Robitussin (guanethidine),
dextromethorphan [DM], Sudafed) and other catecholamine-inducing meds
* L-Tryptophan (no longer marketed in the US)
* Beware �vitamin supplements� or �organic medications�
FOODS:
* Alcohol, particularly Chianti and other aged red wines
* foods that contain high levels of tyramine (fava beans, certain aged
cheeses, organ meats), among others
PHYSICAL CONDITIONS:
* Pheochromocytoma
* Liver disorders
* Congestive heart failure
* Hypertension
* Epilepsy
* Hypomania
* Hypotension
* In light of recommendations regarding Sudafed�s likelihood of inducing O2
toxicity, take particular care before using EAN when taking MAOIs. (My
opinion only, based on his is the author�s opinion only).
IMHO, you have an obligation to inform your dive buddy/instructor that you
are taking these (or any) medications. With certain exceptions, therapeutic
medication use does not preclude diving. But your partner should be aware
of what you�re taking and why and should know the side effects of your
medications. Always log your medication use, allergy history, and history
of diseases prominently in your log book---next to your physician�s name and
phone number and your dive insurance card.
More info if I find it---any diving psychiatrists on the list? Chime in�.
Hope this helps!
Best,
Barbara Dwyer, RN, MA
San Francisco
-----Original Message-----
From: Aqua Tech Dive Center [mailto:scuba@di*.co*]
Sent: Saturday, May 06, 2000 12:17 PM
To: quest@gu*.co*
Subject: question regarding Hyperoxic Seizures
I read with great interest Dr. Brian's paper regarding hyperoxic seizures.
Just for my own clarification Dr. Brian mentions MAO inhibitors delay the
onset of seizures because it limits the breakdown of catechlomines that
produce hydrogen peroxide. However it also states that this process
produces or perhaps leaves a surplus of catechlomines that, in turn, cause
an elevation of the catechlomines that could lead to hydrogen peroxide and
subsequently seizure. I was always of the opinion that MAO inhibitors were
an absolute contraindicator of diving activities. Given this response, does
this information indicate a change of medical opinion regarding these
medications? I understand that this issue is a double edge sword, could
anyone clarify? John Cain
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<body bgcolor=3Dwhite lang=3DEN-US style=3D'tab-interval:.5in'>
<div class=3DSection1>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>John, this is a very interesting
question.<span style=3D"mso-spacerun: yes"> </span>(Haven’t =
seen Dr.
Brian’s paper yet).<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>Hypertensive crisis is the most =
common
and deadly effect of combining monoamine oxidase inhibitors MAOIs with =
certain
foods and meds (including OTC drugs).<span style=3D"mso-spacerun: =
yes">
</span>Seizures commonly accompany hypertensive crisis and, under water, =
will
cause drowning.<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>Off the top of my head (from =
clinical
experience):<span style=3D"mso-spacerun: yes"> </span>The MAOIs =
rank among
the oldest classes of antidepressant drugs and work by inhibiting the =
enzyme
monoamine oxidase (as the drug class name indicates).<span =
style=3D"mso-spacerun:
yes"> </span>They are still used clinically because they =
often work
for patients whose depression is refractory to newer and =
“cleaner”
antidepressants (Prozac et al).<span style=3D"mso-spacerun: yes">
</span>However, MAOIs can interact in dangerous ways when combined with =
certain
foods, medications, or are used in people with some clinical =
conditions---and
they are highly lethal when used for overdose =
attempts.<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>This is a sketchy list of
MAOI/food/drug/disease interactions.<span style=3D"mso-spacerun: =
yes">
</span>Divers who may be taking these (or any drugs, particularly any
medications that act upon the central nervous system [CNS] *<b><span
style=3D'font-weight:bold'>must</span></b>* consult a =
psychiatrist---preferably
one who is knowledgeable in dive medicine--before diving).<span
style=3D"mso-spacerun: yes"> </span>These MDs are rare; call =
DAN.<span
style=3D"mso-spacerun: yes"> </span>Be aware, though, that very =
little data
are available regarding the effects of most medications at depth.<span
style=3D"mso-spacerun: yes"> </span>If you’re taking an =
MAOI, seek expert
opinion before diving, particularly in cold, deep, overhead, and other
stressful environments.<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>MAOIs are notorious for their
interactions with other medications, foods, and diseases (this is a =
*short*
list):<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><b><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New =
Roman";font-weight:bold'>DRUGS:<o:p></o:p></span></font></b></
span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<ul style=3D'mso-margin-top-alt:0in' type=3Ddisc>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>(“newer” antidepressants such as =
Prozac, Paxil and
other SSRIs; also Buspar;
<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>older tricyclic antidepressants ( Elavil,
Nortriptiline, Pamelor and others), =
<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>some antihypertensives, =
<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>some narcotics (Demerol, codeine, morphine, most =
likely
others)<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>Other CNS depressants =
<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>Stimulants (Sudafed, cocaine, presumably =
Dexedrine and
similar drugs)<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>OTC drugs (cough medicine containing Robitussin
(guanethidine), dextromethorphan [DM], Sudafed) and other =
catecholamine-inducing
meds<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>L-Tryptophan (no longer marketed in the =
US)<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>Beware “vitamin supplements” or =
“organic
medications”<o:p></o:p></span></font></span></li>
</ul>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><b><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New =
Roman";font-weight:bold'>FOODS:<o:p></o:p></span></font></b></
span></p>
<ul style=3D'mso-margin-top-alt:0in' type=3Ddisc>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>Alcohol, particularly Chianti and other aged red =
wines<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l0 level1 =
lfo4;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>foods that contain high levels of tyramine (fava =
beans,
certain aged cheeses, organ meats), among others<span =
style=3D"mso-spacerun:
yes">
</span><o:p></o:p></span></font></span></li>
</ul>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><b><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman";font-weight:bold'>PHYSICAL =
CONDITIONS:</span></font></b></span><span
class=3DEmailStyle16><font color=3Dnavy><span =
style=3D'mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New =
Roman"'><o:p></o:p></span></font></span></p>
<ul style=3D'mso-margin-top-alt:0in' type=3Ddisc>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New =
Roman"'>Pheochromocytoma<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>Liver =
disorders<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>Congestive heart =
failure<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New =
Roman"'>Hypertension<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New
Roman"'>Epilepsy<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New
Roman"'>Hypomania<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New
Roman"'>Hypotension<o:p></o:p></span></font></span></li>
<li class=3DMsoNormal style=3D'color:navy;mso-list:l1 level1 =
lfo8;tab-stops:list .5in'><span
class=3DEmailStyle16><font size=3D3 color=3Dnavy face=3D"Times New =
Roman"><span
=
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;mso-ascii-font-family=
:
"Times New Roman";mso-hansi-font-family:"Times New =
Roman";mso-bidi-font-family:
"Times New Roman"'>In light of recommendations regarding =
Sudafed’s likelihood
of inducing O2 toxicity, take particular care before using EAN when =
taking
MAOIs.<span style=3D"mso-spacerun: yes"> </span>(My opinion =
only,
based on his is the author’s opinion =
only).<o:p></o:p></span></font></span></li>
</ul>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>IMHO, you have an obligation to =
inform
your dive buddy/instructor that you are taking these (or any) =
medications.<span
style=3D"mso-spacerun: yes"> </span>With certain exceptions, =
therapeutic
medication use does not preclude diving.<span style=3D"mso-spacerun: =
yes">
</span>But your partner should be aware of what you’re taking and =
why and should
know the side effects of your medications.<span style=3D"mso-spacerun:
yes"> </span>Always log your medication use, allergy history, and =
history
of diseases prominently in your log book---next to your =
physician’s name and
phone number and your dive insurance =
card.<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>More info if I find it---any =
diving
psychiatrists on the list?<span style=3D"mso-spacerun: yes"> =
</span>Chime
in….<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>Hope this =
helps!<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New =
Roman"'>Best,<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'><![if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>Barbara Dwyer, RN, =
MA<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;mso-ansi-font-size:12.0pt;
mso-ascii-font-family:"Times New Roman";mso-hansi-font-family:"Times New =
Roman";
mso-bidi-font-family:"Times New Roman"'>San =
Francisco<o:p></o:p></span></font></span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D2 =
color=3Dnavy face=3DArial><span
style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><!=
[if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D2 =
color=3Dnavy face=3DArial><span
style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><!=
[if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal><span class=3DEmailStyle16><font size=3D2 =
color=3Dnavy face=3DArial><span
style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:Arial'><!=
[if =
!supportEmptyParas]> <![endif]><o:p></o:p></span></font><
/span></p>
<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblue
face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma;color:blue'>-----Original
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> Aqua Tech Dive
=
Center
[mailto:scuba@di*.co*]<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Saturday, May
06, =
2000 12:17
PM<br>
<b><span style=3D'font-weight:bold'>To:</span></b>
quest@gu*.co*<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> question =
regarding
Hyperoxic Seizures</span></font><font color=3Dnavy><span =
style=3D'color:navy;
mso-color-alt:windowtext'><o:p></o:p></span></font></p>
<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
color=3Dnavy
face=3D"Times New Roman"><span =
style=3D'font-size:12.0pt;color:navy'><![if =
!supportEmptyParas]> <![endif]></span></font><font
color=3Dnavy><span =
style=3D'color:navy;mso-color-alt:windowtext'><o:p></o:p></span></fo
nt></=
p>
<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
color=3Dblack
face=3D"Times New Roman"><span style=3D'font-size:10.0pt;color:black'>I =
read with
great interest Dr. Brian's paper regarding hyperoxic seizures. =
Just for
my own clarification Dr. Brian mentions MAO inhibitors delay the =
onset of
seizures because it limits the breakdown of catechlomines that produce =
hydrogen
peroxide. However it also states that this process produces or =
perhaps
leaves a surplus of catechlomines that, in turn, cause an elevation of =
the
catechlomines that could lead to hydrogen peroxide and subsequently
seizure. I was always of the opinion that MAO inhibitors were an =
absolute
contraindicator of diving activities. Given this response, does =
this
information indicate a change of medical opinion regarding these
medications? I understand that this issue is a double edge sword, =
could
anyone clarify? John Cain</span></font><font
color=3Dnavy><span
style=3D'color:navy;mso-color-alt:windowtext'><o:p></o:p></span></fo
nt></=
p>
</div>
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