Posted 24 May 2013 - 12:46 PM
I can't speak for the other MAOIs, but Parnate may have a few reasons that probably suggest it shouldn't be taken sublingually. Orally, it already has a short time to reach peak plasma concentration and half life- two hours or something like that. As an analog of amphetamine and weak norepinephrine and dopamine releaser, sublingual administration would likely speed up this reaction, and following effects, in a drug already prone to many and various side effects beyond the regular MAOI problems. Let alone cardiac effects. Some people get very anxious/uncomfortable/irritable with regular dosing. This is speculation though, and I have no degree or experience to comment with any confidence in the chemical/pharmacological nature of how MAO inhibition would be changed.
More practically, as someone on 80-mg of Parnate, sublingual administration just seems inconvenient. The pills only really come in 10-mg tablets, and taking a normally required dose would be a mouthful, so to speak. One or two pills wouldn't be terrible, for a social anxiety 30-mg dose.
Personally, I have tried taking some sublingually, as a depressed idiot- it doesn't taste all that bad, but I do believe the onset of my regular side-effects was quicker. (Also, I don't have the best sense of taste, having taken centrophenoxine and a few others. In an effort to avoid terrible stomach problems with Wellbutrin, I also tried it sublingually with 75-mg pills. Like eating boric acid. Awful. Then again, I read that some people do that with Wellbutrin to get some sort of drug abuse effect, so maybe it has a bitterant or something like that. Nonetheless, words from a drug idiot.) With the orthostatic hypotension I have from the drug, and a standing pulse of 110 or something like that after administration, I would hesistate to take it in such a way.
Most importantly, I find the "Cheese Effect" to be very idiosyncratic across the spectrum of patients. I have an accurate blood pressure monitor from a hospital job, and have taken my blood pressure multiple times after a variety of different meals, and have never once had a significant change in pressure over a period of time. I avoid blue cheese, spoiled foods, aged parmesan (to some degree, a sprinkle or two didn't make a difference.), and aged meats. Even after accidentally eating a full meal of pasta with great aged prosciutto (I thought it was over-salted roasted red peppers, which were in the dish), I had no significant change in pressure over a monitoring period of two hours. But that is how it has worked with me, and Parnate is quite tempermental. I will still stick to safe foods for now.
It does work very well for social anxiety, with accompanying therapy. A mixture of CBT, mindfulness, and review of my personal evaluatory framework and expectations has made a huge difference.
Then again, I'm still depressed (with some abnormalities on an MRI, though), so it depends. Good luck with your health.
