Posted by chemist on April 10, 2004, at 19:29:30
In reply to drug drama (for anyone good at chemistry), posted by socialdeviantjeff on April 10, 2004, at 1:39:05
hi there, from chemist...first off, looks like you are more on the dysthemic side of the bipolar spectrum, and halcion and zyprexa aren't helping that. second, you are being double-dosed with zyprexa and abilify. there is a trend in using novel anti-psychotics for bipolar disorder, and one of the more weight-neutral ones is geodon, which you might consider in lieu of zyprexa. abilify has sub-micromolar binding affinities for receptors too numerous to mention, and i suspect that it, too, is causing you to be quite groggy. halcion is causing anterograde amnesia and your early-morning ``hangovers,'' and frankly i am surprised that ambien (10 mg prn hs insomnia) was not offered first. for a mood stabilizer - if you cannot find one of the anti-psychotics to do the trick - you might try trileptal. although you are allergic to tegretol, the crossover incidence for allergy/reaction to trileptal is about 25%. tegretol is an autoinducing drug that is metabolized via the CYP450A pathway, and the intermediate (the 10,11-epoxide) is what causes hepatic impairment and - perhaps - the side effects. trileptal is metabolized via an enzyme known as aryl ketone reductase, and the epoxide intermediate is not formed, rather the monohydroxy derivative (MHD) - which is the stuff that is actually pscyhopharmacologically active - is produced (note bene: MHD is the final product that results from metabolism of both tegretol and trileptal). your mood might be enhanced by dexedrine or ritalin. my preferred med is dexedrine, although if you are going for the brand-name version (SKF/E-18 5 mg tablets vs. generic or spansules), be aware that the coloring used is contraindicated in people with allergies to aspirin...hope this gives you some insight, all the best, chemist
> Ok, my DX is MD, GAD and BPD.
>
> I've been on a few drugs over the years. I have never hit a standard theraputic dose. The side effects have been varied and major. Some of the common SE's have been: fatigue, nausea, muscle pain, tremors, cognitive problems, etc.
>
> Here is the short list of stuff I can't tolerate:
> B Vitamin supplements
> 5-HTP
> St John's wort
> Paxil
> Zoloft
> Amitryptaline
> Desimpramine
> Wellbutrin (allergies)
> Prozac (allergies)
> Neurontin (allergies)
> Lexapro
> Lithium
> Tegretol
> Perphenazine
>
> Right now I'm on 5 mg. Abilify, 5 mg Zyprexa and .25 mg Halcion and not doing al that well. The Halcion is good for sleep but leaves me groggy. So does the Zyprexa plus weight gain and cognitive problems. The Abilify causes anxiety and sleep problems. This combo does help with *some* psych problems.
>
> So what am I missing? Am I a poor drug metabolizer? What should my pdoc be looking for?
>
> Any input is welcome and appreciated.
poster:chemist
thread:334797
URL: http://www.dr-bob.org/babble/20040407/msgs/335012.html