Posted by Larry Hoover on September 6, 2004, at 8:35:20
In reply to Wow, my pdoc was just talking abou this..., posted by gardenergirl on September 3, 2004, at 14:33:57
> How cool is that? I saw my new pdoc today, after a rocky month of multiple side effects. She concluded, rightly so, that I am medication sensitive, and talked about how this might be related to a deficiency in one or two liver enzymes. She also mentioned that there is not wide-spread testing at this point, but that the human genome project and genetic testing may help in selecting medications and doses in the future to avoid problems like I have had.
>
> Incidentally, I would suspect I am a poor metabolizer and my family heritage is Finnish. Wonder if there is a regional/genetic connection?
>
> And this explains to some extent how once I got nearly hypomanic from an antibiotic...Biaxin XR. All the pharmacist could say when I called was "maybe your liver is not metabolizing it well." As if I had some liver pathology. Hmmmm.
>
> Thanks for posting this.
>
> ggBiaxin is not only a substrate of enzyme 3A4, it is also an inhibitor. Makes predictions of what is going to happen rather difficult. Also, if you are ingesting any of the following, there is a strong likelihood of an interaction caused by these inhibitors: Ketoconazole (Nizoral), Itraconazole (Sporanox), Erythromycin, Grapefruit Juice, Seville Oranges, Nefazodone (Serzone), Fluvoxamine (Luvox), Fluoxetine (Prozac), Diltiazem (Cardizem), Verapamil (Calan), Clarithromycin (Biaxin), Omeprazole (Prilosec), Propoxyphene (Darvon), Ritonavir (Norvir), Indinavir (Crixivan), Nelfinavir (Viracept), Saquinavir (Fortovase)
From:http://www.geocities.com/hupiteekki/paihde01.htm
One of the most common enzyme deficiencies is in enzyme 2D6. If you've ever used codeine, you can predict your 2D6 activity rather accurately, based on your reaction. If 2D6 activity is low, you will get constipation and dry mouth, but poor pain control. If normal 2D6 activity, you'll get a nice balance between side effects and pain relief. If you have high 2D6 activity (so-called extensive metabolizers), you'll get a major high. 2D6 converts codeine to morphine. It's a prodrug for morphine. Poor metabolizers get little or no morphine. Normal metabolizers get something like extended-release morphine. Extensive metabolizers get something like an IV injection of morphine. The variability in 2D6 activity is at least 118-fold, or 11,800% difference in the rate of morphine yield.
Lar
poster:Larry Hoover
thread:385176
URL: http://www.dr-bob.org/babble/20040904/msgs/386997.html