Posted by chemist on September 23, 2005, at 2:14:35
In reply to Re: Is there a lethal klonopin mix???, posted by FredMD on September 22, 2005, at 2:48:15
hello there, chemist here...my comments delineated by asterisks, below...all the best, chemist
*** first of all, your posting name implies you hold an M.D. can you provide the requisite information to Dr. Hsuing (confidentially) to ensure that your input here is taken with the appropriate heft due to a practicing doctor of medicine? ***
> This Web site is infamous for extremely poor pharmacological advice and for notoriously harmful approaches to those who expose suicidal thoughts.
*** can you provide summaries - you use the words ``infamous'' and ``notorious,'' implying widely-known and documented - supporting this claim, addressing the items you note, specifically? ***
The responses offered in this thread seem to confirm the opinions of colleagues.
*** colleagues of whom? Dr. Bob? you? and if not Dr. Bob - which implies the psychiatric community, which as a whole is not known to endorse suicide or inapproriate use or dispensation of medication - then i assume you colleagues are te ones who agree with your assertions. is this correct? ***
Shame on the globe-trotting physician who runs this site, for censoring factual information from his ostensibly "educational" Web site.
*** Dr. Bob censors posts to threard by removing words considered vulgar (relacing letters with asterisks); or, in cases when a poster continues to post deliberately obscene and/or inflamatory nonsense as an internet ``troll'' might do. further, this is a publicly-viewable website and the advice and commentary provided herein is made by people who are simply posting opinion or information that can be ignored or heeded by the reader. ***
>
> Here's an idea. We can tell the truth while the professor and his needy sidekicks stick his holier-than-thou don't-mess-with-my-tea-party rules up his well-fed a$$.*** the statement above does nothing other than diminish the credibility of your assertions and especially confirms that you are not, in fact, a doctor of medicine. ***
>
> The drugs you have on your shelf might kill you if you take them all at once. But you might not die quickly. You might survive only to later die slowly and painfully as a result of kidney or liver failure. Or you might continue to live but with severely damaged cognitive or neuromotor capacities.*** these statements are correct. the use of the word ``might'' is of utmost importance, and highlights the fact that using prescription medication as directed - or not - does not invariably result in the patient's death or being irreversibly injured. ***
>
> Elavil, a branded compilation of amitriptyline, has toxic effects whether taken alone or in combination with other drugs. Deaths by deliberate or accidental overdosage have occurred with this class of drugs.*** Elavil - or, for that matter, amitriptyline - is not a ``class of drugs.'' further, Elavil is not a ``compilation'' of amitriptyline: it is the name brand (trade mark) of a formulation of the active tricyclic antidepressant ingredient (amitriptyline). the toxic effects are well-quantified and need not be repeated here. clarification of whether Elavil is a ``class of drugs'' or not or a ``compilation'' or amitriptyline or not does warrant addressing. ***
Serontinin and norepinepherine reuptake inhibitors such as Effexor (branded venlafaxine ) are especially dangerous in combination with tricylics that "can increase the amount of a co-ingested drug reaching the systemic circulation if that co-ingested drug normally undergoes first pass metabolism via these CYP enzymes (P450 enzymes 1A2, 2C19, and 3A3/4) during its absorption phase."*** well, FredMD, it's a good thing that venlafaxine is a substrate of isoenzyme 2D6 and 3A4 and not the others. it's also a good thing to do some research about metabolic pathways of drug delivery before making a post such as yours on a public website, in my opinion. ***
> http://www.preskorn.com/columns/0207.html?print=1
>
> "...over 10 years in the United Kingdom, 1512 fatal poisonings have been attributed to benzodiazepine with or without alcohol. Of drugs frequently prescribed, temazepam had the highest number of deaths per million prescriptions (fatal toxicity index) at 11.9, above that of some tricyclic antidepressants."
> http://www.prn2.usm.my/mainsite/bulletin/1996/prn6.html
>*** how many were with, how many without? and why are the data from 1996? and above all, it appears that tricyclics are looking good vs. benzodiazepines, from your reporting. ***
> Drummer and Odell: a blood-diazepam concentration of 5 g/mL might be a threshold value for drug toxicity and could result in a fatal outcome.
>
*** impossible. wrong. the mass of one mL of water is 1 gram. assuming that blood is, in fact, ``thicker'' than water but not more than a few tens of micrograms/mL, your claim states that one can actually dissolve 5 grams of diazepam in 1 g of blood. on a fundamental level, there simply is not enough solvent to accomodate the solute . on a practical level, the information you are providing is entirely incorrect. ***
> Excess blood concentrations of Inderal branded propranolol can result in congestive heart failure, which can also result from excess blood concentrations of amitriptyline. Two drugs with similar side effects and toxicity should be treated with caution and considered potentially dangerous when co-ingested.*** thanks, FredMD, for re-stating the mantra that drugs which interact unfavorably ought not be simultaneously ingested by the patient. and check again on congestive heart failure with propranolol...***
>
> Imitrex, a branded preparation of sumatriptan, has triggered serious heart problems in people with heart disease.*** who would have thought? did you know that sugar has triggered serious pancreatic problems in people with diabetes? ***
Various cardial
*** ``cardial'' is a made-up word, FredMD. cardiac is what you mean. ***
complications have been reported in reacton to therapeutic dosages of Imitrex, and the drug should be treated with caution when administered in combination with drugs that can trigger congestive heart failure.
>
*** more information from the PDR...***
> Polypharmacacy with ethanol and any of the benzos is potentially fatal because ethanol opens chloride ion channels. Though Holmgren and Jones found no increased toxicity of ethanol with concurrent use of benzos, clinicians widely caution against the combination.*** interesting. the opening of chloride ion channels by ethanol as well as drugs of the benzodiazepine class is the reason why concomitant use of both is potentially fatal? check your references. then again, don't: they appear to go on to state that despite this (erroneous) tidbit, that the toxicity of ethanol (which is the killer) is not enhanced whn used with benzos. ***
Benzos otherwise are preferred because they do not reduce potentiation by increaseing influx of chlorine ions, but when co-ingested with ethanol, synergistic effects are widely believed to result in greater loss of neural potentiation than would result from either CNS depressant when taken alone.
*** i cannot make any sense of the statement above. finally, your post is a great example of why one might label PB a source of information not founded in factual sources, in my civil opinion. thank you for stopping in.***
all the best, chemist
poster:chemist
thread:555925
URL: http://www.dr-bob.org/babble/20050921/msgs/558415.html