![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by socialdeviantjeff on April 10, 2004, at 1:39:05
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
PerphenazineRight 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.
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.
Posted by socialdeviantjeff on April 11, 2004, at 0:48:01
In reply to Re: drug drama (for anyone good at chemistry) » socialdeviantjeff, posted by chemist on April 10, 2004, at 19:29:30
Thanks, Chemist! I appreciate the time you took to put your response together. I have some things to discuss with my pdoc. I appreciate it.
Now I'm a novice at this sort of thing, so if I'm wrong please let me know. I looked up the ways these drugs are metabolized and Cytochrome P450 came up again and again. Could it be that the drugs aren't being metabolized properly due to a problem with this system? Could an excess of these drugs and/or their metabolites explain why I have such bad side effects? I really am a beginner in this stuff.
TIA
Posted by chemist on April 11, 2004, at 14:05:35
In reply to Re: drug drama (for anyone good at chemistry), posted by socialdeviantjeff on April 11, 2004, at 0:48:01
my pleasure...you could have a very real genetic component that is responsible for the metabolism of these drugs. the CYP enzymes of most import for us are 1A2, 2C9, 2C19, 2D6, and 3A4. zyprexa's route is via the 1A2 and 2D6 routes, while halcion is primarily metabolized by 3A4 and inhibits 2C8 and 2C9, thus i would expect no interation (on the enymatic level) for zyprexa and halcion. now, abilify (aripiprazole), is metabolized via 2D6 and 3A4 but is not an inhibitor of 2D6, so i would not think there would be an interaction bewteen abilify and zyprexa as they are both metabolized (initially) by 2D6. zyprexa is metabolized in a minor way by 2D6, and apparently if you are deficient in 2D6 this does not affect zyprexa metabolism. all that said, anywhere from 8-10% of the population are classified as poor-metabolizers of 2D6 substrates (abilify) ad you might be one of them. thus, the result is a higher concentration of the active metabolite than if you were not in the 8-10% and given the same dose. now, you also mention tardive dyskinesia, and that is one of the so-called extra pyrimidal side effects that do arise in the use of anti-psychotics such as abilify and zyprexa. my take is that you might be a poor metabolizer and need to have you doses curtailed; or that you are simply being doubly-medicated with zyprexa and abilify to achieve the same therapeutic goal...please let me know if any of this helps, looking forward to your respone...all the best, chemist
> Thanks, Chemist! I appreciate the time you took to put your response together. I have some things to discuss with my pdoc. I appreciate it.
>
> Now I'm a novice at this sort of thing, so if I'm wrong please let me know. I looked up the ways these drugs are metabolized and Cytochrome P450 came up again and again. Could it be that the drugs aren't being metabolized properly due to a problem with this system? Could an excess of these drugs and/or their metabolites explain why I have such bad side effects? I really am a beginner in this stuff.
>
> TIA
Posted by socialdeviantjeff on April 12, 2004, at 18:59:13
In reply to Re: drug drama (for anyone good at chemistry) » socialdeviantjeff, posted by chemist on April 11, 2004, at 14:05:35
Thanks again!
My pdoc is cryptic, that being a euphemism. I appreciate your input. I believe he is double-medicating. I have never tolerated a full dose of anything. He has a pharmacology degree and most of the time it feels like we're shhoting in the dark. I think I'm going to push for some tests.
Hope everything is going well for you.
Posted by chemist on April 12, 2004, at 21:49:22
In reply to Re: drug drama (for anyone good at chemistry) » chemist, posted by socialdeviantjeff on April 12, 2004, at 18:59:13
my pleasure, i hope my intuition is right on...a pharmacology degree has rapidly become a less than useful thing, given the variety of meds out there and the willingness of patients to explore all the alternatives.....please let me know if i can provide to you any more information, all the best, chemist
> Thanks again!
>
> My pdoc is cryptic, that being a euphemism. I appreciate your input. I believe he is double-medicating. I have never tolerated a full dose of anything. He has a pharmacology degree and most of the time it feels like we're shhoting in the dark. I think I'm going to push for some tests.
>
> Hope everything is going well for you.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.