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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by ace on September 28, 2006, at 21:55:50
In reply to Anna Nicole's son's death..., posted by saturn on September 28, 2006, at 18:15:51
>
> was apparently caused by an arrythmia from zoloft, lexapro and methadone. What's the deal with that?cardiotoxicity between the three drugs...the arythmia must have been very strong...that is VERY rare. I BET my bum that he was using street drugs too!
Posted by notfred on September 28, 2006, at 22:17:39
In reply to Re: Anna Nicole's son's death... » saturn, posted by ace on September 28, 2006, at 21:55:50
SAN JUAN, Puerto Rico (AP) -- Anna Nicole Smith's 20-year-old son died from a lethal combination of methadone and two antidepressant drugs, a U.S.-based pathologist who conducted a private autopsy said Wednesday.
Toxicology tests showed Daniel Smith had methadone, Zoloft and Lexapro in his system when he died September 10 in a hospital room in the Bahamas where his former Playboy Playmate mother was recuperating from giving birth to a daughter, according to Cyril Wecht.
"The fact that we have these drugs and the levels of the drugs overwhelmingly and most logically point to this being a tragic, accidental, drug-related death," Wecht said from his home in the Pittsburgh area.
Wecht said Smith apparently died from a "classical" combination of the drugs which had a lethal "cumulative effect on the central nervous system."
http://www.cnn.com/2006/SHOWBIZ/TV/09/27/smith.son.ap/index.html
Posted by Declan on September 29, 2006, at 0:52:47
In reply to Re: Anna Nicole's son's death..., posted by notfred on September 28, 2006, at 18:50:56
Is the problem with Zoloft and methadone or all SSRIs and methadone?
I'd never heard of this before.
Posted by saturn on September 29, 2006, at 6:37:16
In reply to Re: Anna Nicole's son's death... » saturn, posted by ace on September 28, 2006, at 21:55:50
> >
> > was apparently caused by an arrythmia from zoloft, lexapro and methadone. What's the deal with that?
>
> cardiotoxicity between the three drugs...the arythmia must have been very strong...that is VERY rare. I BET my bum that he was using street drugs too!That was also my first thought, but to the best of my knowledge toxicology reports found no evidence of street drugs. Kindly...Saturn.
Posted by notfred on September 29, 2006, at 7:54:59
In reply to Re: Anna Nicole's son's death..., posted by Declan on September 29, 2006, at 0:52:47
> Is the problem with Zoloft and methadone or all SSRIs and methadone?
>
> I'd never heard of this before.Read the link I provided.
Posted by flmm on September 29, 2006, at 12:10:20
In reply to Re: Anna Nicole's son's death..., posted by notfred on September 29, 2006, at 7:54:59
So is the problem strictly with methadone and ssrs meds, or 2 different ssri meds combined? Is vicoden similar?
Posted by fca on September 29, 2006, at 12:17:02
In reply to Re: Anna Nicole's son's death..., posted by flmm on September 29, 2006, at 12:10:20
Abstract that I ran across yesterday but I can not remember which journal--was on pub med. Methadone has a known side effect of possible cardiac dysrhythmia--I would be interested to know why he was on methadone--tragic from many perspectives--to many drugs in to many parts of his life
----------------------------------------------------Psychoactive medication is frequently used in methadone maintenance treatment programs (MMP) to treat comorbid mental disorders (depression, anxiety, schizophrenia) in opiate-addicts. Thus, several pharmacological interactions are possible. This problem becomes more relevant with the introduction of new CNS-drugs like SSRI, atypical antipsychotics or new anticonvulsants. The most common interactions seen in practice are pharmacodynamic in nature, most often due to the cumulative effects of different drugs on the central nervous system (e.g. neuroleptics or benzodiazepine interactions). However important pharmacokinetic interactions may occur particularly between methadone and antidepressant drugs: Desipramine plasma levels are increased by methadone; further fluvoxamine (and fluoxetine to a less extent) may cause an important increase in serum methadone concentrations. The inhibition of different clusters of the cytochrome P450 system are involved in these interactions. Several lines of evidence suggest that benzodiazepines and methadone may have synergistic interactions and that opiate sedation or respiratory depression could be increased. This is a serious problem, given the widespread use of benzodiazepines among MMP patients. Experimental but not clinical data support methadone and lithium interactions. Finally, classic anticonvulsant drugs, such as phenytoin, carbamazepine and phenobarbital, produce dramatic decreases in methadone levels, which may precipitate a withdrawal syndrome; valproic acid and the new anticonvulsant drugs do not have these effects. Accordingly, caution is advised in the clinical use of methadone when other CNS-drugs are administered.
Posted by ed_uk on September 29, 2006, at 15:01:23
In reply to Re: Anna Nicole's son's death..., posted by Declan on September 29, 2006, at 0:52:47
Hi Dec
Very high doses of methadone can cause cardiac arrhythmias. Problems are most likely when the methadone dose exceeds 100mg per day or if interacting drugs are taken.
Ed
Posted by Declan on September 29, 2006, at 17:18:55
In reply to Re: Anna Nicole's son's death... » Declan, posted by ed_uk on September 29, 2006, at 15:01:23
Since methadone seems to cause low level depression for which the treatment is SSRIs (around here) this is a problem.
Posted by Phillipa on September 29, 2006, at 19:36:55
In reply to Re: Anna Nicole's son's death..., posted by Declan on September 29, 2006, at 17:18:55
This may not be relavant but I heard just heard that methadone was worse for the body than heroine. Love Phillipa
Posted by Declan on September 29, 2006, at 19:55:51
In reply to Re: Anna Nicole's son's death... » Declan, posted by Phillipa on September 29, 2006, at 19:36:55
Posted by Jost on September 29, 2006, at 22:39:25
In reply to That's right (nm) » Phillipa, posted by Declan on September 29, 2006, at 19:55:51
What is there about methadone that's more harmful, Declan?
I know it's much easier on the gastrointestinal tract, which is a serious issue for those on morphine and related drugs. So it can depends on your medical situation, and probably other things.
Jost
Posted by Declan on September 30, 2006, at 4:45:30
In reply to Re: That's right » Declan, posted by Jost on September 29, 2006, at 22:39:25
What's toxic about methadone? I dunno, but it's not subtle. Just my experience. Too toxic for the Wermacht (can't resist). It *is* considerably less constipating than oral morphine. It's not *that* bad. People just get a bit depressed and sweat a lot. Then there's the people who say it rots your teeth and bones, but it didn't do that to me.
Posted by Squiggles on October 1, 2006, at 9:21:51
In reply to Anna Nicole's son's death..., posted by saturn on September 28, 2006, at 18:15:51
>
> was apparently caused by an arrythmia from zoloft, lexapro and methadone. What's the deal with that?I don't know; and i don't trust that we *will*
know; sounds like an interaction to me--
SSRIs are not the light drugs we were led
to believe.I'm sorry he died, and in a monitoring hospital too :-(
Squiggles
Posted by saturn on October 1, 2006, at 13:33:01
In reply to Re: Anna Nicole's son's death... » saturn, posted by Squiggles on October 1, 2006, at 9:21:51
>
> I don't know; and i don't trust that we *will*
> know; sounds like an interaction to me--
> SSRIs are not the light drugs we were led
> to believe.They certainly aren't. I'm not anti-SSRI but zoloft nearly made my heart explode. I don't think most physicians have an appreciation for how powerful they can be.
Posted by flmm on October 1, 2006, at 18:28:50
In reply to Re: Anna Nicole's son's death... » Squiggles, posted by saturn on October 1, 2006, at 13:33:01
I have been doing a little reading up on methadone and I have come to find out it is the only opiate pain reliever that builds up in the system! Gee, do you think this is significant? Why was he on this drug in the first place? I think the problem is more with the methadone than the ssri meds! My understanding is Anna Nicole did not like the first doctors drug report and had her own doctor do it. HEROIN ADDICT MAYBE? Anyway, something is not right here, let's not jump to conclusions about zoloft or lexapro! This kid had some problems, why was he taking Meth?.................
Posted by flmm on October 1, 2006, at 18:39:05
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by flmm on October 1, 2006, at 18:28:50
You know, we can talk about the drug combo all we want, but the question really is ,how much methadone? I smell something fishy.............
Posted by saturn on October 1, 2006, at 18:43:38
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by flmm on October 1, 2006, at 18:28:50
>let's not jump to conclusions about zoloft or lexapro! This kid had some problems, why was he taking Meth?.................
what conclusions?
Posted by flmm on October 1, 2006, at 18:49:02
In reply to Re: Anna Nicole's son's death..HOLD ON! » flmm, posted by saturn on October 1, 2006, at 18:43:38
It is clear most people here will assume it was the antidepressants and not methadone!People here love to bash their meds! Come on now! I don't often here of zoloft causing death, now meth or heroin.............
Posted by notfred on October 1, 2006, at 19:09:26
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by flmm on October 1, 2006, at 18:49:02
> It is clear most people here will assume it was the antidepressants and not methadone!
Why ? I posted what the pathologist who conducted a private autopsy said:
SAN JUAN, Puerto Rico (AP) -- Anna Nicole Smith's 20-year-old son died from a lethal combination of methadone and two antidepressant drugs, a U.S.-based pathologist who conducted a private autopsy said Wednesday.Toxicology tests showed Daniel Smith had methadone, Zoloft and Lexapro in his system when he died September 10 in a hospital room in the Bahamas where his former Playboy Playmate mother was recuperating from giving birth to a daughter, according to Cyril Wecht.
"The fact that we have these drugs and the levels of the drugs overwhelmingly and most logically point to this being a tragic, accidental, drug-related death," Wecht said from his home in the Pittsburgh area.
Wecht said Smith apparently died from a "classical" combination of the drugs which had a lethal "cumulative effect on the central nervous system."
http://www.cnn.com/2006/SHOWBIZ/TV/09/27/smith.son.ap/index.html
Posted by Declan on October 1, 2006, at 22:14:30
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by notfred on October 1, 2006, at 19:09:26
The amount of methadone in the system tells you nothing about the respiratory depressant effect. Similarly, I think, should methadone accumulate, that tells you little. Methadone is a med? Is there some AD vs All-the-fun-drugs(?) thing going on here. Some paradigm conflict?
Posted by notfred on October 1, 2006, at 23:32:43
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by Declan on October 1, 2006, at 22:14:30
> The amount of methadone in the system tells you nothing about the respiratory depressant effect. Similarly, I think, should methadone accumulate, that tells you little. Methadone is a med? Is there some AD vs All-the-fun-drugs(?) thing going on here. Some paradigm conflict ?
There is really no way to tell with what little info we have; the pathologist is the one that has more extensive info so I would go with his call on this.The LD50 is at least an order of magnitude different between a Methadone naive vs experienced
person. Methadone is the last choice as a street drug as other oipoids yield a more/stronger/better high. Methadone is highly controled in the US, in MM programs patients can only take it at the MM clinic under direct observation. This makes diversion hard. Heroin is easy to find in the US.
This suggests the kid was in a MM program and would be oipoid tolerant and knowlagable as to
Methadone's 24 hr half life; less likely to take too much w/i a 24 hr period, his LD50 would be high & he would be tolerant to respiratory depression.There is no easy way to tell if one is a slow metabolizer of any med. The pathologist may have direct knowledge of how much of each med was taken
so he would know if any one drug was taken in excess of the LD50.It is quite common for people to die taking far less that lethal doses of multiple meds, if they are a slow metabozizer of one, some or all the meds they took. The so called "classic presentation" that the pathologist mentioned.
This is why doc's do not start people on multiple meds at once if they can avoid it and introduce
a new med at a very low dose. That way toxic conditions present themselves slowly instead of killing the patient.
Posted by saturn on October 2, 2006, at 11:49:08
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by flmm on October 1, 2006, at 18:49:02
> It is clear most people here will assume it was the antidepressants and not methadone!
Really?
>>People here love to bash their meds!
I don't think that is fair. I just want to know what caused his death--no bias in favor of or against any meds.
Respectfully...Saturn
Posted by Declan on October 2, 2006, at 14:19:30
In reply to Re: Anna Nicole's son's death..HOLD ON!, posted by notfred on October 1, 2006, at 23:32:43
It is certainly possible for an opiate naive person to OD on 30mg, quite possibly less, and combinations are unpredictable. Some people on MM are on as high as 240mg, and I suspect tolerance is such that all that's left is addiction and toxicity. That's an 8 fold difference.
Posted by notfred on October 2, 2006, at 17:55:15
In reply to Re: Anna Nicole's son's death..HOLD ON! » notfred, posted by Declan on October 2, 2006, at 14:19:30
Some people on MM are on as high as 240mg, and I suspect tolerance is such that all that's left is addiction and toxicity.
And LD50 is even higher.
This is the end of the thread.
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