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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jealibeanz on January 22, 2007, at 15:38:01
I've heard that certain medications prolong or increase the effectiveness of various drugs. I think that antacids (TUMS)and proton-pump inhibitors(Protonix, Prevacid)may do this since it decreases or slows the absorbtion and elimination of the other medications.
Does anyone know anything about this?
I'm taking Xanax and Ritalin LA. I know my doctor won't increase the Xanax, probably that Ritalin, since I'm not at max dose.
I've also heard that grapefruit may work. I can't remember though. I know grapefruit interacts with a lot of drugs in a negative manner.
Posted by yxibow on January 22, 2007, at 20:18:18
In reply to Increasing the Effect of Medications, posted by jealibeanz on January 22, 2007, at 15:38:01
> I've heard that certain medications prolong or increase the effectiveness of various drugs. I think that antacids (TUMS)and proton-pump inhibitors(Protonix, Prevacid)may do this since it decreases or slows the absorbtion and elimination of the other medications.
>
> Does anyone know anything about this?
>
> I'm taking Xanax and Ritalin LA. I know my doctor won't increase the Xanax, probably that Ritalin, since I'm not at max dose.
>
> I've also heard that grapefruit may work. I can't remember though. I know grapefruit interacts with a lot of drugs in a negative manner.Yes, this is (primarily) through the P450 cytochrome system, in your liver.
The grapefruit juice interaction is generally not clinically relevant unless you drink a lot of grapefruit juice or you drink it at the same time as your medication ingestion (peak). I don't think most medications would notice an occasional half slice grapefruit for breakfast.
Essentially deliberately affecting the Xanax is of course going against your doctors orders.
The clinically relevant table is at
http://medicine.iupui.edu/flockhart/clinlist.htm
Basically, a medication that is a Substrate is held in the body longer by an Inhibitor.
So if you really love grapefruit juice ... well I can't tell you to go against your doctor's orders but you get the picture. Just remember also that excess fluid intake can be fatal (e.g. those jackasses who made a Wee for a Wii contest on KDND Sacramento, and essentially committed manslaughter on a poor gal who drank a fatal amount of water.)
Its normally considered a hindrance to polypharmacy rather than an intentional playing around with cytochromes, but its your body.
-- Jay
Posted by blueberry1 on January 22, 2007, at 20:24:33
In reply to Increasing the Effect of Medications, posted by jealibeanz on January 22, 2007, at 15:38:01
Don't quote me on this, but I don't think grapefruit juice will affect ritalin.
Grapefruit juice slows down an enzyme called CYP3A4 which is the one that breaks down xanax. So it would increase xanax. But how much?
The unknown part of the deal is that you don't know how much grapefruit juice to drink or how often. Sounds kind of tricky. I would be afraid to try it myself for fear of overdose, when in reality maybe it would be so tame I wouldn't even notice it. I don't know.
Posted by jealibeanz on January 22, 2007, at 20:31:01
In reply to Re: Increasing the Effect of Medications » jealibeanz, posted by yxibow on January 22, 2007, at 20:18:18
I think it would take a whole lot of grapefruit, plus an overdose of meds to make any considerable differences.
Aside from liver metabolism, I was wondering about gastric absorbtion/digestion.
I know some forms of stimulants are less effective if taken with food, since gastric acid increases it's catabolism.
I know Concerta is uneffected by food, but think that Ritalin was the one which is less effective w/food. So I was think PPI's may help?!
I don't know of anything else off-hand about the BDZ interactions, beside meds metabolisms in the CYP34A. But I know there are other ways to prolong its use.
Posted by laima on January 22, 2007, at 21:14:35
In reply to Re: Increasing the Effect of Medications, posted by jealibeanz on January 22, 2007, at 20:31:01
I agree, ritalin more effective on an empty stomach.I heard that alcohol can render some antidepressents ineffective, but don't know any details.
Posted by Phillipa on January 22, 2007, at 21:30:03
In reply to Re: Increasing the Effect of Medications, posted by laima on January 22, 2007, at 21:14:35
Laima I heard the same thing which makes me wonder if the first ad I ever took and seemed to work with xanax could have with the 4-6 beers I was drinking at the time at night? Love Phillipa
Posted by laima on January 22, 2007, at 21:34:04
In reply to Re: Increasing the Effect of Medications » laima, posted by Phillipa on January 22, 2007, at 21:30:03
Perhaps alcohol only interferes with certain antidepressents then? I wonder which ones? The friend who told me felt sure wellbutrin was one, but whether or not she's right, or which other ones, I don't know.
Posted by Phillipa on January 22, 2007, at 21:50:41
In reply to Re: Increasing the Effect of Medications » Phillipa, posted by laima on January 22, 2007, at 21:34:04
No I heard that too years ago that alchohol negated the effects of antidepressants. Love Phillipa hence why I've always taken the benzos.
Posted by jealibeanz on January 23, 2007, at 10:46:32
In reply to Increasing the Effect of Medications, posted by jealibeanz on January 22, 2007, at 15:38:01
Providing one answer to my own question... oral contraceptives increase the plasma levels, decrease clearance, and increase the half-life of BZD's fairly significantly.
Posted by blueberry1 on January 23, 2007, at 16:43:09
In reply to Increasing the Effect of Medications, posted by jealibeanz on January 22, 2007, at 15:38:01
I read an abstract at pubmed.com where they used low doses of the antidepressant serzone to smooth out the peaks and troughs of xanax. Serzone inhibits the enzyme that breaks down xanax.
Posted by yxibow on January 23, 2007, at 19:53:06
In reply to Re: Increasing the Effect of Medications, posted by blueberry1 on January 23, 2007, at 16:43:09
> I read an abstract at pubmed.com where they used low doses of the antidepressant serzone to smooth out the peaks and troughs of xanax. Serzone inhibits the enzyme that breaks down xanax.
As long as one is careful about Serzone itself, because you're putting three medications through the liver now. Nefazodone has had some liver issues so testing say baseline and 4-6 weeks later would be prudent.
But I don't see the point of using other medications to artificially alter P450 enzymes than convincing your doctor you need a little boost of Xanax, and as long as you're taking Xanax you might as well be taking Xanax XR so you don't have peaks and valleys with interdosal withdrawal and you're less likely to develop Xanax tolerance because its a 24+ hour half life.
Medicine usually dictates the MED (minimum effective dose) and minimum use of medications and invasive procedures to maintain suppression or elimination of symptoms.-- Jay
Posted by blueberry1 on January 23, 2007, at 21:26:46
In reply to Re: Increasing the Effect of Medications » blueberry1, posted by yxibow on January 23, 2007, at 19:53:06
I totally agree. I just thought it was interesting they actually tried that, instead of doing something simple like maybe take the daily dosage and divide into 5 doses instead of 4, or go with the XR version. Adding another med, especially one so sedating like serzone, seems like overkill to me. No way to monitor what is doing what. Too many variables and too much risk.
> > I read an abstract at pubmed.com where they used low doses of the antidepressant serzone to smooth out the peaks and troughs of xanax. Serzone inhibits the enzyme that breaks down xanax.
>
> As long as one is careful about Serzone itself, because you're putting three medications through the liver now. Nefazodone has had some liver issues so testing say baseline and 4-6 weeks later would be prudent.
>
>
> But I don't see the point of using other medications to artificially alter P450 enzymes than convincing your doctor you need a little boost of Xanax, and as long as you're taking Xanax you might as well be taking Xanax XR so you don't have peaks and valleys with interdosal withdrawal and you're less likely to develop Xanax tolerance because its a 24+ hour half life.
>
>
> Medicine usually dictates the MED (minimum effective dose) and minimum use of medications and invasive procedures to maintain suppression or elimination of symptoms.
>
> -- Jay
Posted by jealibeanz on January 24, 2007, at 9:12:21
In reply to Re: Increasing the Effect of Medications » yxibow, posted by blueberry1 on January 23, 2007, at 21:26:46
Yeah that would smooth out peaks and valley's of Xanax, but also help with anxiety if the patient responds well to antidepressants.
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