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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by linkadge on September 7, 2008, at 8:53:59
D-methylphenidate is apparently active at 5-ht2b receptors. It is uncertain whether it is an agonist or antagonist.
Does this concern anybody in the context of 5-ht2b receptor agonists potentially damaging cardiac valves?
Linkadge
Posted by Phillipa on September 7, 2008, at 12:28:33
In reply to methylphenidate 5-ht2b, posted by linkadge on September 7, 2008, at 8:53:59
Link glad you're back and have no idea what you're talking about maybe someday if I read enough of what others write on these threads. Love Phillipa
Posted by Racer on September 7, 2008, at 14:55:57
In reply to methylphenidate 5-ht2b, posted by linkadge on September 7, 2008, at 8:53:59
>
> Does this concern anybody in the context of 5-ht2b receptor agonists potentially damaging cardiac valves?
Yes, it's a concern, although I would want to know more before it became a big concern for me.On the other hand, there are so many things in this world which can potentially damage us, things we can't necessarily escape exposure to. Sure, this is something we can avoid exposure to, but I think it's a balance between the potential risk of cardiac valve damage and the symptoms which the medication is prescribed for.
It's a cost-benefit analysis which each of us has to make for ourselves. Is the disorder being treated causing sufficient distress to outweigh the potential risk? Would the quality of life be worse with an untreated condition, or with the potential for this specific heart damage down the road? For me, with my family history of cardiac problems, and my personal history with its additional cardiac risks, my analysis would be pretty easy for me: I am almost certainly going to develop heart problems, probably when I hit menopause, and adding another potential risk factor is of less concern than the symptoms I was taking Ritalin for. That's personal to me, though.
What I think is important, though, is having the information to make the analysis, and having it presented in an understandable manner. I think a lot of doctors out there are not terribly good at explaining some of this stuff to patients. Still, that's really a different topic than this thread, so I'll stop now.
Thanks for posting this question, Linkadge.
Posted by dbc on September 7, 2008, at 17:59:43
In reply to Yes and no... » linkadge, posted by Racer on September 7, 2008, at 14:55:57
Yes and also strattera does if i remember correctly. I've tried both and both seemed to have more cardiac activity than old fashioned D-amphetamine.
Posted by Phillipa on September 7, 2008, at 18:54:32
In reply to Re: Yes and no..., posted by dbc on September 7, 2008, at 17:59:43
Whole family has died of cardiac disease either as a one time MI or strokes. So for me the answer is simple I would not take a med known to damage my heart. It's bad emough that synthroid worsens osteoporsis and I will not take the meds for it and my endo has said that vita D is more important than ca and mg. So she did a blood test on D. I get EKG's a lot and so far so good and excercise daily whether I want to or not it's a must for me. I can deal with anxiety but not heart disease. That's me. Phillipa
Posted by linkadge on September 7, 2008, at 19:59:05
In reply to Yes and no... » linkadge, posted by Racer on September 7, 2008, at 14:55:57
I appreciate your analysis but it doesn't make any sense to me :)
I mean this is your heart.
Linkadge
Posted by linkadge on September 7, 2008, at 20:02:52
In reply to Re: Yes and no..., posted by dbc on September 7, 2008, at 17:59:43
This is more than hypertension thought. The drugs can raise blood pressure, but this is a risk that may have yet gone undetected.
d-MPH acts as an agonist at 5-ht2b receptors. This can cause direct cardiac valve dammage. The two dopamine agonists permax and cabergoline were withdrawn because they could dammage cardiac valves with the same mechanism (ie 5-ht2b agonism).
I am firing off a few emails this week to see if I can get some responces.
Linkadge
Posted by Racer on September 7, 2008, at 21:28:27
In reply to Re: Yes and no... » Racer, posted by linkadge on September 7, 2008, at 19:59:05
I thought that we were talking about the potential that it could cause damage, rather than a certainty? (I also thought I read that they weren't sure if it was agonist or antagonist, but that may mean I'm not paying enough attention...)
At any rate, I was taking Ritalin for a couple of years, and I may take Ritalin again at some point. Yes, it's a concern that it may have the potential to cause damage -- but I'd want a lot more specific information before I wrote it off as a non-starter.
The bottom line for me is that my functioning is severely impaired by depression, and Ritalin helped more than the alternatives. With a choice between the potential that some cardiac damage may occur -- and may not occur -- from taking the medication, and my state when I am unmedicated, there's not much choice for me. I'd almost choose to take arsenic if it helped.
And that's interesting about Permax -- it was used in horses to treat Cushing's disease. I didn't know it had been withdrawn. Funny -- half the medications given my animals in the past decade seem to be off the market now.
Posted by Phillipa on September 7, 2008, at 23:41:43
In reply to I thought there was some question? » linkadge, posted by Racer on September 7, 2008, at 21:28:27
I wouldn't mess with my heart once it's gone that's it. If you've ever worked with cardiac patients they would gladly rather be depressed than dying. Just my feeling. Phillipa
Posted by Nadezda on September 8, 2008, at 9:07:14
In reply to I thought there was some question? » linkadge, posted by Racer on September 7, 2008, at 21:28:27
I also thought this was speculation,, rather than fact.
Are there any studies on ritalin that led to the question, linkadge? Cardiac effects of 5ht2b agonism seem to be there for some drugs, but since drugs affect different systems and the same systems differently, is there anything specifically with ritalin?
Nadezda
Posted by bleauberry on September 8, 2008, at 21:40:39
In reply to methylphenidate 5-ht2b, posted by linkadge on September 7, 2008, at 8:53:59
Just a little perspective. I could come up with a bunch of examples, here is just one.
A med has a physical risk. Ok. Fine. Hey, they all do. Even aspirin or tylenol. Take tylenol everyday and there are some real risks.
But these meds, like tylenol, ritalin, zyprexa, whatever, they do improve lives. Not for free. There is always a risk when any food, supplement, herb, or medicine changes biochemistry from its norm. Is it worth risking remote damage to a heart valve from a med to avoid going to an early grave from not taking that med? (untreated psych illness, stress, causing rapid aging or suicide?) There is a trade off, a benefit/risk ratio. If the benefit is good, then the risk is low. If there is not much benefit from the med, then the risk is too high.
Amalgam fillings. Hey, they're perfectly fine, right? Never FDA approved. But who cares. The thinkheads at the Dental Association figured solidified mercury is just fine, never considered it might degrade, wear, age, crack, or vaporize 24/7. Much better to use a safe ceramic material, but hey, amalgam is dirt cheap so do that instead. The risk was way way way too high. The second most toxic substance on the planet planted into the mouths of millions of people. Skyrocketing numbers of depression, MS, alzheimers, autism, immunological disorders, allergies, neurological disorders, parkinsons, on and on.
If it's ok to put the deadly toxin mercury in your mouth, then I wouldn't worry to much about ritalin. Just to put it in perspective.
Risk/benefit. That's what it's about. Nothing is free.
Posted by linkadge on September 9, 2008, at 6:39:33
In reply to Re: I thought there was some question?, posted by Nadezda on September 8, 2008, at 9:07:14
Theres is one study that recently recognized a significant "affinity" of ritalin for 5-ht2b. If this is 5-ht2b agonism it could be significant.
In the wake of the effects of the withdrawn parkinsons drugs, I would want to figure out pretty quickly if this is an agonist or not.
It also moight be a target for ritalin as 5-ht2b agonists appear to block locomotor hyperactivity.
Linkadge
Posted by linkadge on September 9, 2008, at 6:42:18
In reply to Re: methylphenidate 5-ht2b, posted by bleauberry on September 8, 2008, at 21:40:39
Alright,
this was not a posts where I was looking for a o"its ok, theres no problem, the med is safe" responce.
I was wondering if anybody had come across further research on the nature of its affinity, or who were simiarly concerned since the mechanism is potentially there.
Take care,
Linkadge
Posted by Nadezda on September 9, 2008, at 8:59:44
In reply to Re: I thought there was some question? » Nadezda, posted by linkadge on September 9, 2008, at 6:39:33
Do you happen to have the cite for that study? I was looking for it-- and for whether ritalin is an agonism at that receptor--
I somewhat think it is, based on what I was seeing-- but then I also saw that there was uncertainty.
My other question was whether there might be some counterbalancing action of ritalin that make its agonism less harmful,.
Since it's been around for a long time, I'd think there would be some sense of whether long-time users had heart valve damage. Any studies of that?
Nadezda
This is the end of the thread.
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