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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Basia on February 13, 2008, at 1:43:53
Hi
My 400mg Lamictal seems to have pooped out , although my new AP, Seroquel , seems to be gradually making a difference to the psychosis element of my BPI diagnosis. I have not suffered mania for about 8 years, when I had mania and delusions for a few weeks a couple of times when stopping my medication.
What I would like to know is if I can take St John's Wort with Lamictal and Seroquel. I do not think that I am THAT at risk of mania as I have mostly been plagued by depression with my previous meds Sulpiride, Carbamazepine and Lamictal (after it pooped out, as it saved my life for the first year or two).
Thanks for your input!
Lyn
Posted by bleauberry on February 13, 2008, at 19:09:44
In reply to St JW contraindications?, posted by Basia on February 13, 2008, at 1:43:53
SJW significantly speeds up the liver enzyme CYP3A4, which is involved with many meds. But it also has the opposite effect with another enzyme. Not sure by I think it is CYP2D6.
A lady on 30mg zyprexa started taking SJW without consulting her doctor. She did improve. When the doctor found out he drew her blood to test her zyprexa levels. They were the equivalent of 90mg. She had tripled her zyprexa dosage, without actually changing her dose, by adding SJW to the mix.
SJW is contraindicated with HIV meds, cancer meds, and others, because it basically lowers the blood levels of those meds so much that stable patients become more ill and even die as if they stopped taking their meds. Even though their doses were unchanged, SJW effectively cut the dose in half.
So whether SJW helps your mood or makes it unstable or whatever is only something you can discover by actually trying it. But more important is what will it do to the blood levels of the drugs you take? Will they increase a lot? Will they decrease a lot? Either one of those scenarios could throw things way out of whack for you.
You should probably spend some time at pubmed and on google and search all you can for stuff like "St Johns Wort CYP3A4", Hypericum liver enzymes, and similar wordings. Do the same thing with your med. Get to know in detail what each is likely to do to the other. The information is all out there, just takes some digging.
That being said, I have no doubt there are hundreds or thousands of people that add SJW to meds. My doctor had me add it to prozac and zyprexa. That ended up being a mistake because it brought me to the edge of serotonin syndrome after a month, and it somehow made me very vulnerable to anxiety ever since.
Posted by cache-monkey on February 14, 2008, at 20:57:33
In reply to St JW contraindications?, posted by Basia on February 13, 2008, at 1:43:53
There's a doctor at IUPUI who's created a nifty chart covering many CYP interactions:
http://medicine.iupui.edu/flockhart/table.htm
[Caveat: I don't think this is 100% complete ...]If you're new to this, inducers speed up an enzyme, which makes a substrate process out faster. Inhibitors do the opposite, slowing down the elimination of substrates leading to higher circulating levels.
For your purposes: quetiapine (Seroquel) is a substrate of CYP-3A4; St. John's wort is an inducer of the same enzyme. This means that your effective blood level of Seroquel will go down (by some indeterminate amount) if you take SJW.
Hope this helps. Again, remember that the table is not necessarily complete.
Good luck,
cache-monkey
Posted by Basia on February 15, 2008, at 1:56:47
In reply to Liver enzyme table, posted by cache-monkey on February 14, 2008, at 20:57:33
Hi
Thanks to both of you for your help. I think I will stay off the SJW for the time being, at least until I stabilise on the Seroquel, if ever! :(
Have a good weekend
Lyn
This is the end of the thread.
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