Posted by SLS on November 11, 2015, at 14:45:22
In reply to My meds and p450 liver metabolism (SLS and others), posted by Lamdage22 on November 11, 2015, at 13:19:16
> Hey yáll..
>
> I want to replace the Zyprexa with Cannabidiol and if possible also replace the Seroquel with Cannabidiol. If i can replace Zyprexa and Seroquel, i probably wouldnt need Metformin anymore either (it makes me loose hair).
>
> Scott, you told me to research and i did.
>
> Here is what i found out about the cytochrome p450 enzymes that metabolize my meds.
>
> Seroquel: Cyp 3A4
> Zyprexa: Cyp 1A2, to a lesser extent: Cyp 2D6
> Nortriptyline: Cyp 2D6
> Venlafaxin (complicated: see link): https://www.pharmgkb.org/pathway/PA166014758
> Cannabidiol: Cyp 3A4, Cyp 2C19, Cyp 2B(x)??? (cyp 2b subfamily, not sure which enzyme!)
> Metformin is not metabolized by the liver.
>
> What does this mean for my treatment? Is it possible and advisable?
>
> THXThe most important factor in assessing the pharmacokinetic (drug level) interactions of these drugs is whether or not they are inhibitors or inducers of liver enzymes. Of course, I don't know enough to be sure, but I don't recognize any of the drugs you listed as being inhibitors or inducers, so there would be very little effect on the levels of one drug upon the other. If you happen to recall seeing the word "inhibitor" used in association with one of these drugs, try to identify it.
As far as pharmacodynamic (drug mechanism) interactions, I don't see any problems either. I do like the combination of nortriptyline with venlafaxine. I experienced a mild-to-moderate improvement with it. Unfortunately, we didn't push the dosage of nortriptyline high enough, so I really don't know how well I ultimately would have responded to that treatment. Be aware that some people gain significant amounts of weight with nortriptyline. I think it would be premature to discontinue it at this point, and it would only confound your ability to evaluate the other changes you are about to make. You can always try replacing nortriptyline with desipramine in the future if necessary. However, you might find that staying with nortriptyline is perfectly fine after refining your AP treatment.
Have you investigated N-acetylcysteine (NAC)? I may have already asked you this. Be aware that NAC can sometimes take 3 - 6 months to produce results when treating depression. There is also some evidence that it helps with psychotic and obsessive disorders. In addition to being a precursor of the potent antioxidant, glutathione, NAC also modulates glutamate activity.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1083961
URL: http://www.dr-bob.org/babble/20150929/msgs/1083962.html