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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by willow on February 26, 2001, at 22:32:47
This isn't a "mental health drug," but I was wondering why it wasn't available in the states. My doctor has prescribed it to help with digestion, make things move quicker. The effexor really has slowed things down and may be aggravating a previous stomache problem. I've tried to do an interaction thing with all my meds on the internet and couldn't find this one on the web-site I was using.
Posted by willow on March 1, 2001, at 16:28:41
In reply to domperidone?, posted by willow on February 26, 2001, at 22:32:47
Could you look it up? I believe you're in Canada too. The doctor said the effexor may effect the effectiveness of the domperidone and my pharmascist said it was vice versa. Just looking for another's idea. It also mentioned something similar to dopimine I think. Will it mess with a good balance?
Thanks in advance.
Posted by Cam W. on March 1, 2001, at 19:21:37
In reply to Cam?, posted by willow on March 1, 2001, at 16:28:41
Willow - The answer is not that straight forward. The net result is, if any, is not easy to predict. It also depends on if you are taking Effexor or Effexor XR and the dosage.
•So, instead of covering all potential possibilities, could you tell me the dosages of both drugs and when and how often you take them. Also, you may as well add any other meds you take regularily, and I will do a full analysis of possible outcomes, pertinent to your drug regimen.•
The net result will probably be nothing, but depending on which Effexor you are taking, both your doc and pharmacist could be wrong or they both could be right (weird, huh - or4, more likely the whole thing could be a moot point). It is not just a matter of reading the literature, it is also a matter of understanding the neurotransmitter system effects of the drugs involved in a potential pharmacodynamic interaction.
The net effect is probably not going to make any clinical difference, anyway; but post back with the answers to the above questions and I will try to figure it out. The potential interaction is probably just an academic, rather than clinical (real life) problem. - Cam
> Could you look it up? I believe you're in Canada too. The doctor said the effexor may effect the effectiveness of the domperidone and my pharmascist said it was vice versa. Just looking for another's idea. It also mentioned something similar to dopimine I think. Will it mess with a good balance?
>
> Thanks in advance.
Posted by willow on March 1, 2001, at 22:29:20
In reply to Re: Cam? » willow, posted by Cam W. on March 1, 2001, at 19:21:37
Here I go:
When I wake up "75mg(cap.sr 24h)Effexor XR" & "20mg Losec"
about 5 hours later "75mg Effexor XR" & "10mg domperidone"
when I go to sleep about another 5 hours later "10mg domperidone" & "5-10mg baclofen" or "1-2 tylenol #1"
I take the tylenol if I'm in pain instead of the baclofen because it'll help me get to sleep since it lessens the pain. I do too occasionally take the tylenol #1 during the day and/or evening, probably a couple times a week.
I started taking the effexor in October. I've just started needing to take "1/2-1 25mg meclizince hcl tablet" again :( I usually take this in the evening because it can make me drowsy.
"150mg ranitidine" when needed
I haven't needed to use "10mg cyclobenzaprine" or "flonase" since I started the effexor. The flexeril has lost it's ability to stop the muscle spasms. It use to knock me out withing 20 minutes but I would still have pain in the muscles affected by the spasm for about one to two weeks. The baclofen is better. I started using it this summer and haven't had any severe cramping related to the muscle spasms, but still have some pain in my muscles.
I've just started the domperidone initially one a day. I think it is making me nauseaus and the first few days it gave me a headache and now when I upped the dose I feel nauseaus more nauseaus in the evenings. The effexor hasn't upset my stomach at all just slowed it down. My pharmascist doesn't think the nausea is related to the medications.
Do you have any idea why the domperidone isn't available in the states? Does it affect brain chemistry? From what I was able to find it isn't suppose to affect the brain. Am I right?
Thanks again
Willow in Northern Ontario
Posted by willow on March 3, 2001, at 8:25:57
In reply to Re: Cam?, posted by willow on March 1, 2001, at 22:29:20
Cam
My follow-up got archived.Here I go:
>
> When I wake up "75mg(cap.sr 24h)Effexor XR" & "20mg Losec"
>
> about 5 hours later "75mg Effexor XR" & "10mg domperidone"
>
> when I go to sleep about another 5 hours later "10mg domperidone" & "5-10mg baclofen" or "1-2 tylenol #1"
>
> I take the tylenol if I'm in pain instead of the baclofen because it'll help me get to sleep since it lessens the pain. I do too occasionally take the tylenol #1 during the day and/or evening, probably a couple times a week.
>
> I started taking the effexor in October. I've just started needing to take "1/2-1 25mg meclizince hcl tablet" again :( I usually take this in the evening because it can make me drowsy.
>
> "150mg ranitidine" when needed
>
> I haven't needed to use "10mg cyclobenzaprine" or "flonase" since I started the effexor. The flexeril has lost it's ability to stop the muscle spasms. It use to knock me out withing 20 minutes but I would still have pain in the muscles affected by the spasm for about one to two weeks. The baclofen is better. I started using it this summer and haven't had any severe cramping related to the muscle spasms, but still have some pain in my muscles.
>
> I've just started the domperidone initially one a day. I think it is making me nauseaus and the first few days it gave me a headache and now when I upped the dose I feel nauseaus more nauseaus in the evenings. The effexor hasn't upset my stomach at all just slowed it down. My pharmascist doesn't think the nausea is related to the medications.
>
> Do you have any idea why the domperidone isn't available in the states? Does it affect brain chemistry? From what I was able to find it isn't suppose to affect the brain. Am I right?
>
> Thanks again
> Willow in Northern Ontario
Posted by Cam W. on March 3, 2001, at 11:19:11
In reply to Re: Cam?, posted by willow on March 3, 2001, at 8:25:57
Willow - I am guessing here, but the probable reason that domperidone is not sold in the States is because it has not been approved for sale by the FDA, while at the same time the patent protection on it has probably run out. The FDA requires American clinical trials to be done (clinical trials from other countries are not enough) to prove that domperidone is as good as or better than drugs already available in the U.S. Domperidone is probably as good as most drugs in it's class, but a company would have to spend a hundred million or so dollars to have it approved and they would not be able to recoup this money. Because the patent protection has run out, as soon as the company received FDA approval to sell it, any other company could also sell it, too (without having to shell out for testing). This, and the fact that there are several other drugs in it's class (gastrointestinal [GI] motility modifier), there is no financial incentive to have domperidone approved for use in the U.S. Also, since it isn't better than other drugs in it's class, it would not capture a significant market share.
In a nutshell, Company A doesn't want to shell out a whole bunch of money on a drug that will not gain a large share of the market, and even if it did, Company B could produce and sell it because domperidone is not protected by a patent (which has expired). No profit = no incentive to have it approved for sale
These are probably reasons why Imovane™ (zopiclone) and Manerix™ (moclobemide) are not sold in the States, either. You are not going to be able to profitably market a drug that is not much better than other drugs in it's class, especially if the time left on it's patent protection is short.
Now, on to why both your doctor and pharmacist were both telling the truth:
This may be true in the sense that Effexor can cause constipation or diarrhea, thus affecting domperidone's actions on the intestines. Effexor is exerting this effect through peripheral (esp GI) serotonin-3 receptors, while domperidone is affecting peripheral (esp GI) dopamine receptors. So both drugs are acting on the intestines in different ways, affecting the action of each other (thus, your doc is right).
That being said, this is more or less a moot point, because after 2 to 4 weeks of Effexor therapy the serotonin-3 receptors in the GI tract are down-regulated and no longer affect the domperidone.
The domperidone does not cross the blood brain barrier, so it does not affect the brain's dopamine receptors. Therefore it does not affect Effexor's antidepressant activity to any appreciable extent. Except maybe a little bit, via an indirect action on the vagus nerve, but only enough to give you a slight headache (thus your pharmacist is right, too).
I hope this clears things up a bit. Simple, huh (but not as simple as just looking it up - I actually had to think it through, therefore I could be wrong)?
In any case, there is no problem taking these two drugs together- Cam
Posted by willow on March 3, 2001, at 12:56:49
In reply to Re: Cam? » willow, posted by Cam W. on March 3, 2001, at 11:19:11
> Willow - I am guessing here, but the probable reason that domperidone is not sold in the States
This is the end of the thread.
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