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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Ame Sans Vie on August 24, 2003, at 6:28:48
I'm just now starting to worry (not much, but just a bit concerned) that the medications I take (Dexedrine Spansules, Xanax XR, Klonopin Wafers, and Ultram) will inevitably cause some sort of imbalance in my brain chemistry. For example, long-term use of amphetamines I believe could lead to dopaminergic and noradrenergic inadequacy (correct me if I'm wrong on any of this). And Dexedrine is really the only one I'm concerned about, actually. I know alprazolam and clonazepam are quite benign (though I may want to add some gingko biloba or something to my supplement regime to prevent possible memory loss), and I can't foresee any difficulties with Ultram.
Anyway, does anyone have any ideas of anything I could take (over-the-counter preferably, but any and all suggestions are welcome) that would decrease these hypothetical risks? For example, could Eldepryl be of benefit? Phenylalanine?
Posted by Shawn. T. on August 24, 2003, at 16:23:24
In reply to Prevention of long-term negative effects?, posted by Ame Sans Vie on August 24, 2003, at 6:28:48
It wouldn't hurt to take a potent antioxidant or two with Dexedrine (I'd bet that you already do). In animal models of amphetamine neurotoxicity, antioxidants seem to block the neurotoxic effects of most of the amphetamine- like drugs. You're definitely going to change catecholamine levels with Dexedrine; that's just the nature of the drug. How it and the other drugs that you're taking affect your particular brain chemistry on a day-to-day basis would be fairly difficult to determine.
Shawn
Posted by stjames on August 24, 2003, at 16:31:37
In reply to Prevention of long-term negative effects?, posted by Ame Sans Vie on August 24, 2003, at 6:28:48
For example, long-term use of amphetamines I believe could lead to dopaminergic and noradrenergic inadequacy (correct me if I'm wrong on any of this). And Dexedrine is really the only one I'm concerned about, actually.
I would not expect this to happen unless your were
taking amphetamine at levels of abuse; at least an order a magnitude higher.
Posted by Ame Sans Vie on August 24, 2003, at 21:09:52
In reply to Re: Prevention of long-term negative effects?, posted by stjames on August 24, 2003, at 16:31:37
Thanks for the replies -- I do take (many, lol) powerful antioxidants, so hopefully I've got myself covered.
Posted by btnd on August 25, 2003, at 1:23:15
In reply to Re: Prevention of long-term negative effects?, posted by stjames on August 24, 2003, at 16:31:37
> For example, long-term use of amphetamines I believe could lead to dopaminergic and noradrenergic inadequacy (correct me if I'm wrong on any of this).
IMO not quite so. Dopamine system is pretty robust when it comes to rebuilding itself (unlike the serotonin). Unless you use high doses of amphetamine-type stimulants, there is no need to worry about dopamine toxicity or inadequacy over time. Although it wouldn't hurt to use anti-oxidants: alpha lipoic-acid, green tea extract, vit.E - anything except Vit.C which, via unknown mechanism, counteracts amphetamine action.
When it comes to norepinephrine - even high doses of amphetamine are not toxic to norepinephrine and its' storage site. Norepinephrine levels change when the drug is working - amphetamines release it and inhibit its reuptake.
>And Dexedrine is really the only one I'm >concerned about, actually.I wouldn't worry about Dexedrine more than about Adderall/Desoxyn. They are pretty much all amphetamines (desoxyn - methamphetamine) with the same method of action, same effects and side-effects in therapeutic doses.
> I would not expect this to happen unless your were
> taking amphetamine at levels of abuse; at least an order a magnitude higher.I agree 100%.
Posted by btnd on August 25, 2003, at 1:48:31
In reply to Prevention of long-term negative effects?, posted by Ame Sans Vie on August 24, 2003, at 6:28:48
> ...For example, long-term use of amphetamines I believe could lead to dopaminergic and noradrenergic inadequacy (correct me if I'm wrong on any of this). And Dexedrine is really the only one I'm concerned about, actually.
>
> ...Anyway, does anyone have any ideas of anything I could take (over-the-counter preferably, but any and all suggestions are welcome) that would decrease these hypothetical risks? For example, could Eldepryl be of benefit? Phenylalanine?
I will soon start pretty much the same regime (Klonopin, Xanax normal or SR, Ultram, Dexedrine,Xyrem) so I was researching this topic too (mainly Dexedrine long-term neuro-degeneration). IMO When it comes to supplements anti-oxidants should be of use with every type of amphetamine - lipoic acid, green tea, vit.E, grape seed extract.
Eldepryl/Deprenyl would also be a good idea, since selegiline increases dopamine levels.
I also think that my 2 nightly Xyrem doses are beneficial, when it comes to Dexedrine usage - because Xyrem (GHB) increases dopamine in every part of the brain pretty significantly.I will also use andrewB's method to prevent amphetamine tolerance and eliminate any potential damage - take Memantine or Acamprosate. Both are NDMA antagonists and prevent amphetamine tolerance.
And I will still use Enada NADH at low level during the week, since it increases dopamine transmission via different mechanism than other meds.
Take care,
Brad
Posted by Ame Sans Vie on August 25, 2003, at 7:28:05
In reply to Re: Prevention of long-term negative effects?, posted by btnd on August 25, 2003, at 1:23:15
> > For example, long-term use of amphetamines I believe could lead to dopaminergic and noradrenergic inadequacy (correct me if I'm wrong on any of this).
>
> IMO not quite so. Dopamine system is pretty robust when it comes to rebuilding itself (unlike the serotonin). Unless you use high doses of amphetamine-type stimulants, there is no need to worry about dopamine toxicity or inadequacy over time. Although it wouldn't hurt to use anti-oxidants: alpha lipoic-acid, green tea extract, vit.E - anything except Vit.C which, via unknown mechanism, counteracts amphetamine action.Just for the record, vitamin C expedites excretion of amphetamines... or hinders their absorption... I forget. :-)
> I wouldn't worry about Dexedrine more than about Adderall/Desoxyn. They are pretty much all amphetamines (desoxyn - methamphetamine) with the same method of action, same effects and side-effects in therapeutic doses.
Just to clarify, I meant I was a bit more concerned about the Dexedrine than the Ultram and benzos, not other amphetamines. I've taken amphetamines on and off for seven years, and I just switched from Desoxyn to Dexedrine a few weeks ago... I don't know why I didn't begin to worry until now. But from the information you gave, it appears that all is well. :-)
Posted by Ame Sans Vie on August 25, 2003, at 7:32:08
In reply to Re: Prevention of long-term negative effects?, posted by btnd on August 25, 2003, at 1:48:31
> I will also use andrewB's method to prevent amphetamine tolerance and eliminate any potential damage - take Memantine or Acamprosate. Both are NDMA antagonists and prevent amphetamine tolerance.
Dextromethorphan is also an NMDA antagonist and has been used for these same purposes... think I'll do a little research on it. I'm sure Olney's lesions aren't a concern at recommended dosages taken long term.
Posted by btnd on August 25, 2003, at 13:52:11
In reply to Re: Prevention of long-term negative effects? » btnd, posted by Ame Sans Vie on August 25, 2003, at 7:32:08
> > I will also use andrewB's method to prevent amphetamine tolerance and eliminate any potential damage - take Memantine or Acamprosate. Both are NDMA antagonists and prevent amphetamine tolerance.
>
> Dextromethorphan is also an NMDA antagonist and has been used for these same purposes... think I'll do a little research on it. I'm sure Olney's lesions aren't a concern at recommended dosages taken long term.
>Naah I wouldn't mess with DXM to help out with amphetamine tolerance even if it could work that way. Funny thing that of 5 NDMA antagonists that could prevent amphetamine tolerance, 3 of them are recreational drugs. Ketamine, PCP, DXM are all full NDMA antagonists. But I'll definitely try to acquire Acamprosate for this purpose, Memantine is as good but way more expensive. And DXM and especially PCP can have some serious side-effects.
Posted by stjames on August 25, 2003, at 21:49:41
In reply to Re: Prevention of long-term negative effects? » btnd, posted by Ame Sans Vie on August 25, 2003, at 7:28:05
Just for the record, vitamin C expedites excretion of amphetamines... or hinders their absorption... I forget. :-)
As I mentioned b4, make the urine more acidic,
excrete amphetamine faster, more basic & it goes the other way.
Posted by Ame Sans Vie on August 25, 2003, at 22:55:14
In reply to Re: Prevention of amphetamine tolerance » Ame Sans Vie, posted by btnd on August 25, 2003, at 13:52:11
I used to be a very heavy DXM abuser... about 1,400mg (two eight oz. bottles of Robitussin Maximum Stength Cough) every other day for six months, so I do know all about the havoc it can wreak. However, I've heard (fairly often, actually) of doctors using it at recommended dosage levels (i.e. 60mg bid using Delsym or another extended-release formulation) for the NMDA receptor antagonism -- especially in alcoholics, opiate addicts, coke addicts, and speed addicts.
Posted by btnd on August 25, 2003, at 23:59:30
In reply to Re: Prevention of amphetamine tolerance » btnd, posted by Ame Sans Vie on August 25, 2003, at 22:55:14
> I used to be a very heavy DXM abuser... about 1,400mg (two eight oz. bottles of Robitussin Maximum Stength Cough) every other day for six months, so I do know all about the havoc it can wreak.
Holy .... ! 1400mg/daily??? I didn't even know humans can tolerate such high dose :)
However, I've heard (fairly often, actually) of doctors using it at recommended dosage levels (i.e. 60mg bid using Delsym or another extended-release formulation) for the NMDA receptor antagonism -- especially in alcoholics, opiate addicts, coke addicts, and speed addicts.
Hmm 60 mg is pretty decent and low enough amount = 4 tablets of my anti-cough tabs. But they are definitely instant release, not extented - would that make a difference?
I'll try to dig on pubmed today to find out more info. Thanks for the tip.Brad
Posted by btnd on August 26, 2003, at 0:46:26
In reply to Re: Prevention of amphetamine tolerance, posted by btnd on August 25, 2003, at 23:59:30
Here are some studies (not many studies on DXM at pubmed). All of them mention that dextrometorphan is a NDMA antagonist, but there are no doses used.
Ame - Could you try to find the 60 mg value of DXM's action on NDMA? I'd be glad cause it would be the cheapest way to avoid amphetamine tolerance.
Posted by Ame Sans Vie on August 26, 2003, at 2:19:50
In reply to Re: Prevention of amphetamine tolerance, posted by btnd on August 25, 2003, at 23:59:30
> Holy .... ! 1400mg/daily??? I didn't even know humans can tolerate such high dose :)
lol, yeah... I was pretty surprised too. And even this amount only brought me to a "third plateau" experience.
> Hmm 60 mg is pretty decent and low enough amount = 4 tablets of my anti-cough tabs. But they are definitely instant release, not extented - would that make a difference?
Nope, only difference would be that you'd have to take it four times a day. Delsym (dextromethorphan polystirex) is inexpensive and only requires the bid dosing, so I'd suggest going with it, just for convenience's sake.
Posted by Ame Sans Vie on August 26, 2003, at 2:22:01
In reply to Re: Prevention of amphetamine tolerance (DXM), posted by btnd on August 26, 2003, at 0:46:26
Most of what I've heard about this has been anecdotal (though from people I know well, not the whole, "my sister's best friend's 4th cousin twice removed said it worked for him," kinda deal), though I have read some case reports. I'll try to dig them up for you.
Posted by stjames on August 27, 2003, at 19:47:30
In reply to Re: Prevention of amphetamine tolerance (DXM) » btnd, posted by Ame Sans Vie on August 26, 2003, at 2:22:01
It has been suggested the there is a link between
DMX and seretonin syndrome. Some of the cases of SS have happened with persons who have taken DMX along with an AD. I avoid DMX.
Posted by Shawn. T. on August 27, 2003, at 20:57:39
In reply to DXM and seretonin syndrome link, posted by stjames on August 27, 2003, at 19:47:30
DXM exhibits two high affinity binding sites; one of these is the serotonin reuptake transporter and the other is the sigma-1 receptor. Also, it has two low affinity binding sites that have been identified as the sigma-2 receptor and the NMDA receptor. Evidence seems to suggest that DXM is a serotonin reuptake inhibitor; at very high doses, it would be expected to induce the serotonin syndrome in a similar manner to SSRI's. For this reason, high doses of DXM should not be taken with other drugs that increase synaptic serotonin levels. My reference for the serotonin transporter/DXM interaction can be found at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9105700&dopt=Abstract
Shawn
Posted by btnd on August 28, 2003, at 8:18:28
In reply to Re: Prevention of amphetamine tolerance (DXM) » btnd, posted by Ame Sans Vie on August 26, 2003, at 2:22:01
So basically we have following NDMA antagonists:
1. Memantine (Akatinol/Axura)
2. Acamprosate (Campral)
3. Amantadine (Symmetrel/Amantix)
4. Dextrometorphan/DXM
5. Ketamine
6. PCPI've put 5. and 6. just for the actual fact that they have NDMA blocking properties.I don't think it would be wise to use those drugs to prevent amphetamine tolerance.
As for the rest - here is the problem. What dosage should be used of any of the NDMA antagonists to protect against amphetamine tolerance development?
When it comes to the cost - DXM is definitely the cheapest option. Next one is Amantadine, then Acamprosate. Memantine is way more expensive.
I tried searching online documents and abstracts but couldn't find any dosages recommended. If anyone finds out the info on this topic - please post them.
Take care,
Brad
Posted by Ame Sans Vie on August 28, 2003, at 8:52:03
In reply to 6 NDMA antagonists for amphetamine tolerance, posted by btnd on August 28, 2003, at 8:18:28
Sorry! I meant to do some research on this for you a few days ago and just forgot. I'll get right on it.
~~Michael
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