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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
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?
THX
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.
- Scott
Posted by Lamdage22 on November 11, 2015, at 23:21:02
In reply to Re: My meds and p450 liver metabolism (SLS and others) » Lamdage22, posted by SLS on November 11, 2015, at 14:45:22
It looks like its complicated with Cannabidiol!! Check "drug metabolism".
http://www.medicinalgenomics.com/wp-content/uploads/2013/01/Bergamaschi_2011.pdf
Posted by Lamdage22 on November 11, 2015, at 23:24:15
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by Lamdage22 on November 11, 2015, at 23:21:02
I have tried NAC. I was well for the first two days and then i was sh*tty from day 3 forward so i stopped.
Posted by SLS on November 12, 2015, at 7:01:09
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by Lamdage22 on November 11, 2015, at 23:21:02
> It looks like its complicated with Cannabidiol!! Check "drug metabolism".
>
> http://www.medicinalgenomics.com/wp-content/uploads/2013/01/Bergamaschi_2011.pdfThere is a lot of stuff there.
Here is the summary offered by the article:
"In summary, the metabolism of drugs by cytochrome P450s 3A, 2C and 2B subfamilies can be affected when CBD in simultaneously administered. On the other hand, CBD extracts or Sativex do not seem to inhibit or induce hepatic CYP450, probably because the administration of CBD and THC is simultaneous, which avoids the pharmacokinetic interaction, in addition to the fact that the dose ratios are very low (=1) to induce pharmacokinetic blockade [118][119]."
Unfortunately, I can't find in the article the magnitude of P450 interactions described. Am I right in thinking that Seroquel might be a problem? I don't know.
- Scott
Posted by Lamdage22 on November 12, 2015, at 7:02:48
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by SLS on November 12, 2015, at 7:01:09
I dont know if i should take it.
There are side effects listed in that article that make me worry.
IDK WHAT to do... go back to a hospital?
Crap.
Posted by SLS on November 12, 2015, at 7:40:40
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by Lamdage22 on November 12, 2015, at 7:02:48
> I dont know if i should take it.
>
> There are side effects listed in that article that make me worry.
>
> IDK WHAT to do... go back to a hospital?
>
> Crap.What's happening right now such that you feel hospitalization might be the right thing to do?
Are you concerned with your safety?
How does Risperdal or Invega affect you? If your concern is psychotic depression, this might be a better drug for you than Seroquel as an acute treatment - at least temporarily.
- Scott
Posted by Lamdage22 on November 12, 2015, at 7:42:59
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by SLS on November 12, 2015, at 7:40:40
> What's happening right now such that you feel hospitalization might be the right thing to do?
>
> Are you concerned with your safety?
>
I just dont want to wait with Nortriptyline dosage escalation to 75mg.. And i want to systematically try all AD drugs i havent tried yet.> How does Risperdal or Invega affect you? If your concern is psychotic depression, this might be a better drug for you than Seroquel as an acute treatment - at least temporarily.
>
>
> - Scott
>Both do nothing for me. I am not psychotic.
Posted by Lamdage22 on November 12, 2015, at 10:53:11
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by Lamdage22 on November 12, 2015, at 7:42:59
I suppose it could be done outpatient, too.
Posted by Lamdage22 on November 13, 2015, at 14:32:43
In reply to Re: My meds and p450 liver metabolism (SLS and others), posted by Lamdage22 on November 12, 2015, at 7:42:59
75mg gave me "numb d*ck".
Cant do it. Now i pray that 50mg will have a positive impact.
This is the end of the thread.
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