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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Squiggles on March 28, 2007, at 9:31:12
I trust this man:
Squiggles
Posted by Phillipa on March 28, 2007, at 11:06:38
In reply to Whom can you trust?, posted by Squiggles on March 28, 2007, at 9:31:12
How do you know him? Love Phillipa
Posted by Squiggles on March 28, 2007, at 12:01:49
In reply to Re: Whom can you trust? » Squiggles, posted by Phillipa on March 28, 2007, at 11:06:38
I don't "know" him. I have only read
his site, and he strikes as being the most
cautious and practical doctor in dispensing
drug and drug combos.Squiggles
Posted by Squiggles on April 21, 2007, at 12:20:36
In reply to Re: Whom can you trust? » Squiggles, posted by Phillipa on March 28, 2007, at 11:06:38
Clonazepam is metabolized by the liver.
My friend has been getting foggier and
more confused since clonazepam was introduced (3.0mg - i suggest 2.0 and now she's more
alert but still slammed into sleep after taking 2.0mg), She also takes imipramine (now 250mg), which i do not know if that is metabolized by the liver.The intoduction of clonazepam happened after/around the time Serzone was tried on her, which was discontinued after a few months. I thought that perhaps the serzone screwed up the liver, but the docs. did not think that was it.
There is no doubt however, that after taking clonazepam, she falls into bed into a comatose-like sleep.
Whazzup?
Squiggles
Posted by Larry Hoover on April 21, 2007, at 13:26:01
In reply to Drugs metabolized by the liver, posted by Squiggles on April 21, 2007, at 12:20:36
> Clonazepam is metabolized by the liver.
>
> My friend has been getting foggier and
> more confused since clonazepam was introduced (3.0mg - i suggest 2.0 and now she's more
> alert but still slammed into sleep after taking 2.0mg), She also takes imipramine (now 250mg), which i do not know if that is metabolized by the liver.
>
> The intoduction of clonazepam happened after/around the time Serzone was tried on her, which was discontinued after a few months. I thought that perhaps the serzone screwed up the liver, but the docs. did not think that was it.
>
> There is no doubt however, that after taking clonazepam, she falls into bed into a comatose-like sleep.
>
> Whazzup?
>
> SquigglesFrom drugs.com:
"Interactions between your selected drugs
clonazepam and imipramine (Moderate Drug-Drug)MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking clonazepam and tricyclic antidepressants. However, one case report has described decreased desipramine levels during concurrent administration with clonazepam. The mechanism is unknown.
MANAGEMENT: Patients should be monitored for excessive or prolonged CNS and respiratory depression. Ambulatory patients should made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, or confusion) and counseled to avoid activities requiring alertness until they know how these agents affect them. Patients should also be advised to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities."
The Serzone didn't permanently affect the liver, or your friend's doctors would have been all over it.
A similar interaction exists between Serzone and clonazepam, though. Your friend should be reporting this excess sedation to her doctor. The dose still seems too high, *for her*. Comatose is not a good reaction.
Lar
Posted by Squiggles on April 21, 2007, at 13:49:45
In reply to Re: Drugs metabolized by the liver » Squiggles, posted by Larry Hoover on April 21, 2007, at 13:26:01
> A similar interaction exists between Serzone and clonazepam, though. Your friend should be reporting this excess sedation to her doctor. The dose still seems too high, *for her*. Comatose is not a good reaction.
>
> Lar
>
>
Thank you for taking the time to answer.
"Comatose" is only a transient initial state,
gradually turning to sedation, to sleep, to
relaxation and then awake. (3 hrs. post K injestion).Thanks again. Could be the interaction/dose.
Squiggles
Posted by Larry Hoover on April 21, 2007, at 14:39:06
In reply to Re: Drugs metabolized by the liver, posted by Squiggles on April 21, 2007, at 13:49:45
> Thank you for taking the time to answer.
> "Comatose" is only a transient initial state,
> gradually turning to sedation, to sleep, to
> relaxation and then awake. (3 hrs. post K injestion).
>
> Thanks again. Could be the interaction/dose.
>
> Squiggles
>Just to be clear, there is a liver interaction. Both drugs are processed by liver enzyme 3A4. There is also a functional interaction, as both drugs have sedating qualities.
The way you manage these is by adjusting dose. That includes managing one dose to zero, if necessary. I reiterate, comatose is not a reasonable drug effect. It's all about quality of life, not ability to suffer through it.
Lar
Posted by Squiggles on April 21, 2007, at 14:54:42
In reply to Re: Drugs metabolized by the liver » Squiggles, posted by Larry Hoover on April 21, 2007, at 14:39:06
>
> Just to be clear, there is a liver interaction. Both drugs are processed by liver enzyme 3A4. There is also a functional interaction, as both drugs have sedating qualities.
>
I know that a chronic exposure to imipramine, like many other psychiatric drugs may have wearing
effect on the brain, e.g. dopamine depletion. So that's one avenue of exploration.It could many things:
- too high an imipramine dose
- too high a K dose
- interaction between the two
- post gastro surgery effect on the metabolism of the drug
- Serzone after the surgery affecting the liver
- and one more thing-- this version of imipramine has been recently introduced. It may just be very weak in comparison to other brands, as they are not introducing generic versions. I have had generic versions which were weak. So this sleepiness may actually be a DEPRESSSION as a result of a weak imipramine.Yes, i know i have a hyperactive imagination; never let a stone unturned, unless the worms have now made their home under there. :-)
Quality of life sucks! It's pathetic. I don't know how doctors have the gall to criticize lithium, and be puritanical about opiates.
Squiggles
This is the end of the thread.
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