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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by sheilac on July 25, 2012, at 13:27:52
I have a great Pdoc right now who is retiring and I hate that.
But she understands my body pretty well. She's been in the business for years and has seen it all.
I remember asking her why I got sick or experienced awful side effects when at the "therapeutic dose" of meds. I mean one pill of Wellbutrin XL 150 lasted me 3 days and I barley slept. The absolute lowest dose of Vyvanse kept me awake for days and I lost 7 lbs in one week on it. 40mg of Prozac just about killed me.
I asked her if there was something wrong with me. She said that every so often she comes across a patient that is a slow metabolizer. She said most bipolars are fast metabolizers and therefore require much higher doses.
She said it had to do with liver enzymes and how quickly my liver breaks down meds. She said it is rare, but she has seen it. She said it didn't mean I was any less BPII than someone else, but that for me 450mg of Lithium acted as an antidepressant and calming agent, but for a fast metabolizer they may need 4 times that much easy. She said a therapeutic dose of lithium for me might be lethal. But, she did say in time I may be able to work up to 600mg, it just might take a while.
I guess it made me feel better, but it just makes it harder. There are so many meds out there that would have worked for me if the manufacturers made them in lower doses.
She said now that I know how my body works it will be easier to explain to my new doc. And she said the good thing is that there is always room to go up.
I was scared there was something wrong with my liver, but she assured me my liver was working fine, it's just slow with breaking down meds. (I always give her my bloodwork from my regular doc)
I guess I feel better now.
Posted by Phillipa on July 25, 2012, at 16:49:31
In reply to Slow metabolizer / liver enzymes, posted by sheilac on July 25, 2012, at 13:27:52
Sheila no idea how to interpret this maybe someone can? Phillipa
Posted by b2chica on August 2, 2012, at 12:24:19
In reply to Slow metabolizer / liver enzymes, posted by sheilac on July 25, 2012, at 13:27:52
Hi.
i'm taking a pharmacology course right now and recently learned about this. completely agree with pdoc first of all.BUT i have learned that (although genetic polymorphism studies is in its infancy) there is a Polymorphism in CYP(450)-an enzyme for metabolism- that responsible for major differences in drug metabolism. mainly on two enzymes: CYP2D6 and CYP2C19
many antidepressants, antipsychotics and other meds are dependant on CYP2D6
so if you have say no copies of the 2D6 gene your plasma concentration of the drug (amount of drug in your system)-lets say Nortriptyline- could be (say) 60% higher than for someone with 13 copies. or if a person took 10-hydroxynortriptyline (metabolite of Nort) that same person with 13 copies now can reach 200% concentration vs those with 0 copies.
i know its vary dependant on the person, the amount of genes and the drug vs metabolite.
but i was glad that i could totally appreciate your circumstances regarding medication. and wanted to CERTAINLY express to you that there is NOTHING wrong with you. it is amazing how complex yet homeostatic our bodies are.
ps. your ethnic background could play a role regarding the genetic component as there are markedly expressed frequencies of genetic polymorphisms.
Best wishes
b2c
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