i reduced my thyroxine.........I am not in the USA......THANK YOU, i will look it up when on laptop......

Sassy- will insurance pay for the drug/ genetic testing? My Mom had a psychiatrist send for genetics when he put her on an antidepressant. I wonder if all the fantastic amounts of misery I have with drugs is not caused by an inability to metabolize the drug or too much too fast etc. I had some unusual side effects during ACT-like most patients were constipated and about chit myself inside out- unending yellow diarrhea. Taxol caused blisters on the bottom of my feet and neuropathy. I can't tolerate NSAIDs without mouth ulcers and stomach pain. The anesthesiologist who knocked me out for a colonoscopy asked me if I had restless leg syndrome because I was still twitching and moving while getting propofol! I get weird reaction to things. Neurontin turned me into a water balloon, Afinitor same thing edema, heart arrhythmias, Altace caused puking. I wonder how to get insurance to pay for it. It might be very useful information.

I definitely have PTSD over cancer treatments. As well as from other miserable scary things in childhood! ERs scared me to death as a child and I still see the place as one of doom... avoid at all costs. I wouldn't be surprised if all cancer patients don't qualify for PTSD. They say it's widespread in children who have undergone chemo and cancer treatments.

Hi folks and Aio. I sent a Pm to Aio. She said I could put my findings re: her drugs here.

If my count is right she is on 15 drugs. Two offending drugs that caused hospitalizations are Lexapro and Cymbalta. There are other drugs only used during chemo.

I plugged them into my Genelex drug checker. All but two have some interation. Not surprisingly, Lexapro had a red flag warning for a drug interaction with two drugs. Zofran and esomeprazole. Zofran and Lexapro together have the potential to cause a cardiac rhythm problem called Torsades. Very serious potential. Very serious. When I saw that, it was an OH MY response. Simply with that potential, IMHO, the drugs should have never been prescribed together. Torsades is considered one of the worst rhythm disturbances and can be fatal.

Esomeprazole is a PPI- Proton Pump Inhibitor used for gerds, acid reflux, gastritis, treatment of ulcers. Names in the USA that you might be familiar with are protonix, aciphex, prevacid, Prilosec/omeprazole. Usage of a PPI is so common, that I think the perception is they are benign or little trouble drugs. This is not true. One of the long term consequences of the PPI's is osteoporosis. This is a significant problem with the drugs that BC patients are given. A little known fact is if a PPI is discontinued , it should be over several weeks.

Aio and All consider dietary changes to reduce acid problems i.e stopping coffee or caffeine (soda's) is a biggy. Check the foods that you eat daily to see what are acid producing. Lifestyle changes. Don't lay down after eating. Take a walk. At night, you may consider putting the top end of the bed up on rizers--a few inches is good. Lose weight. Stop smoking. Reduce alcohol. Not preaching--I have my vises LOL.  Oh, all of them.

 A suggestion that the drug checker made was to switch to a  H2 blocker. In the USA, Pepcid is the most common. But as  with all drugs it also has consequences, so should be entered into the drug checker to evaluate for interactions. The clinical trials showed minimal s.e.'s, but as with many drugs there were post marketing reports of problems. Two older drugs, Tagamet and Zantac, should be used cautiously as they can have more s.e.'s than Pepcid.

For this portion, I would like you all to re-read my coined phrase definition of Paintball Therapy in one of the above posts. When Lexapro and Cymbalta were prescribed, no genetic testing was done to evaluate Aio's ability to properly metabolize a SSRI or SSNRI. Should testing be done on all patients? Not necessarily so, but many qualifiers should be considered before the drugs are used 1. history-how does this patient respond to drugs i.e. problems with many types of drugs? 2. polypharmacy--taking many drugs at one time? Think of polypharmacy as a soup. Each time you add something to a soup you change the flavor, the foods interact. In polypharmacy, every drug added has the potential to change how things work. Because of the intense study and accomplishment of understanding metabolism, we can predict how a drug will work with other drugs. But if the pharmacists & docs don't do the responsible thing and either look at the drugs manually or use a drug interaction checker that is programed to do the work, They are practicing Paintball therapy. In Aoi's case had they checked, they would have seen the interaction problems. They threw the paintball, and let it splatter all over. The problem with this paintball isn't just a mark on a wall, this could have been lethal.

Is it starting to gel as to why I like my coined phrase--Paintnall Therapy. I predict within 5 years it'll be in the lexicon LOL.

 The fact that she was hospitalized after taking Lexapro and a period of time after Cymbalta, with each she didn't recover until the drug was stopped, is serious. The lay public may perceive that the drug must not be needed if she reacts that way. Uh Uh, doesn't work that way. On top of that the serious drug interaction with Zofran is just NOT ACCEPTABLE.

This link is to a Genelex page that explains about the testing for 5-HTT. Our particular interest is how it would apply for depression.

http://genelex.com/pharmacogenetic-tests/5htt/

Under construction--it'll be awhile

Today during my daily spa activity necessary b/c of a thyroid complication. I had an OMD moment. The major question that you're asking Aio is: what drug would be safe for you to use for depression in light of your previous negative experiences?

In Dec. 2009, I asked my PCP for an antidepressant. I told her that I was pretty distrustful of the side effects of all the psych drugs. From her experience, what did she perceive as the least problematic of all the drugs available. She suggested Savella(trade name in USA--Forrest Pharmaceuticals). It had recently been approved in spring of 2009 in the USA for use in fibromyalgia. It was recognized as having only mild to moderate antidepressant indications.

I have post polio and met the diagnostic criteria for fibromyalgia. Significantly made worse by Arimedex. The Arimedex, I quit in Nov. 2009 b/c the pain increase was unbearable. Subsequently, I tried Femara  and Aromasin.

I am, also, cautious about new drugs. Savella--Milnacipran--generic name, has been available in Europe since the mid 90's. Not a new drug, just a new drug in the USA. For me it was a home run. Not a new drug, good for depression and fibro.  Did a relook at the monograph(drug info). I forgot in the USA it was only approved by FDA for Fibromyalgia. Memories a little fuzzy, but I think it had to do with having to repeat clinical trials for depression, if it was going to be approved for that in the USA. Check your countries for approval use.

Before I started writing here, I did an Evidence Based Search for publications. There are numerous studies. I chose this meta-analysis study b/c I felt most lay people  could read it and understand it. When as a lay person reading studies, over-read(skip) the statistical info--it just makes you confused.--me too sometimes. I have included here the conclusion of the study. The bolding emphasis will be mine.  I will also link to the whole study b/c each section of the study compares Milnacipran to other psych drugs. It may be of interest to others that are on different TCA's and SSRI's, other SNRI's. In reading the study if you need to translate the name of the drug or drug class look at the list I posted on page 1.

For those in the USA, the reason you haven't heard of it much is Forrest Pharm was granted proprietary rights by the FDA as a trade name drug until 2021. It can't be produced or dispensed as a generic drug. It's expensive. My PCP doc kept me in samples from 2009 until I discontinued it in 2013. Bless her. Also, there was a conception I think that it wasn't of value in major depression, only mild to moderate. This study from 2010 clearly disproves that misconception, as some of the other studies do too. I do encourage you to read the entire study, it truly is worth the time. You'll like the info regarding weight loss

Milnacipran: a unique antidepressant?

Whether or not the profile described above justify referring to milnacipran as a unique antidepressant, it is clear that this agent has a distinct combination of characteristics.

It is the only SNRI with a balanced (1:1) activity on NE and 5-HT reuptake inhibition. Its efficacy in mild, moderate, and severe depression and a good overall tolerability are combined with a low risk of causing pharmacokinetic drug- drug interactions, sexual dysfunction, minimal effects on body weight in normal-weight patients, and a lack of toxicity in overdose. This particular profile qualifies milnacipran as a first-line antidepressant for many depressed patients. Milnacipran may be particularly well-suited for low-energy, slowed-down patients. Patients who have been withdrawn from SSRIs or other antidepressants due to lack of efficacy or intolerance may find milnacipran to be an effective therapeutic option.

Note that this overview highlights what we consider to be the most interesting and relevant points of the profile of milnacipran and does not claim to be exhaustive. Approved indications and safety recommendations may vary between countries, so prescribers should check on the summary of product characteristics in their own country.

Link to entire study;

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938282/

Abstract link   http://www.ncbi.nlm.nih.gov/pubmed/20856597

---------------------------------

Link to my favorite drug site. It's run by the government, surprising it's great.  Monograph on Milnacipran as written for the USA. Check your country's source for monographs.

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d37684d6-5134-49e6-9867-5fd67c9dfd90 

[edit 12/6/2014-- I have asked the Mods to delete the above list. It hyperlinks and that is a problem. I'll rewrite Aio's list]

Aio I can't edit the above post. The intent of the post was to make sure I had all your meds listed . I don't want to leave anything out. I didn't realize they would hyperlink back to genelex. Please review the list.  Post here what drugs may need to be added. I must have not hit the save button for milnacipran. No biggy I will do it next time I log in.

BTW the intent with all this info is to give you info that you can take and discuss with your docs.

You need to be your own advocate as far as drugs go. It's tough, I know. We would like to think are docs are well schooled in everything. It's tough on them too. We are in an unparalleled time of explosion of science and medical information. But with our encouragement the docs will work it out. 

I was so excited about remembering about Milnacipran. I forgot to write the key reason--Duh---It is not metabolized in the liver enzyme paths. It does it's work as a SNRI and then is mostly excreted unchanged or combines with another chemical. That's why it's not a troublesome drug. No other psych drug does this YAY. But wait until all the drug checking analysis is done.

I have all ready looked at the results of the checker. Where the evidence of drugs showing a combined response is going to be in the brain. You have many that act on the brain.

You have drugs having trouble getting metabolized in the liver,  and then their hoped for work in the brain is made difficult b/c of splatter effect(paintball splatter). But give it a little time. By the time we are done you will have a load of suggestions to help improve things. 

Lili hellooo (waving) did I answer your question?

Hi Lily, Where are you? Miletc. is it's generic name. I think this is one of those deja vus things. I happen to know a wee bit about drugs, Happen to have personal experience with Miletc. It happens to be a drug that has the lowest drug interaction profile of all the psych drugs. AND it was either responsible or helpful with a 30 lb weight  loss. Anyways, I lost 30lbs after I started it. That weight stayed off until my thyroid went kafluey. Thyroid caused a 50 lb weight gain. LOL maybe I should go back on Miletc. Hmmmmmmmmmm

That study I linked to above had a section about all the differences that  Miletc.  had from the other pysch(psychotropic) drugs. Some I hadn't paid any attention too like sexual dysfunction. No sex in my life at the time . All the other drugs have an effect on libido. Miletc. doesn't or statistically insignificant.  I liked that study b/c it taught me stuff I didn't know and it was comparing the other SNRI's SSRI's and TCA's. Never knew some of the comparison info between the three classes of drugs. Good info.

"Affected Drug Drug Exposure (PK) Clinical Effect (PD) Causative Agents ketamine Some zolpidem Some fentanyl patch Some milnacipran Some Lyrica Some oxycodone&  esomeprazole Some oxycodone" not going to address genetics at the moment. Going to talk about the "work of the drugs".

All these drugs interact in the brain b/c they have an affect/effect on the brain chemistry or a receptor site for a particular brain function. B/c they each have a splatter effect individually when given together they overlap. The overlap is what can get us into trouble.

Idea--- BBL

Hope I can remember everything I just did in the drug checker. I deleted and substituted drugs to see if that would reduce the splatter affect/effect.

 Took out Xanax and substituted lorazepam(Ativan). Took out zoldipem(Ambien) and substituted melatonin. Substituted famotidine(Pepcid) a 5h2 blocker for esomeprasole  a PPI proton pump blocker. Took out ketamine b/c that has already been nixed by the pain team, therefore, isn't applicable and was messing up the checker results. Took out Lyrica b/c it's indication is neuropathy & fibromyalgia and it was interferring with milnacipran. Splatter effect/affect definitely reduced.

Not sure what to do with Zofran. Drug checker still shows that it can interact with The 5h2 drugs (famotidine-Pepcid) and Benadryl. (NEED TO ADD NOTE HERE BUT HAVE TO CHECK SOMETHING--see below post).  Zofran seems to be very naughty at interacting with drugs. It's interaction can cause Torsades. Torsades is nasty, should be avoided if at all possible. Again Torsades is a cardiac dysrhythmia that can be lethal. ( NEED TO CHECK IF ZOFRAN CAN DO THIS ON IT'S OWN---see next post).

Also, you didn't say it, but with your history the likelihood of neuropathy is predictable. So, you do need a drug that can help with that. The only drugs approved for that are the gabapentins--Lyrica and Neurontin. I'll substitute Neurontin and see if it changes anything.

BBL

Benadryl---lol  one of my mantras is "Just when you think you know something, take another look". Benadryl or diphenhydramine is the go to drug for the prevention or correction of an allergic response. That allergic response is related to histamine release. Benadryl blocks histamine release. I couldn't remember exactly it's H class. Had to go to several sources to find it. Finally got the best info on Wikipedia.

Wikipedia may seem a strange source, but I have increasingly found it's very good for everything. In this case of Benadryl, it was VERY interesting. It gave much more info about how Benadryl works than any other source. I've linked it. If you read it , you may find it too technical.

What I learned was that Benadryl has a very wide spread affect on many different system receptors. It's Splatter affect is big. It explains why it would interact with Zofran and so many of the other drugs either directly or indirectly.

Why I mention this here is most nursing and medical professionals, I'm betting don't know this. We are so used to using it for prevention or correction of an allergic response. BUT it can be a troublemaker too.

 I can say I have literally seen it work it's magic when a patient has an allergic response. It is absolutely the go to drug.....splatter effect be damned in that situation.

http://en.wikipedia.org/wiki/Diphenhydramine

Continuing with 5HT3 blockers as alternatives to Zofran. Very interesting.

I'll restate, I'm flummoxed as to why Serotone is not used in the USA. I plugged each 5HT3 drug into the drug checker. All of them followed paths in the liver, many of them 3A4. Many of them interacted with Fentanyl & oxycodone. Other drugs.

I'm not going to put all that info here except for one Aloxi--palonosetron. My head is swimming, if I put them all here we'd drown.

Aloxi--palonosetron

BBL getting more info

Aio and All,  we have only tapped the surface of what's happening with Aio's drugs and drug metabolism. But based on what you've read here, I hope you can see the value of the use of a drug checker and metabolism genetics.

Paintball Drug Therapy just isn't acceptable. 

I've had success with time release oxycodon for over 18 months now. Combined w the cymbalta. I originally used it for peripheral neuropathy in my feet from chemo taxol in 2004. So I've been on it awhile now. 60 mg keeps the tears from. Pouring out my eye

Goodness me, no wonder doctors don´t look this up you would need a computer program to work it all out!

My surgery is cancelled so Fentanyl no longer on the table..........BUT I am very stressed, went to the doctor who has prescribed me Trazodone, known as Desyrel in USA but with my liver enzymes high I don´t want to start it...............I think this is a fairly individual anti dep though, was prescribed to me for sleep and anxiety........any comments or anyone who has had any experience with this please? I am on Exemestane too which I think depresses me

exemestane

Trazaodone first row, second row trazodone metabolite --(mCPP)

AIO, understand about the move. Not fun, particularly when everyone isn't pitching in. Take care.