Can We Talk, AGAIN?

Anonymous · December 2007

Can We Talk, AGAIN?

Anonymous · December 2007

I'm taking a few supplements and I'm wondering have any of you "updated" what you take? What have you quit taking?

As some of you know I was dxd with small vessel disease. I don't know why I'm scared about this, but I am. So, please excuse me for "obsessing." Frown

When I talked to my pcp about the report that my onc sent to him he didn't seem too upset about it. I asked what my MRI report said and he started naming different places in my brain that was detected. I mentioned that the PA wanted to make sure I took an aspirin a day and wanted to make sure my blood pressure was under control. At my pcp's office in Dec. my bp was 150/90. I don't remember being upset (nervous). He always takes it more than once (especially for me who had white coat syndrome). However, he didn't want to treat my bp at this time because it wasn't high enough. What I think is if it stayed that way he would. Also, I am on Toprol for palpitations which also helps with bp. The probem is that he won't see me again until June. Therefore, no one is checking my bp...well I will be seeing the onc in March (I think).

Okay. Now to the supplements. Right now I'm taking one low dose adult aspirin. I'm also taking one Tumeric, fish oil (one Coromega and one fish oil cap), CoQ10, Vitamin C, Vit D, Calcium, Mag, Glucosamine/chondroiton/MSM, R-Lopic Acid (every other day), one Green Tea Extract, I think that's all. Tongue out What I wonder is will certain supplements (the first three that I mentioned) also thin my blood. We know that we are told not to take certain supplements before surgery. So, could it be a bit dangerous to take aspirin and these supplements?

I also curious as to what you are NOW taking. What have you changed?

And of course I worry about what's interacting with Arimidex. And that's not JUST supplements, but also meds because I don't believe the "scientists" know crap about what's what when it comes to AIs.

Thanks for your input.

Shirley

Calico · December 2007

Shirley,

I take some of the same as you do, except the last three Glucosamine etc....or Aspirin I don't. I also take Milk Thistle and Selenium.

God Bless

JoanofArdmore · December 2007

{{{Shirley}}}.I just came to say YOU can have us discuss ANYTHING, anytim.You, AND Calico are two of the sweetest ladies on these boards!

I'm just headin' out with Woodendog, but will join the thread later on.

Suffice to say I've changed nada (and I'm STILL taking the grapeseed from way back, too!)

Calico · December 2007

Joan,

you are to kind, you are giving me a "big head" as we say in Germany.

I sure could use a Woodendog too to keep me going without excuses....

Thanks for reminding me, I did add one grape seed capsule a day about a week ago (if I don't forget) and I take 6 mg Melatonin before sleep which gives me the most "entertaining" dreams lol.....

God Bless

TenderIsOurMight · December 2007

Shirley,

From the hormone test, Kashcraft posted this drug interaction site which I used last night:

Link: http://mhc.daytondcs.com:8080/cgi-bin/ddiD?verification=03F1629Hs60&id=8411&status=303030

Note; You have to paste the link together, after the ? mark put in the rest starting with the verification

Now this site is a tad overwhelming at first. And it doesn't have a lot of supplements, like green tea, grape seed (but has grape juice) etc..

I was using it because I really believe Arimidex and Lipitor worsened my SE's. That's when I found that Arimidex is a substrate for CYP 3A4 and that Lipitor is a minor to moderate inhibitor of this pathway. Arimidex, however, unlike Tamoxifen, is not a pro-drug. What you see is what you get. This interaction would suggest Arimidex would increase in my blood (they say 25 to 75% moderate (goes to 150%).

Now I am still thinking on this point. Maybe someone could help me out here. But I think an increase in Arimidex (not a prodrug), an aromatase inhibitor acting on the body's aromatase enzyme (which inhibits testosterone to estrogen etc), would not result in inhibition of aromatase by Arimidex because it's not a prodrug, meaning arimidex doesn't need to get broken down more for it's pharmacologic action. If anything, it may cause more or greater aromatase inhibition throughout the body. Kind of like taking 2 Arimidex at once, which the drug company says not to do, as then you can suffer from "total body aromatase inhibition". Sounds nasty to me and I sure don't want it.

So, if the Lipitor works to keep the Arimidex circulating, maybe I was getting a double whammy on my joints, muscles etc... Only thing is, I've been holding the Lipitor for 4 weeks, and while I'm some better I'm not all better.

Still, you may wish to use this to check your main meds, and your supplements. On the left, type in your drug in full, and it will highlight the name in their list. The press the Add. Do another drug, then press the Add. Then hid Check interactions.

Once you're in interactions, press the arrows and more pop up windows will come up. There is one simple line which says, Lipitor will increase Arimidex. If you hit there information buttons, on the right a window will pop up giving the CYP path. Just play with it some. Always hit the "back and keep" button to add on another and another drug, or you'll have to start all over again.

Anyways, thought i'd let you know. I agree with your comment about the AI's and less being known. Let's keep on looking.

Tender

NativeMainer · December 2007

Tender--

re: "I was using it because I really believe Arimidex and Lipitor worsened my SE's. That's when I found that Arimidex is a substrate for CYP 3A4 and that Lipitor is a minor to moderate inhibitor of this pathway. Arimidex, however, unlike Tamoxifen, is not a pro-drug. What you see is what you get. This interaction would suggest Arimidex would increase in my blood (they say 25 to 75% moderate (goes to 150%). "

You've got it right. With Lipitor inhibiting the 3A4 system, Arimidex levels will be higher in the blood stream on the recommended "one-size-fits-all" dose. Higher levels usually correspond with worse side effects. So you are getting lots of protection from bc, but may be getting into toxic levels in the blood, which is rarely a good thing.

Another thing I would be concerned about: lipitor is notoriously hard on the liver (that's why blood tests need to be done periodically while taking lipitor). If Arimidex is hard on the liver, too, the combo could cause severe liver problems.

Anonymous · December 2007

Okay, I haven't been to the "drug checker" yet. I may have to do this tomorrow. My daughter will be back in a minute...she and her dad went to get us our take out...being good...having a salad. Laughing

I also take Lipitor. C'mon! Don't tell me we could get in trouble here. Geez! I'm already crazy enough. I get more dizzy lately, but am blaming that on the SVD.

I'm ALWAYS wondering what MAY react with the Arimidex. My insurance company would be very happy if I'd choose another cheaper, generic drug for my cholesterol.

Thanks, Tender, for this newly discovered info (new to me). You ALWAYS come up with so many answers. And so much of it is over my head! But I try to read and understand. And if I don't understand I'm coming back here for interpretation. Wink

And Joan, as always you are a sweetheart. I can't seem to get in all my drugs and supplements. I haven't started back on grapeseed extract yet.

What would I do without YA'LL.

Shirley

LizM · December 2007

Tender, thanks so much for the link.

I was surprised at some of the interactions with Femara:

brocolli

Advil

Aleve

Aspirin

Tylenol

Milk Thistle

Voltaren

cp418 · December 2007

LizM - Thank you for posting interactions for Femara!! I had no idea as I've been taking Advil and Aspirin for body aches and I eat brocolli regular. How did you get this list to display? Joann

chemo072 · December 2007

Tender - I am SOOO confused today. I ran the interactions, and it says

affected drug: tamoxifen, prodrug

will go: UP

because of: buproprion (wellbutrin)

and the mechanism is: CYP2D6 moderate inhibition (jersey barrier)

So, if normal metabolism of tamoxifen on the CYP2D6 highway has two lanes of traffic heading one direction, and the wellbutrin acts like a moderate freeway barrier in the middle of the lanes of traffic, then does that mean that the traffic backs up, meaning that levels of the affected drug go UP....on this side of the barrier?

But tamoxifen is a prodrug, meaning it has to change into something else (endoxifen) in order to work, and my understanding of the inhibitor was that it lowered the levels of the end product.... So that little traffic will get through to the other side of the traffic barrier....Thus end levels would go DOWN, not up.

???? Help, what logicial step am I missing ???? And is the highway/traffic metaphor limiting my thinking?

LizM · December 2007

OK I stand corrected. When I ran the interactions list all of the above were mentioned; however, only brocolli and voltaren changed the metabolism and only voltaren lowered the effectiveness. Brocolli affected the CYP2A6 pathway which is only one of the pathways for Femara with the main one being CYP3A4 and the report indicated the loss of effectiveness is unknown. However, it does cause me to think because I eat brocolli sprouts regularly and I think I will stop. I was using voltaren cream (which is different from the drug) which is why I plugged that drug in also. When I ran the report with only Femara and Advil, Aleve and Tylenol it did not change it's effectiveness. Sorry for the confusion. The report is fun to run. I had to join a free trial for 30 days to run it. The link is above posted by Tender.

chemo072 · December 2007

hah. I just read further down the genemedrx list, it says:

endoxifen, end metabolite: DOWN

because of: buproprion

so yes, I did understand!

So, with the highway metaphor, a prodrug is like passing a town on the freeway - only what gets past that town counts. With the normal drugs, everything before that town counts. Or, a different metaphor is that a prodrug is like taking the freeway exit onto an arterial or a rural road....you only get on to that road if the pro-drug is metabolized into its end product.

But in general, we're thinking about traffic getting through, or getting backed up.

Now in my case, as an intermediate CYP2D6 metabolizer, one lane of traffic is blocked. So I only have one lane of traffic getting through at all, which means that normal drug levels that have to take that highway will get backed up, so we should try to reduce traffic on that highway = take lower doses. Install a stop light at the on ramps, etc. Keep those drug levels (=traffic) from getting really stacked up.

And buproprion or any other inhibitor, in the intermediate metabolizer metaphor would effectively place a jersey (freeway) barrier in the middle of my one lane of traffic, which means that NO traffic would get through on that highway (however, I assume traffic would be moving on the other metabolism highways, assuming they work, don't know, haven't been tested)....so tamoxifen levels would rise and endoxifen levels would be nearly nonexistent, as traffic wouldn't even be getting to the rural road (=endoxifen) exit.

Whew....now my head hurts. But it helps to try to visualize what's happening.

TenderIsOurMight · December 2007

Haaa..those nasty jersey barriers! They had a hard enough time keeping car traffic flowing right, let alone drug traffic as on this site!

Not sure most like those jersey barriers.

You've got it, AmyaM.

Native Mainer, thank you for your valuable insight! Pharmacology knowledge is every increasing. Can you imagine us at our pharmacy, checking a hand held CYP electronic monitor, and turning down our meds based on interactions? Wonder if that day will ever come, but I suspect the portable device is already out there.

All the best everyone,

Tender

chemo072 · December 2007

Ok, I just have to add one small thing from the genemedrx drug interaction site...the results indicate that:

partaking in a certain oncologist-recommended nausea reducing substance (take a guess here folks, think Melissa Etheridge) INCREASES the endoxifen-active metabolite along its CYP2C9 pathway. So, a little of that substance might help get traffic moving a little faster on that particular highway....interesting....

though that brings up a "(seesaw) = Reminder: What lowers the parent compound raises the level of its active metabolites.."

And the seesaw raises an interesting point....wonder if that's really true? does lowering the parent compound of tamoxifen increase the level of the end metabolite? So why not just take lower doses of tamoxifen??? Am I missing something here??

But why wouldn't less traffic on the highway mean less traffic to take the exit onto the rural road? ??? Sigh. Confused again.

Also, I wonder what ELSE increases endoxifen???

So in our universe of metabolism metaphors there are not only jersey barriers but speed limit changes (though the GeneMedRx site uses the metaphor of fans for induction)....or maybe speed limit increases isn't the right image....because faster doesn't equal more if the amount of traffic is the same ...hmmm.....maybe it turns the sedans into SUVs, so that a bigger car arrives in the end?

Also, I think I made a strategic error in not getting the tamoxifen metabolizing minor pathway of CYP2C9 measured. Sigh....

saluki · December 2007

Liz- If you have concern about the Voltaren Creme, I'd give the Traumeel

ointment a try. It's a homeopathic and I am finding it very helful and it works quickly.

You had me going there for a few minutes there with the milk thistle. Thank you for clarifying that! I've been using it daily for the past 5 years and I take Femara.

TenderIsOurMight · December 2007

AmyaM,

It's through the metabolism of the Tamoxifen to the active metabolite that the Tamoxifen in one's blood gets lowered.

Not sure about this site's images: see saw etc.. but yes, in general, the more a prodrug, parent compound like Tamoxifen is metabolized the greater the "end"metabolite. (their not implying through taking a lower dose of Tamoxifen itself).

Curious what you mention about increasing endoxifen through some antinausea agent affecting a different path: cyp2C9.

Gosh, can you just imagine where pharmacogenetics is taking us? Give your DNA blood sample, and some day, based on your genotype, with weighing in on phenotype, you'll get "personalized" anti-cancer pathways that should work best for you! Exciting isn't it?

Question is how are they going to impliment this knowledge? I can't imagine clinical trials for all of these pathways and drugs....Any thoughts?

Shirley, I'm adding in via edit, that perhaps we have highjacked your thread by re-discussing these drug breakdowns through CYP's etc.. I wanted to give you that fairly new drug interaction side for your CAM drugs, and I'm sorry if we've gone back to Tam and Fem discussion. Hope you don't mind.

Tender

chemo072 · December 2007

Yes, Shirley, apologies for the hijacking....I get carried away sometimes. Hope all goes well for you....

and Tender - aha! I get it now with the seesaw effect - if there is a finite amount of a pro-drug in one's system (a dose), it either has to be in a pre-metabolized state or a post-metabolized state. So increasing endoxifen (post-metabolism) necessarily means that the amount of tamoxifen (pre-metabolism) goes down. Sorry to be slow about that. The highway metaphor was a little limiting that way.

LizM · December 2007

Saluki, I ran the interaction of Femara and Milk thistle and there was none. Voltaren seemed to be the biggest problem for me. I will try the other cream. Do you buy it at organic markets? I have one close to me that I routinely shop at and I will check there. Thanks

Tender, thanks so much for the link. It is exactly what I was looking for. I'm always worried that the supplements, foods and other meds I'm taking might interfere with Femara.

Sorry Shirley if we highjacked the thread. If you have not visited the link Tender posted I would recommend doing so. It is very helpful. However, it differs somewhat from what Edge has told us about interactions. For example, Edge has indicated that you shouldn't take garlic with Femara but the link above shows no problems with Femara and garlic. Edge also indicated that you shouldn't eat brocolli sprouts with Aromosin and the link also says no problem but shows there could be a problem with brocolli and Femara which surprised me since I eat brocolli sprouts daily.

saluki · December 2007

Liz- Yes it should be available at any health food place. WF carries it as well. I order mine from iherb since their prices are excellent. You don't need the gel. The ointment is not greasy and is a fraction of the price.

Gosh--Its ashame we lost all the old threads last time BCO changed because, I remember a very long one about Femara, Broccoli sprouts and garlic. Here we are covering the same territory a couple of years later.

TenderIsOurMight · December 2007

A Rhyme For very Kind and Loyal Shirley,

A gift from us to you, for all we recognize at bc.org you do

And let's also here mention your and our friend, Joan D'Ardmore, too!

Without the two of you

We might not grasp as well what to do

For CAM knowledge sure is fine

And now your post's question so very much merits our time

By Tender et friends..

"Now to the supplements. Right now I'm taking one low dose adult aspirin. I'm also taking one Tumeric, fish oil (one Coromega and one fish oil cap), CoQ10, Vitamin C, Vit D, Calcium, Mag, Glucosamine/chondroiton/MSM, R-Lopic Acid (every other day), one Green Tea Extract, I think that's all. What I wonder is will certain supplements (the first three that I mentioned) also thin my blood. We know that we are told not to take certain supplements before surgery. So, could it be a bit dangerous to take aspirin and these supplements?"

Shirley, here is a list of blood thinners on the Memorial Sloan Kettering CAM site:http://www.mskcc.org/mskcc/html/11570.cfm

Search About Herbs: blood thinners

#ABCDEFGHIJKLMNOPQRSTUVWXYZ

Found 37 out of 232 records - SHOW SUMMARIES

Horse Chestnut

Ginger

Garlic

Licorice

Bilberry Fruit

Inositol Hexaphosphate

Sho-saiko-to

Seasilver

Scullcap

Saw Palmetto

Arnica

Chamomile (German)

Devil's Claw

Guggul

Guarana

Green Tea (note: by limiting platelet clumping. I didn't know this. ? source of bruises)

Grape Seed

Goldenseal

Glehnia

Ginseng (Asian)

Ginseng (American)

Ginkgo

Forskolin

Feverfew

Fenugreek

Evening Primrose Oil

Willow Bark

Vitamin E

Vitamin A

Cat's Claw

Butchers Broom

Pau D'arco

Passionflower

Bromelain

Turmeric

Reishi Mushroom

Red Clover

Tumeric:Anticoagulants / Antiplatelets: Turmeric may increase risk of bleeding

FishOils: Omegaven:Herb-Drug Interactions May increase the effect of other anticoagulant/antiplatelet agents.

Lab Interactions: May reduce levels of alpha-tocopherol and beta-carotene (5) (14).

High levels of omega-3 fatty acids may decrease triglyceride and increase LDL cholesterol levels (3).

Doses higher than 3 grams per day may increase bleeding time

Co-enzyme Q counters our Vitamin K: "Warfarin: CoQ may antagonize the effects of warfarin. CoQ is structurally similar to vitamin K (opposite of blood thinning).

I'm not sure why Fish Oil wasn't listed initially as a blood thinner in the MSK list above.

Thank you and Joan for your wit, knowledge and patience, Shirley!

T.

iodine · December 2007

Just a bit about taking BP--if done the second time(or more), in the same arm, without a considerable wait, it will be higher.

I also HATE when the cuff is pumped way up, it's SO not necessary! If experienced, one can listen while pumping and help determine when to stop just above the proper numbers.

Ok, that's my rant for today.

LizM · December 2007

Right now I am taking:

Cal/Mag/D 1000/400/1600 (get additional Calcium/D with OJ and yogurt)

glucosome/chondroitin

digestive enzymes

acacia fiber

fish oil (1 capsule)

whey protein from cows not treated with rBGH

Aleve or Advil (2 Aleve or 4 Advil)

Milk Thistle (off and on)

Alpha lapoic acid (off and on)

brocolli sprouts (stopped today after checked interaction with Femara)

1/2 tsp of cinnamon daily

1/2 tsp of tumeric daily

3-4 cups of green tea daily

Anonymous · December 2007

Thank you ALL. You have NOT hijacked "my" thread. What you have done is make me realize how dumb I am. I'll have to study the link provided BECAUSE I don't understand all this "stuff." Remember, I have a brain problem. Laughing Hey, why not use it for an excuse. Cool

And, Tender, thank you so much for you lovely poem. You're way too kind. "Our" Joan is a sweetie. I'm not seeing her here nearly enough lately and I miss her! She makes me smile.

About fish oil...the first thing my surgeon asked me before my biopsy was, do you take fish oil? Yep, I said. He said, stop taking it before the biopsy. And, of course, they gave me a drug list full of stuff not to take. However, I'm not taking 3 grams a day.

So, I suppose I won't stop taking the supplements I AM taking. I don't think they'll make me "bleed." I was thinking about upping my aspirin, but I won't at this time.

Doctors don't know CRAPPOLA about this stuff. That's why I need you researchers and pharmacists. Wink You think we could teach them a thing or two? I don't believe they'd take to kindly to that.

I think I'm messing up my newly polished fingernails. Yell But I just couldn't wait to get back on here to see what you smarties have posted.

Thanks again!

Shirley

Anonymous · December 2007

Dotti, I too hate it when the darn cuff cuts off the circulation in my arm. It mostly happens when the digital bp machine is used. My doc pumps it himself and I don't remember it being too tight. And, he can't take it in the other arm....mild lymphedema.

My last two visits to Duke my bp was going up a bit. They use the automatic bp cuff. However, during chemo my bp was very good. Who knows!

Cynthia1962 · December 2007

My gyn recently told me to take a baby aspirin daily, but I'm wondering if it has to be aspirin because it's a rare day that I don't take ibuprofen and doesn't it thin the blood, too?

Tender - am I understanding the list of blood thinners you posted correctly in that Co-Q10 acts as a blood clotter? Is that a problem when I'm trying to have thinner blood?

Shirley - I take a lot of the same supplements as you plus the Toprol. I'm not taking the glucosamine and RLA, but I take DIM and sometimes milk thistle. Do you know not to take your calcium when you take Toprol? It is so hard to keep all this straight. I still don't have when to take what sorted out.

Cynthia

TenderIsOurMight · December 2007

Cynthia,

On the CAM MSK site they suggest CO-Q counteracts our natural Vitamin K, which acts to assist in blood clotting. But they list this as an issue for people on blood thinners, such as coumadin/warferin.

Our platelets are extremely sensitive to aspirin, and when exposed to it, are less prone to clump, which is felt to be one of the first incitive events in blood clot formation, followed by layering on of cholesterols amongst other.

I believe the two mechanisms (the platelet clot and the Vit K assisted cascade for blood clotting ) are independent, yet ultimately all is linked from the big picture view.

Please check with your physician, especially if you're taking Aspirin for heart purposes. Wouldn't want to steer anyone incorrectly here.

Tender

Cynthia1962 · December 2007

Thanks, Tender. I'm not taking aspirin for my heart (at least not yet), it was suggested to avoid a clot while on Tamoxifen. I appreciate the info. Looks like I should be using aspirin.

Cynthia

Anonymous · December 2007

Yes, Cynthia, now that you mention it I remember I'm not supposed to take Calcium with Toprol. However, I also take Synthroid and I have to wait four hours before I take calcium. Therefore, it's no problem with those two.

It is a pain in the you-know-what remembering when to take what.

Shirley

Can We Talk, AGAIN?

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