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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by beardedlady on April 11, 2002, at 14:17:14
I went to an allergist the other day because I am now allergic to so many antibiotics that I can't take anything for my sinus infections (which I never used to get, either). The doc asked whether I was sensitive to other meds, and I couldn't really think of anything until: I had a full eye exam last September, and my pupils stayed dilated for 28 hours! He said, "Ah!"
Although I am not quite sure I understand what he said, here's what I think it was: Lots of meds, like those eye drops and sulfa antibiotics (which just recently gave me hives) are slow metabolizers in the liver anyway, so it's possible that a medication like Serzone (or other antidepressants) can have some kind of effect on those meds and make them last longer. Does that sound right? And does that sound like it might be true?
slow beardy : )>
Posted by Ritch on April 11, 2002, at 15:26:02
In reply to slow metabolism and med sensitivity, posted by beardedlady on April 11, 2002, at 14:17:14
> I went to an allergist the other day because I am now allergic to so many antibiotics that I can't take anything for my sinus infections (which I never used to get, either). The doc asked whether I was sensitive to other meds, and I couldn't really think of anything until: I had a full eye exam last September, and my pupils stayed dilated for 28 hours! He said, "Ah!"
>
> Although I am not quite sure I understand what he said, here's what I think it was: Lots of meds, like those eye drops and sulfa antibiotics (which just recently gave me hives) are slow metabolizers in the liver anyway, so it's possible that a medication like Serzone (or other antidepressants) can have some kind of effect on those meds and make them last longer. Does that sound right? And does that sound like it might be true?
>
> slow beardy : )>Hi beardy,
My last trial on Prozac got axed because I was having nighttime hallucinations and the neuro thought that the fluoxetine was causing some type of liver thing (I can't remember what he said exactly), which was allowing it to overaccumulate to a toxic level. Yes, other meds can cause other meds blood levels to rise to possibly toxic levels. The next tests I want to take is a full liver function thing-that is what I recommend. Also, getting a blood level of some of the meds you are taking might be a good idea, too. Wow, 28 hrs for the atropine to wear off! You must have had a slit-lamp exam. It took about 8-12 hrs for my eyes to go back to normal.
Mitch
Posted by beardedlady on April 11, 2002, at 15:46:16
In reply to Re: slow metabolism and med sensitivity » beardedlady, posted by Ritch on April 11, 2002, at 15:26:02
Mitch:
Did the liver thing; thanks. I'm totally normal. Regarding toxic levels, I don't think that's what the allergist meant. He seemed to imply it would simply take longer to leave my body, since I was adding the slowly metabolised med to slow metabolism caused by Serzone. As for the sulfa allergy, it's the most common antibiotic allergy going. What I didn't make clear, stupid me, was that I took one pill at 4:00 p.m., and I got three hives. I got three hives every day for a week every day between 4:00 and 6:00 p.m.! Is that odd?
I also took Tequin, which gave me severe joint pain all through my body. That happened after the second pill. I took a third dose on the third day, and I stopped. The joint pain lasted for two months! They thought I had fibromyalgia! (It has been gone since September, though; I do not have fibromyalgia.)
Thanks for the input.
beardy : )>
Posted by medlib on April 12, 2002, at 10:53:38
In reply to slow metabolism and med sensitivity, posted by beardedlady on April 11, 2002, at 14:17:14
Hi beardy--
I think that your post may be referring to 3 (or more) different mechanisms of action. With the caveats that I'm no Cam, and my explications often come packaged with liberal amounts of shoe leather:
--A true allergic reaction (not a side effect) is a histamine-mediated response to a specific substance that has entered the blood stream. If that allergen is a drug, the allergic response is not affected by the presence of other drugs (unless they are antihistamines). This result also is independent of liver metabolism and of the drug's half-life. If you've encountered a drug (or its very close cousin) at least twice, you are not likely to become allergic to it with repeated or prolonged exposures. However, a drug which causes a mild allergic reaction at first *can* cause more severe reactions in subsequent contacts.
MDs will swear that it's not possible to have an allergic reaction to a drug on first exposure (because the body has not had an opportunity to develop allergen-specific antigens). But, I've had anaphylactic (potentially life-threatening allergic) reactions to 2 new antibiotics, neither of which I'd taken before; neither is closely related to an Ab I'm already allergic to, either. That's one reason (among many) that I consider *all* medical explanations hypotheses, not facts.
--How long effects of a drug last is influenced by a number of factors, the greatest of which is the nature of the drug itself. Even within the same drug category, variations can be substantial. (The half-life of Effexor is measured in hours; Prozac's can be measured in days.) Thus, your lengthy pupillary dilation may be related more to the type of drug used than to your individual rate of metabolism. Other important factors include the route of delivery (IV, oral, under or through the skin, etc.) and the body system affected. To illustrate, the atropine Mitch mentioned is not as useful for adult eye exams as some other agents because of its slow onset and long duration. But, the same drug administered by IV (during CPR, for example) increases a slow heart rate (bradycardia) in seconds.
--Most drugs are metabolized (broken down) in the liver by enzymes (called cytochromes) which collectively are designated P450. One of these enzymes (3C4) metabolizes several ADs, including Serzone and Prozac. When 2 drugs are taken which are metabolized by the same enzyme, they compete with one another for its use. The losing competitor must stick around in the body longer waiting for its turn; so, less of it is needed to achieve the same therapeutic effect. (I'm not sure what factors determine which drug wins in such competitions.) And, yes, several antibiotics utilize the 3C4 enzyme (like the myacin family). This slowed metabolism in the presence of pharmacological competitors plays a much smaller role in overall drug variability than the factors mentioned above, though.
Btw, posting to a teacher of writing is intimidating, at least to me.
Not a poet, either---medlib
Posted by beardedlady on April 12, 2002, at 12:27:54
In reply to Re: slow metabolism and med sensitivity » beardedlady, posted by medlib on April 12, 2002, at 10:53:38
Yes, but...
I know the difference between half life and metabolism, but isn't the half life of sulfas relatively short? And wouldn't a slow metabolism cause the side effects to last longer? (Hence still having hives for five days and the nasty side effects of Tequin for a month?)
I've had eye exams a bunch of times, but I have never been dilated for more than eight hours.
Regarding antibiotic allergies, I got a rash from erythromycin first time I took it. It took years for me to develop one to penicillin, and then it was anaphylactic shock. The allergist said it's likely that I'm not still allergic too it, as so long a time has elapsed. (I have noticed many of my allergies last for less than a decade.) As for the sulfa (bactrim) allergy, I took it with no problems in March; I took it again in July and got hives.
Maybe we should chalk it up to bad genes and sporadic troubles.
Your grammar was terrific, by the way. And though I don't recall your name on the PSB board, thanks for lurking around the poems.
beardy : )>
This is the end of the thread.
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