BfromNJ Posted February 13, 2019 Posted February 13, 2019 So I am an ultrarapid metabolizer on the CYP450. I had the genomind test done. So it turned out the mirtazapine is one of the drugs that was in my "use with caution" column. Basically I guess I metabolize this drug quicker and I am supposed to use caution when this drug is taken "in the presence of inducers" (ie other drugs in the CYP450). It can make the drug less effective. With that being said, does anyone know that being I am an ultrarapid metabolizer , will this affect my taper/withdraw? My doctor had indicated when I started the med that this really just meant that the mirt. would be less effective when I take another med that is an inducer or drink coffee, smoke, etc. 9/2018- lexapro low dose few days.11/3/2018- zoloft 2 days 11/7/18 - 11/15/18 - Prozac 9 days, from 10 mg for week, to 20 11/16 inpatient put on Lexapro for a few days, Cymbalta, 2 days 11/24-12/8 - gabapentin 100 mg 3xs per day - a very fast taper 1/7 - tbuspar for three days- blurry vision, jerky eye 1/17/19 - 2/15/19- mirtazapine 15 mg - started taper on 1/30 2/20/19 gabapentin 600 mg. . 12/20- taper finished 2/20/19 - seroquel 25 mg current - taken 10 pm 2/20/19- luvox (generic) 25 mg. 4/6/19 to 18.75 mg .held . Started taper again 1/7/21- 15 mg, 2/7/21- 12.5 mg, 3/7/21 -10 mg, 4/1/21- 9 mg, 5/1/21- 8.1 mg, 5/27/21- updose to 10 mg, 6/21- in patient updose to 50 mg, 6/25/21- reduce to 10 mg (current) . 9/5- split dose 5mg am/5 mg pm. 9/20- 4 mg am/5 mg pm . 9/1/21- took one dose of vistril 50 mg. 9/1/21-accidental double dose of seroquel- 50 mg
Administrator Altostrata Posted February 13, 2019 Administrator Posted February 13, 2019 What this means is you might have to take higher doses to get an effect from mirtazapine when you're taking it. If you also ingest an inducer (could be a drug, a supplement, or even a food) of the same liver enzyme, your metabolization of the original drug will be speeded up even more, to the point you might experience withdrawal symptoms. The danger for rapid metabolizers is that they can handle such high doses of drugs without side effects, doctors may overlook the risk of gradual organ damage over time. You are not taking a particularly high dose of mirtazapine. This doesn't mean anything for tapering. You taper to the rate you can tolerate. If you get withdrawal symptoms, you taper more gradually. Generally, these genetic tests are useful only to identify potential drug-drug interactions for drugs that you are considering taking or already taking. They don't indicate anything about withdrawal. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted.
Vonnegutjunky Posted February 14, 2019 Posted February 14, 2019 Also it depends on if the drug your taken is converted to its active form via cyp450. if it is converted to its active form via cyp450, you can get too much of the active drug into your system at once, and the rest of the enzymatic pathway doesn’t clear it, meaning a low dose can feel like an overdose. Here is is a nice little chart. https://selfhacked.com/blog/cyp-enzymes-interact-supplements-related-genes/ *Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) *No other supplements or vitamins *Taper schedule in the pdf Blank.pdf https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564
BfromNJ Posted February 14, 2019 Author Posted February 14, 2019 Thanks. Very useful. So basically im screwed coming and going. Lol. 🙄😂 9/2018- lexapro low dose few days.11/3/2018- zoloft 2 days 11/7/18 - 11/15/18 - Prozac 9 days, from 10 mg for week, to 20 11/16 inpatient put on Lexapro for a few days, Cymbalta, 2 days 11/24-12/8 - gabapentin 100 mg 3xs per day - a very fast taper 1/7 - tbuspar for three days- blurry vision, jerky eye 1/17/19 - 2/15/19- mirtazapine 15 mg - started taper on 1/30 2/20/19 gabapentin 600 mg. . 12/20- taper finished 2/20/19 - seroquel 25 mg current - taken 10 pm 2/20/19- luvox (generic) 25 mg. 4/6/19 to 18.75 mg .held . Started taper again 1/7/21- 15 mg, 2/7/21- 12.5 mg, 3/7/21 -10 mg, 4/1/21- 9 mg, 5/1/21- 8.1 mg, 5/27/21- updose to 10 mg, 6/21- in patient updose to 50 mg, 6/25/21- reduce to 10 mg (current) . 9/5- split dose 5mg am/5 mg pm. 9/20- 4 mg am/5 mg pm . 9/1/21- took one dose of vistril 50 mg. 9/1/21-accidental double dose of seroquel- 50 mg
Rachellynn Posted February 14, 2019 Posted February 14, 2019 Is there somewhere to run raw data from 23andme through to find this information out? I too suspect liver issues with/from these drugs🙄 ive been told I’m a slow oxidizer but not sure if that’s the same thing. Thanks! Rachel - 1998-2012 Prozac 20mg 2012-2014 Prozac 40mg Sept 17 Remeron 15mg, March ‘18 7.5mg Jan 31 - Feb 13 1/4 - 1mg Ativan Jan 31 - feb 5 - 2mg Prozac, 4mg feb 7 feb 10 - 10mg rem, Feb 27 - 7.5mg rem Feb 27 - March 6th - 5mg Baclofen March 12th - Keppra 250mg March 24 - 30mg phenobarbital
Vonnegutjunky Posted February 14, 2019 Posted February 14, 2019 (edited) 4 hours ago, BfromNJ said: Thanks. Very useful. So basically im screwed coming and going. Lol. 🙄😂 Lol,I think we all are! Regardless of metabolic issues 😂😂😂 honestly, just becuse you have the gene doesn’t mean it’s turned on. It could be, mine actually turned on, and now I know why I had such an extremely adverse reaction to a once previously well tolerated medication. But becuse you are susceptible, I would say just go slower with your taper than what’s suggested, and you will probably have more intesne waves than others, if your gene has expressed. Also take this advice as a grain of salt becuse I am only speaking from my personal experience and I am in way an expert. (Mod Note: I think member meant to say "I am in no way an expert".) Just my own research from what happened to me. Edited February 14, 2019 by ChessieCat added mod note *Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) *No other supplements or vitamins *Taper schedule in the pdf Blank.pdf https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564
Vonnegutjunky Posted February 14, 2019 Posted February 14, 2019 13 minutes ago, Rachellynn said: Is there somewhere to run raw data from 23andme through to find this information out? I too suspect liver issues with/from these drugs🙄 ive been told I’m a slow oxidizer but not sure if that’s the same thing. Thanks! The only place I know of that will do it online is through selfhacked, it’s called selfdecode, it’s on their site, I don’t know what the charge is. *Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) *No other supplements or vitamins *Taper schedule in the pdf Blank.pdf https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564
Moderator Emeritus ChessieCat Posted February 14, 2019 Moderator Emeritus Posted February 14, 2019 4 hours ago, Vonnegutjunky said: I am only speaking from my personal experience and I am in way an expert. (Mod Note: I think member meant to say "I am in no way an expert".) Just my own research from what happened to me. Made the above correction to this post about what I think Vonnegutjunky really meant. * NO LONGER ACTIVE on SA * MISSION ACCOMPLISHED: (6 year taper) 0mg Pristiq on 13th November 2021 ADs since ~1992: 25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq: 50mg 2012, 100mg beg 2013 (Serotonin Toxicity) Tapering from Oct 2015 - 13 Nov 2021 LAST DOSE 0.0025mg Post 0 updates start here My tapering program My Intro (goes to tapering graph) VIDEO: Antidepressant Withdrawal Syndrome and its Management
BfromNJ Posted February 14, 2019 Author Posted February 14, 2019 my doctor ordered it through genomind. 9/2018- lexapro low dose few days.11/3/2018- zoloft 2 days 11/7/18 - 11/15/18 - Prozac 9 days, from 10 mg for week, to 20 11/16 inpatient put on Lexapro for a few days, Cymbalta, 2 days 11/24-12/8 - gabapentin 100 mg 3xs per day - a very fast taper 1/7 - tbuspar for three days- blurry vision, jerky eye 1/17/19 - 2/15/19- mirtazapine 15 mg - started taper on 1/30 2/20/19 gabapentin 600 mg. . 12/20- taper finished 2/20/19 - seroquel 25 mg current - taken 10 pm 2/20/19- luvox (generic) 25 mg. 4/6/19 to 18.75 mg .held . Started taper again 1/7/21- 15 mg, 2/7/21- 12.5 mg, 3/7/21 -10 mg, 4/1/21- 9 mg, 5/1/21- 8.1 mg, 5/27/21- updose to 10 mg, 6/21- in patient updose to 50 mg, 6/25/21- reduce to 10 mg (current) . 9/5- split dose 5mg am/5 mg pm. 9/20- 4 mg am/5 mg pm . 9/1/21- took one dose of vistril 50 mg. 9/1/21-accidental double dose of seroquel- 50 mg
Vonnegutjunky Posted February 15, 2019 Posted February 15, 2019 Hers was done through 23 and me, she has raw data, it’s different and needs to be decoded. Yes Chessie! Thank you! *Currently at 8.2-8.5 mg of my 10mg pill of Paxil (they actually weigh 12.5mg) january 2023 I began reducing my med again. I was a 9mg weight for years, I went to 8.9 in January, went to 8.6mg in February, and in March 2023 I went down to 8.5-8.2 mg ( my scale varies, so I stick within that .3 range because of that) *No other supplements or vitamins *Taper schedule in the pdf Blank.pdf https://docs.google.com/document/d/1-5vShtJtwAOGA30OxIP87steLmMdFzD29F0fzAPD564
Bee5 Posted September 8, 2019 Posted September 8, 2019 Hi All, What is the name of this test? i.e. how would I enquire about it? Is is the CYP450 metbabolism genotype test? Regards, Bee5 7 months of prescribed polypharmacy in 2015-2016, including several classes of psych meds. 1st attempt at taper was too fast. 2nd attempt is underway. 1 Mar 2018: 37.5 mg paroxetine, 150 mg lamotrigine, 300 mg quetiapine 1 Oct 2020: 30 mg paroxetine, 150 mg lamotrigine, 37.5 mg quetiapine 15 May 2022: 25 mg paroxetine, 150 mg lamotrigine, 0 mg quetiapine 11 Jan 2024: 20 mg paroxetine, 118.75 mg lamotrigine Supplements: Iron, Vit D magnesium glycinate, omega 3 I am not a medical professional. All my posts are my opinions only, based on my experiences.
BfromNJ Posted September 8, 2019 Author Posted September 8, 2019 My psych doctor did it. They swan your mouth and send it out. I didnt find it useful in the long run as far as helping with side effects knowledge etc. And most ins doesnt cover it. 9/2018- lexapro low dose few days.11/3/2018- zoloft 2 days 11/7/18 - 11/15/18 - Prozac 9 days, from 10 mg for week, to 20 11/16 inpatient put on Lexapro for a few days, Cymbalta, 2 days 11/24-12/8 - gabapentin 100 mg 3xs per day - a very fast taper 1/7 - tbuspar for three days- blurry vision, jerky eye 1/17/19 - 2/15/19- mirtazapine 15 mg - started taper on 1/30 2/20/19 gabapentin 600 mg. . 12/20- taper finished 2/20/19 - seroquel 25 mg current - taken 10 pm 2/20/19- luvox (generic) 25 mg. 4/6/19 to 18.75 mg .held . Started taper again 1/7/21- 15 mg, 2/7/21- 12.5 mg, 3/7/21 -10 mg, 4/1/21- 9 mg, 5/1/21- 8.1 mg, 5/27/21- updose to 10 mg, 6/21- in patient updose to 50 mg, 6/25/21- reduce to 10 mg (current) . 9/5- split dose 5mg am/5 mg pm. 9/20- 4 mg am/5 mg pm . 9/1/21- took one dose of vistril 50 mg. 9/1/21-accidental double dose of seroquel- 50 mg
Bee5 Posted September 9, 2019 Posted September 9, 2019 Fair enough. But I think that this should be a standard test for every patient BEFORE being put on psychotropic drugs. This could avoid so much toxicity and akathisia! Do you know how much the test costs? 7 months of prescribed polypharmacy in 2015-2016, including several classes of psych meds. 1st attempt at taper was too fast. 2nd attempt is underway. 1 Mar 2018: 37.5 mg paroxetine, 150 mg lamotrigine, 300 mg quetiapine 1 Oct 2020: 30 mg paroxetine, 150 mg lamotrigine, 37.5 mg quetiapine 15 May 2022: 25 mg paroxetine, 150 mg lamotrigine, 0 mg quetiapine 11 Jan 2024: 20 mg paroxetine, 118.75 mg lamotrigine Supplements: Iron, Vit D magnesium glycinate, omega 3 I am not a medical professional. All my posts are my opinions only, based on my experiences.
BfromNJ Posted September 9, 2019 Author Posted September 9, 2019 8 minutes ago, Bee5 said: Fair enough. But I think that this should be a standard test for every patient BEFORE being put on psychotropic drugs. This could avoid so much toxicity and akathisia! Do you know how much the test costs? 300.00. 9/2018- lexapro low dose few days.11/3/2018- zoloft 2 days 11/7/18 - 11/15/18 - Prozac 9 days, from 10 mg for week, to 20 11/16 inpatient put on Lexapro for a few days, Cymbalta, 2 days 11/24-12/8 - gabapentin 100 mg 3xs per day - a very fast taper 1/7 - tbuspar for three days- blurry vision, jerky eye 1/17/19 - 2/15/19- mirtazapine 15 mg - started taper on 1/30 2/20/19 gabapentin 600 mg. . 12/20- taper finished 2/20/19 - seroquel 25 mg current - taken 10 pm 2/20/19- luvox (generic) 25 mg. 4/6/19 to 18.75 mg .held . Started taper again 1/7/21- 15 mg, 2/7/21- 12.5 mg, 3/7/21 -10 mg, 4/1/21- 9 mg, 5/1/21- 8.1 mg, 5/27/21- updose to 10 mg, 6/21- in patient updose to 50 mg, 6/25/21- reduce to 10 mg (current) . 9/5- split dose 5mg am/5 mg pm. 9/20- 4 mg am/5 mg pm . 9/1/21- took one dose of vistril 50 mg. 9/1/21-accidental double dose of seroquel- 50 mg
Bee5 Posted September 9, 2019 Posted September 9, 2019 Ok, that is quite pricey; but if you go through people's polypharmacy stories on this forum, I would say the price is worth it if it means that no doctor will prescribe multiple medication to vulnerable people. 7 months of prescribed polypharmacy in 2015-2016, including several classes of psych meds. 1st attempt at taper was too fast. 2nd attempt is underway. 1 Mar 2018: 37.5 mg paroxetine, 150 mg lamotrigine, 300 mg quetiapine 1 Oct 2020: 30 mg paroxetine, 150 mg lamotrigine, 37.5 mg quetiapine 15 May 2022: 25 mg paroxetine, 150 mg lamotrigine, 0 mg quetiapine 11 Jan 2024: 20 mg paroxetine, 118.75 mg lamotrigine Supplements: Iron, Vit D magnesium glycinate, omega 3 I am not a medical professional. All my posts are my opinions only, based on my experiences.
BfromNJ Posted September 9, 2019 Author Posted September 9, 2019 6 minutes ago, Bee5 said: Ok, that is quite pricey; but if you go through people's polypharmacy stories on this forum, I would say the price is worth it if it means that no doctor will prescribe multiple medication to vulnerable people. Right. But a simple check by the doctor for interactions isn't too much to ask. I don't see why they dont simply use drugs.com. we all can do it here. I was inpatient and had no access internet so I trusted them. All three meds interact. They should know better without having to do genetic testing. 9/2018- lexapro low dose few days.11/3/2018- zoloft 2 days 11/7/18 - 11/15/18 - Prozac 9 days, from 10 mg for week, to 20 11/16 inpatient put on Lexapro for a few days, Cymbalta, 2 days 11/24-12/8 - gabapentin 100 mg 3xs per day - a very fast taper 1/7 - tbuspar for three days- blurry vision, jerky eye 1/17/19 - 2/15/19- mirtazapine 15 mg - started taper on 1/30 2/20/19 gabapentin 600 mg. . 12/20- taper finished 2/20/19 - seroquel 25 mg current - taken 10 pm 2/20/19- luvox (generic) 25 mg. 4/6/19 to 18.75 mg .held . Started taper again 1/7/21- 15 mg, 2/7/21- 12.5 mg, 3/7/21 -10 mg, 4/1/21- 9 mg, 5/1/21- 8.1 mg, 5/27/21- updose to 10 mg, 6/21- in patient updose to 50 mg, 6/25/21- reduce to 10 mg (current) . 9/5- split dose 5mg am/5 mg pm. 9/20- 4 mg am/5 mg pm . 9/1/21- took one dose of vistril 50 mg. 9/1/21-accidental double dose of seroquel- 50 mg
Bee5 Posted September 9, 2019 Posted September 9, 2019 But they DON'T! My first psychiatrist had me on SIX psychotropic meds SIMULTANEOUSLY. It really is a miracle that I survived! 7 months of prescribed polypharmacy in 2015-2016, including several classes of psych meds. 1st attempt at taper was too fast. 2nd attempt is underway. 1 Mar 2018: 37.5 mg paroxetine, 150 mg lamotrigine, 300 mg quetiapine 1 Oct 2020: 30 mg paroxetine, 150 mg lamotrigine, 37.5 mg quetiapine 15 May 2022: 25 mg paroxetine, 150 mg lamotrigine, 0 mg quetiapine 11 Jan 2024: 20 mg paroxetine, 118.75 mg lamotrigine Supplements: Iron, Vit D magnesium glycinate, omega 3 I am not a medical professional. All my posts are my opinions only, based on my experiences.
Boges11 Posted January 4 Posted January 4 Do you have to dose more frequently to avoid interdose withdrawal if ultra rapid metabolizer of a medicine? Prior to March 2020 - no meds in 37yr life., no anx or dep. mar’20- hospital with Covid like sym- panic attack- adverse reaction to ceftriaxone AB-rash and tongue swelling Never was covid, likely stomach bug Apr ‘20- told see psychiatrist after hospital(didn’t know one panic attack shouldn’t) .75mg K and 5mg Lex May ‘20- switched to 25mg Sertraline mid June ‘20- .75-.625mg K by psych in week spiraled ended up in ER; 10mg Trazodone for sleep, tapered over 2wks july’20- Sert taper 25mg-18mg - aka terrible didnt know what it was ;Dr change to 5mg Prozac- aug’20-tapered 5mg Proz next 4 weeks, 1/4 pill a week. Aug’20- Sept 5mg ambien tapered off over a month in Sept 2020. 12mg Seroquel given and immediately tapered over 3ks in Oct 20. Jan ‘21- 2wks 10mg Elavil for sleep; eye issues so CTd per Dr- 6wk Wd. Mar’21- slow K taper .635mg to .005mg-Aug’23 ;may’22 drop .01mg/mo the last .16mg- severe acute, akathisia,in dark closet for 10 wks -eyes severe any light aka worse. beta blockers once -worse, spec clonidine-severe reaction. Severe SI and attempt - Psych hospitals Nov/Dec23- multiple meds one off, Depakote 10 days 250mg, ECt twice ugh muscle relaxer ketamine and propofol 12/2/23- psych hosp 7.5mg Mirtazapine for severe aka, myoclonic jolts, eye issues and no benefit . 12/10- forced 15mg 5 days, 7.5 since 12/15/23 .home 12/18. covid + 12/22/23. Neg 12/30. hell on mirt adverse effects(severe RLS, aka worse,brain racing/swirling, eye flashing, jolts) after dose Comp liq early Feb; 6.1mg 5/10/24 Severe neuro issues, aka on and off 100+ symptoms thru K taper and on
Administrator Altostrata Posted January 5 Administrator Posted January 5 On 1/3/2024 at 5:08 PM, Boges11 said: Do you have to dose more frequently to avoid interdose withdrawal if ultra rapid metabolizer of a medicine? Possibly, or schedule doses strategically. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted.
Boges11 Posted January 5 Posted January 5 @Altostrata thank you. I’ve only been on this 4 weeks and dose one time 9:30 PM. for the last week and a half been having nausea, body, burning, joint pain, etc. etc. start between 3 and 4 AM once I wake up and building over and then battling that stuff through the day. It gets better closer to my 9:30 PM dose sometimes but not always. Since I’m having adverse reactions also taking my dose, I’m struggling to try to sort all this out battling severe acathisia (had prior and likely TD) and bedbound. Prior to March 2020 - no meds in 37yr life., no anx or dep. mar’20- hospital with Covid like sym- panic attack- adverse reaction to ceftriaxone AB-rash and tongue swelling Never was covid, likely stomach bug Apr ‘20- told see psychiatrist after hospital(didn’t know one panic attack shouldn’t) .75mg K and 5mg Lex May ‘20- switched to 25mg Sertraline mid June ‘20- .75-.625mg K by psych in week spiraled ended up in ER; 10mg Trazodone for sleep, tapered over 2wks july’20- Sert taper 25mg-18mg - aka terrible didnt know what it was ;Dr change to 5mg Prozac- aug’20-tapered 5mg Proz next 4 weeks, 1/4 pill a week. Aug’20- Sept 5mg ambien tapered off over a month in Sept 2020. 12mg Seroquel given and immediately tapered over 3ks in Oct 20. Jan ‘21- 2wks 10mg Elavil for sleep; eye issues so CTd per Dr- 6wk Wd. Mar’21- slow K taper .635mg to .005mg-Aug’23 ;may’22 drop .01mg/mo the last .16mg- severe acute, akathisia,in dark closet for 10 wks -eyes severe any light aka worse. beta blockers once -worse, spec clonidine-severe reaction. Severe SI and attempt - Psych hospitals Nov/Dec23- multiple meds one off, Depakote 10 days 250mg, ECt twice ugh muscle relaxer ketamine and propofol 12/2/23- psych hosp 7.5mg Mirtazapine for severe aka, myoclonic jolts, eye issues and no benefit . 12/10- forced 15mg 5 days, 7.5 since 12/15/23 .home 12/18. covid + 12/22/23. Neg 12/30. hell on mirt adverse effects(severe RLS, aka worse,brain racing/swirling, eye flashing, jolts) after dose Comp liq early Feb; 6.1mg 5/10/24 Severe neuro issues, aka on and off 100+ symptoms thru K taper and on
Administrator Altostrata Posted January 5 Administrator Posted January 5 Please ask questions about your particular situation in your Introductions topic. This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner. "It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein All postings © copyrighted.
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