Jshect major issues with Wellbutrin/Deplin and klonopin addiction

[Altostrata]

....

How did you figure this out, while my psychiatrist, family practitioner, and a cardiologist couldn't? What is wrong with these people?

Jshect, all doctors (and pharmacists) are supposed to check for drug conflicts via the P450 liver enzymes pathways. This information is in the public domain. Your doctors were too lazy to look this up.

 

P450 cyp conflicts are among the easiest of adverse effect sources to identify. This should be of no surprise whatsoever to your current psychiatrist (or any other of your doctors).

 

Yes, get a liver function test. But the problem is the same: You need to reduce the drug burden while not destabilizing cardiac functioning or triggering withdrawal symptoms. A gradual reduction is best.

 

My guess is, when you reduce loxapine and oxcarbazepine you will see less adverse reactions from Wellbutrin, because the other drugs are blocking its metabolism, it's backing up, and you're getting a higher concentration of it than you would if it was being normally metabolized.

 

I also suspect drug-drug interactions with trazodone causing excessive mCPP during the day, causing symptoms of irritability, etc. But reducing the liver traffic should help with that, too.

 

Yes, you can copy and paste anything above and show it to your doctor. The report from the Drug Interactions Checker is reputable and your doctor should be very aware of the P450 liver enzyme issues. The drugs.com information is from official FDA sources.

 

From FDA information

Loxapine comes in 5mg capsules http://www.drugs.com/pro/loxapine.html

 

Oxcarbazepine comes in 150 mg tablets that are scored http://www.drugs.com/pro/trileptal.html

and a liquid form

 

300 mg/5 mL (60 mg/mL) Oral Suspension: off-white to slightly brown or slightly red suspension. Available in amber glass bottles containing 250 mL of oral suspension. Supplied with a 10 mL dosing syringe and press-in bottle adapter.

 

Bottle containing 250 mL of oral suspension……………………………………………………………NDC 0078-0357-52

 

Store Trileptal oral suspension in the original container. Shake well before using.

 

Use within 7 weeks of first opening the bottle.

 

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature].

 

 

The NDC number is the ordering number. Give the NDC number to your doctor.

 

Loxapine capsules can be opened and the powder divided, get empty gelatin capsules to do this and, for precise measurement, a scale to weigh the powder. It may be available as a liquid, which would make tapering a lot easier. Get your pharmacist to look this up and give the NDC number to your doctor.

 

(Hmm, loxapine is both a cyp 2D6 substrate and inhibitor http://www.drugbank.ca/drugs/DB00408

This means it inhibits its own metabolism. Yes, this is a prime suspect.)

 

Oxcarbazepine tablets are scored, that means they're meant to be split. But tapering with the liquid would be a lot easier.

[Jshect]

 

So, here's another guess at a plan: Reduce the loxapine first by 10% for 2 weeks, then trazodone by 10% for 2 weeks. These two actions will speed up the metabolism of bupropion and reduce adverse effects of mCPP. Then reduce oxcarbazepine by 10% for 2 weeks and repeat the cycle for the 3 drugs, monitoring carefully for weird symptoms.

 

This is important: You should keep notes on paper about the dosages, times you take the drugs, and symptom pattern for every day.

 

 

Unless otherwise indicated, info about P450 cyp substrates, inducers, and inhibitors is from a pharmacist site:

http://www.ppag.org/attachments/wysiwyg/3/Psych_Drug_Metabolism_Handout.pdf

and Genelex, a gene testing company http://www.genemedrx.com/Cytochrome_P450_Metabolism_Table.php

Alto, so are you saying do just 2 cycles of this (reducing Loxapine, oxcarbazepine, and Trazadone), then check in with you and then we'll start to lower the Wellbutrin?

[Altostrata]

Please keep in touch with us throughout the process.

 

With any luck, this reductions will not rock the boat too much.

 

You're seeing your new psychiatrist tomorrow, correct? Here's what I would do:

 

1) TODAY: Go to your pharmacist and find out whether you can get loxapine as a liquid. Check on prices for this and liquid oxcarbazepine and whether your insurance covers them. Get the NDC numbers from the pharmacist.

 

Also find your nearest compounding pharmacy http://survivingantidepressants.org/index.php?/topic/1425-compounding-pharmacies-us-uk-and-elsewhere/

 

2) At your psychiatrist appointment: First, find out his recommendation for minimizing your drugs. This will indicate to you if he is reasonable, informed, and willing to work with you.

 

3) Then, present what you've learned here. Discuss it with him, if possible. If discussion is not possible, go on to step 4. (Also make plans to find another psychiatrist or doctor you can work with.)

 

4) No matter what his attitude is, your goal is to come out of the meeting with prescriptions you can use to taper. Make your request calmly, politely, firmly, and repeatedly, as though you were training a large dog.

 

Loxapine: Get your loxapine prescription filled in 5mg capsules OR a prescription for the liquid OR a prescription for a liquid from a compounding pharmacy.

 

If he doesn't know how to write a prescription for a compounded liquid, it goes something like this:

 

Compounded liquid, xxx milligrams loxapine in xxx milliliters for a concentration of 1 milligram:1 millilters. Take 4mg in a.m. and 6mg in p.m.

 

Here's a recipe for compounded loxapine liquid

http://www.pharmacytimes.com/publications/issue/2008/2008-01/2008-01-8368

It indicates the compounded liquid is good for only 2 weeks. You'd need to get it compounded twice a month.

 

Because of the short shelf-life, the compounded liquid option doesn't look good to me. You might as well mix your own from capsules every day, see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Oxcarbazepine: You will also want a prescription for oxcarbazepine liquid to use later. Don't get it filled until you need it.

 

Trazodone: Get your regular prescription for trazodone. you can make a DIY liquid when you need to reduce trazodone http://survivingantidepressants.org/index.php?/topic/2883-tips-for-tapering-off-trazodone-desyrel/

 

If you're going to taper using liquids, be sure to get a large oral syringe (5mL or 10mL) and a few small oral syringes (0.5mL or 1mL), see http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/

Edited March 19, 2014 by Altostrata
fixed link

[Skyler]

Wow Alto, dynamite post. You sure nailed the 'how to approach' the doc recipe. I wonder if an edit would turn this into a sticky?

[Jshect]

Well, I went to my new psychiatrist today, and I should have trusted my initial instincts. This guy would not listen at all. My last visit, and this visit, he spent nearly the whole time going over my previous psychiatric history. All 14 years of it. Apparently, in the past I've been diagnosed with schizoaffective disorder and bipolar, so he would not take me off any of the medications, I think he wants me on more. He thinks the PVCs are unrelated to the medications, which I am 100% positive they started when I tried reducing the Wellbutrin. So, looks like I'm temporarily on my own (with you guys.)  I made an appointment with my old psychiatrist for April 8th, and although he sort of panicked when I started having PVC, he's a pretty easy-going guy and I'm positive if I show him this info he will read it and go along with it. I'm done with my new psychiatrist. I do not have schizoaffective disorder or bipolar. The mania has only occurred while on antidepressants. I'm furious.

In the meantime, I want to get started on reducing the medications. Above you mentioned how to open the Loxapine capsule and cut out 10%. The only problem is I don't have a digital scale, and I don't feel like paying hundreds of dollars for one that is accurate to the milligram (unless you know of a cheap one.) I could break the pill open and just take out a little bit of powder (estimate 10%.) 

I could also reduce the Trazodone with the method you also recommended above.

What do you think Alto?

 At some point while lowering the Oxcarbazepine and Loxapine, I'm going to have to start simultaneously lowering the Wellbutrin, because although the Loxapine and Oxcarbazepine may be causing the PVCs, without them the Wellbutrin will trigger bad mania.

[Altostrata]

Too bad about the psychiatrist. He sounds like a very familiar type.

 

Making a liquid from the loxapine is the best way to titrate more precisely. See http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

You need to get oral syringes. Your local pharmacy will have some large ones. Compounding pharmacies and veterinarians carry small ones.

 

According to a UK medical group http://stockportccg.org/wp-content/uploads/2012/01/34838_Med_Admin_Dysphagia.pdf it's safe to put the powder in water.

[Jshect]

Day #1

-I used a 10 ml syringe

-A tiny, clear plastic Tupperware with a top.

-A spoon to stir

 

1. I twisted the capsule and dropped the 10 mg of Loxapine powder into the tupperware.

2. I filled the 10 ml syringe with water and squirted 8 ml into the tupperware

3. I stirred with the spoon

4. I then squirted the remaining 2 ml of water on the spoon and into the tupperware (to get the loxapine off the spoon) for a total of 10 ml of water in the     tupperware. 

5. I put the top on the tupperware and shook it

    (No matter how much I stirred and shook the tupperware, I could still see a few giant chunks floating in the solution at the bottom) 

6. I sucked up about 9.5 ml (even though that's only a 5% reduction, I'm guessing it's more like 10% because of the remaining chunks in the bottom and     powder sticking to the spoon, tupperware and syringe.) The solution was cloudy and tasted awful, which was a good sign the Loxapine mixed       reasonably well.       

7. I squirted the 9.5 ml into my mouth.

8. I then sucked up 100 ml of water and squirted the water into my mouth to get any excess Loxapine off the syringe. 

 

So hopefully, I got around 90% (9 mg)  of my usual 10 mg dose

 

Does that sound like I did it correctly, and actually got about a 10% reduction?

if you point out a flaw in one of my steps let me know!

[Skyler]

Does that sound like I did it correctly, and actually got about a 10% reduction?

if you point out a flaw in one of my steps let me know!

Sounds like a lot of work... I would use an amber pill bottle, add 10 CC of water to the powder, put the cap on and shake gently until the particles are evenly suspended. Then use a 1 cc oral syringe and take out .5 CC of water. Drink what is left in the vial, refill with water and drink again.

 

How does this sound. The pharmacy will give you both a 1 cc oral syringe and a pill vial.

 

Congratulations on making your first liquid solution!

[Altostrata]

I would put half of the water in the vial, then add the powder from the capsule, shake gently, then add the rest of the water, put top on vial and shake vigorously. Skyler has a good idea, take out 10% and discard, drink the rest, put more water in the vial and drink it to rinse out any powder left.

 

When you add water to a powder, it tends to clump up. Better to add powder to a liquid.

[Jshect]

Day #2 of 9 mg of Loxapine and doing pretty well overall. One thing that surprised me though, was my PVCs were really bad this afternoon and tonight. As you were saying this whole situation is paradoxical, because the downers are causing the PVCs rather than the uppers, so I thought for sure it would get little better today.

 

Another thing that is paradoxical, is that caffeine can cause PVCs in the short term, but reduce them in the long-run. I regularly take caffeine (though not a lot) and it definitely interacts with my Deplin and/or Wellbutrin and gives me a higher high. Sometimes when I take caffeine, it causes an immediate spike in PVCs. However, if I go 4 or 5 days without caffeine, I get an even higher spike in palpitations. I think the reason for this, is that when I had a manic summer on Wellbutrin and Deplin, I was taking exactly 50 mg of caffeine every morning. If I don't take it for a couple of days, I can definitely tell a difference in my energy level, and the irritability and agitation (which are symptoms produced by the Wellbutrin) decrease (so I'm guessing it is interacting with the accelerators and enhancing them). I am guessing when I don't take it for 4 or 5 days, the acceleration decreases and the brakes (Loxapine, Oxcarbazepine, Klonopin, Bystolic) have more of an effect. 

 

Anyway, I had a small cup of coffee today (which is more caffeine than I usually have) and I had a ton of PVCs later on during the day. Since the .1 mg drop in Loxapine, I also became a little manic. When I have an antidepressant/Deplin/caffeine induced mania, I usually don't have PVCs (which lends credence to your hypothesis that the downers are causing it.), but today I did.

 

So, it could just be the coffee today. However, there is another situation that could be paradoxical. The beta blocker (Bystolic) could be both causing and preventing PVC's at different times. The beta blocker definitely decreased them in the short term when I first took it. And about a month ago, I forgot to take my beta blocker and the next day I started having a ton of PVCs, until I took it. However, in the long-term it's most likely contributing to the downer effects of the Loxapine, Oxcarbazepine, and Klonopin. So, it could be that the decrease in Loxapine, decreased the effects of the Beta Blocker, which in the short-term could trigger more PVCs, but hopefully in the long-term they will decrease.

 

Oh, this whole situation is a mess.

 

Usually, when I have PVCs they occur like this:

When I have Wellbutrin and Deplin in the morning, I have none (accelerators in full swing)

around the mid afternoon I may start to have one or two (accelerators effects decreasing)

In the evening I get more PVCs.

Almost immediately after taking my night meds (the brakes: Loxapine, Klonopin, Oxcarbazepine) and Trazodone. I get a huge spike in the amount of PVCs. If the meds weren't so sedating I probably wouldn't be able to get to sleep. That definitely supports your hypothesis that the downers are causing it. After about an hour of taking my nighttime meds, the PVCs decrease.

 

What an f***ing mess!

 

Sorry, for the long rambling post. 

[Jshect]

10:30 PM Oh, the PVCs are giving me such terrible anxiety tonight. I'm having slight withdrawal symptoms from the Loxapine, but it's not really that bad. Thank goodness for the 10% taper you guys told me about. Fortunately, the minor mania I was having today was pleasant, and not the Wellbutrin-induced angry nightmare I sometimes have. I'll keep you up to date on the amount of PVCs I have per minute and my mood tomorrow. I'll either have no caffeine tomorrow or have a (25-50 mg) cup of tea and see what happens. 

[Jshect]

Question:

Am I going to want to get a 100 ml beaker when I create liquid solutions of the 150 mg Oxcarbazepine Tablet, and the 50 mg Trazodone tablet?

Or can I just use the 10 ml and 1 ml syringes?

 

I just took the Loxapine and Bystolic and  my anxiety has decreased. I guess some of the anxiety could have been from withdrawing from the Loxapine. 

 

Thank goodness I have you guys to help me through this. I can't believe that with insurance that slimy psychiatrist probably makes around $100 every 15 minutes for poisoning people. $400 a minute for pushing pills. Forget illegal drug dealing. Become a legal drug dealer and make $200,00 a year. That jerk-off's going to retire a millionaire, meanwhile his patients will probably end up unemployed or underemployed with permanent liver damage. 

[mammaP]

Question:

Am I going to want to get a 100 ml beaker when I create liquid solutions of the 150 mg Oxcarbazepine Tablet, and the 50 mg Trazodone tablet?

Or can I just use the 10 ml and 1 ml syringes?

 

I just took the Loxapine and Bystolic and  my anxiety has decreased. I guess some of the anxiety could have been from withdrawing from the Loxapine. 

 

Thank goodness I have you guys to help me through this. I can't believe that with insurance that slimy psychiatrist probably makes around $100 every 15 minutes for poisoning people. $400 a minute for pushing pills. Forget illegal drug dealing. Become a legal drug dealer and make $200,00 a year. That jerk-off's going to retire a millionaire, meanwhile his patients will probably end up unemployed or underemployed with permanent liver damage. 

Couldn't have put it better myself!  

Not sure about the beaker, I think you should be able to manage with the syringes, but then I am a skinflint! 

[Skyler]

Question:

Am I going to want to get a 100 ml beaker when I create liquid solutions of the 150 mg Oxcarbazepine Tablet, and the 50 mg Trazodone tablet?

Or can I just use the 10 ml and 1 ml syringes?

Much easier to use a pill vial from the pharmacy and the two sizes of syringes you mention. Don't try to make this more complicated than you need. Thus far I don't know of anyone who has used a beaker. (A member here, Rhi may be using a beaker along with a pipette.. she's a lab tech and used to messing with this sort of equipment. Alto used syringes and pill vials.)

 

I've been taking liquid Lyrica and liquid requip for a year and the method I use is FAST, EASY, and ACCURATE.

[Altostrata]

A beaker will be more precise in measuring 100mL of liquid. Just be consistent with your measurements.

 

jshect, your drug cocktail situation is so complex, I don't know what to suggest. I'm worried about the PVCs.

 

I would definitely avoid caffeine, it has a very long half-life and complicates the liver enzyme problems.

 

It's going to take about 4 days for the loxapine reduction to fully register. Everything is adjusting now. Maybe the PVCs will settle down?

 

When do you take Klonopin?

 

Please update your signature specifying when you take your various drugs, also you're taking Wellbutrin SR.

[Skyler]

A beaker will be more precise in measuring 100mL of liquid. Just be consistent with your measurements.

Yes, but Alto, I don't understand why she is using 100 mls of diluent? 10 ccs is enough by my reckoning.

[Altostrata]

One cc = one mL. They are equivalent.

[Jshect]

"I would definitely avoid caffeine, it has a very long half-life and complicates the liver enzyme problems."

 

I don't understand what is really happening in my brain or liver, but I think the caffeine, using your analogy, has become one of the accelerators. Drug.com doesn't list it as interacting with Deplin or Wellbutrin, but I think it definitely does. I've tried going a few days without it and I started getting a lot of PVCs because the accelerators have been reduced (I guess?). I mean I can feel the usual Wellbutrin side effects dramatically decrease when I don't take caffeine. Deplin's newer and on drug.com they say it doesn't interact with anything which is BS. Even according to Deplin's Website, it interacts with antidepressants and makes them more potent. I can attest to that. 

 

"It's going to take about 4 days for the loxapine reduction to fully register. Everything is adjusting now. Maybe the PVCs will settle down?"

 

The PVCs were a lot better today. Thank goodness!!!!! I think when I eat a healthier, low glycemic diet it may also help reduce the PVCs (maybe). 

 

Question:

 

I know my situation is delicate but I am concerned with the amount of time it's going to take me to get off of these meds. I am really torn on this one. I know these meds are effecting my heart and that's dangerous. But if I'm tapering a med at 10% every two weeks and I'm on 7 medications. At that rate it's going to take 140 weeks to completely get off of these meds. That's almost three years. The Wellbutrin has me in pain, both of my parents are dying (my safety net), and I've trained for a job that I can't do when I'm in pain (massage therapy). I can't wait three years to do this job. But i don't want to have heart failure or something. Maybe when the Wellbutrin's reduced by 30 or 40 % the pain will disappear. Maybe some meds I could taper at 10% every week. Tapering one med by 10% every week would take 70 weeks. Still a long time, but I know it's going to take time. My main concern, job-wise, is the Wellbutrin and the pain, but at the same time 10 PVCs a minutes causes such unbearable anxiety I can't function at all. Oh brother what have I gotten myself into?!?!? Curse the day I first went to a psychiatrist.  

[Altostrata]

I am so relieved the PVCs are better today.

 

I know the 10% taper takes a long time. Our usual recommendation is to do it every month, so in your case, a reduction every 2 weeks is an accelerated taper.

 

Our 10% advice is very conservative for everyone. Your situation is so complex, I'm trying to be extra careful. Yes, it may take a long time, but with any luck, you'll feel better and better as the drugs are reduced. There may be a point where you feel so confident in understanding their interaction, you'll have a sense of what to reduce and can go faster.

 

I agree the Wellbutrin should go, but I believe its effect will be reduced when you reduce other drugs. They are stopping your metabolism of Wellbutrin. It's like a drain being plugged up. We're reducing the gunk causing the backup.

 

There's lots of propaganda out there about Deplin. It's only a megadose of a B vitamin. Many B vitamins are activating; I believe that's what you're feeling. Please don't worry about it.

 

If you self-medicate with caffeine, please do it in a very regular way, otherwise it could confuse your symptom pattern. Speaking of which, are you keeping notes on paper about when you take your drugs and when symptoms occur? This can be very helpful.

 

By any chance, did you see this guy http://www.harrisonburg-psych.com/

[Rhiannon]

This is the scale I use--it's quite affordable, although of course not as accurate as the thousand-dollar kind.

http://www.amazon.com/American-Weigh-GEMINI-20-Portable-MilliGram/dp/B0012TDNAM

[Rhiannon]

Wow Alto, dynamite post. You sure nailed the 'how to approach' the doc recipe. I wonder if an edit would turn this into a sticky?

 

Me vote yes too!

[Jshect]

 

 

"If you self-medicate with caffeine, please do it in a very regular way, otherwise it could confuse your symptom pattern. Speaking of which, are you keeping notes on paper about when you take your drugs and when symptoms occur? This can be very helpful."

 

-Yes, I'm going to try to limit it to a (25-50 mg caffeine) cup of green tea.

 

 

"By any chance, did you see this guy http://www.harrisonburg-psych.com/"

 

Yes, how did you know? I guess others on here have had run-ins with him. He's not a nice fellow. He's arrogant and condescending. He really wouldn't listen to what I was saying. I left him a nasty review in the past online.

 

Yes, I need to pay closer attention to what I take. I'm having some PVCs today. I had two cups of green tea (50 - 100 mg  caffeine) today so maybe that was it. I've really got to limit it to one. Caffeine makes me feel so good though. Also, I take one and a quarter pills of Clonazepam. Sometimes, I can tell a difference if I take a larger or smaller quarter. It's hard to cut it exactly the same each time. Any advice on that one?

 

I'm sure I could crush it and create a liquid suspension, but I really don't want to end up having to create seven liquid suspensions each day, but if I have to I will.

[Meimeiquest]

Another thing to keep in mind is that Wellbutrin inhibits one of the CYP450 enzymes...it is doing more than just using up bandwidth.

[Jshect]

Another thing to keep in mind is that Wellbutrin inhibits one of the CYP450 enzymes...it is doing more than just using up bandwidth.

Can anyone provide me a link to an article or something that explains what it going on with these liver enzymes so I can get on the same page as you? Thanks.

Also, what about the neurotransmitters these meds are effecting in the brain? Is there a reason you guys focus specifically on liver enzymes?

 

Question:

I try to take my meds around the times listed in my signature. If I take my meds a couple of hours later one night could that have a noticeable effect on my body (like trigger PVCs)?

[Jshect]

Damn, PVCs are bothering me tonight. I didn't have them yesterday. Alto is right, I need to start writing everything down and see what factors could be causing them. There's so many factors though: The time I take my pills, amount of caffeine, my diet, size of the quarter pills of Klonopin I cut, am I getting differing amounts of Loxapine each night with the liquid taper... ??? I took my night pills at 1:00 AM instead of 10:45 PM last night. 

 

Also, I took the MTHFR genetic test that measures if you have genetic flaws that reduce your ability to metabolize folic acid. I have some of those genetic flaws (not all of them) so that may be one of the reasons I reacted so strongly to Deplin. If you would like to know my exact results let me know.

[Altostrata]

Please try to control the variables. Yes, that big a difference in the time you take your drugs could make a big difference.

 

Do you have good communication with any of your doctors? Any MD can write a prescription for a compounded liquid. Having the loxapine compounded would reduce uncertainty in one area.

 

I am hoping your system will settle down a bit more on Monday.

 

Can you canvass the psychiatrists and neurologists in your area by phone to see if you can find one who will work with you? Addiction medicine specialists, usually psychiatrists, should have experience tapering, though you might have to insist on a slow taper. Tell the doctor you are taking 6 drugs, you are having serious adverse effects, you do not have confidence in your diagnosis (if any), and you need help tapering.

 

How about phoning this group at U of Virginia Charlottesville http://www.medicine.virginia.edu/clinical/departments/psychiatry/sections/neurobiologicalstudies/uvacare/staffinfo-page

or these doctors http://www.madinamerica.com/service-directory/directory-category/individual-practitioner/

maybe they can recommend someone in your area.

 

I wish I knew a helpful doctor near you.

[Meimeiquest]

http://medicine.iupui.edu/clinpharm/ddis/main-table/

 

This in the info on liver enzymes.

 

 

Would be interested in your genetic info, I am sort of exploring that area. Did you read the thread here on methylation?

 

Sorry so fast, I am doing the "kids off to school" thing.

[Jshect]

 

 

"I wish I knew a helpful doctor near you."

 

I think my old psychiatrist may actually be very helpful in this regard. He is a laid-back, intelligent, nice fellow. I left him because he didn't know what to do about the PVCs. I think that maybe he got scared (lawsuit) when I started having what I thought were skipped heart beats. I have an appointment with him, and I'll tell the PVCs aren't necessarily harmful, and I'll show him the info presented to me on this forum and I'm pretty sure he'll comply.

[Altostrata]

Let's not make any bones about it, the PVCs are sign that something is not good.

Is this the doctor who prescribed all these drugs for you? Even so, if he's cooperative, just as well.

meimei, good call on Wellbutrin. Yes, it's a cyp2d6 inhibitor. But jshect is taking so many brakes, my guess is reducing them first will reduce the cardiac effects. Wellbutrin can still be metabolized via cyp2b6, of which it is a substrate.

 

Flockhart is a good resource, but I've found it to be incomplete. There is still a lot to be known about drug metabolism. Drugbank has more detail, which I've incorporated into the list below.

 

The inducers (speeds up) are in italics and the inhibitors (blocks) underlined. All others are substrates (metabolized by that enzyme).

loxapine CYP1A2, CYP2D6, CYP3A4 http://www.drugbank.ca/drugs/DB00408
oxcarbazepine CYP2C19, CYP3A4, CYP1A4 Sandson, 2003
trazodone* CYP3A4, CYP2D6 (mCPP) http://www.drugbank.ca/drugs/DB00656 http://www.ncbi.nlm.nih.gov/pubmed/9836023
buproprion (Wellbutrin)* CYP2C19, CYP2D6, CYP3A4 http://www.drugbank.ca/drugs/DB01156
clonazepam* CYP1A2, CYP2C9, CYP2C19, CYP3A4
nebivolol CYP1A2 (P-glycoprotein substrate) http://www.drugbank.ca/drugs/DB04861

 

*According to DrugBank "High CYP Inhibitory Promiscuity"

 

(jshect, could you post these cyp notes in your signature? Thanks.)

 

So, it's all a big log jam. (Trazodone, buproprion, and clonazepam do stand out as prime offenders.)

 

Neil Sandson in Baltimore, MD is one of the top experts on CYP conflicts http://www.healthgrades.com/physician/dr-neil-sandson-y64ns/appointment

jshect, your psychiatrist might want to confer with him.

[Jshect]

Yes, the medications are definitely responsible for the PVCs.

Today, I somehow forgot to take my morning meds @ 10:45 AM. I started feeling worse as the day progressed. 

At

2:12  7 PVCs/minute and felt awful

2:45    took my (Wellbutrin and Deplin) morning meds

3:12  4 PVCs/minute

3:32  0 PVCs and felt fine

[Altostrata]

Nice job with the signature.

 

I have a hunch, see what you think. How about staggering your morning meds? Take the Wellbutrin at 10:30 and the Deplin a couple of hours later. Or split the Wellbutrin dose. This may distribute their balancing effect later in the day.

 

Otherwise, please be very regular with your drug schedule. You're obviously very sensitive to the half-lives, etc.

[Jshect]

The results of my MTHFR test:

 

C677T    Heterozygous mutation

A1298C  Heterozygous mutation 

 

I have one copy of the C677T Mutation and one copy of the A1298C mutation 

 

This is associated with:

-decreased enzyme activity (approximately 50-60% of normal activity)

-increased homocysteine risk

-increased cardiovascular risk and thrombosis

-possible methotrexate intolerance and patients may require dosage adjustments or discontinuation

 

I also had a nutrient deficiency test. Because I am on Deplin (I guess) my Folate levels are borderline, however my B2 and B12 were deficient. 

[Meimeiquest]

The results of my MTHFR test:

 

C677T    Heterozygous mutation

A1298C  Heterozygous mutation 

 

I have one copy of the C677T Mutation and one copy of the A1298C mutation 

 

This is associated with:

-decreased enzyme activity (approximately 50-60% of normal activity)

-increased homocysteine risk

-increased cardiovascular risk and thrombosis

-possible methotrexate intolerance and patients may require dosage adjustments or discontinuation

 

I also had a nutrient deficiency test. Because I am on Deplin (I guess) my Folate levels are borderline, however my B2 and B12 were deficient.

 

Thank you!

[Altostrata]

Those are the most common MTHFR variations.

 

It could be your original symptoms were B vitamin deficiencies. The weakness, etc. sounds like a nutritional thing.

 

What's your diet like?

[Jshect]

 

What's your diet like?

My diet has not been great over the course of my life. I always ate some healthy stuff, but I also ate a lot of unhealthy foods as well. Now I am seeing a dietitian and cleaning up my diet. 

 

I have had strange reactions when I try to take vitamins and specifically B vitamins.

This is from a journal entry I wrote on my reactions:

 

For some reason I am having a reaction with vitamins. I took a little less than half of the1000 mcg B-12 today and although I was more energized, I didn't feel that well. I seem to have reactions with everything ever since I started taking Deplin along with Wellbutrin. I have been taking 15 mg of Deplin (methylfolate) for three years and my folate levels are still borderline. Maybe, if I order the brand you suggested, it will have less additives than my current brand and that will make a difference. I found this journal about previous vitamin experiences:

 

Senior vitamins

 B vitamins bad side effects

 regular adult vitamins bad side effects

 senior vitamins better at first than bad side effects

It made me pleasant, conversation skills improved, depression lessened, music and literature came alive to me, the senses became heightened and it wasn't mania, I was more under control (all though I did feel a little on the wild side). My conversations came easier, my memory was a little bit better, I was having very interesting conversations. Most of the time these ideas and deep thoughts escape me, I can't think of them, the gears in my mind aren't turning. I didn't need as much sleep, I was motivated, I got into cooking healthy foods, now the confusion's back. I was funnier, more pleasant, happier. 

Update: I am having some sort of major reaction to Vitamins & specifically B vit. I get extremely weak & disoriented, my arms get numb, my hands get even number, I get extremely disoriented.

start out b vitamins: feel great, smarter, happier, more motivated... gradually the energy & smarts decrease... then all of a sudden I get this horrible reaction. I just feel terrible. But my PAC's decrease. I don't get it. Why do my PAC's decrease? Why do I feel so weak & disoriented?

Update 5-21

I started taking vitamin b-12 alone. First 500 mcg, day 2 250 mcg, & than less and less each day thereafter. I felt intoxicated, insomnia, my brain felt spacey, I got really hot, my arms were numb, and I started to itch all over I just feel in general uncomfortable. Even when I lowered the dosage to like 100 mcg I had some of those reactions. When walking to work I had a sensation like something hit me in the back of the left side of my upper neck and head. I then felt a very warm sensation. I started getting chest pains the other day as well. My heart palpitations were better though. What could be causing this? 

On another note, as you may know, I had a very strong reaction to Deplin (an extremely high dosage of the 

 

I just don't understand how I could have such a great reaction at first and then have such horrible side effects next

 

I read somewhere it could be binding to mercury and causing issues. It could also be additives mixed in with the vitamins. 

Do you have any idea why I am getting this reaction?

 

 

Now that I know I am deficient in B-12 and B-2, you would think I'd feel better taking b-vitamins and B-12, not worse.????

[Jshect]

Again, I want to thank you guys for helping me! It's so great to have people trying really hard to understand my issue. Sorry, to bombard you with so many issues. My memory isn't that great. I completely forgot about this reaction to vitamins, b-vitamins, and b12 until I read that I was deficient in B2 and B12, and borderline in folate (I must have been deficient before 3 years of l-methylfolate). FInally, finally after 20 years, I feel like I am getting somewhere.