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How does being a rapid or ultrarapid metabolizer affect tapering or withdrawal?


BfromNJ

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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 

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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.

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  • Altostrata changed the title to How does being a rapid or ultrarapid metabolizer affect tapering or withdrawal?

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

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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 

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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 

 

 

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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 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

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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

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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

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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 

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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

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  • 6 months later...

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.

 

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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 

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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.

 

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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 

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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.

 

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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 

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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.

 

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  • 4 years later...

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 anxiety or depression.

mar’20- hospital with Covid like sym- panic attack- scared by reaction to ceftriaxone antibiotic - rash and tongue Never was covid, likely stomach bug

Apr ‘20- told to see psychiatrist after hospital(didn’t know one panic attack shouldn’t) .75mg K and 5mg Lexapro

May ‘20- switched to 25mg Sertrakine  mid June ‘20- .75-.625mg K by psych in weeek spiraled ended up in ER bc so sick; 10mg Trazodone for sleep, tapered 10mg over 2wks Jul ‘20

july’20- Sertrtrakine taper 25mg-18mh - aka terrible didnt know what was ;Dr said let’s change to 5mg Prozac

aug’20-tapered 5mg after taking for 2 weeks 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 3 weeks in Oct 20. Jan 21- 2 weeks 10mg  Elavil for sleep(didn’t know better), eye issues so CTd per Dr- 6wk Wd.

Mar’21- Started slow K taoer .635mg to .005mg-Aug’23 ;may’22-Aug 23-drop .01mg K liquid comp a month the last .16mg Jumped at .005mg-severe acute, akathisia and in dark closet for 8 wks bc eyes severe any light caused aka worse. all beta blockers once and caused worse, spec clonidine ,severe reaction. Severe SI and attempt - Psych hosoitaks invol Nov/Dec23- multiple meds one off, Lipitor for 3 wks- forced when refused, Depakote trial 10 days 250mg, ECt twice ugh with muscle relaxer ketamine and propofol- all meds what I didn’t want used against me and forced.

12/2/23- psych hosp 7.5mg Mirtazapine for severe aka but myoclonic jolts, eye issues and no benefit . 12/10- forced me 15mg 5 days, 7.5 since 12/15/23 .home 12/18. Tested covid positive 12/22/23. Negative 12/30. nightmare traumatized and hell on mirt not knowing what’s adverse effects(severe RLS, brain racing/swirling, eye flashing, jolts) after taking 

Severe neuro issues

100+ symptoms thru K taper and on

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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.

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@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 anxiety or depression.

mar’20- hospital with Covid like sym- panic attack- scared by reaction to ceftriaxone antibiotic - rash and tongue Never was covid, likely stomach bug

Apr ‘20- told to see psychiatrist after hospital(didn’t know one panic attack shouldn’t) .75mg K and 5mg Lexapro

May ‘20- switched to 25mg Sertrakine  mid June ‘20- .75-.625mg K by psych in weeek spiraled ended up in ER bc so sick; 10mg Trazodone for sleep, tapered 10mg over 2wks Jul ‘20

july’20- Sertrtrakine taper 25mg-18mh - aka terrible didnt know what was ;Dr said let’s change to 5mg Prozac

aug’20-tapered 5mg after taking for 2 weeks 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 3 weeks in Oct 20. Jan 21- 2 weeks 10mg  Elavil for sleep(didn’t know better), eye issues so CTd per Dr- 6wk Wd.

Mar’21- Started slow K taoer .635mg to .005mg-Aug’23 ;may’22-Aug 23-drop .01mg K liquid comp a month the last .16mg Jumped at .005mg-severe acute, akathisia and in dark closet for 8 wks bc eyes severe any light caused aka worse. all beta blockers once and caused worse, spec clonidine ,severe reaction. Severe SI and attempt - Psych hosoitaks invol Nov/Dec23- multiple meds one off, Lipitor for 3 wks- forced when refused, Depakote trial 10 days 250mg, ECt twice ugh with muscle relaxer ketamine and propofol- all meds what I didn’t want used against me and forced.

12/2/23- psych hosp 7.5mg Mirtazapine for severe aka but myoclonic jolts, eye issues and no benefit . 12/10- forced me 15mg 5 days, 7.5 since 12/15/23 .home 12/18. Tested covid positive 12/22/23. Negative 12/30. nightmare traumatized and hell on mirt not knowing what’s adverse effects(severe RLS, brain racing/swirling, eye flashing, jolts) after taking 

Severe neuro issues

100+ symptoms thru K taper and on

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  • Administrator

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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