![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by andromeda on August 14, 2004, at 11:28:53
It seems like I take a med for awhile and then its just to much in my system after awhile. Is the half life med building up on itself? I am very sensitive to meds in the first place. Is it better to take a med about every 3 days instead of daily as not to get to much med in ones body? Am on abilify at this time for depression for bi-polar and am not exactly a happy camper to be honest. Ended Lamictal and will probably be started on Topamax next. Been doing this for 12 years now and not getting much relief from any of the meds in the depressive phase. SSRI's actually cause mania in me.
Posted by Larry Hoover on August 15, 2004, at 13:27:21
In reply to half lifes, posted by andromeda on August 14, 2004, at 11:28:53
> It seems like I take a med for awhile and then its just to much in my system after awhile. Is the half life med building up on itself?
For most medications, dosing schedules are set up so that you take a med again at roughly the length of the half-life. So, if a med has a half-life of eight hours, you take it three times a day. The idea is to maintain, as closely as possible, a steady blood concentration of the drug.
There is a "building" effect going on, but if you take a full dose at the point where the half of the original dose still remains (the definition of half life), and continue on in that pattern, the effect is to create a more or less stable blood concentration that stays between one and two times the peak concentration seen after the very first dose.
After a number of doses, you get a blood concentration which is represented by the infinite series: 1 + 1/2 + 1/4 + 1/8 + 1/16....
Again, using mathematical concepts, the sum of that series approaches the limiting value 2. At the half-life time, it falls to about 1, but then you take another dose, bringing it back to 2 again.
This assumes linear kinetics, but I'll stop there.
> I am very sensitive to meds in the first place.
Maybe you're simply being prescribed too much?
> Is it better to take a med about every 3 days instead of daily as not to get to much med in ones body?
No. Absolutely not. Your blood concentration would drop far too low before you took your next dose. You'd feel like a yo-yo.
> Am on abilify at this time for depression for bi-polar and am not exactly a happy camper to be honest.
Abilify has a very long half-life, about three days. Bear with me....what I just said is still true.
When a drug with a long half-life like Abilify is considered, the daily dosing is adjusted so that the buildup in the blood is the only consideration. The mathematical calculation of the total blood concentration is far more complicated under such conditions (I wouldn't even attempt it here), but the effect is known. You actually come out better off with daily dosing of a long half-life med, for two reasons. The decline in blood concentration is much smaller, proportionately, than that of shorter half-life meds, before the next dose. And, you don't have to try and remember which day your dose is to be taken. It's much easier to take a drug daily than every third day.
> Ended Lamictal and will probably be started on Topamax next. Been doing this for 12 years now and not getting much relief from any of the meds in the depressive phase. SSRI's actually cause mania in me.
I hope you will start using fish oil. It sounds like it might be just the ticket.
Lar
Posted by chess on August 16, 2004, at 3:46:44
In reply to Re: half lifes » andromeda, posted by Larry Hoover on August 15, 2004, at 13:27:21
I've gone through this with Klonopin ...
Klonopin has a half-life of 18-50 hours, so you would think it could be taken just once or twice a day, but some people need to take it three or four times a day because even though its half-life is long its "duration of action" averages to around eight hours. Duration of action is the actual clinical therapeutic effect of the medication. There's a good biochemical explanation for it but basically half-life doesn't always mean how long the med will work therapeutically.
Posted by alesta on August 16, 2004, at 4:48:14
In reply to Re: half-lifes, posted by chess on August 16, 2004, at 3:46:44
thank you both for that information (while I definitely can’t say i understand all of it, lol). i was just recently wondering about half-lifes.
Someone posted this on the net about Klonopin:
"Here are some things that you may not know about Clonazepam: It has a 50 hr half life which means it takes 50 hours for it to dissipate to half of the dose that you took. Sounds good to most and a lot of doctors say that is a good thing but here is what they don’t tell you, If your doc tells you to take 1mg twice a day that means by the end of only one month your steady plasma level of Clonazepam will be around 30 to 40 mg and that is no lie! You have now created havoc on your GABA system and you are officially an addict even if you don’t want to be."
I *knew* that wasn’t right, lol. so, (please bear with me, here), are you saying that even if there was this immense buildup (she used the 50-hour half-life), it wouldn't cause someone to be addicted because the "duration of action" is the only period where it affects the brain, right?
Amy
Posted by Larry Hoover on August 16, 2004, at 6:19:47
In reply to Re: half-lifes, posted by alesta on August 16, 2004, at 4:48:14
> thank you both for that information (while I definitely can’t say i understand all of it, lol). i was just recently wondering about half-lifes.
>
> Someone posted this on the net about Klonopin:
>
> "Here are some things that you may not know about Clonazepam: It has a 50 hr half life which means it takes 50 hours for it to dissipate to half of the dose that you took. Sounds good to most and a lot of doctors say that is a good thing but here is what they don’t tell you, If your doc tells you to take 1mg twice a day that means by the end of only one month your steady plasma level of Clonazepam will be around 30 to 40 mg and that is no lie!Well, they exaggerated the half-life, and the peak plasma concentration will not reach 30 mg at that dosing schedule. Off the top of my head (the math is complex), I'd estimate 6 to 8 mg. Moreover, clonazepam is extensively metabolized, by a series of liver enzymes, and enzymes in the digestive tract with the same function (which is called first-pass metabolism), so a lot of it is lost before it can even get to the blood that circulates through the body.
> You have now created havoc on your GABA system and you are officially an addict even if you don’t want to be."
You have not created havoc on the GABA system. Quite the contrary, you are treating a disturbed GABA system. Moreover, although you can become addicted, the dose is not an issue all by itself. Your body can become physiologically dependent on the drug, but that is not addiction. Somebody is playing a mean game with words.
> I *knew* that wasn’t right, lol. so, (please bear with me, here), are you saying that even if there was this immense buildup (she used the 50-hour half-life), it wouldn't cause someone to be addicted because the "duration of action" is the only period where it affects the brain, right?
>
> AmyDon't worry about the duration of action thing in relation to addiction. Addiction is more than becoming physiologically dependent on a drug. Addiction is that whole "gotta increase the dose to get a buzz" tolerance, using more despite intense adverse effects, using drugs despite disruptions in essential functioning caused by the drugs (e.g. using drugs instead of eating, sleeping, paying the rent, etc.), thingie.
Somebody out there is just not being nice.
Lar
Posted by alesta on August 16, 2004, at 7:06:46
In reply to Re: half-lifes » alesta, posted by Larry Hoover on August 16, 2004, at 6:19:47
Wow. Thanks, Lar!! sure do appreciate it.:)
amy
Posted by Larry Hoover on August 16, 2004, at 7:47:56
In reply to Re: half-lifes, posted by alesta on August 16, 2004, at 7:06:46
> Wow. Thanks, Lar!! sure do appreciate it.:)
>
> amy
>
You're welcome.Lar
Posted by andromeda on August 16, 2004, at 9:01:26
In reply to Re: half lifes » andromeda, posted by Larry Hoover on August 15, 2004, at 13:27:21
>
> I hope you will start using fish oil. It sounds like it might be just the ticket.
>
> LarThank you very much for the explanation. I will take your word for it bc right now my brains are pretty much mush and comprehension is slowed way down.
I went and bought some fish oil. Not sure how much to take though. Brand name is Triomega-3 from Wal-Mart. EPA and DHA is 500 mg and Total omega-3 fatty acids 570 mg. EPA and DHA ratio is approx. 2 to 1. It says to take one capsule daily but I am not sure from reading elsewhere if that would be enough. I took 2 capsules last night. Am dx with bipolar II with atypical depression and anxiety. I took it once before probably 3 years ago but quit bc of the seal burps but now know to take it with a meal. I didn't give it much of a trial the first time around and don't remember what else I was taking.Found an interesting article this weekend in Readers Digest on Drug Sensitivity and genetic blood tests that I thought you might be interested in. Wondered if you knew or have heard anything about this? I'll write it out below in its entirety. Was a short article.
Drug Sensitivity
Genetic Blood Test.Who Should Benefit
If you're on a medication that has strong side effects, makes you feel lousy or does not seem to be working well enough, talk to your doctor about pharmacogenetic testing.Why?
Nearly half of all drugs-including certain painkillers and anti-depressants are processed by gene-regulated enzymes called CYP450. Millions of people have mutations that allow drugs to build up to toxic levels-or render themselves ineffective.What's involved?
A pinprick on the finger provides the blood for the test that identifies many DNA sequences in genes, allowing doctors to spot the mutation.Test Positive-Now What?
Your doctor will lower or raise your dose, or change your medication altogether. This can save months of trial and error.Cost??
$200-$600
Readers Digest September 2004My doc has been trying to adjust meds for years but not to sure HMO would cover a test like this and how much it would help my doctor to know what to do even with test results. Have been started on high doses and lowered doses. Just can't seem to find the combination that works.
Thanks again.
Posted by alesta on August 17, 2004, at 1:54:37
In reply to Re: half-lifes » alesta, posted by Larry Hoover on August 16, 2004, at 6:19:47
hi, lar,
i was looking back over your post so i could understand it better. now i see that we weren't communicating well on my last question. i do realize that physiological dependence is not the only element in addiction, but i was only asking about the physiological aspect of addiction because that's what she was referring to in her post, when she said:> > You have now created havoc on your GABA system and you are officially an addict even if you don’t want to be."
just wanted to clear that up, so you don't think i'm totally clueless here. i'll be sure to communicate my question in a more concise manner next time.
thanks again,
amy
Posted by Larry Hoover on August 17, 2004, at 10:47:38
In reply to Re: half-lifes, posted by alesta on August 17, 2004, at 1:54:37
> hi, lar,
> i was looking back over your post so i could understand it better. now i see that we weren't communicating well on my last question.I was just making sure that I covered all the bases.
> i do realize that physiological dependence is not the only element in addiction, but i was only asking about the physiological aspect of addiction because that's what she was referring to in her post, when she said:
>
> > > You have now created havoc on your GABA system and you are officially an addict even if you don’t want to be."There is a common tendency to confuse/confound addiction and physiological dependency, and it is usually used by people with the intent of bringing emotional stigmas to bear on an issue of private concern. An insulin-dependent diabetic is not stigmatized. Why should a benzodiazapine-dependent GAD sufferer be so stigmatized?
> just wanted to clear that up, so you don't think i'm totally clueless here. i'll be sure to communicate my question in a more concise manner next time.
>
> thanks again,
> amyI most certainly never thought you were clueless. ;-) Rather, I am a little anal.
Lar
Posted by alesta on August 17, 2004, at 11:25:15
In reply to Re: half-lifes » alesta, posted by Larry Hoover on August 17, 2004, at 10:47:38
thank you so much for your kind reply, lar. i hope sometime in the future i could possibly trouble you with a few more questions. (your competency and knowledge are positively mind-boggling!)
take care,
amy
Posted by Larry Hoover on August 17, 2004, at 11:27:07
In reply to Re: half-lifes, posted by alesta on August 17, 2004, at 11:25:15
> thank you so much for your kind reply, lar. i hope sometime in the future i could possibly trouble you with a few more questions. (your competency and knowledge are positively mind-boggling!)
>
> take care,
> amyAbsolutely no bother. I'd be delighted.
Lar
Posted by Larry Hoover on August 19, 2004, at 6:49:32
In reply to Re: half lifes, posted by andromeda on August 16, 2004, at 9:01:26
> >
> > I hope you will start using fish oil. It sounds like it might be just the ticket.
> >
> > Lar
>
> Thank you very much for the explanation. I will take your word for it bc right now my brains are pretty much mush and comprehension is slowed way down.If you would like me to revisit anything I said, and expand on the ideas, or make it more comprehensible....
> I went and bought some fish oil. Not sure how much to take though. Brand name is Triomega-3 from Wal-Mart. EPA and DHA is 500 mg and Total omega-3 fatty acids 570 mg. EPA and DHA ratio is approx. 2 to 1. It says to take one capsule daily but I am not sure from reading elsewhere if that would be enough. I took 2 capsules last night.
Night? With food, I hope. I'd target four caps a day, maybe split in two doses?
> Am dx with bipolar II with atypical depression and anxiety. I took it once before probably 3 years ago but quit bc of the seal burps but now know to take it with a meal. I didn't give it much of a trial the first time around and don't remember what else I was taking.
If it isn't obviously helpful to your brain, please just use it anyway. It is very good for your heart, helps prevent Alzheimer's, certain age-related visual disorders, and others.
>
> Found an interesting article this weekend in Readers Digest on Drug Sensitivity and genetic blood tests that I thought you might be interested in. Wondered if you knew or have heard anything about this? I'll write it out below in its entirety. Was a short article.Ya, but the pin-prick test was withdrawn by the FDA this year (I'm pretty sure)....it's a computer chip with a mini-laboratory on it. It'll be back, but I don't think it's available right now. There is a blood test available that you need to get the arm-puncture for, though.
Just one example of those enzyme issues, what is called cytochrome P450 2D6. The important part is the 2D6. It has been found that the activity of this enzyme varies by 118-fold (not 118%, 100 times that, 11,800%), and that's just in Caucasians. The most rapid metabolizers are called "extensive metabolizers". Most people are kind of in the middle. The poor metabilizers are called "slow metabolizers". Many drugs are metabolized by 2D6, and you have to consider whether the drug is active before 2D6 changes it, or whether 2D6 makes it active.
In the case of some antidepressants, the active drug is de-activated by 2D6. So, the active drug gradually decreases in the blood as the liver enzyme destroys it. Extensive metabolizers exhibit short drug half-lives, as the drug is rapidly destroyed. They might find a lot of "yo-yo" effect in the physical reaction to the drug, and poor efficacy overall. Slow metabolizers exhibit grossly extended drug half-lives, severe side-effects, and the drug can build up to even toxic levels (just like an overdose), even at normal therapuetic doses.
The other side of the coin is when a drug is made active by that enzyme. An example is codeine, which is converted to morphine. Codeine is meant to be something like "slow release morphine", and it is often considered to be a pro-drug, the term for an inactive drug which is enzyme-activated.
However, extensive metabolizers convert the codeine to morphine in one bang (more or less), and they get quite high off it. Those are the people who just love getting their hands on Tylenol 3's. Slow metabolizers don't get much analgesia at all (if any), and instead are stuck with the side-effects of codeine itself (nausea, constipation, etc.).
So, you may not need a blood test to understand something about 2D6 activity. If you have extensive side effects from antidepressants, and codeine doesn't work worth a ****, then you are a 2D6 slow metabolizer, in all probability.
The neat thing about the blood test is it assigns an exact value to the metabolic rate (not just slow or fast), and you get readings on five (or is it six?) different enzymes, not just 2D6.
> Thanks again.You're welcome.
Lar
Posted by andromeda on August 22, 2004, at 13:03:11
In reply to Re: half lifes » andromeda, posted by Larry Hoover on August 19, 2004, at 6:49:32
Hey Lar,
Thank you so much for your help with my questions. Your answers very helpful for me to understand better.
I am better able now to understand explanations of half lifes since taking some fish oil. Just seem a little sharper on my thinking and comprehension now.
I am in horticulture and I had to always tell customers to back off insceticides bc of the persistence of half lifes. So I think that was confusing me too.
I tried 2 capsules of fish oil for 2 days and had to back off to one a day. Was quite euphoric the first day and 2nd day turned irritable. Dreams were scary and had a hard time falling asleep. I started seeing detail better and colors were brighter and when that happened I knew it was working like Prozac/SSRI's for me. Didn't have the cotton mouth though. One capsule seems to keep me a little sharper even though I start rhyming to much and that is a sign for me to back off of it. Still am lethargic, apathetic and have a huge appetite.
I have to be a slow metabolizer. Your explanation explains things better for me. Thanks. It took me years to get the docs to listen to me and lower the doses. I cannot take Lortab, demerol, codeine nor morphine. I thought I was just allergic to them. Usually end up throwing pain killers up if given in pill form or if to large a dose. For pain I just prefer to go to sleep.
There were a lot of meds I took at regular doses and so that opens up a whole lot of new trials for me of trying them at lower doses. I always thought that just a low dose of lithium would be helpful. The therapuetic dose was horrible even though its not an antidepressant or pain killer.
I did go off my abilify before taking fish oil bc it didn't seem to be helping any. I added back in 25 mg of lamictal bc it does help with swings and migraines and for some reason allergies. Taking more lamictal than 25 mg does not help. May go ahead with the switch to low dose topamax to see if that will help with my ravenous appetite. Appetite seems to have increased with the fish oil even though it is only one capsule.
Now all I have to do is explain this all to my psychiatrist at the end of the month in 15 minutes or less.:-)
Thanks for your patience and understanding Larry.
Andromeda
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.