![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Anna P. on April 12, 2000, at 17:43:27
Hello Cam W. I wanted to ask you a question, as I have the ignorant physician that I think need to change.
I need to stay on stimulating medications, but since few months I started to experience the heart and chest sensations,
heart pain, short breath after some medications.(Moclobemide, Dexedrine)
That happen even after taking cold medicine(stimulating effect) with antidepressant such as Tianeptine.
I'm still on Tianeptine, which is supposed to have no cardiac effects.
My doctor was thinking switching me to Parnate, but I need to investigate that problem first. I know this is not anxiety, and I check my heart 6 months ago.
What can be a possible cause of that?Anna P.
Posted by Cam W. on April 12, 2000, at 19:01:05
In reply to Heart pain, short breath after meds...Cam W. ?, posted by Anna P. on April 12, 2000, at 17:43:27
.
Anna - Sorry Anna, I am the drug guy. I am not trained in diagnoses. It could be drug-related (stimulant-related?) palpitations, or something like that, but I could not say with any certainty. Maybe someone else on the page could help. - Cam W.
Posted by saint james on April 13, 2000, at 15:19:20
In reply to Heart pain, short breath after meds...Cam W. ?, posted by Anna P. on April 12, 2000, at 17:43:27
I know this is not anxiety, and I check my heart 6 months ago.
> What can be a possible cause of that?
>
> Anna P.James here....
What kind of heart test did you have 6 mo ago and why ?
j
Posted by Mark H. on April 13, 2000, at 19:58:21
In reply to Re: Heart pain, short breath after meds...anyone ?, posted by Cam W. on April 12, 2000, at 19:01:05
Hi Anna,
I've experienced angina (or at least what I suspect is angina) from taking methylphenidate, and I've experienced shortness of breath very much like what I would expect from mild heart failure with beta-blockers. Some of the stimulants *seem* to restrict blood-flow to the heart (although I'm not a doc and I have no idea why that would be), and some of the heart-slowers (which I take adjunctively for depression) *seem* to make the heart less efficient, therefore causing shortness of breath.
Because of the seriousness of heart disease and the medical profession's documented tendency to give less credence to women who complain of chest pains (!), I'd recommend you follow up with your doctor, even if your treadmill (?) EKG was good 6 months ago.
Also, as SJ asked, it would help to know how much of what medicines you're taking.
Best wishes,
Mark H.
Posted by Anna P. on April 15, 2000, at 13:56:32
In reply to Re: Heart pain, short breath after meds...Cam W. ?, posted by saint james on April 13, 2000, at 15:19:20
>
>
> What kind of heart test did you have 6 mo ago and why ?
>
> jI had a trade mill, EKG and USG(?)not shure about the name, but to see your heart on screen,
just like they do for pregnent women, all done by
cardiologist.At that time I took respectively,
Moclobemide
Moclobemide+Ritalin (stopped working)
Moclobemide+Dexedrine(stopped working)
Dexedrine gave me the chest pain for shore
Moclobemide+Dexedrine+Ketoconazole (for infection)
since that, I had a heart pain on just MoclobemideIt's to advanced stuff for me, but what is cytozome P-450, and what can happen besides increasing the amount of the drug in the blood? Anybody?
Anna P.
Posted by Cam W. on April 15, 2000, at 14:35:33
In reply to Re: Heart pain, short breath after meds... ?, posted by Anna P. on April 15, 2000, at 13:56:32
> It's to advanced stuff for me, but what is cytozome P-450, and what can happen besides increasing the amount of the drug in the blood? Anybody?
>
> Anna P.Anna - The cytochrome system is a number of slightly different enzymes produced by the liver to convert hydrophobic, lipid soluble compounds (ones that dissolve in fats) into hydrophilic, water soluble ones. The kidney can excrete water soluble compounds in the urine easier than lipid soluble ones. The cytochrome system is the main detoxifying system of the liver.
Drugs are usually lipid soluble so that they have a longer half-life in the body. The drug can bind to plasma protein or hide in fat cells and slowly be released, rather than acting all at one time.
The cytochrome enzymes are divided into families and sub-families, depending on their structure and how they chemically act on a compound. Different sub-familes metabolize different compounds (not only drugs, but also foods, toxins, or nearly anything the body is trying to excrete).
The cytochrome enzymes use a number of chemical reactions to turn a compound water soluble: N-demethylation, carboxylation, oxidation, hydroxylation and N-methylation.
Some different ethic populations have livers that contain differing amounts of these enzymes, making them more (or less) susceptible to the effects of certain drugs. This is why different races are affected by drugs differnetly. Even within the same ethnic populations, variations occur, resulting in drugs having different effects and lengths of action in different people. This system is one of the reasons we say, that with drugs, "YMMV -your mileage may vary".
Some drugs can induce some families or sub-families of cytochrome enzymes. Drugs like Tegretol, Dilantin and barbiturates and cruciferous vegetables like brussel sprouts, cabbage and charbroiled meats and cigarette smoke can cause the liver to increase the amount of specific enzymes that the body produces. Other drugs that use this specific enzyme as a major metabolic route will be excreted from the body faster.
Conversely, other drugs, like Serzone, some SSRIs, Erythromycin and Tagamet and a food like grapefruit can inhibit certain cytochrome enzymes from being produced. Other drugs that use this system will have less enzyme present to metabolize them and may bulid up in the body to toxic levels.
Hope this wasn't too confusing - Cam W.
Posted by Scott L. Schofield on April 17, 2000, at 13:36:47
In reply to Re: Cytochrome P450 Enzyme System, posted by Cam W. on April 15, 2000, at 14:35:33
> Anna - The cytochrome system is a number of slightly different enzymes produced by the liver to convert hydrophobic, lipid soluble compounds (ones that dissolve in fats) into hydrophilic, water soluble ones. The kidney can excrete water soluble compounds in the urine easier than lipid soluble ones. The cytochrome system is the main detoxifying system of the liver.
This post has been added to the SLS archive.
- Scott
Posted by Anna P. on April 18, 2000, at 13:02:38
In reply to Re: Cytochrome P450 Enzyme System, posted by Scott L. Schofield on April 17, 2000, at 13:36:47
> > Anna - The cytochrome system is a number of slightly different enzymes produced by the liver to convert hydrophobic, lipid soluble compounds (ones that dissolve in fats) into hydrophilic, water soluble ones. The kidney can excrete water soluble compounds in the urine easier than lipid soluble ones. The cytochrome system is the main detoxifying system of the liver.
>
>
> So, now I know what it is, but it is still too confusing for me.
For example,if I took all the three drugs that acts upon that system: Moclobemide,
Dexedrine, and Ketoconazole what might happen?I mean,is it not safe to take the combo of meds that act on the same system?
Back to my chest pain and short breath:
- my psychiatrist doesn't know
- my physician doesn't know, and doesn't want to know - he said my heart is fine
- my cardiologist did tests and found nothing
Now, the problem still exist, I get the heart pain and short breath after any stimulating medications.
Currently, I take Tianeptine for my dysthymia, which doesn't have the cardiac effects.
If I only add even the Aspirin or cold medicine, within the few hours I get the short breath and heart sensations.
What would you do in my shoes?
I need to switch the antidepressant, it doesn't help, what if I get the pain again?Anna P.
Posted by Cam W. on April 18, 2000, at 23:57:49
In reply to Re: Cytochrome P450 Enzyme System, posted by Anna P. on April 18, 2000, at 13:02:38
Anna - I don't think that ketoconzole interferes with Dexedrine or moclobemide metabolism (but I am not 100% positive) or act on the same metabolic system. The Manerix and Dexedrine could potentially interact, (from a theoretical point of view, because of Manerix's relationship to MAOIs) causing increased blood pressure. I have not heard of any problem, but I haven't seen that combination used. Follow what the doc says, especially if he has had experience with this combination, but ask him to regularly check your blood pressure, just to be safe. I am really not sure what your reaction to cold medicines is (could be a slight allergy, but that's only a guess). - Cam W.
Posted by Anna P. on April 19, 2000, at 18:34:56
In reply to Re: Cytochrome P450 Enzyme System, posted by Cam W. on April 18, 2000, at 23:57:49
* Follow what the doc says, especially if he has had experience with this combination, but ask him to regularly check your blood pressure, just to be safe. I am really not sure what your reaction to cold medicines is (could be a slight allergy, but that's only a guess). - Cam W.
Doc doesn't know...(I mean my physician). My problems have started since, but moclobemide and dexedrine is a common combo as my pdoc said, it must be ketoconazole, I'm so frustrated, and have nobody to help
Anna P.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
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.