My daughter is unable to take any macrolide or antibiotic that uses the P450 chytochrome system pathways in the liver because she is currently being tapered off of Lexapro, a SSRI.The Lexapro was prescribed for TMJ clenching due to possible anxiety.

She is about 160 pounds.How does one treat the lyme in the cell and the bloodstream when one cannot use the macrolides such as Ketec, Biaxin and Zithromax due to drug to drug interactions with the lexapro?

Is there any treatment protocol that worked for anyone?? Her doctor is stumped and only has her on amoxicillin at 2 875Mg a day and I see a down slide happening.

..........any solutions........maybe Rife.......

How about Bicillin shots............are they effective by themselves?? Are they metabolised by the liver?

Minocycline???

There must be many that also cannot take macrolides due to being on a SSRI and have a successful protocol for lyme .

a

[This message has been edited by auntybiotic1499 (edited 25 April 2005).]

[This message has been edited by auntybiotic1499 (edited 25 April 2005).]

minocycline has deep tissue and cellular penetration as well as being able to cross the blood brain barrier.

both excellent treatment choices to discuss with your doctor.

there is a new antibiotic as well called ketek which is a ketolide, an advanced macrolide. you can check the chemistry on it to see if does not have the interaction problem your daughter has with the macrolides.

ketek has a fairly good track record and is often used concurrently with flagyl.

best of luck!!!

-zip

Thanks for the info.

Ketec is metabolized 50% thru the P450 Chytochrome system and she is not able to take that either.

My daughter was put on Lexapro for TMJ problems and she is being slowly tapered off of that horrrible addictive drug so anything that goes thru thr p450 system will raise the Lexapro levels which is NOT what we want to do.

I will see what her LLMD has to say at our next appointment.

Are Bicillin shots painful and does Blue Cross Blue shiels cover them??

Thanks for your reply. This isa 15 year old child and we are hoping to avoid IV's.

The Flaygl is metabolized by the P-450 System so she is unable to take that for awhile.

I will look up the Omnicef, and this in combination with Doxy or Mino??

Her doctor was stumped and only Rx amoxicillin and she is getting worse.

I was just thinking of you and your daughter. Please e-mail me so we can talk, I wanted to let you know what's been going on and to ask how your daughter's tummy problems are.

I spike to Pfizer regarding Zithromax rather than just look on the internet. On the Internet it said that said it was safe to use.

Pfzier chemist told me that it does use the P450 system for metabolism and that in their own tests done with Zithromax taken at same time as Zoloft (their product).

The Zithromax raised the levels of the Zoloft by 100 times due to drug to drug interaction by competion for the same liver pathways.

Since all SSRI'S are similiar and all use the P 450 Chytochrome pathway system for metabolism...........I was definately afraid of using Zithromax with the Lexapro for fear of the Levels of the Lexapro being raise dramatically and causing Serotonin Syndrome as the Biaxin XL did with the Lexapro.

I will call Pfizer again and just double check............. but I spoke directly to the chemist at Pfizer the first time.

So now we (her doctors) have no clue what to use to agressively treat her lyme. I will call the makers of Omnicef and check the metabolism of that medication if it is liver or kidney but most are liver pathways.

I think penicillins are metabolized in the kidneys. This is all a nightmare and I am sure my daughter is not the only lyme patient that was on a SSRI and Macrolide antibiotic at the same time. Most must think their lyme relapsed because the symptoms of the drug to drug interaction are so similiar to lyme disease symptoms.

a

However, some people can't take sulfa drugs.

I just dug up an old thread on this drug and sent it around (bactrim and septra are the same thing).

I wish I had answers for you, but I don't think mino will work. According to this spreadsheet, it too uses the P450 pathway.
http://aamm.unm.edu/show_sheet.php?s_id=2

Good luck finding the right regimen,

Sue

Edited to add, I'm on zith and mino now, and I get liver pain when I take each one. Liver pain seems to be my personal indication that I ingested a p450 drainer.

Thanks for the link. It seems that none with lyme should take SSRI's because it is opening a can of worms.

If you are more computer literate than I, canyou check how Omnicef is metabolized, if by the Pathways of the P450 Chytochrome and specilfically the 2D6
2C19
and I think 3A (not sure but can recheck this number). How about Bicillin shots.

This is so new that the doctors are just stumped by it.

Thanks Sue, you are still an angel.

Although I have no idea about the chemistry of these antibiotics, I can say that mino had a strange psychological side effect. Even though it worked very well on Lyme and bartonella, you might want to try it in low doses at first, to see if your daughter can tolerate it.

Looks like Omnicef is metabolized by teh kidneys. No mention of P450 in anything I found on it. Here are some excerpts:

Omnicef (cefdinir) is a 3rd generation cephalosporin.

3rd generation cephalosporins have broader activity against Gram negatives.
Members include: Cefdinir (Omnicef), Cefoperazone (Cefobid), Ceftazidime (Fortaz), and Ceftriaxone (Rocephin), and Cefotaxime (Claforan).

Cephalosporins are excreted by the kidneys using glomerular filtration and tubular secretion.

Metabolism and Excretion

Cefdinir is not appreciably metabolized. Activity is primarily due to parent drug. Cefdinir is eliminated principally via renal excretion with a mean plasma elimination half-life (t1/2) of 1.7 (�0.6) hours. In healthy subjects with normal renal function, renal clearance is 2.0 (�1.0) mL/min/kg, and apparent oral clearance is 11.6 (�6.0) and 15.5 (�5.4) mL/min/kg following doses of 300 and 600 mg, respectively. Mean percent of dose recovered unchanged in the urine following 300- and 600-mg doses is 18.4% (�6.4) and 11.6% (�4.6), respectively. Cefdinir clearance is reduced in patients with renal dysfunction (see Special Populations: Patients with Renal Insufficiency below).

ZuZuu: yes, I made a warning about it well over a year ago. I found out on my own just what mixing Biaxin and zoloft ( as ONE example does and I rampantly warned people. . It is listed on drug websites.

Sue, Thanks for the info on omnicef, now I wonder if that would be effective alone to treat lyme?

Just got off the phone with Pfizer Lyddie, they told me that Zithromax was metabolized by the P450 system but that there were no studies as to which pathways were used. I am afraid to use it because of this.

ZuZu,
Even the best lyme doctors are unaware of the drug interactions, I found out when my daughter got extremely ill and I researched it.

SSRI's interact with most medications used by Lyme patients such as advil, motrin, xanax, proilsec, difuican, valium and heart medications and the macrolide antibiotics and erythomycin. There is a list on the internet. I don't have the link right here but look up Flockhart P-450 Drug to Drug interaction and you should get several links.

The results with the macrolides is that the level of the SSRI is raised by at least 40%/ as in my daughter's case this can be devastating.

With other medications, it varies, I know xanax levels are raised the taking SSRI's.

For example it says "NOT azithromycin and telithromycin" (Ketek) under the Substrates, so does this mean that these drugs would not be a problem with SSRI's?

The Ketek paperwork (it happens to be handy) say, "Telithromycin is a strong inhibitor of the cytochrome P450 3A4 system. Co-administration of Ketek tablets and a drug primarily metabolized by the cytochrome P450 3A4 enzyme system may result in increased plasma concntration of the drug co-administered with telithromycin that could increase or prolong both the therapeutic and adverse effects. Therefore, appropiate dosage adjustments may be necessary for the drug co-administered with telithromycin." So if Lexapro uses a different enzyme system than the 3A4, there's not a problem, right?

My doctor changes antibiotics every one to two months to avoid resistance. Also throws in Flagl for 5 days every month.

Good luck!

Aunty, BTW, the tummy problems that the doctors at Children's dismissed as psychological have proven to be quite real. Endoscopy showed extensive inflammation of the entire GI tract, including esophagus and stomach, and also a huge amount of yeast. A kid with diabetes on antibiotics is in a small group of people- including patients w/AIDS and cancer patients on immune-suppressing drugs- who are very vulnerable to major yeast problems.
This in turn causes "leaky gut" we think, with gluten intolerance and other food reactions, including bloating and huge amounts of lluid retention. She's starting to improve...

I hope your daughter is doing better. Sound like you are making some progress with the withdrawal. You are a hero Mom!

We discover drug interactions all the time these days, which the MD's don't know. A lot of them have to do with diabetes. The proton-pump inhibitors used to stop acid production in the stomach cause major low blood sugars for people on insulin. Then add fluconazole for the yeast and, guess what, fluconazole increases the concentration of the proton-pump inhibitor in the blood, further increasing the danger of lows. The MD didn't know any of this.

My daughter does see Dr J. the children's lyme doctor.

I brake for tics,

Ketec should not be used with Lexapro. I checked with the manuafactor as i was hoping that could be a alternative to the Biiaxin.

Lexapro used three pathways for metabolization in the liver.
They are 3A4
2D6
2C19
I spoke directly to the chemist from Forest labs to find this out as many do not list all three. The 3A is also why Lexapro interacts with Biaxin.

Therefore if you are taking Ketec with Lexapro it is raising the levels of the lexapro in you body .no one can say by what amount but theory states by 40% to 100%.

This happened with my daughter and the Biaxin.

To your question, can you just take it at diffrent times. NO is the answer. This is due to the fact that the way Ketec is prescribed, the purpose is to keep the concentrations the same in the blood for 24 hours until your next dose.

The same applies to the Lexapro dosing, one Lexapro a day will keep the concentration for about 26 hours in the blood.

Just taking two medications that use the same pathway can make one a slow metabolizer and the liver will not properly break down the medications............

this can lead to toxic levels even if there was not a drug to drug interaction.

I gave my daughter the Biaxin at 7AM in the morning and the Lexapro at 9:30 PM at night and she still had a serious interaction between the two that we thought were worsening of her lyme symptoms.

The pharmacist did not even know about the interaction between Biaxin and Lexapro.

Biaxin XL
Ketek
Lexapro
Zithromax
Zoloft
Add or Delete Drugs

Start Over with a New List of Drugs

(Note: Not all drug interactions are known or reported in the literature, and new drug interactions are continually being reported. This information is provided only for your education and for you to discuss with your personal healthcare provider. )

CLARITHROMYCIN (in Biaxin XL) may interact with GRAPEFRUIT JUICE

Grapefruit juice may block the breakdown of clarithromycin in the intestines. This could cause an increase in blood levels of clarithromycin which could increase the risk of side effects from this antibiotic. Potential side effects of clarithromycin include headache, diarrhea, and nausea. You should avoid drinking grapefruit juice or eating grapefruit while taking clarithromycin. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is poorly documented and is considered moderate in severity.

Last Updated: February 2005

--------------------------------------------------------------------------------

FOOD may interact with CLARITHROMYCIN (in Biaxin XL)

Food may slightly delay the absorption of clarithromycin from the stomach into the bloodstream. However, it does not appear from currently available evidence that the effectiveness of clarithromycin is reduced if taken with food. Clarithromycin may be taken either with or without food. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is poorly documented and is considered moderate in severity.

Last Updated: February 2005

--------------------------------------------------------------------------------

SERTRALINE HYDROCHLORIDE (in Zoloft) may interact with CLARITHROMYCIN (in Biaxin XL)

Clarithromycin may block the breakdown of sertraline by the liver. If this happens, blood levels of sertraline could be increased and this could increase the risk of side effects including nausea, dizziness, headaches, and sleep disturbances. Other more serious side effects may occur due to sertraline's effect on serotonin, a chemical that is found in the brain. Initially, excess levels of serotonin in the brain may cause increased confusion and restlessness. Other possible symptoms may include weakness, fever, nausea, and anxiety. In rare cases, high levels of serotonin in the brain may cause severe complications like seizures, stroke, and even death. If these drugs are used together, your doctor may want to monitor you closely when therapy with clarithromycin is started or stopped, or when the dose of clarithromycin is changed. If you are experiencing problems, it may be necessary to adjust the dose of sertraline. You may want to ask your healthcare provider about this potential interaction if you think you are having problems.

This interaction is poorly documented and is considered major in severity.

Thats what this site said its Express scripts.

Lyddie

Ibrake for tics,

Ketec cannot be taken with Lexapro.

Lexapro uses three pathways in the liver. Check with Forest Labs. They are 3A
2D6
2C19

I spoke with the chemist at the makers of Ketec hoping this may be a suitable medication but it is not.

Ketec and Lexapro share the 3A enzyme pathway causing the levels of the Lexapro to be dramatically increased.

Ketec levels are constant thruout the day for a 24 hour period as well as lexapro levels. Depending on one's metabolization, you can not determine how quickly either drug will filter thru the liver.

Upon withdrawal from Lexapro, testing has shown that the liver still has high levels of the medication even if one is a good phase two detoxifier. Lexapro is very hard to remove because it is often recirculated thru the body in the bile in some.

Lexapro is VERY addicting, just miss a dose for two to thrr days and you will see withdrawals. Lexapro needs to be slowly tapered, similiar to Paxil, to help with the hellish symptoms of withdrawal.

I realize that the Drug interaction lists do not show these interactions because the research is so new on the P450 Chytochrome system.

That is why my daughter got into the problems with the Biaxin and Lexapro.it did not come up but it does exist.

If you doubt me look at the drug inserts and read them carefully. They will break it down into what drugs metabolized thru which pathways not to use and then it takes a lot of looking into.

Biaxin interacts with Lexapro and Ketec. I know because I spoke to the chemist at the manufactors.

Zithromax did there own studues with Zoloft and showed interactions.

I am just trying to warn others so that no one has to suffer as my daughter is now doing. Do not trust the interaction charts an this P450 system as they are NOT corrext. I know this for certain.

Mayo Clinic is at the cutting edge of this research with drug interations and I have spoken to two of the head doctors there. They actually now have blood tests that you can have done to see how your liver metalizes the P450 drugs prior to taking the drugs in hopes to prevent bad adverse interactions and effects.

In one post you suggest looking up Flockhart P-450 Drug to Drug interaction. In the last post, you say "Do not trust the interaction charts an this P450 system as they are NOT corrext. I know this for certain." So how do you suggest researching potential drug interactions?

Ibreak for tics,

Iam saying that many drugs are KNOWN to cause a reaction but if one is not listed, look up the way the medication is metabolized either liver or kidney.

Ifit is the liver I would suggest calling the manufacturer and asking directly.....I no longer trust the pharmacist as we were not informed of the Biaxin to lexapro interaction.

The chart is also helpful in knowing what dugs to avoid that ARE listed. If one is not listed in the charts and is metabolized by the liver it warrants further research to compare the pathways used with the pathways used by other medicatyions you are taking.

Most people have never evn heard of the P-450 System. More reading can be foundon the internet and different charts that may be easier to understand.

Yes, the Mayo Clinic test are the DNA testing for the liver enzymes, some are born without certain enzymes so this can effect drugs taken.

Prilosec is metabolized by the liver, and uses the CP450 system. The only other medication that she is on is insulin. When only one drug is inolved, should I still be concerned?

Prilosec causes hypoglycemia for my daughter. Hypos for people on insulin are listed as a common side-effect, but M's don't know about this one either.

It has been several months since she stopped the SSRI's hasn't it??

I know I was told to allow several months after the last dose of the SSRI before taking anything going thru the same pathways due to some people having a poor phaseII liver detox.

In phase II of the liver detox the body removes the toxins that are in the liver out of the body...for some this can be a several month process depending on the gluthione activation.

I would think it should be fine. If by chance you start the medication and notice her "withdrawal symptoms from the SSRI returning" you can easily stop the prolisec.
I think you should be fine, check with her doctor.

Is your daughter completely over the withdrawals? No anxiety, mood swings, sleeplessness, weight gain?? If she is you are so lucky.

I am taking it that you daughter is a diabetic with stomach problems. Does she have Lyme too. Gastroparesis is very common with diabetics. Since I really dont know her symptoms, I am just going on a hunch. It is one of the last things GI Docs check because, there is not a whole lot that can be done. Diet is very important, and gastroparesis plays havoc with absorption and sugar levels.

I got the Gastroparesis under control with diet and treatment of Lyme, babs and bart. My sugar levels are now back under control.

Reducing stomach acid is not always the answer to our problems just a convientent way for a doctor to get you out of the office in 5 minutes.

Proton Pump Inhibitors, are really not a good answer for stomach problems. For treatment of Ulcers, yes they are necessary, for almost everything else they actually create more problems than they help.

They are even worse for you if you are taking antibiotics, almost a sure way to give yourself a C-dif infection. If your daughter is having nausa, vomiting episodes, bloatedness, the feeling of the need to eat, then when she eats feels full. These are all signs of gastroparesis. I would ask the doc to order a gastric emptying study. If you need any other info let me know.

Hwlatin, gastroparesis has been on the list to consider. Sometimes her blood sugar patterns would seem to indicate gastroparesis, with lows after eating followed by highs, but this has stabilized some.

We are taking things step by step. Right now, endoscopy has shown gastritis and esophagitis, with very visible yeast throughout, also cultured on biopsy.

We had to investigate celiac because going gluten-free seems to have helped.

My daughter did a lot of antibiotics for Lyme, and abx plus diabetes equals yeast, big time. Fluconoazole and strict gluten-free, yeast-free diet have helped a lot. If she has leaky gut (which has recently been tested) then her food sensitivities may heal as her stomach heals, I guess.

I have a lot of reservations about Prilosec, but it may actually help Probiotics settle in (no acid around). I am going to give her 1/4 dose and see if she has hypoglycemia. If hypos are a big problem with this drug, then she won't take it. At any rate, I dont' want her take it for more than 14 days (not 4-6 weeks). I've lost my trust in doctors lately, esp. w/RX's.

Two GI doctors have gotten really impatient over the issue of lows w/Zantac or (now) Prilosec. It seems as if this problem, diabetes and meds, is very inconvenient, and my daughter just doesn't fit in the usual box.

To me, it is obvious that getting rid of stomach acid, will affect digestion and absorption of food, and therefore blood sugars, for people who take insulin. For others, the body would probably adjust the amount of insulin released, but people with diabetes don't have that luxury.

I hope you find some answers real soon. I remember watching my son doubled over in pain with his stomach, it is absolutly painful to watch your child go through it. I understand how you feel.

Thanks again..and Aunty, keep me posted...hope you find a med that is okay for her Lyme and that she gets off the SSRI okay...