![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 87. Go back in thread:
Posted by Cindy W on July 1, 2000, at 12:02:03
In reply to Re: Effexor-side effects, posted by Rita on July 1, 2000, at 10:16:04
> > I started Effexor about 2 months ago and was up to 150mg day and I was also already taking Trazodone for sleep. I had about a half a dozen days where I would get a wierd dizziness off and on throughout the day. It started up again one night while laying in bed and actually made my eyes roll downward for a second. In the morning, the "episodes of dizziness" progressed to the point where it was happening constantly. It was almost like an electical charge in my brain and getting dizzy was an after-effect of these charges. It got to the point where I was feeling tingling down my right arm to my palm & fingertips whenever I got the "charges". I slowly discontinued using Effexor and I've been back on Prozac for a couple days now and I've never had any side effects from that. Has anybody ever had this type of experience with Effexor?
> >
> > I also have nightmares (waking up with my fists clenched), night sweats and see "trails" sometimes
>
> Hello again. As Snowdancer mentioned, I too can relate to the various side effects you mentioned. For me, most of them went away after several weeks; but would return briefly if I changed the dose, missed a dose, or got over stressed/tired. The teeth clenching has persisted, but apparently not as bad as yours. Flexeril (at night) might help....it's a muscle relaxant and helped me with both the teeth clenching and the muscle jerks/spasms. Have been getting off the drug over the past few weeks... Starting at 275mg, began cutting back (with doctor's permission) by 25mg/week...now down to 100mg and still OK. Tried to stop before by cutting back 50mg/day (the size of my pills)...disaster!! Like someone else said...scared me back on. Now I use a pill cutter and every time I cut back, I readajust to make sure I spread the remaining dose as evenly over each 24 hour period as possible. Best of luck to all of you. Effexor's a good drug; works when many others don't; however, it has it's own idiosyncracies and doesn't work for everyone (like Prozac didn't work for me). Trust your doctor and your body! ... RitaHello! i feel so lucky, because i take Effexor 275 mg/day and it doesn't bother me in any way. Hope you find the right thing!
Posted by Snowdancer on July 1, 2000, at 16:35:56
In reply to Re: Effexor-side effects, posted by Cindy W on July 1, 2000, at 12:02:03
> > > I started Effexor about 2 months ago and was up to 150mg day and I was also already taking Trazodone for sleep. I had about a half a dozen days where I would get a wierd dizziness off and on throughout the day. It started up again one night while laying in bed and actually made my eyes roll downward for a second. In the morning, the "episodes of dizziness" progressed to the point where it was happening constantly. It was almost like an electical charge in my brain and getting dizzy was an after-effect of these charges. It got to the point where I was feeling tingling down my right arm to my palm & fingertips whenever I got the "charges". I slowly discontinued using Effexor and I've been back on Prozac for a couple days now and I've never had any side effects from that. Has anybody ever had this type of experience with Effexor?
> > >
> > > I also have nightmares (waking up with my fists clenched), night sweats and see "trails" sometimes
> >
> > Hello again. As Snowdancer mentioned, I too can relate to the various side effects you mentioned. For me, most of them went away after several weeks; but would return briefly if I changed the dose, missed a dose, or got over stressed/tired. The teeth clenching has persisted, but apparently not as bad as yours. Flexeril (at night) might help....it's a muscle relaxant and helped me with both the teeth clenching and the muscle jerks/spasms. Have been getting off the drug over the past few weeks... Starting at 275mg, began cutting back (with doctor's permission) by 25mg/week...now down to 100mg and still OK. Tried to stop before by cutting back 50mg/day (the size of my pills)...disaster!! Like someone else said...scared me back on. Now I use a pill cutter and every time I cut back, I readajust to make sure I spread the remaining dose as evenly over each 24 hour period as possible. Best of luck to all of you. Effexor's a good drug; works when many others don't; however, it has it's own idiosyncracies and doesn't work for everyone (like Prozac didn't work for me). Trust your doctor and your body! ... Rita
>
> Hello! i feel so lucky, because i take Effexor 275 mg/day and it doesn't bother me in any way. Hope you find the right thing!Hi, Just wanted to say that for my experience these symptoms only happen when going off of the effexor or if I've missed my dose a few days in a row, as long as I take it every day I never have these symptoms either, other than the nightmares and I've always had them with all ad's. Just wanted to let you know... :) Snowdancer
Posted by Snowdancer on July 1, 2000, at 16:41:47
In reply to Re: Effexor-side effects, posted by Cindy W on July 1, 2000, at 12:02:03
> > > I started Effexor about 2 months ago and was up to 150mg day and I was also already taking Trazodone for sleep. I had about a half a dozen days where I would get a wierd dizziness off and on throughout the day. It started up again one night while laying in bed and actually made my eyes roll downward for a second. In the morning, the "episodes of dizziness" progressed to the point where it was happening constantly. It was almost like an electical charge in my brain and getting dizzy was an after-effect of these charges. It got to the point where I was feeling tingling down my right arm to my palm & fingertips whenever I got the "charges". I slowly discontinued using Effexor and I've been back on Prozac for a couple days now and I've never had any side effects from that. Has anybody ever had this type of experience with Effexor?
> > >
> > > I also have nightmares (waking up with my fists clenched), night sweats and see "trails" sometimes
> >
> > Hello again. As Snowdancer mentioned, I too can relate to the various side effects you mentioned. For me, most of them went away after several weeks; but would return briefly if I changed the dose, missed a dose, or got over stressed/tired. The teeth clenching has persisted, but apparently not as bad as yours. Flexeril (at night) might help....it's a muscle relaxant and helped me with both the teeth clenching and the muscle jerks/spasms. Have been getting off the drug over the past few weeks... Starting at 275mg, began cutting back (with doctor's permission) by 25mg/week...now down to 100mg and still OK. Tried to stop before by cutting back 50mg/day (the size of my pills)...disaster!! Like someone else said...scared me back on. Now I use a pill cutter and every time I cut back, I readajust to make sure I spread the remaining dose as evenly over each 24 hour period as possible. Best of luck to all of you. Effexor's a good drug; works when many others don't; however, it has it's own idiosyncracies and doesn't work for everyone (like Prozac didn't work for me). Trust your doctor and your body! ... Rita
>
> Hello! i feel so lucky, because i take Effexor 275 mg/day and it doesn't bother me in any way. Hope you find the right thing!PS: Cindy, after 3 months at 150 mg effexor is not quite doing it for me, did you notice a difference when u jumped to 275mg, was it a big improvement? Just wondering if I should suggest going higher on the dosage to my dr.... thx! Snowdancer
Posted by Rita on July 1, 2000, at 20:20:31
In reply to Re: Effexor-side effects » Cindy W, posted by Snowdancer on July 1, 2000, at 16:41:47
>
> PS: Cindy, after 3 months at 150 mg effexor is not quite doing it for me, did you notice a difference when u jumped to 275mg, was it a big improvement? Just wondering if I should suggest going higher on the dosage to my dr.... thx! SnowdancerSnowdancer: You didn't ask me, but thought an answer might be helpful anyway... ...if not, you can ignore it :-)... I worked my way up to 300...25 mg at a time...and somewhat reluctantly (although at my choice), once I was above 200mg (some crazy notion of mine, that that should CERTAINLY be enough)...I found that each 25mg added, brought me just a bit closer to feeling "OK"... and when I hit 300mg...it just felt right. I don't know if everyone senses a difference in such small increments...but if you're tuned into your body and you're not feeling "right" yet at 150mg...but tolerating the drug well, I'd suggest it to your Doc. Best of luck to you. ....Rita
Posted by Snowdancer on July 1, 2000, at 21:20:11
In reply to Re: Effexor-side effects, posted by Rita on July 1, 2000, at 20:20:31
> >
> > PS: Cindy, after 3 months at 150 mg effexor is not quite doing it for me, did you notice a difference when u jumped to 275mg, was it a big improvement? Just wondering if I should suggest going higher on the dosage to my dr.... thx! Snowdancer
>
> Snowdancer: You didn't ask me, but thought an answer might be helpful anyway... ...if not, you can ignore it :-)... I worked my way up to 300...25 mg at a time...and somewhat reluctantly (although at my choice), once I was above 200mg (some crazy notion of mine, that that should CERTAINLY be enough)...I found that each 25mg added, brought me just a bit closer to feeling "OK"... and when I hit 300mg...it just felt right. I don't know if everyone senses a difference in such small increments...but if you're tuned into your body and you're not feeling "right" yet at 150mg...but tolerating the drug well, I'd suggest it to your Doc. Best of luck to you. ....Ritawell thanks Rita! I really appreciate your advice!
I will talk to my doctor about upping my dosage then. Have you by chance lost any weight with this med? I was on and off prozac for eight yrs and gained quite a bit of weight with it and my dr says that effexor has weight loss as a side effect. just curious. Thanks again! XOXOXO
Posted by Rita on July 1, 2000, at 21:56:27
In reply to Re: Effexor-side effects » Rita , posted by Snowdancer on July 1, 2000, at 21:20:11
> well thanks Rita! I really appreciate your advice!
> I will talk to my doctor about upping my dosage then. Have you by chance lost any weight with this med? I was on and off prozac for eight yrs and gained quite a bit of weight with it and my dr says that effexor has weight loss as a side effect. just curious. Thanks again! XOXOXOHi again...no, I didn't lose weight; but I had a complication (fibromyalgia) which meant I couldn't exercise ...however; I didn't gain any on it...even after I got a handle on the fibromyalgia...so that's a plus! and that's with a real MINIMUM of exercise...so, perhaps if you're good about routine workouts, you might get lucky and enjoy that positive side effect of losing weight!
Posted by Lesley on July 1, 2000, at 22:46:05
In reply to Re: Effexor-side effects » Lesley, posted by Snowdancer on June 30, 2000, at 22:36:05
> OH Most definately! People call them everything from
> brain spikes to nerve spikes in the brain to brain
> flashes, oh it's unreal! We all no exactly what
> the other person is trying to describe as soon as they
> start! It's unreal, I hated going back on this med
> after all the he!! I went through while going off
> it, and never went through any of it with prozac. My
> dr blew a gasket when I took myself off though and
> a couple mo later told me to go back on it so I did
> since I was in the hptl due to crashing hard and
> trying to od. I really had to listen to his advice
> at that point and to keep my husband satisfied. yes
> I remember all to well the dizzy episodes where I
> would just turn my head or even move my eyes from
> one object to another and get them brain flashes,
> nerve spikes, what ever they are! And the sweating
> is horrid not to mention the nightmares. I think
> I'm better off not taking this stuff but then I
> hit rock bottom when coming off it. The only reason
> I quit prozac (my miracle pill!) was my body seemed
> to build up a tolerance to it and I gained 30 lbs.
> which added to my depression ofcourse! Well good
> luck to you, feel free to email me if you have any
> addl questions! snowdancer@ameritech.net :)
Its been 3 days since quitting Effexor and 1 week since my really bad day. I've been taking 20 mg prozac again. This morning the head zaps started again with tingling down my arm. My husband convinced me to take 37mg effexor and see if it relieved the problem and it did after about an hour. But I'm not sure I should be taking both meds at the same time and I also want to quit effexor altogether.
I found a website, Health-center.com, that also had a site for Effexor withdrawals, as a matter of fact, there were 30 pages of comments from people that have experienced all these same things. I printed it out & am going to take it to my doctor as proof that other people experience these same symptoms.
Posted by Snowdancer on July 1, 2000, at 22:56:07
In reply to Re: Effexor-side effects, posted by Lesley on July 1, 2000, at 22:46:05
>
> > OH Most definately! People call them everything from
> > brain spikes to nerve spikes in the brain to brain
> > flashes, oh it's unreal! We all no exactly what
> > the other person is trying to describe as soon as they
> > start! It's unreal, I hated going back on this med
> > after all the he!! I went through while going off
> > it, and never went through any of it with prozac. My
> > dr blew a gasket when I took myself off though and
> > a couple mo later told me to go back on it so I did
> > since I was in the hptl due to crashing hard and
> > trying to od. I really had to listen to his advice
> > at that point and to keep my husband satisfied. yes
> > I remember all to well the dizzy episodes where I
> > would just turn my head or even move my eyes from
> > one object to another and get them brain flashes,
> > nerve spikes, what ever they are! And the sweating
> > is horrid not to mention the nightmares. I think
> > I'm better off not taking this stuff but then I
> > hit rock bottom when coming off it. The only reason
> > I quit prozac (my miracle pill!) was my body seemed
> > to build up a tolerance to it and I gained 30 lbs.
> > which added to my depression ofcourse! Well good
> > luck to you, feel free to email me if you have any
> > addl questions! snowdancer@ameritech.net :)
>
>
> Its been 3 days since quitting Effexor and 1 week since my really bad day. I've been taking 20 mg prozac again. This morning the head zaps started again with tingling down my arm. My husband convinced me to take 37mg effexor and see if it relieved the problem and it did after about an hour. But I'm not sure I should be taking both meds at the same time and I also want to quit effexor altogether.
> I found a website, Health-center.com, that also had a site for Effexor withdrawals, as a matter of fact, there were 30 pages of comments from people that have experienced all these same things. I printed it out & am going to take it to my doctor as proof that other people experience these same symptoms.That's a great idea! I hate to tell you this but
when I stopped my effexor the first time, I went
from 150mg to 75mg for a week and a half then 37mg
for the last week and I STILL went through pure
he!! going off it slowly like that... I'd say
you have two choices, go off it slowly and still
go through the withdrawls or cold turkey, which
I also did once and pure he!! but like I told my
husband, "I just want this sh!t out of me!!!"
damned if we do and damned if we don't unfortunately,
I feel for you, I would love to go back on prozac
but my system built up a tolerance to it and it
just stopped working after years of relief from the
black hole... God I wish you all the luck, I would
like to think that taking the 20mg of prozac would
help relieve some of the withdrawl symptoms but
maybe because they are two different types of ad's
that is why it does not help. Wish I could help
you more, I SURE know what you are going through...
good luck and keep me posted please! >> SD
Posted by Cindy W on July 3, 2000, at 9:11:03
In reply to Re: Effexor-side effects » Cindy W, posted by Snowdancer on July 1, 2000, at 16:41:47
> > > > I started Effexor about 2 months ago and was up to 150mg day and I was also already taking Trazodone for sleep. I had about a half a dozen days where I would get a wierd dizziness off and on throughout the day. It started up again one night while laying in bed and actually made my eyes roll downward for a second. In the morning, the "episodes of dizziness" progressed to the point where it was happening constantly. It was almost like an electical charge in my brain and getting dizzy was an after-effect of these charges. It got to the point where I was feeling tingling down my right arm to my palm & fingertips whenever I got the "charges". I slowly discontinued using Effexor and I've been back on Prozac for a couple days now and I've never had any side effects from that. Has anybody ever had this type of experience with Effexor?
> > > >
> > > > I also have nightmares (waking up with my fists clenched), night sweats and see "trails" sometimes
> > >
> > > Hello again. As Snowdancer mentioned, I too can relate to the various side effects you mentioned. For me, most of them went away after several weeks; but would return briefly if I changed the dose, missed a dose, or got over stressed/tired. The teeth clenching has persisted, but apparently not as bad as yours. Flexeril (at night) might help....it's a muscle relaxant and helped me with both the teeth clenching and the muscle jerks/spasms. Have been getting off the drug over the past few weeks... Starting at 275mg, began cutting back (with doctor's permission) by 25mg/week...now down to 100mg and still OK. Tried to stop before by cutting back 50mg/day (the size of my pills)...disaster!! Like someone else said...scared me back on. Now I use a pill cutter and every time I cut back, I readajust to make sure I spread the remaining dose as evenly over each 24 hour period as possible. Best of luck to all of you. Effexor's a good drug; works when many others don't; however, it has it's own idiosyncracies and doesn't work for everyone (like Prozac didn't work for me). Trust your doctor and your body! ... Rita
> >
> > Hello! i feel so lucky, because i take Effexor 275 mg/day and it doesn't bother me in any way. Hope you find the right thing!
>
> PS: Cindy, after 3 months at 150 mg effexor is not quite doing it for me, did you notice a difference when u jumped to 275mg, was it a big improvement? Just wondering if I should suggest going higher on the dosage to my dr.... thx! Snowdancer
Snowdancer, I noticed changes from Effexor-XR during the first week. I did feel better as the dosage increased, though. Talk to your pdoc and see if that's a good idea for you. Good luck!
Posted by Libby on July 3, 2000, at 11:36:16
In reply to Re: Effexor-side effects, posted by Lisa on January 8, 1999, at 9:54:52
Lisa wrote...
> I have found it hard to write and my mind starts racing a lot lately. I really do not want to stop taking Effexor because I haven't felt this good in years, but the side effects are wearing down on me. It's almost like I have two choices Mental health or physical health.<This is what I started to feel like after my doc increased my dose of Effexor XR from 150 mg/day to 300 mg/day. In my case, the sleep problems were definitely dose-dependent. Stepping the
dose back down (GRADUALLY) has helped. My moods are still good and I can sleep again... Effexor alone didn't help my concentration problems... If anything, they got WORSE at higher doses... You might ask your doc about taking something else for those symptoms.It turns out that I may be ADD, as well as depressed... I just started taking Ritalin and that has helped a great deal in just a few days. Even if you're not ADD, drugs, like Ritalin, Wellbutrin, ProVigil, and Adderall, for
instance that can improve concentration, even
in depressed people without ADD...Best of luck...
L.
Posted by Sunnely on July 4, 2000, at 23:15:54
In reply to Re: Effexor-side effects, posted by Lesley on June 30, 2000, at 19:21:45
If you have missed a dose or two of Effexor, chances are you are experiencing withdrawal symptoms. Unfortunately, Effexor seems to provoke the most rapid and nasty withdrawal symptoms among the new generation of antidepressants. Dizziness, vertigo, insomnia, agitation, "shock-like" sensations, flu-like symptoms are not uncommon withdrawal symptoms of Effexor.
Prozac, with its serotonin effect, usually alleviates the withdrawal symptoms of Effexor. It is OK to combine the two drugs and then gradually taper down the dose of Effexor to comfortable level until it is completely stopped.
Increased sweating (and nightmares) have been reported with the use of SSRIs (Prozac, Zoloft, and others) and Effexor. The "trails" you sometimes see are most likely due to trazodone. Other visual disturbances reported with the use of trazodone are "seeing again" medically termed palinopsia, and "ghost shadows." These visual disturbances are believed to be dose-dependent, so cutting down the dose of trazodone may help alleviate this problem. FYI, with the addition of Prozac, your blood level of trazodone may rise due to Prozac's inhibiting effect on the liver enzymes that trazodone depend on. BTW, these visual phenomena have also been reported with the use of Serzone (nefazodone), which is structurally related to trazodone.
Posted by Cindy W on July 5, 2000, at 0:01:25
In reply to Re: Effexor-side effects, posted by Sunnely on July 4, 2000, at 23:15:54
> If you have missed a dose or two of Effexor, chances are you are experiencing withdrawal symptoms. Unfortunately, Effexor seems to provoke the most rapid and nasty withdrawal symptoms among the new generation of antidepressants. Dizziness, vertigo, insomnia, agitation, "shock-like" sensations, flu-like symptoms are not uncommon withdrawal symptoms of Effexor.
>
> Prozac, with its serotonin effect, usually alleviates the withdrawal symptoms of Effexor. It is OK to combine the two drugs and then gradually taper down the dose of Effexor to comfortable level until it is completely stopped.
>
> Increased sweating (and nightmares) have been reported with the use of SSRIs (Prozac, Zoloft, and others) and Effexor. The "trails" you sometimes see are most likely due to trazodone. Other visual disturbances reported with the use of trazodone are "seeing again" medically termed palinopsia, and "ghost shadows." These visual disturbances are believed to be dose-dependent, so cutting down the dose of trazodone may help alleviate this problem. FYI, with the addition of Prozac, your blood level of trazodone may rise due to Prozac's inhibiting effect on the liver enzymes that trazodone depend on. BTW, these visual phenomena have also been reported with the use of Serzone (nefazodone), which is structurally related to trazodone.Sunnely, i agree with what you wrote...sounds like a missed dose of Effexor to me! Also, the visual trails happened to me with serzone (in fact, i kind of miss them! they were kind of fun!) but have disappeared since i'm now only taking 50-75 mg/night of serzone (since i'm cutting the pills up, it's hard to tell exactly the dose, but no more visual trails).
Posted by Sunnely on July 5, 2000, at 22:26:57
In reply to Re: Effexor-side effects, posted by Cindy W on July 5, 2000, at 0:01:25
Dear Cindy,
I'm glad to hear that your visual "trails" have disappeared. (Or may be not, since you seemed to be having fun with them.) :)
Watch for drug interactions with Serzone. Certain drugs may raise the blood level of Serzone and cause a return of the visual trails even though you're keeping same dose. These drugs include: certain antibiotics such as erythromycin and Cipro; antidepressants such as Prozac and Luvox; antifungal drugs such as Nizoral and Sporanox; Tagamet for ulcer. Avoid grapefruit juice, too. Propulsid (cisapride), drug for stomach reflux, should not be combined with Serzone. Serious medical consequences may occur including sudden death. (This drug should be off the market by now, anyway.)
Happy "trails" to you. ;)
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
> Sunnely, i agree with what you wrote...sounds like a missed dose of Effexor to me! Also, the visual trails happened to me with serzone (in fact, i kind of miss them! they were kind of fun!) but have disappeared since i'm now only taking 50-75 mg/night of serzone (since i'm cutting the pills up, it's hard to tell exactly the dose, but no more visual trails).
Posted by Cindy W on July 5, 2000, at 23:44:21
In reply to Re: Effexor-side effects, posted by Sunnely on July 5, 2000, at 22:26:57
> Dear Cindy,
>
> I'm glad to hear that your visual "trails" have disappeared. (Or may be not, since you seemed to be having fun with them.) :)
>
> Watch for drug interactions with Serzone. Certain drugs may raise the blood level of Serzone and cause a return of the visual trails even though you're keeping same dose. These drugs include: certain antibiotics such as erythromycin and Cipro; antidepressants such as Prozac and Luvox; antifungal drugs such as Nizoral and Sporanox; Tagamet for ulcer. Avoid grapefruit juice, too. Propulsid (cisapride), drug for stomach reflux, should not be combined with Serzone. Serious medical consequences may occur including sudden death. (This drug should be off the market by now, anyway.)
>
> Happy "trails" to you. ;)
>
> +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
>
> > Sunnely, i agree with what you wrote...sounds like a missed dose of Effexor to me! Also, the visual trails happened to me with serzone (in fact, i kind of miss them! they were kind of fun!) but have disappeared since i'm now only taking 50-75 mg/night of serzone (since i'm cutting the pills up, it's hard to tell exactly the dose, but no more visual trails).Sunnely, happy trails to you too!
Posted by SLS on July 6, 2000, at 7:38:08
In reply to Re: Effexor-side effects, posted by Sunnely on July 5, 2000, at 22:26:57
Dear Sunnely,
This is great information.
I am curious about the grapefruit juice. What kind of interaction occurs?
Also, can you describe in a bit more detail the interaction between Propulsid and Serzone?
Thanks.
- Scott
> Watch for drug interactions with Serzone. Certain drugs may raise the blood level of Serzone and cause a return of the visual trails even though you're keeping same dose. These drugs include: certain antibiotics such as erythromycin and Cipro; antidepressants such as Prozac and Luvox; antifungal drugs such as Nizoral and Sporanox; Tagamet for ulcer. Avoid grapefruit juice, too. Propulsid (cisapride), drug for stomach reflux, should not be combined with Serzone. Serious medical consequences may occur including sudden death. (This drug should be off the market by now, anyway.)
Posted by Sunnely on July 6, 2000, at 19:45:54
In reply to Re: Effexor-side effects » Sunnely, posted by SLS on July 6, 2000, at 7:38:08
Dear Scott,
Your question deals with drug-drug (or food) interactions.
When drugs are taken concurrently, drug-drug interactions are bound to occur. Fortunately, most do not lead to any clinical importance or just mild discomfort. Unfortunately, some interactions lead to serious consequences, including death. Others lead to loss of effectiveness of one or more drugs involved.
The interaction between grapefruit juice and Serzone mainly involves the type called "pharmacokinetic." (The other type is "pharmacodynamic.") When a drug is taken is taken orally, four major processes of pharmacokinetics are involved: 1. absorption (gastrointestinal tract), 2. distribution, 3. metabolism, and 4. excretion. It is the stage of metabolism where most of the major drug interactions occur, mainly involving the liver.
In the liver, there are several enzymes that play a big role in the break down of different drugs. Prominent among these liver enzymes are the ones called "cytochrome P450," enzymes (CYP for short). Although there are several CYPs known so far, only about 5 major ones are involved in the metabolism of different drugs, including the psychotropic drugs. Included among these CYPs is the enzyme called CYP3A4.
CYP3A4 is involved in the metabolism (breakdown) of Serzone. Therefore, it is a "substrate" of this enzyme. Grapefruit juice markedly inhibits the action of this enzyme. Therefore, it is an "inhibitor" of this enzyme. Inhibition of this enzyme leads to a decrease in the metabolism of the "substrate" of this enzyme. This leads to an increase in the blood level of the "substrate" which in turn leads to an increase in the "substrate's" side effects or toxicity. In short, Serzone (substrate of CYP3A4) + grapefruit juice (inhibitor of CYP3A4) ---> decreased metabolism of Serzone ---> increased Serzone blood level ---> increased side effects or toxicity from Serzone.
The same mechanism is involved with drug-drug interaction between Serzone and Propulsid. This time it is the Serzone that is doing the inhibition (same liver enzyme involved, CYP3A4). FYI, Serzone is both a "substrate" and an "inhibitor" of CYP3A4. Propulsid is a "substrate" of CYP3A4. Excess blood levels of Propulsid resulting from interactions with other drugs have been reported to cause serious heart rhythm irregularities including sudden death. I believe there were about 80 deaths reported from these interactions. Most of these reports came from drug-drug interactions with Propulsid and other drugs that inhibit CYP3A4 such as the antibiotic erythromycin, and the antifungals (Nizoral, Sporanox). Since Serzone is a marked inhibitor of CYP3A4, serious drug interaction with Propulsid is possible, although I have not read in the literature deaths from this particular interaction. This is the reason why the drug company (Janssen) was forced to take this drug off the (US) market. Incidentally, for what it's worth, at one point, Pres. Clinton was on Propulsid for GERD.
FYI, Seldane and Hismanal, both nonsedating antihistamines, were taken off the market for similar reason as Propulsid. There were approximately 120 deaths related to drug-drug interactions involving these drugs.
For more info on Grapefruit Juice Drug Interactions, check out this excellent website created by a Canadian Pharmacist: http://powernetdesign.com/grapefruit/
Good Luck.
===========================================================================
> Dear Sunnely,
>
> This is great information.
>
> I am curious about the grapefruit juice. What kind of interaction occurs?
>
> Also, can you describe in a bit more detail the interaction between Propulsid and Serzone?
>
> Thanks.
>
>
> - Scott
>
>
> > Watch for drug interactions with Serzone. Certain drugs may raise the blood level of Serzone and cause a return of the visual trails even though you're keeping same dose. These drugs include: certain antibiotics such as erythromycin and Cipro; antidepressants such as Prozac and Luvox; antifungal drugs such as Nizoral and Sporanox; Tagamet for ulcer. Avoid grapefruit juice, too. Propulsid (cisapride), drug for stomach reflux, should not be combined with Serzone. Serious medical consequences may occur including sudden death. (This drug should be off the market by now, anyway.)
Posted by SLS on July 7, 2000, at 6:46:54
In reply to Re: Effexor-side effects, posted by Sunnely on July 6, 2000, at 19:45:54
Hi Sunnely.
Thanks for the explanation.
This whole grapefruit thing is news to me. I wonder to what degree similar drug interactions with other foods have gone unrecognized. Thanks for the URL.
Regarding the differences between the interactions of GJ and Serzone versus Serzone and Propulsid, are these explained by differences in binding affinity or some other form of competition for enzyme sites?
1. Does GJ bind more tightly than Serzone bind more tightly than Propulsid to CYP?
2. Is there a difference between "competition" and "inhibition"? Is an inhibitor catalyzed at the site it is inhibiting?
Are you are involve professionally in the medical field? I'm not, but I guess I like to pretend sometimes.
I didn't know that Seldane was discontinued. Heart conduction stuff?
- Scott
Posted by Sunnely on July 7, 2000, at 23:30:32
In reply to Re: Effexor-side effects, posted by SLS on July 7, 2000, at 6:46:54
Hi Scott,
You do ask tough questions.
Let me see...
There are many types of CYP inhibition. The following are two of the most common types: 1) "competitive" - 2 drugs compete for the same binding site with only one being metabolized (with enough drug one can overcome the inhibition); and 2) "mechanism-based" - the metabolites of the drugs such as cimetidine (Tagamet) or erythromycin (E-mycin) complex with and tie up the CYP.
Both grapefruit juice and Serzone are marked inhibitors of a specific CYP called CYP3A4. I don't know which one inhibits CYP3A4 the most. (Since both are considered marked inhibitors of this CYP, this is probably immaterial.)
"Competitive inhibition" is one of the 2 most common types of antagonizing the action of CYP. The other one is via "mechanism-based" inhibition. (See explanation above). Yes, it is possible that an inhibitor of a specific CYP is also catalyzed (substrate) by the same CYP. There are drugs that are, at the same time "substrates" and "inhibitors" of a specific CYP. For example, Paxil is a "substrate" of CYP2D6 and at the same time an "inhibitor" of this particular CYP. In effect, Paxil is inhibiting its own metabolism. This phenomenon is called "autoinhibition." On the other hand, there are drugs that are "substrates" of a specific CYP and at the same time "inducers" of the same CYP. For example, Tegretol is a "substrate" of CYP3A4 and an "inducer" of this same CYP. In short, Tegretol is inducing its own metabolism. This phenomenon is called "autoinduction." This is the reason why, after several weeks, the blood level of Tegretol tends to decline even if the dose and all other factors remain the same. There are also drugs that are "substrates" of a specific CYP and "inhibitors" of another CYP. This is exemplified by quinidine, a heart drug. There are also drugs that are "substrates" of several CYPs at the same time. There are also drugs that are "inhibitors" of several CYPs at the same time. There are also drugs that are "inducers" of several CYPs at the same time. This CYP busines is too complex to explain. Remember, there are close to 3 dozen human CYP isoenzymes discovered so far (the number still growing), yet we only know very few of them as to how they work.
Yes, Seldane and Hismanal have been off the market (US) due to serious heart conduction problem. They tend to cause electrocardiogram abnormality called "prolongation of QT" interval which can potentially cause serious heart rhythm irregularity called "torsades" and sudden death. (Fexofenadine, an active metabolite of Seldane, without the heart effect, is now available. It is probably more popularly known as Allegra.)
Yes, same stuff with Propulsid (cisapride), that heart "thingie."
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
> Hi Sunnely.
>
> Thanks for the explanation.
>
> This whole grapefruit thing is news to me. I wonder to what degree similar drug interactions with other foods have gone unrecognized. Thanks for the URL.
>
> Regarding the differences between the interactions of GJ and Serzone versus Serzone and Propulsid, are these explained by differences in binding affinity or some other form of competition for enzyme sites?
>
> 1. Does GJ bind more tightly than Serzone bind more tightly than Propulsid to CYP?
>
> 2. Is there a difference between "competition" and "inhibition"? Is an inhibitor catalyzed at the site it is inhibiting?
>
> Are you are involve professionally in the medical field? I'm not, but I guess I like to pretend sometimes.
>
> I didn't know that Seldane was discontinued. Heart conduction stuff?
>
>
> - Scott
Posted by SLS on July 8, 2000, at 9:02:12
In reply to Re: Effexor-side effects » SLS, posted by Sunnely on July 7, 2000, at 23:30:32
> You do ask tough questions.
It's a gift.
Thanks for your wonderfully detailed explanation. I hope to see you around.
- Scott
Posted by Carol on November 24, 2000, at 20:46:41
In reply to Re: Effexor-side effects, posted by Orin on May 18, 2000, at 21:43:42
I have been on effexor for about 8 or 9 months now, and wow, haveI ever gained weight. About 50 pounds in that time period. Now, that's depressing!! I have also discovered I have fibromyalgia and haven't been able to exercise much. I am not sure which is to blame for the weight gain. Has anyone else experienced weight gain with effexor?
Posted by Shannon on January 29, 2001, at 21:43:26
In reply to Re: Effexor-side effects, posted by Orin on May 18, 2000, at 21:43:42
I HAVE BEEN ON EFFEXOR NOW FOR 5 MONTHS AND IT HAS WORKED VERY WELL FOR ME. COULD ANYONE TELL ME IF THEY HAVE EXPERIENCED HAIR LOSS. IT CONSTANTLY COMES OUT WHEN I BRUSH IT AND I HAD NEVER NOTICED THAT BEFORE. ALSO DO YOU GRADUALLY INCREASE THE DOSAGE EVENTUALLY.
Posted by normama on February 9, 2001, at 20:40:24
In reply to Re: Effexor-side effects, posted by Shannon on January 29, 2001, at 21:43:26
> I HAVE BEEN ON EFFEXOR NOW FOR 5 MONTHS AND IT HAS WORKED VERY WELL FOR ME. COULD ANYONE TELL ME IF THEY HAVE EXPERIENCED HAIR LOSS. IT CONSTANTLY COMES OUT WHEN I BRUSH IT AND I HAD NEVER NOTICED THAT BEFORE. ALSO DO YOU GRADUALLY INCREASE THE DOSAGE EVENTUALLY.
I have been on EffexorXR for 3 weeks (75mg)and have developed an incredibly itchy scalp. I had this happen to me a few years back when I was taking phenfen. Eventually my hair began to fall out. Once I stopped the phenfen the itching stopped and my hair grew back. I'm afraid it's happening again with the Effexor. I hate to stop taking it since it is working well for my depression. Has anyone else had this side effect?
Posted by Ryan on February 19, 2001, at 23:37:17
In reply to Re: Effexor-side effects » Shannon, posted by normama on February 9, 2001, at 20:40:24
> > I HAVE BEEN ON EFFEXOR NOW FOR 8 MONTHS AND IT IS THE ONLY AD THAT HAS WORKED FOR ME. I TAKE 300MG EVERY MORNING. I AM HAVING TROUBLESOME SIDE EFFECTS HOWEVER. ITCHING SCALP, WEIGHT GAIN, ABSOLUTELY NO ENERGY, AND INSOMNIA. IF ANYONE HAS ADVICE OR KNOWS OF A BETTER AD PLEASE LET ME KNOW.
Posted by Lorraine on February 20, 2001, at 9:45:10
In reply to Re: Effexor-side effects » normama, posted by Ryan on February 19, 2001, at 23:37:17
> > > I HAVE BEEN ON EFFEXOR NOW FOR 8 MONTHS AND IT IS THE ONLY AD THAT HAS WORKED FOR ME. I TAKE 300MG EVERY MORNING. I AM HAVING TROUBLESOME SIDE EFFECTS HOWEVER. ITCHING SCALP, WEIGHT GAIN, ABSOLUTELY NO ENERGY, AND INSOMNIA. IF ANYONE HAS ADVICE OR KNOWS OF A BETTER AD PLEASE LET ME KNOW.
Re insomnia--when do you take your dose and is it a split dose. I have to take mine early in the morning and I take GABA (a natural enzime you can get at the health food store) before bed to help me sleep.
Re energy and weight gain--perhaps your pdoc will augment with amphetamine or Wellbutrin which may counter balance these effects. You may be able to lower your dose of effexor in this event as well. Good luck.
Posted by Ryan on February 21, 2001, at 22:42:53
In reply to Re: Effexor-side effects, posted by Lorraine on February 20, 2001, at 9:45:10
Thank you for the reply Lorraine. I am starting Wellbutrin SR 150mg. and Sonata today.
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