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1088Re: [METHADONIA ] grapefruit juice and methadone& Tagamet(cimethedine)

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  • odubya
    Jan 19, 2004
      Hey Folks~ While we are finsihing up with this topic I felt I might
      as well contribute some more that has to do with the subject of
      affecting your dose positively..( that IS the point of this, isn't
      it?) OH, and a very special thanks to the poster who put all the
      technical information about this on the board. There's a soul close
      to my heart! OK, since almost the onset of mmt I heard about Tagamet
      (Cimethedine) affecting your dose. When someone I know was refused a
      needed increase in their methadone they started taking these on a
      daily basis. They DO increase the strength of your dose from my
      experience. Each person is different but they were taking 10 tablets
      15 minutes before dosing. That was probably more than enough. When
      they first started taking them they had different effects depending
      on the time they took them. Sometimes they got sleepy if they took
      them too early or too late. But that went away with time. The only
      negative effect they got from taking all these was it messed with
      their blood cell levels. THis was found out from a blood test. They
      finally got the increase and didn't have to take them anymore and
      everything returned to normal(as far as the blood cells) So this does
      work but the timing and amount will change from person to
      person..Just use caution as with everything..Have a great day! OW




      --- In DOLOPHINEA_CAFE@yahoogroups.com, "Dann White" <dannw87@e...>
      wrote:
      > Well my Mrs. certainly must have known what she was talking about-
      she likes
      > the Ruby Red Tropicana but that is white GF juice with Grape juice
      added
      > for color-didn't know such an offhand remark could get such a
      response
      >
      > Dann and Elizabeth (The Florida Grapefruit Juice Girl)
      >
      >
      > > [Original Message]
      > > From: James <friendlyfarmer2001@y...>
      > > To: <DOLOPHINEA_CAFE@yahoogroups.com>
      > > Cc: <friendlyfarmer2001@y...>
      > > Date: 1/15/2004 3:39:15 PM
      > > Subject: Re: [METHADONIA ] grapefruit juice and methadone
      > >
      > > Now there Ms.ssv55 this is indeed some wonderfull news
      > > if it's true,I thank you for the 'post of the month'
      > > and will give a follow up Sunday and tell all if
      > > indeed this "white grapefruit " advice did in fact
      > > work on me !
      > > Thanks,
      > > Jim/friendlyfarmer2001
      > >
      > > --- ssv55@e... wrote:
      > > > Hello Dann and RG,
      > > > White grapefruit juice also affects drug metabolism.
      > > > Some patients
      > > > have had
      > > > good results potentiating an inadequate dose by
      > > > drinking 8 ozs. of
      > > > WHITE
      > > > grapefruit juice when dosing.  I found this info at
      > > > the following
      > > > URL:
      > > >
      > > > http://www.vhpharmsci.com/document/Article22.htm
      > > >
      > > > When ingested together, grapefruit juice can
      > > > interact with various
      > > > medications, resulting in potentially toxic drug
      > > > levels and
      > > > adverse effects.
      > > >
      > > > Certain bioflavonoids contained in citrus juices can
      > > > affect drug
      > > > metabolism.
      > > > The major bioflavonoid in grapefruit juice is
      > > > naringin, which is
      > > > partially metabolized
      > > > by enteral bacteria to form naringenin.1,2
      > > > Naringenin is a potent
      > > > inhibitor of the
      > > > cytochrome p450 liver enzymes: CYP1A2, CYP3A3 and
      > > > CYP3A4. There is
      > > > however,considerable inter-individual variability in
      > > > the effects of
      > > > grapefruit juice on
      > > > drug metabolism, in part due to :
      > > > 1) amount of naringenin formed by an individual,
      > > > 2) amount of naringin present in a brand of
      > > > grapefruit juice,
      > > > 3) dilution of grapefruit juice used, and
      > > > 4) other substances in grapefruit juice accounting
      > > > for the
      > > > interaction.
      > > >
      > > > Table 4 lists drugs whose levels may significantly
      > > > increase if given
      > > > concomitantly with grapefruit juice. CSU
      > > > Pharmaceutical Sciences will
      > > > place a label
      > > > stating "Do not take with grapefruit juice" if a
      > > > patient is ordered
      > > > any drug listed
      > > > below.
      > > >
      > > > Table 4. Grapefruit Juice-Drug Interactions
      > > >
      > > > Drug
      > > >                            
      > > >            
      > > > Dihydropyridine Calcium Channel Blockers:
      > > > -amlodipine†
      > > > -felodipine
      > > > -nicardipine
      > > > -nifedipine†
      > > > AVOID grapefruit juice OR monitor for decreased BP,
      > > > increased HR if
      > > > taken together
      > > >
      > > > Terfenadine
      > > > AVOID grapefruit juice as may result in
      > > > cardiotoxicity (prolonged QT
      > > > interval)
      > > >
      > > > Cyclosporine†
      > > >  AVOID grapefruit juice, unless prescribed to
      > > > specifically
      > > > increase cyclosporine levels
      > > >
      > > > HMG-CoA Reductase Inhibitors (Statins)‡:
      > > > -atorvastatin
      > > > -cerivastatin
      > > > -lovastatin
      > > > -simvastatin†
      > > > AVOID grapefruit juice as potential for myopathy or
      > > > rhabdomyolysis¶
      > > >
      > > > Cisapride†
      > > >  AVOID grapefruit juice as potential for
      > > > cardiotoxicity (torsades
      > > > de pointes, prolonged
      > > > QT interval)¶
      > > >
      > > > Benzodiazepines
      > > > -triazolam
      > > > -oral midazolam†
      > > > AVOID grapefruit juice or monitor for increased
      > > > sedation if used
      > > > together
      > > >
      > > > Quinidine†
      > > > AVOID; significance unknown
      > > >
      > > > Saquinavir
      > > > AVOID; signficance unknown
      > > >
      > > > Estrogens
      > > > -ethinyl estradiol†
      > > > -17ß estradiol
      > > > AVOID - significance unknown
      > > > ====================================================
      > > > ====================================================
      > > >  http://www.atforum.com/pages/current_pastissues
      > > > /Vol6s97.html#anchor649123
      > > >
      > > >
      > > >
      > > >
      > > >
      > > >
      > > >
      > > > OTC Drugs, Juice, Vitamins
      > > > John St. Peter, PharmD, BCPS - Pharmacist in Charge
      > > > for HFA, and
      > > > Assistant Professor,
      > > > College of Pharmacy at the University of Minnesota -
      > > > has previously
      > > > expressed
      > > > concern in Addiction Treatment Forum (Vol. IV, #2)
      > > > about the
      > > > potential interactions of
      > > > methadone with OTC medications, tobacco, and
      > > > caffeine. He noted, for
      > > > example, that
      > > > acetaminophen (e.g., Excedrin®, Tylenol®) has
      > > > inherent
      > > > toxicities which can affect
      > > > hepatic drug metabolism and impact methadone blood
      > > > levels.
      > > > St. Peter and his clinical team have also observed
      > > > that there are
      > > > drug metabolism
      > > > differences between ethnic groups, such as Asians,
      > > > Caucasians, and
      > > > African-
      > > > Americans. Age also plays a role affecting changes
      > > > in drug
      > > > metabolism. Other sources
      > > > have noted that some persons are naturally "aberrant
      > > > metabolizers"
      > > > and "burn away"
      > > > methadone up to four times faster than others. The
      > > > specific roles of
      > > > these differences
      > > > regarding methadone metabolism, however, are still
      > > > under
      > > > investigation by the HFA
      > > > team.
      > > > There has been some mention, often anecdotally, of
      > > > grapefruit juice
      > > > intensifying
      > > > methadone's effects when the two are regularly taken
      > > > together.
      > > > According to
      > > > Andersen and Payte, grapefruit juice appears to
      > > > inhibit certain
      > > > enzymes (CYP-450
      > > > activity) that metabolize methadone in the liver,
      > > > thus slowing its
      > > > breakdown. Hence,
      > > > higher blood plasma levels of methadone than
      > > > expected might possibly
      > > > result. Some
      > > > sources have attributed naturally high
      > > > concentrations of flavonoids
      > > > in grapefruit juice
      > > > as producing this effect.
      > > > Contrary to current myth, there is no accepted
      > > > evidence that orange
      > > > juice produces
      > > > similar potentiating effects. However, Payte
      > > > mentions that large
      > > > doses of vitamin C
      > > > (the amount might vary by individual) could create a
      > > > more acidic
      > > > urine leading to
      > > > decreased methadone blood levels. This is because
      > > > the acidic
      > > > condition inhibits
      > > > reabsorption of methadone by the kidneys, so more of
      > > > the drug is lost
      > > > in the urine.
      > > > The plasma half-life of methadone could be reduced
      > > > to as little as
      > > > 16-20 hours in an
      > > > acid urine. Conversely, in an alkaline urine (pH
      > > > 7.8) a half-life of
      > > > 42.1 +/- 8.8 hours
      > > > has been reported
      > > > ====================================================
      > > >
      > > > I have also read that Tagament can increase the
      > > > blood concentration
      > > > of methadone,
      > > >
      > > === message truncated ===
      > >
      > >
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