picking the right medications

[Guest guest]

How exciting, I got back my daughter's pharmogenetic report from

Cincinnati Children's and we found that one class of drugs she

would not respond to well (CYP2C19) but ones in the CYP2D6 class

she would respond well to. She happened to be on a C19 drug.

And her psychiatrist suggested another C19.

I am so hopeful and excited to finally have a method for drug

selections.

This also means that any anagelesics, proton pump inhibitors,

hormones etc in the CYP2C19 class she should avoid and seek

medications from the CYP2D6 class.

I feel finally like there is some hope in finding a anti-depressant

that will help.

I am so excited and hopeful.

Pam

[Guest guest]

I hope this helps you find the meds that work. What wil you try now?

Bonnie

>

> How exciting, I got back my daughter's pharmogenetic report from

> Cincinnati Children's and we found that one class of drugs she

> would not respond to well (CYP2C19) but ones in the CYP2D6 class

> she would respond well to. She happened to be on a C19 drug.

> And her psychiatrist suggested another C19.

>

> I am so hopeful and excited to finally have a method for drug

> selections.

>

> This also means that any anagelesics, proton pump inhibitors,

> hormones etc in the CYP2C19 class she should avoid and seek

> medications from the CYP2D6 class.

>

> I feel finally like there is some hope in finding a anti-depressant

> that will help.

>

> I am so excited and hopeful.

>

> Pam

>

[Guest guest]

Pam,

That's great! Let us know how it goes! I would be interested in having

my daughter tested as well.

Dina

>

[Guest guest]

We just got the report today, and it only test 2 of the most

common pathways the CYP2D6 drugs (she was an excellent metabolizer)

and CYP2C19 (poor). There are other drug paths too.

So it would be best if we tried CYP2D6 only pathway drugs for my daughter since

we know she does well on those. Prozac is one

of them. Clinical trials at Mount Sinai show kids with ASD

do well on it, so perhaps this would be one.

The other pathways I am going to try to reverse engineer,

I know my daughter does better with motrin than tylenol

for fever reducing, I am going to suspect that the drugs

in the motrin class too may be better choices.

Here is the chart, you can see that if your child has had a

positive response to certain cough medications or anti-histimines

you can perhaps figure out other classes. And if there

has been a poor response you can avoid those classes too.

Motrin is a CYP2C9 drug pathway.

Tylenol is a CYP1A2 drug pathway.

So I am also going to guess my daughter will do better on C9 drugs.

Since tylenol dosesn't work as well as motrin.

Adderall and Strattera are P2D6 drugs, if we wanted to try

these it would be ok, since she does have attentional issues

too.

NyQuil is a CYPC9 pathway drug, as is Robitussin DM.

I would expect her not to have a bad reaction to this.

15%GRED drugs prevacid, prilosec are CYPC9, so we won't ever

try these with her.

http://medicine.iupui.edu/clinpharm/ddis/table.asp

Mayo Clinic has a book Psychiatric Pharmocogenomics

by Dr. Mrazek that I ordered and it has good summaries at

the end of each chapter.

For the majority of people that respond well to medications

these tests are not necessary. But in our family my

husband and daughter have not found a medication to help

reduce anxiety, and the path we were on we would not

have. They both have different psychiatrist but they both

were suggesting new drugs that they would not have been

able to metabolizer.

I am so thankful that our therapist pointed us in the

direction of Mayo Clinic DNA testing.

I hope others are helped too.

Pam

Pam

> >

> > How exciting, I got back my daughter's pharmogenetic report from

> > Cincinnati Children's and we found that one class of drugs she

> > would not respond to well (CYP2C19) but ones in the CYP2D6 class

> > she would respond well to. She happened to be on a C19 drug.

> > And her psychiatrist suggested another C19.

> >

> > I am so hopeful and excited to finally have a method for drug

> > selections.

> >

> > This also means that any anagelesics, proton pump inhibitors,

> > hormones etc in the CYP2C19 class she should avoid and seek

> > medications from the CYP2D6 class.

> >

> > I feel finally like there is some hope in finding a anti-depressant

> > that will help.

> >

> > I am so excited and hopeful.

> >

> > Pam

> >

>

[Guest guest]

also has a good response to motrin when febrile (I use it each time he

has a fever), but was terrible on Prozac? Could be a mood thing. Interesting

though I wish mood stabilizers were on that list.

Bonnie

> > >

> > > How exciting, I got back my daughter's pharmogenetic report from

> > > Cincinnati Children's and we found that one class of drugs she

> > > would not respond to well (CYP2C19) but ones in the CYP2D6 class

> > > she would respond well to. She happened to be on a C19 drug.

> > > And her psychiatrist suggested another C19.

> > >

> > > I am so hopeful and excited to finally have a method for drug

> > > selections.

> > >

> > > This also means that any anagelesics, proton pump inhibitors,

> > > hormones etc in the CYP2C19 class she should avoid and seek

> > > medications from the CYP2D6 class.

> > >

> > > I feel finally like there is some hope in finding a anti-depressant

> > > that will help.

> > >

> > > I am so excited and hopeful.

> > >

> > > Pam

> > >

> >

>

[Guest guest]

Bonnie, that is true for my dd too. She has a great response to Motrin but not

Prozac at all. I wonder how other illnesses play into this. For instance, my dd

is bipolar and Prozac caused her to become severely manic. Does the test just

show that she could be a great responder to Prozac but due to her comorbid

bipolar it is a disaster for her? Pam, I would be careful with Prozac if you

still think your dd may be bipolar. Also, I thought Motrin is a better fever

reducer than Tylenol overall regardless of test results. Stormy

________________________________

To:

Sent: Sat, February 19, 2011 9:46:06 AM

Subject: Re: picking the right medications

also has a good response to motrin when febrile (I use it each time he

has a fever), but was terrible on Prozac? Could be a mood thing. Interesting

though I wish mood stabilizers were on that list.

Bonnie

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..

[Guest guest]

Pam, all very interesting, that's for sharing. I wondered how that test worked,

results and all. So much about meds we (I) don't know, helps to understand why

those drugs in same class won't work for all, etc.

Do keep us updated, this is interesting. Especially when many are sensitive to

meds, could be a good guide for them.

>

> We just got the report today, and it only test 2 of the most

> common pathways the CYP2D6 drugs (she was an excellent metabolizer)

> and CYP2C19 (poor). There are other drug paths too.

>

> So it would be best if we tried CYP2D6 only pathway drugs for my daughter

since we know she does well on those. Prozac is one

> of them. Clinical trials at Mount Sinai show kids with ASD

> do well on it, so perhaps this would be one.

>

[Guest guest]

That's what I would assume too Stormy...that the genetic testing speaks to drug

metabolism and not other mitigating factors such as comorbidities.

>

> Bonnie, that is true for my dd too. She has a great response to Motrin but not

> Prozac at all. I wonder how other illnesses play into this. For instance, my

dd

> is bipolar and Prozac caused her to become severely manic. Does the test just

> show that she could be a great responder to Prozac but due to her comorbid

> bipolar it is a disaster for her? Pam, I would be careful with Prozac if you

> still think your dd may be bipolar. Also, I thought Motrin is a better fever

> reducer than Tylenol overall regardless of test results. Stormy

>

>

>

>

> ________________________________

>

> To:

> Sent: Sat, February 19, 2011 9:46:06 AM

> Subject: Re: picking the right medications

>

>

> also has a good response to motrin when febrile (I use it each time he

> has a fever), but was terrible on Prozac? Could be a mood thing. Interesting

> though I wish mood stabilizers were on that list.

>

> Bonnie

>

>

> MARKETPLACE

> Find useful articles and helpful tips on living with Fibromyalgia. Visit the

> Fibromyalgia Zone today!

>

>

> ________________________________

>

> Stay on top of your group activity without leaving the page you're on - Get

the

> Yahoo! Toolbar now.

>

>

> Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use

> .

>

>

>

>

>

>

>

[Guest guest]

All drugs have a pathway for metabolism. Many of the

genes for metabolizing cancer and psychiatry drugs have been

identified and can be tested to see if people have

a normal gene or a variant (in that case they would

have less of the drug available and it would be less effective).

Mayo Clinic is leading the way for gene testing to see

what drugs work for which people and cancer is one

area you want to get the drug right and the other

area is pediatric psychiatry.

The test is called the p450 drug sensitivity test.

So it really is just helping to determine what drugs should not

be considered.

It still is very complicated for kids with co-morbid

diagnosises, PDD, and autism spectrum disorders.

I still don't know if my daughter needs OCD treated

or would a mood stabizer or anti-psychotic drug

help more.

Her main issues are OCD, social anxiety and hyperaurosal.

She gets progressively more irritable and inflexible as

the day progresses, every day, day in day out, worse

during the school year. She does have a PDD. She did

respond to melatonin at 3mg (another Mayo Clinic recommendation for

kids with developmental disorders).

I am hoping that another SSRI trial will be more effective,

but I just don't know at this point if a mood stabizer

or anti-psychotic drug is what is needed.

It is very scary. Risk of triggering mania can't be predicted.

Pam

>

> Bonnie, that is true for my dd too. She has a great response to Motrin but not

> Prozac at all. I wonder how other illnesses play into this. For instance, my

dd

> is bipolar and Prozac caused her to become severely manic. Does the test just

> show that she could be a great responder to Prozac but due to her comorbid

> bipolar it is a disaster for her? Pam, I would be careful with Prozac if you

> still think your dd may be bipolar. Also, I thought Motrin is a better fever

> reducer than Tylenol overall regardless of test results. Stormy

>

>

>

>

> ________________________________

>

> To:

> Sent: Sat, February 19, 2011 9:46:06 AM

> Subject: Re: picking the right medications

>

>

> also has a good response to motrin when febrile (I use it each time he

> has a fever), but was terrible on Prozac? Could be a mood thing. Interesting

> though I wish mood stabilizers were on that list.

>

> Bonnie

>

>

> MARKETPLACE

> Find useful articles and helpful tips on living with Fibromyalgia. Visit the

> Fibromyalgia Zone today!

>

>

> ________________________________

>

> Stay on top of your group activity without leaving the page you're on - Get

the

> Yahoo! Toolbar now.

>

>

> Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use

> .

>

>

>

>

>

>

>

[Guest guest]

It is interesting and complicated. Drugs also affect

other neurotransmitters in the brain,

making it very complicated to figure out which drug to choice

once you know you can metabolize it.

We still depend so much on a psychiatrist that can

assess the symptoms and determine what type of neurotransmitters

are needed to be increased or decreased.

I understand serotonins role in anxiety and perservating and OCD,

but when the drug also affects dopamine, noraadrenergenics,

lowers aurosal levels, reduces hyperactivity etc. ...I do not

fully see the whole picture or what combination may help

my daughter.

Pam

> >

> > We just got the report today, and it only test 2 of the most

> > common pathways the CYP2D6 drugs (she was an excellent metabolizer)

> > and CYP2C19 (poor). There are other drug paths too.

> >

> > So it would be best if we tried CYP2D6 only pathway drugs for my daughter

since we know she does well on those. Prozac is one

> > of them. Clinical trials at Mount Sinai show kids with ASD

> > do well on it, so perhaps this would be one.

> >

>

[Guest guest]

Right, it doesn't tell you if you should not increase

dopamine or serotonin levels. It just says if you have

the normal genes to metabolize the drug.

Prozac increased dopamine too much and triggered a manic

episode.

Your daughter was put on a mood stabizer right? I remember you

saying it was very complicated to figure out what she needed.

My brother in law is bipolar and zoloft must not increase

dopamine as much. It did not worsen his manic symptoms

but it of course didn't help him either. Prozac may

have worked too well and increased dopamine too much.

It is a really complicated for some people.

Pam

>

> Bonnie, that is true for my dd too. She has a great response to Motrin but not

> Prozac at all. I wonder how other illnesses play into this. For instance, my

dd

> is bipolar and Prozac caused her to become severely manic. Does the test just

> show that she could be a great responder to Prozac but due to her comorbid

> bipolar it is a disaster for her? Pam, I would be careful with Prozac if you

> still think your dd may be bipolar. Also, I thought Motrin is a better fever

> reducer than Tylenol overall regardless of test results. Stormy

>

>

>

>

> ________________________________

>

> To:

> Sent: Sat, February 19, 2011 9:46:06 AM

> Subject: Re: picking the right medications

>

>

> also has a good response to motrin when febrile (I use it each time he

> has a fever), but was terrible on Prozac? Could be a mood thing. Interesting

> though I wish mood stabilizers were on that list.

>

> Bonnie

>

>

> MARKETPLACE

> Find useful articles and helpful tips on living with Fibromyalgia. Visit the

> Fibromyalgia Zone today!

>

>

> ________________________________

>

> Stay on top of your group activity without leaving the page you're on - Get

the

> Yahoo! Toolbar now.

>

>

> Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use

> .

>

>

>

>

>

>

>

[Guest guest]

The anti-psychotic drugs are on the list and many anti-convulsants,

lithium is not a p450 drug.

Pam

> > > >

> > > > How exciting, I got back my daughter's pharmogenetic report from

> > > > Cincinnati Children's and we found that one class of drugs she

> > > > would not respond to well (CYP2C19) but ones in the CYP2D6 class

> > > > she would respond well to. She happened to be on a C19 drug.

> > > > And her psychiatrist suggested another C19.

> > > >

> > > > I am so hopeful and excited to finally have a method for drug

> > > > selections.

> > > >

> > > > This also means that any anagelesics, proton pump inhibitors,

> > > > hormones etc in the CYP2C19 class she should avoid and seek

> > > > medications from the CYP2D6 class.

> > > >

> > > > I feel finally like there is some hope in finding a anti-depressant

> > > > that will help.

> > > >

> > > > I am so excited and hopeful.

> > > >

> > > > Pam

> > > >

> > >

> >

>

[Guest guest]

Pam, my dd became stable on a combination of Lithium, Geodon, Neurontin and

Lamictal. She can not handle having any SSRI even with all those other meds.

This combo allows her to function very well. Prior she was very disabled. So,

this has given her life back to her. Stormy

________________________________

To:

Sent: Sat, February 19, 2011 10:48:39 PM

Subject: Re: picking the right medications

Right, it doesn't tell you if you should not increase

dopamine or serotonin levels. It just says if you have

the normal genes to metabolize the drug.

Prozac increased dopamine too much and triggered a manic

episode.

Your daughter was put on a mood stabizer right? I remember you

saying it was very complicated to figure out what she needed.

My brother in law is bipolar and zoloft must not increase

dopamine as much. It did not worsen his manic symptoms

but it of course didn't help him either. Prozac may

have worked too well and increased dopamine too much.

It is a really complicated for some people.

Pam

>

> Bonnie, that is true for my dd too. She has a great response to Motrin but not

> Prozac at all. I wonder how other illnesses play into this. For instance, my

dd

>

> is bipolar and Prozac caused her to become severely manic. Does the test just

> show that she could be a great responder to Prozac but due to her comorbid

> bipolar it is a disaster for her? Pam, I would be careful with Prozac if you

> still think your dd may be bipolar. Also, I thought Motrin is a better fever

> reducer than Tylenol overall regardless of test results. Stormy

>

>

>

>

> ________________________________

>

> To:

> Sent: Sat, February 19, 2011 9:46:06 AM

> Subject: Re: picking the right medications

>

>

> also has a good response to motrin when febrile (I use it each time he

> has a fever), but was terrible on Prozac? Could be a mood thing. Interesting

> though I wish mood stabilizers were on that list.

>

> Bonnie

>

>

> MARKETPLACE

> Find useful articles and helpful tips on living with Fibromyalgia. Visit the

> Fibromyalgia Zone today!

>

>

> ________________________________

>

> Stay on top of your group activity without leaving the page you're on - Get

the

>

> Yahoo! Toolbar now.

>

>

> Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use

> .

>

>

>

>

>

>

>

[Guest guest]

Pam,

Okay, I'm trying to understand the chart. My daughter has done very

well on Prozac. I'm trying to figure out what we would need to switch

her to if it ever stops working and can't understand the table. I see

fluoxetine on the list, but maybe you can tell me how to read the table?

thx,

Dina

[Guest guest]

Here is the thing, most people of European descent (70% or more) have

normal variants of the genes that metabolize psychiatric drugs. So

I don't want to scare anyone. Your daughter may do well on any other

of the SSRIs.

The top of the column across are all the p450 drugs that are

involved in the first stage of drug metabolism for many many

drugs. Under each column is the list of drugs that use this

gene as a main gene for metabolism. If your daughter

did well on prozac you may be able to assume she has a normal

gene for the 2D6 gene. So any drugs that rely on 2D6 she will

at least be able to metabolize.

You may enjoy reading this article from the Mayo Clinic:

http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2629

Pam

>

> Pam,

>

> Okay, I'm trying to understand the chart. My daughter has done very

> well on Prozac. I'm trying to figure out what we would need to switch

> her to if it ever stops working and can't understand the table. I see

> fluoxetine on the list, but maybe you can tell me how to read the table?

>

> thx,

> Dina

>