RE: itching and psc

[Guest guest]

All are different -- I'm learning to use my itching strategically

(when it isn't too bad). If I'm sitting in a therapy room (as a

psychotherapist) and I start itching more, I know I'm either (a)

concerned about something happenning in the session or ( bored.

Boredom as a therapist is not the best thing and it is quite

informative (sometimes of my own stuff and sometimes of the clients'

issues).

For me, there seems to be no connection to labs or anything. However,

I've noticed that after I'm taking 50mg Naltrexone 2x/day for a

couple weeks, my itching fades. I then go back off the naltrexone. By

the time I stop taking it, I can stay off for about 2 or 3 days with

minimal itching. Then it creaps back. This is getting to be a

pattern -- Aubrey, could you perhaps address how the serum

concentrations of various metabolites of this drug may continue to

act. I know the half-life for the drug itself is rather short, but I

also know the major metabolite is active. How long do serum

concentrations remain at therapeutic levels?>

PSC '94. Listed for Tx since 6/03, though labs & sx improved since

then. Live donor on standby if and when sx return.

Age 30, married 9 years, 3 children (8,4,1). PhD candidate, clinical

psychology. Hobby: Singer (w/ master's in opera) and church choir

director.

[Guest guest]

Thanks for the info Cheryl. We are still trying to adjust to the fact that Mark has PSC and wish we had some sort of way to know how things will progress for him. It's hard to figure out how to live in the uncertainty of somewhere between 7 and 30 years things will get bad. Does it mean anything if CO2 levels are high? It looked like 0 or 1 to 15 was normal. Mark is at 30. Just curious. I wasn't able to go with him to his last appointment and he forgot to ask.

Hope you have a great afternoon,

wife of Mark PSC 2003

-----Original Message-----From: Logan Berg Sent: Tuesday, December 16, 2003 11:33 PMTo: Subject: itching and psc

,

Itching in and of itself doesn't indicate a whole lot. For many of us, it was one of our first symptoms. Others never experience it at all. Some see an increase in certain labs with itching (builirubin or alkaline phosphatase), while another's itching isn't related to labs at all. Some itch more with stress or because they eat certain things. I itch really, really bad when I take pain medication (hydrocodone). I've been having an increase with my itching lately. At times it gets so bad that I feel like tearing my skin off and I lose sleep. Other times it's just very annoying. I am seldom itch-free. There is no certain answer about severity of itching in relationship to progression of psc. Mark should mention it to his doctor though. There are several things that could relieve his itching.

Take care,

Cheryl Berg, Idaho 45Married 25 years, 4 children, 2 grchildrenPSC 01, UC 00, Fibromyalgia, hypothyroid,hiatal hernia, ulcer, gall baldder removed '93disability (retired English teacher)

RE: rash and flu shots

It seems like there is always a lot of talk about itching - is it anindicator of how far advanced your disease is or just an annoying symptom?Mark has begun to itch a lot lately and we were wondering if it meansanything. Thanks for any info you have. wife of Mark PSC 2003

[Guest guest]

Hi ,

I saw your question about your husband's CO2 levels, and I thought I

would try to reply about this point. Is your husband taking

corticosteroids and/or antacids? The reason I ask is that drugs that

can increase CO2 (HCO3-) measurements include corticosteroids and

excessive use of antacids --- see the following article in the

MedlinePlus Health Information Encyclopedia:

http://www.nlm.nih.gov/medlineplus/ency/article/003469.htm

Best regards,

(father of (18 yr); dx PSC 07/03; dx UC 08/03)

>Does it mean anything if CO2 levels are high? It looked like 0 or 1

to 15 was normal. Mark is at 30. Just curious. I wasn't able to go

with him to his last appointment and he forgot to ask.

[Guest guest]

Hi Phil;

I saw your question about Naltrexone and thought I would try to

respond.

According to Crabtree (1984): " Naltrexone is rapidly and completely

absorbed after oral administration but undergoes substantial first-

pass extraction and metabolism by the liver. Naltrexone has a half-

life of 3.9-10.3 hours and a slow terminal elimination-phase half-

life of 96 hours. The major metabolite of naltrexone is 6-beta-

naltrexol, which is present in plasma in greater concentrations than

the parent drug. " (Crabtree BL. Review of naltrexone, a long-acting

opiate antagonist. Clin. Pharm. 3: 273-280 (1984)).

Porter and co-workers (2002) conclude that the potency of 6beta-

naltrexol in vivo is time-dependent, and it has a longer duration of

action than naloxone and naltrexone, consistent with a

pharmacokinetic longer terminal half-life. Therefore, 6beta-naltrexol

is likely to contribute to the efficacy of naltrexone in humans. "

(Porter SJ, Somogyi AA, White JM. In vivo and in vitro potency

studies of 6beta-naltrexol, the major human metabolite of naltrexone.

Addict. Biol. 7: 219-225 (2002)).

But Bertolotti and coworkers (1997) note that there are " important

changes in the systemic availability of naltrexone and 6 beta-

naltrexol in liver cirrhosis; such alterations are consistent with

lesser reduction of naltrexone to 6 beta-naltrexol and appear to be

related to the severity of liver disease. This must be considered

when administering naltrexone in conditions of liver insufficiency. "

(Bertolotti M, Ferrari A, Vitale G, Stefani M, Trenti T, Loria P,

Carubbi F, Carulli N, Sternieri E. Effect of liver cirrhosis on the

systemic availability of naltrexone in humans. J. Hepatol. 27: 505-

511 (1997)).

So metabolism of naltrexone to 6 beta-naltrexol may be much slower in

patients with impaired liver function and so it might not be possible

to extrapolate from studies with normal liver metabolism to the

situation in PSCers?

I wish you all the best with your internship application!

Happy holidays and best regards,

Dave (father of (18yr); dx PSC 07/03; dx UC 08/03)

> I've noticed that after I'm taking 50mg Naltrexone 2x/day for a

> couple weeks, my itching fades. I then go back off the naltrexone.

By

> the time I stop taking it, I can stay off for about 2 or 3 days

with

> minimal itching. Then it creaps back. This is getting to be a

> pattern -- Aubrey, could you perhaps address how the serum

> concentrations of various metabolites of this drug may continue to

> act. I know the half-life for the drug itself is rather short, but

I

> also know the major metabolite is active. How long do serum

> concentrations remain at therapeutic levels?>

>