Doctors should study their textbooks carefully.

[Guest guest]

I ran across a good discussion of how kinetics is important in the use

of antiseizure medications - it is basically the same discussion as to

why they are important in chelation.

From: Textbook of Clinical Neurology, 2nd ed., by Goetx, Copyright ©

2003, publisher Elsevier

On page 1177

" Half-life (t1/2 ) is the time required for the serum concentration of

a drug to decrease by 50 percent following complete absorption and

distribution of a single dose. A drug's half-life

determines the dosing frequency and, as a rule, the dosing interval

should not exceed one half-life. Drugs with short half-lives should be

administered multiple times per day to

prevent large fluctuations in serum concentration that may produce

adverse effects or breakthrough seizures. Those with longer half-lives

may be administered once daily, which

generally improves compliance. "

........................

Andy . . . .. . . . . . . . . .

[Guest guest]

I saw my ND last week and she thought I was nuts for taking small

frequent doses of chelator.

Seems like many doctors presume that when the chelator level drops in

the bloodstream, it's because it has been flushed out via the kidneys

and bladder, taking lots of mercury with it. If that were the case,

there'd be no harm in ignoring half-lives, as I understand it.

But presumably the chelator is degraded inside the body faster than it

is excreted, thereby freeing up unbound mercury, which explains why I

don't feel as good on the last day of a chelation round.

It would be interesting to know what happens to chelating chemicals

inside the body that don't ever make it out of the body with their

mercury passengers.

>

>

> I ran across a good discussion of how kinetics is important in the use

> of antiseizure medications - it is basically the same discussion as to

> why they are important in chelation.

[Guest guest]

>

> I saw my ND last week and she thought I was nuts for taking small

> frequent doses of chelator.

>

> Seems like many doctors presume that when the chelator level drops in

> the bloodstream, it's because it has been flushed out via the kidneys

> and bladder, taking lots of mercury with it. If that were the case,

> there'd be no harm in ignoring half-lives, as I understand it.

This is an incorrect understanding. It is based on the naive but common

assumption that

binding is irreversible. In fact it is not, and the chelator molecules pick up

and drop heavy

metal ions rapidly compared to their lifetime in the body.

> But presumably the chelator is degraded inside the body faster than it

> is excreted, thereby freeing up unbound mercury,

The unbound mercury is freed up by the chelator simply dropping it. It is

dropped and

bound at certain rates, and the balance of how much is bound depends on the

relationship

of those rates.

Not only shouild doctors study their own textbooks carefully, but admission to

medical

school should require an underlying technical degree and the current med school

faculty

should be replaced by people who DO have technical degrees they got before their

MD

credential.

Andy

[Guest guest]

Of course they would also think you were nuts for taking aspirin every

3rd day of your headache...because it needs to be taken every 4-6

hours. It amazed me that many doctors think pharmocology only applies

to certain substances.

> >

> >

> > I ran across a good discussion of how kinetics is important in the

use

> > of antiseizure medications - it is basically the same discussion

as to

> > why they are important in chelation.

>

[Guest guest]

>

> Of course they would also think you were nuts for taking aspirin every

> 3rd day of your headache...because it needs to be taken every 4-6

> hours. It amazed me that many doctors think pharmocology only applies

> to certain substances.

>

Um, I'm not a doctor and I don't speak pharmocology, but I think that

the every x hours DOES only apply to SOME substances.

I think it depends on the action of the agent in question. I'm not

trying to be " fancy " here with this wording -- I simply don't have

the vocabulary to say it succinctly.

There are tons of things that I think you can take with any old timing

you want. Like stuff that the body retains. Or things that are

intended to create an effect that doesn't need to be " even " .

Or things where an uneven effect is desireable even.

Anyone care to comment on these classes of drugs? My guess is that

the case where even-blood-level is not a factor is a majority

of drugs. Am I wrong?

Moria

[Guest guest]

> >

> > Of course they would also think you were nuts for taking aspirin every

> > 3rd day of your headache...because it needs to be taken every 4-6

> > hours. It amazed me that many doctors think pharmocology only applies

> > to certain substances.

> >

>

> Um, I'm not a doctor and I don't speak pharmocology, but I think that

> the every x hours DOES only apply to SOME substances.

Most, actually. There are a few, but very few, where the object is NOT to

maintain

constant blood levels but to vary them appropriately throughout the day. E. g.

glucocorticoid steroids like hydrocortisone (also known as cortisol),

prednisone, etc.

The number of things where fluctuating concentrations are appropriate is very

limited and

doctors are well aware of them all. (in theory, anyway).

Andy

[Guest guest]

> There are a few, but very few, where the object is NOT to maintain

> constant blood levels but to vary them appropriately throughout the

day. E. g.

> glucocorticoid steroids like hydrocortisone (also known as

cortisol), prednisone, etc.

>

> The number of things where fluctuating concentrations are

appropriate is very limited and

> doctors are well aware of them all. (in theory, anyway).

What about things where it can be taken any which way, and it is

more a matter of convenience -- take it once a day just so that

you keep taking some ...... or where it is timed

for something ELSE -- Like antacids taken with meals or

sleeping pills taken before bed -- or ??

Remember, the category here was ALL DRUGS.....

How does even-blood-level apply to:

anti-depressants

blood pressure medications

hormones

sleeping pills

thyroid meds

pain medication (yes)

antibiotics

anticonvulsants

anti-inflamatory drugs

laxatives (I'd expect no)

sleeping pills (I'd expect no)

For something like anti-depressants, does blood level really

matter -- isn't it more that it needs to be used regularly,

but having a dip for a few hours is no problem? Does that

apply to hormones? And blood pressure medication?

(For most supplements I can't think of any reason that one would

need a steady blood level..... but that is not generally drugs.)

Moria

[Guest guest]

At 2:13 AM +0000 10/28/08, moriamerri wrote:

> > There are a few, but very few, where the object is NOT to maintain

>> constant blood levels but to vary them appropriately throughout the

>day. E. g.

>> glucocorticoid steroids like hydrocortisone (also known as

>cortisol), prednisone, etc.

>>

>> The number of things where fluctuating concentrations are

>appropriate is very limited and

> > doctors are well aware of them all. (in theory, anyway).

>What about things where it can be taken any which way, and it is

>more a matter of convenience -- take it once a day just so that

>you keep taking some ......

I'd say there's no such thing. It's ALL about blood levels, half-life, etc....

>or where it is timed

>for something ELSE -- Like antacids taken with meals

> or

>sleeping pills taken before bed -- or ??

>Remember, the category here was ALL DRUGS.....

Me thinks you treat this too much like a game show in which you like

to play devils advocate. And YOU'RE worried about other answers

confusing people on the list? Come on!

>How does even-blood-level apply to:

>anti-depressants

It does, which is why even medical doctors, as little as they know,

instruct you to take it at the same time each day, religiously.

>blood pressure medications

It does if you want even blood pressure.

>hormones

See Andy's reply above.

>sleeping pills

It does. That's how you wake up at a certain time, when the blood-level drops.

>thyroid meds

are hormones. See above.

>pain medication (yes)

>antibiotics

It REALLY does. Not taking them regularly and missing does is the

number one reason drug-resistant strains of bacteria have developed,

BECAUSE blood level fluctuates.

>anticonvulsants

I don't know how they work. I am uneducated in that field. But I

would bet that when the blood level drops, you are more likely to

have a convulsion.

>anti-inflamatory drugs

It does.

>laxatives (I'd expect no)

Well not in the sense that you probably think a proper laxative is

Ex-lax, which bombs the hell out of your system with a megadose and

causes your colon to spasm. A true laxative, such as supplemental

magnesium, is required at even levels in the body to regulate stool

consistency so that you never get constipated and require drastic

measures.

>sleeping pills (I'd expect no)

Hmm. Seen this one before. And it does, still, six paragraphs later.

>For something like anti-depressants, does blood level really

>matter -- isn't it more that it needs to be used regularly,

>but having a dip for a few hours is no problem?

No. Unless you want fluctuating psych symptoms. See above.

>Does that

>apply to hormones? And blood pressure medication?

Me thinks you're losing track here and repeating your questions. See above.

>(For most supplements I can't think of any reason that one would

>need a steady blood level.....

>but that is not generally drugs.)

Moria. What exactly do you think a drug is? You seem to have this

notion that most are magic little pills that have the desired effect

as soon as they enter our body -- *poof* -- and that's that.

I know I'm simplifying but you have confused me as to what you know.

--

Ralph Nader on the need for moral courage:

[Guest guest]

> >> The number of things where fluctuating concentrations are

> >appropriate is very limited and

> > > doctors are well aware of them all. (in theory, anyway).

>

> >What about things where it can be taken any which way, and it is

> >more a matter of convenience -- take it once a day just so that

> >you keep taking some ......

>

> I'd say there's no such thing. It's ALL about blood levels, half-

life, etc....

>

> >or where it is timed

> >for something ELSE -- Like antacids taken with meals

> > or

> >sleeping pills taken before bed -- or ??

> >Remember, the category here was ALL DRUGS.....

>

> Me thinks you treat this too much like a game show in which you

like

> to play devils advocate.

So then apparently you think my questions are " advocating "

something (other than advocating that I'd like to know).

If I'm advocating something, it must be darned subtle.

Perhaps you can enlighten us all as to what it is.

> And YOU'RE worried about other answers

> confusing people on the list? Come on!

Confusing is one of many difficult things that happens -- you brought

up " confusing " I think (but I'm not going to check) -- and I was

talking about some other kinds of harm -- like feeling shocked

and betrayed when one finds out that the " dose timing thing " is

NOT a standard in the wider world, for example. But I agree

confusion can be a problem too, no argument on that.

>

> >How does even-blood-level apply to:

> >anti-depressants

>

> It does, which is why even medical doctors, as little as they know,

> instruct you to take it at the same time each day, religiously.

Well, you're answering here, sort of -- although I'm reading your

answer as kinda snippy, so I suppose if I want to verify I could

ask friends who take anti-depressants.

>

> >blood pressure medications

>

> It does if you want even blood pressure.

Well, okay. But what's the half life of blood pressure meds?

I'm pretty sure no one wakes up at night to take them.

And doesn't it also depend on the mechanism involved. Might

not your blood pressure go down cumulatively such that even

when there is none of the stuff in your bloodstream your

BP is SOMEWHAT lower?

>

> >hormones

>

> See Andy's reply above.

Actually, Andy did NOT cover the category I just asked about.

Andy did make some short comments, and he missed quite a bit

that interests me, so I asked again. You (and Andy) have no

obligation to answer at all -- but I will point out that you

also did not answer about the category (and range) of hormones.

I currently use (transdermal) progesterone, and I do not

believe that the recommended timing has anything to do with

maintaining blood levels. Then again, it is absorbed by fat

I think, and it is transdermal. But it is one case, and may

exemplify one of the reasons/cases where timing is NOT based

on halflife.

> >sleeping pills

>

> It does. That's how you wake up at a certain time, when the blood-

level drops.

Which would imply (but doesn't say directly) that you actually

need the level NOT to be steady -- and my guess is that you want

it to be active ONLY during the time when you want to be asleep.

Like, from before bedtime for the night but not the day.

>

> >thyroid meds

>

> are hormones. See above.

Were not covered above, unless of course you thing I'm supposed

to take Andy's list of exceptions as saying this -- which I did

not.

>

> >pain medication (yes)

> >antibiotics

>

> It REALLY does. Not taking them regularly and missing does is the

> number one reason drug-resistant strains of bacteria have

developed,

> BECAUSE blood level fluctuates.

So what about the antibiotics I took once a day last year?

These are super-duper-heavy-duty antibiotics. Does this mean

the half life of this stuff is > 24 hours?

> >anticonvulsants

>

> I don't know how they work. I am uneducated in that field. But I

> would bet that when the blood level drops, you are more likely to

> have a convulsion.

I would guess that too -- but you see, I'm asking about how these

various things work. And relative to blood levels, of course,

there are still DIFFERENT reasons. Mercury being a very specific

and different case it seems to me. Not that I'm trying to make

that point, I'm not (and just did elsewhere in another post which

I cannot FIND ggrrrrrr)

-- but the topic is how blood levels apply to other (other=

non-chelation) drugs --- as related or not related --

>

> >anti-inflamatory drugs

>

> It does.

>

> >laxatives (I'd expect no)

>

> Well not in the sense that you probably think a proper laxative is

> Ex-lax, which bombs the hell out of your system with a megadose and

> causes your colon to spasm. A true laxative, such as supplemental

> magnesium, is required at even levels in the body to regulate stool

> consistency so that you never get constipated and require drastic

> measures.

um, well, it could be, unless magnesium is stored, or unless the

effect on the colon is cumulative. And no, I was not necessarily

thinking of exlax (which I have no experience with)...

This is also where some supplements (those where the nutrient is

stored) are a different case -- or a different mechanism.

Which applies to some but not all vitamins.

>

> >sleeping pills (I'd expect no)

>

> Hmm. Seen this one before. And it does, still, six paragraphs later.

>

> >For something like anti-depressants, does blood level really

> >matter -- isn't it more that it needs to be used regularly,

> >but having a dip for a few hours is no problem?

>

> No. Unless you want fluctuating psych symptoms. See above.

>

> >Does that

> >apply to hormones? And blood pressure medication?

>

> Me thinks you're losing track here and repeating your questions.

See above.

No, I did not lose track. I was aware I repeated these, and

did so on purpose, thanks.

>

> >(For most supplements I can't think of any reason that one would

> >need a steady blood level.....

>

>

> >but that is not generally drugs.)

>

> Moria. What exactly do you think a drug is?

Generally people do classify supplements as separate from

drugs, and this use of " people " absolutely includes doctors

and pharma folks.

> You seem to have this

> notion that most are magic little pills that have the desired

effect

> as soon as they enter our body -- *poof* -- and that's that.

you seem to have a vivid imagination about what I believe.

For most supplements I can see the value in using it regularly

but I don't see any problem with having it be uneven.

That is, I don't see any problems that are any worse than not

having that supplement. In many/most cases of deficiency I'd

expect high level of use while there lots. High levels of

viatmin C followed by none can cause rebound scurvy (the body

got used to having lots and is now deficient) -- but I don't

think you need to maintain blood level to avoid this.

>

> I know I'm simplifying but you have confused me as to what you know.

Well, I'm not actually trying to tell you " what I know " , I'm

asking questions. However, you might correctly gather that I

don't know as much about the topic at hand as I'd like to,

and that I don't know the answers to the questions I'm asking.

At this point I'd be interested to know how you

know the yes/no answers you listed. I'd also like to know, if

blood levels are important to maintain in almost all cases, how

does this reflect on drugs that are taken 3 times a day with

meals? Isn't that reasonably common? (This is a question,

. Actually, 2 questions.)

I also wouldn't mind knowing what the medical textbooks

(in the subject line) say. I've read other comments

(in past years) about " similar cases " where dose timing is

considered highly important -- the one that sticks in

mind is people being woken up to take medications in the hospital.

This sounds more like a corner case than the common case, though.

Moria