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Is UltraShy an ultra-fast metabolizer of benzos?

7K views 58 replies 19 participants last post by  UltraShy 
#1 ·
I'm sure if I asked my pdoc about testing to see if I'm a fast metabolizer of Xanax he'd have no clue what to do as this is simply never tested. Here's how things normally work. Doc writes benzo script. Patient takes benzo and it works. Nothing to investigate. Hardly anyone presents a case like me where 10mg doesn't get the job done such that you have a mystery worthy of investigation. The first investigation he'd have to do is how to test me for fast metabolism of benzos. I must admit that I do like the idea of being tested. If it turns out that I'm a fast metabolizer of Xanax it could really work out in my favor.

With my former pdoc this was merely a theory, but if we had test results in black & white showing I'm a fast metabolizer my pdoc would actually have to do something about it. He'd have to get off his a** and treat me! Being a proven fast matabolizer would support my request for an alternative tranquilizer: meprobamate or phenobarbital. I assume they're metabolized differently than Xanax, though I don't know. Or he'd have to prescribe a truly staggering amount of Xanax. Either way I win. Now that I have insurance it would end up covering 80% of the lab work.

Of course, what if I'm not a fast metabolizer? Are there any other possibilities to explain why I get only minimal benefit from benzos?:stu
 
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#3 ·
CD700 said:
Years ago when I took benzos my dosage would have to be really high to get a result.
They are overrated junk…
Which benzo and how many mgs?

We both agree that benzos are overrated junk. Could it be that you too are a fast metabolizer?

CD700 said:
Adderell helped your anxiety yeh ? Taking downers seems counter productive
What's counterproductive about CNS depressants? I drink wine most days. It's a relaxing CNS depressant which I enjoy the effect of. It's also a CNS depressant to which I respond in a typical manner.

Adderall used to help. Doesn't really do anything now. Also can't be mixed with Parnate. That's both in theory & in practice. It doesn't cause a hypertensive crisis, though it raises BP higher than one would prefer to see.
 
#5 ·
Some people just seem to have an unbelievable tolerance to benzos. I'm one of them and I've met a few others. I've wondered about it before myself and I figured it was something genetic. I haven't taken them in years, but I had to take very large doses to feel the effects, too.
 
#6 ·
Maybe I just need a higher dose to get benzos to work. The question is could I actually get some truly staggering dosage if I had test results proving that I'm a fast metabolizer unlike normal humans?

I don't know if you've heard my tale of Ambien that all hinges on dose. I used to think Ambien was a totally useless pill. I based that on 1 or 2 or 4 or 6 and probably even more didn't do a damn thing. I didn't think Ambien would do anything at any dose. Turns out I was wrong. One night I took the remaining contents of a bottle -- 23 pills -- and I got the best sleep and awoke 8 hours later feeling fully awake & well rested. Much to my surprise, Ambien worked & it worked really well. It just took 20+ pills for me to get the same effect normal folks get from a single pill.
 
#22 ·
If I had my way I'd be taking a non-benzo tranquilizer, but I can't f***ing get that because the medical community has its head firmly planted in its rectum and refuses to acknowledge the serious medical needs of those who simply don't respond to benzos! To them benzos are the be all end all of anxiety treatment and if you're unfortunate enough to not be responsive to them they simply ignore your needs. You're told the alternatives are "too dangerous" because safety always trumps efficacy in their totally twisted minds.

As for CBT, that's a nifty idea, except for one little problem: I'm too damn nervous to participate in CBT because I suffer from disabling SA and I can't get any drug that f'ing works!
 
#23 ·
If I were in your position I would take whatever I had to calm me down (in the old days for me that would have been about 5mg of Xanax but I know that doesn't work for you - maybe a few decent shots of something strong?) and go to a good psychologist. I realise now (after a long time and far too many f^&^ing pills ) that it's therapy that will really provide lasting treatment for SA. I'm convinced that a combination of CBT and some form of exposure therapy is really the way to go for SA - something I never would have admitted not that long ago, mind you.

Personally I'm very sick of pills - although today I actually received a diagnosis of bipolar - something I had suspected I had for a while now - so I will be taking a mood stabliser for a long time to come - unfortunately. Better than the crazy things I do when I 'm manic though - I must admit.
 
#26 ·
I think when I came across your posts initially when I joined this forum I offered a comment that you might be an ultra rapid metabolizer since it seems like nothing works for you.

There's obviously a large issue as to why you're not getting side effects from like 70 mg of parnate...
 
#29 ·
There's obviously a large issue as to why you're not getting side effects from like 70 mg of parnate...
Parnate also isn't expected to have much in the way of side effects. It's expected to produce possibly some hypotension & insomnia. When you compare the side effect profile of Parnate with the side effect profile of Nardil, Parnate is the hands down winner even in totally "normal" patients, not just me. Given that I already have insomnia to begin with would I even notice Parnate insomnia?:stu

We also don't know if I metabolize MAOIs in some oddly fast manner or not yet. I have no idea if the same metabolic pathways that are involved in benzos are involved in MAOIs or not. You should keep in mind that I'm not universally abnormal. I respond to some drugs, such as alcohol, in a normal manner. I'm sedated by Seroquel in a normal manner. My BP & pulse are lowered by beta blockers in a normal manner. Statins lower my cholesterol in a normal manner at normal dosage.
 
#30 ·
And I'm still seriously wondering if there are any other possibilities besides fast metabolism. Is there anything else that could possibly explain how I respond to Xanax (and other benzos) so minimally? Or is everyone here certain that if I were tested the results would come back with the obvious results that I'm am indeed a fast metabolizer?

I get the impression that this is test is simply never done. It's never done because substantially everyone responds to benzos and the small minority that doesn't never thinks to be tested? Or is it because it doesn't f'ing matter what the test results say? The test results are just meaningless trivia if they don't prompt my pdoc to get off his a** and treat me accordingly with either a non-benzo tranquilizer or some truly staggering amount of benzos.
 
#31 ·
Maybe your drinking ?

To answer your question from b4, i have tried Xanax, kpin, vallium

They never did anything for me as far as mental anxiety goes and they made my depression worse.

My old routine used to be around 10mg xanax and a heap of coffee then head off to work. Without heaps of coffee it was ****.
 
#34 ·
I think gilmourr is on the right track. a "fast metabolizer" I gather is someone who over-expresses certain CYP enzymes like CYP2D6 or who has particular allelic variants which work abnormally efficiently or both. Or perhaps you over-express two CYP enzymes. The thing to do might be to write down your response to all the drugs you've tried and then cross reference that with lists of CYP enzymes and their ligands and see if there's a pattern or near pattern.
 
#40 ·
This may seem very obvious as you have written many threads about this apparantly but I have not seen many of them, you do understand that the life of Xanax is only 4 hours, right? Dosing every 4 hours is needed, It is an extremely fast compared to other benzo. When I first started Xanax I never felt the side effects, feeling "drunk or sleepy" etc. I felt completely normal, that is how I wanted to feel, no sides effects at all, I think that is how maybe the medicine is meant to work, I dunno, but it also did not help with my anxiety/panic either, therapy, CBT, exposure to panic induced situations over a long period of time did help, maybe Xanax worked a little towards helping me through that but looking back I do not think it did, I am sure my pdoc at the time would disagree and say even though you were still panic ridden it helped to reduce some of it to get you out the front door to attempt living in the real world. You still had the panic but each time it got to be less and less the more you did it. I was taking 4 mg a day. 1mg every 4 hours. Maybe your taking the 10mg all at once and wondering why it is not working 4 hours later.

When all this anxiety came back several years later, I would take Xanax, just small amounts, I would get the side effects that I was looking for, sleepy, so I guess it must be relaxing me this time around, the rebound anxiety is horrible though and last days, when it wears off, I never had that the first time I was taking it, but i was dosing every day, every four hours, for years not just taking them occasionally like now. I never got addicted to it the first time around. no withdrawals when I eventually stopped. No rebound anxiety.

It was initially marketed for long term usage like I was taking it, now it is not because so many people became addicted to it.

I think you are like me in many respects, we both want a medication to work, we both wish it to do all the work and just start living our lives, unfortunately we have also both taken so many different medications that such a miracle medication does not exist for us. That completely bums me out also, like yourself. It's so fing frustrating. Maybe it's time to choose a med with the least sides and find another approach, therapy, exposure, ect, community support programs, etc. I personally am trying this approach but have not found the right medicine yet, Nardil sucks, the sides are really bad and the help it gives me is so small, pdoc says it can take 12 weeks to start working.
 
#41 ·
I have a similar problem. The coming of spring, as usual, got my anxiety through the roof and I barely feel anything from high dose clonazepam. I've finished my Quanil I'm tempted to try seroquel 25mg but I'm afraid of possible adverse effects.
 
#44 ·
What's a high dose of clonazepam to you? I must ask since dosage varies so much that some think 1mg is high while others are taking 6mg a day.

Sorry to hear your supply of meprobamate ran out. I might feel more sorry if I'd actually had the opportunity to try it myself. It's still available in the US, but you're the only person in the entire world that I've ever found to have ever used it. We'll see if I can talk my pdoc into giving me meprobamate. I certainly have a compelling argument for it, though docs aren't known for being logical. I'm fully prepared for an argument about how its "dangerous." My response will be that I have a concealed carry permit, so the state feels I'm competent to carry a lethal weapon. Surely I'm competent to handle some pills then.

As for Seroquel, what adverse effects do you fear? Odds are it will just make you a bit sleepy at that dose since you're not used to it. I've never heard of Seroquel being used to treat anxiety. In the US it's pretty much just a sleep aid due to how very sedating it is. My brother takes 100mg of Seroquel every night. He will use up to 400mg if he's in a situation where it's really hard to sleep. It sedates me too, though I take Saphris instead as my nightly sleep aid.
 
#52 ·
Here's one thing I don't like about Tagamet: cases of male sexual dysfunction were also reported. Well, perhaps since my sex drive is already dead I shouldn't really care. It can't further kill what's already dead.

I've long known about the Tagamet trick for increasing the effect of Xanax though I've never done it. Not sure why. Probably should try it just out of curiosity to see what, if anything, it does. I already bought grapefruit juice, so I could really go wild and used both methods for maximal effect.

I guess at this point I'm not exactly thrilled about adding yet another drug when it seems like I already use a whole damn pharmacy. How many drugs do I use? Well, here's a list. Let's start with prescription meds:

1) Xanax
2) Parnate
3) Flonase
4) Atrovent
5) Saphris
6) Lovaza
7) Cialis (well, due to lack of sex drive that one gets basically no use)
8 ) AndroGel
9) bisoprolol

OTC stuff:
-caffeine tablets
-multi-vitamin/muti-mineral
-low-dose daily aspirin
-alcohol
 
#48 ·
I just looked at this.

Ultrashy have you tried lorazepam, and is it the same story as the other benzos?

It seems most of the benzos are metabolized by cyp 3A4 whereas lorazepam is by glucuronidation. I have no idea what that means.
 
#50 ·
Yes, I have used Ativan, though my experience with it is relatively limited and in the distant past. Way back in 2002 or so my brother would sell me unwanted bottles of Ativan at cost. I don't recall it being anything special compared to other benzos, but then again it's been a really long time so my memory of it isn't that clear. I never tried it out nearly so extensively as I did Xanax, Klonopin, and Valium which are all interchangeable to me.

I have no idea what glucuronidation is either. Good to know you don't know either, as I'd feel really stupid if I was the only clueless one.

I assume the problem of first pass metabolism could be avoided by IV injection, though I'm guessing they don't sell any benzos for home use in vials, do they?:stu Even if they did, seems like finding a vein would be a challenge (they always have a hell of time when doing a blood draw on me), plus there's my fear of needles. I suspect pdocs wouldn't like the idea of IV benzo use even if it was justified by reason of metabolism simply because it's so unconventional and we can't dare to do things out of the norm, you know.
 
#51 ·
UltraShy, you can be anything you want to be! :yes :)
 
#53 ·
You'll have to see a specialislist. I am not sure What kind. Call that doctor who helped you some-what and as for a referral or at least an idea. a neuologist will have a refferall. They Will be able to test your liver, kidney and enzyme function to find our. As a bonus the neurologist will help you findthand prescribe that drug that does work. It will be expensive but you will gwt answers and the right drugs to help you. Meybe that Xyrem you drem about or the more affordable and common Ketamine, a Barbirturate. Good Luck my friend answers are worth it.
 
#54 ·
You'll have to see a specialislist. I am not sure What kind. Call that doctor who helped you some-what and as for a referral or at least an idea. a neuologist will have a refferall. They Will be able to test your liver, kidney and enzyme function to find our. As a bonus the neurologist will help you findthand prescribe that drug that does work. It will be expensive but you will gwt answers and the right drugs to help you. Meybe that Xyrem you drem about or the more affordable and common Ketamine, a Barbirturate. Good Luck my friend answers are worth it.
I assume my pdoc would know and could tell me if such testing is even worth it. Now that I have insurance I fully intend to put it to maximal use to finally end my hell of endless anxiety. Before I always had to worry about cost. Well, with insurance, I don't have to give a damn about cost any more since 80% of testing is picked up by the insurance company. I want drugs that work and it's abundantly clear that run-of-the-mill drugs don't work on me. I'd probably have an easier time getting exotic drugs if I had test results in black & white that confirm that I am a true medical oddity. Such test results would give docs the legal cover they so desire when prescribing unconventional controlled substances.

I see you obviously follow my posts to know that I dream of getting my hands on Xyrem. I'm so desperate for an SA cure that I don't even care that it's obscenely expensive at $2,800 a bottle. That's a simple test of how severe your SA is. If you'd pay that much for a cure, your SA is really severe.
 
#55 ·
Karl, I don't think you are an "oddity". You have SA just like the rest of us.
 
#56 ·
John, I meant I'm a medical oddity in terms of how I respond, or rather don't respond, to so many different medications.

17 Drugs have completely failed:

SSRIs:

-Paxil
-Prozac
-Lexapro
-Zoloft
-Luvox
-Celexa

SNRIs:

-Effexor
-Cymbalta

Tricyclics:
-imipramine

Other Antidepressants:

-Serzone
-Wellbutrin

Antipsychotics:

-Latuda
-Zyprexa
-Abilify

Other drugs:

-Buspar
-Neurontin
-Ultram

Bezodiazepines: (Only marginally effective even in very high dose, still leaving me disabled by anxiety.)

-Xanax
-Klonopin
-Valium
-Ativan
 
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