New test for medication metabolism done by endocrinologist

Hi guys,

I had an appointment with my endo a couple of days ago and was very surprised that he decided to do a new test on me. He said he does not feel I metabolize my medication correctly and wanted to find out what is going on. They did a series of four mouth swabs (& drew blood for another test), but the swabs are sent out, along with a list of the medications you take to see how your body metabolizes the different chemicals.

He's not much of a talker, but is one of the best doctors I have ever seen. I am thinking he is simply concerned about tbe number of medications I take each day. He was happy that I went ahead with the SCS implant, but not surprised that I still have cp.

Apparently you only have to have this done once. It works on all types of pain medications and whatever else you are taking. They say I can give a copy to any doctor and to the pharmacist and they will know which drugs my body can metabolize and the proper dose to give. I seriously don't get how all of it works, but I do know it is DNA/genetic testing and that it will tell a great deal about me.

I have had one test kind of like this before, but the dr who ordered it could not read it...lol. That one was only dealing with heart disease, cholesterol, and triglycerides. It just told them which type of med would work best for me, but she never did anything with the results. I guess I should pull that back out and send it over to the endocrinologist, since he is so good.

I'll let you guys know what we find out. I do know that my urine drug screens show I haven't taken my Xanax xr for 3-5 days when I actually take it every day without fail.

If anybody has already had this done, please tell me more about it.

Thanks!

I don't know specifically what test you had but I do know a little about genetics and drug metabolism

Take codiene for an example.

In a normal body codiene is metabolized into morphine at a particular rate (kind of a small percentage of metabolism)

Some genotypes don't process codiene into morphine at all and the codiene doesn't work well.

Some genotypes process more of the codiene into morphine and the codiene works really well.

Then Morphine is suppossed to be metabolized and eliminated at a certain rate.

Some genotypes don't do that.

So, I take a small amount of codiene (half a teaspoon of cough syrup), metabolize a larger than normal percentage of that to morphine, then don't metabolize the morphine.

I stay very dopy for 12-16 hours.

Also, I have cholenestrase deficiency-so certain anesthesias and paralytics last much longer than they are supposed to.

Most likely what your doc is testing is your ability to process codiene into morphine.

Mos

 

Post Edited (sjkly) : 3/8/2013 3:25:45 PM (GMT-7)

sjkly

A friend of mine has the same issue you have. Codiene makes him loopy for a long time. But for some reason hydrocodone doesn't work very well at all.

I had anesthesia problems like you described when I was in the hospital for a torn esophagus. Actually it happened twice there during twilight sedation for an EGD also. I ended up in ICU both times and it took over 24 hours before I remember anything.

Take care.
Bill

Tramadol works great for me. It is metabolized differently then codiene, it relieves my pain makes me a bit drowsy but not to the point I can't function.

RM,

I had something similar done several years ago. It was a blood only test, but it sounds like the same thing. They did genotyping of genes that encode for the 3 major cytochrome P450 pathways in the liver. CYP450 is a very important enzyme involved in many metabolic processes, including drug metabolism. There are MANY more than 3 CYP450 pathways, but these 3 pathways (CYP2D6, CYP2C9, and CYP2C19) are responsible for metabolizing the majority of drugs that are broken down in the liver -- including most anti-depressants and pain medications.

One of my docs had me tested after years of not responding to pretty much any medication. We were especially concerned about my lack of response to essentially any and all all anti-depressants, but also my lack of response to pain medications (both opioid and non opioid meds).

It turns that I have some genetic mutations that makes 2 of these three pathways highly abnormal in me. One of them (which is considered "THE major pathway") is barely functional, if at all, and another one (which is considered "the second major pathway") does not work at all. Unfortunately, these 2 pathways together metabolize the vast majority of all pain medications, and antidepressants, as well as NSAIDs -- which explains my lack of response to everything. The head of the genetics lab actually called my doctor personally, because my results were so unusual.

The test was definitely helpful in explaining why I don't respond to anything, but unfortunately it didn't provide me with much in the way of medication options, as the list of (pertinent) medications metabolized by the one functioning pathway is very small. My doctors and I now have to look carefully at each and every medication that they want to put me on before it is prescribed, and there are many medications that I absolutely cannot take (including essentially all OTC pain relievers, with the exception of tylenol), as certain medications could cause liver damage, toxicity, or other serious side effects due to my body's inability to metabolize the medication. It also means having to adjust doses of medication that may only be partially metabolized & being careful to start new medications slowly, so we can pick up on any problems early on (I did have one serious reaction to one such medication a couple years ago).

My doctor also has to write a letter to the hospital & surgeon any time that I have surgery. As they need to know that they have to be careful with what & how much anesthesia they use, and also that I cannot metabolize certain pain medications, or that they need to use different dosages.

Anyways, I hope the testing provides you and your doc with some useful information that they can use to adjust your treatments, if necessary, & come up with the best treatment plan for you!

Oh, I'll also mention that there have been some studies done that correlate the presence of these genetic abnormalities with an increased risk/incidence of depression, which I find interesting, since depression has always been a big issue for me.

Skeye

Post Edited (skeye) : 3/8/2013 9:54:51 PM (GMT-7)

RetiredMom, Would you mind sharing what lead you to the endocrinologist? Just trying to formulate some thoughts....

Oh, I wanted to mention that even the smallest amount of codeine makes me (& now my daughter) vomit uncontrollably for hours. We NEVER use it for any reason in our house. So, I don't think he is looking for anything on that specifically. The pamphlet info shows the same tests Skeye had done and several more of the breakdowns like she mentioned. There were a ton of the things, including the ones she mentioned specifically. It's all odd to me because he only treats my hgh deficiency, keeps an eye on my blood sugar, and treats some resistant triglycerides. He's not primary care or even PM, but he is amazing as far as dr's go!

Hi guys. I talked to my psych yesterday (since he is the one who gives me the Xanax) and told him about the test. He was thrilled. He knew it immediately when I said the cyp450 thing and all of the other number letter combinations I couldn't remember.

He explained how it works in its most basic form. It is like a highway to say Atlanta (the liver). There may be one large road leading in where all the medications must travel to reach the city. In this case, the meds are metabolized in the liver to be sent on to do their jobs. There can be roadblocks if a specific medicine is not working correctly or if it collides with another one (like a wreck) and nothing behind this medicine will reach its destination. Basically, we will be able to use the test to see which med/meds/combination of meds are blocking the road (pathway) and find other ones that use smaller, less traveled roads (pathways) to still reach their destinations.

It could be something as simple as two meds binding together or greater in that I could not process certain things no matter what. I take a lot of vitamins and otc's with my scripts because of vitamin deficiencies. The blood tests all tell me what to take, but not how they all interact with each other.

I like the analogy of the road because it gives a visual picture of the pathways our meds follow to reach our pain points.

He said he has done the same testing using vials of saliva on occasion, but that he rarely uses it yet. He did say he may start again if he can find the company that does the swabs. I will be giving him the results, of course, so he can contact them from there.

I hope this helps explain the test in a simple and clear way. I know there are obviously others here who understand the more intricate parts, but I wanted to give a basic explanation for the members who never studied this.

I hope this test sheds some light for you and your doctors. Good Luck!

I'm not sure weather i'm about to start going through all of this i take methadone now for pain management because my tolerance to pain medication was to high well so i was told now i have gone up to 120 and have a peak and trough done which tells them how my body metabolizes the medication because i haven't been feeling well i get a message today that i need to go down immediately and need to come in for an EKG and other testing because the levels in my system were to high so my system isn't breaking it down or what? I'm at a loss but from what i've been reading this may be a reason is there something i could bring up to my Dr to look into if not mentioned when i go??????