Bactrim damaging adrenals?

Hi all, so after a week or so off of Bactrim I was taking for Bartonella. I decided to go back on it yesterday.

Last night trying to sleep was miserable. I started with this heaviness around my head and neck again, racing heart, jolting me awake.

I'd been having this off and on for a month since taking it. This is my second experience w/Bactrim since successfully treating with it in 2014.

Is this what happens to people's adrenal glands while w/subsequent Lyme treatments? Or is this the Bactrim? Thanks!

Quin said...


If you can't tolerate minocycline, you're left with not many good options to treat bartonella. It's really hard to kill and only a few antibiotics are effective.

Quin - there are options without minocycline - in fact mino is the “add-on” antibiotic to Rifampin or Rifabutin which are effective for bart.

The bart “specialist” Dr M uses Rifampin/Rifabutin plus Biaxin for bart.

And LLMD MR prescribes azithromycin or Biaxin with Rif

Yeah, but rifampin/rifabutin mess with adrenals, and bacteria can develop resistance to it.

ElizKA26 said...
I'm officially off the stuff. Gonna talk to my LLMD about Azithromycin or Rifabutin/Rifampin.

Yes, is messing with my sodium.

You’ll need something with the azithromycin -

Girlie said...

ElizKA26 said...
I'm officially off the stuff. Gonna talk to my LLMD about Azithromycin or Rifabutin/Rifampin.

Yes, is messing with my sodium.

You’ll need something with the azithromycin -

I have the Bicillin injections.

Quin, I did well on the Rifampin, actually was kind of weak. I'll ask about the Rifabutin.

Thanks all!

Azithromycin I think probably may come with interactions along with the Bicillin. I'll ask what I can combine with it for Bart.

Girlie said...
I believe Rifabutin and Biaxin have a moderate interaction but the bart “guru” Dr M. pairs them together anyway.
(Combining them may reduce the effectiveness of one of them.)

May have to do with the Cytochrome p450 which has to do with liver detoxification.

Rifampin activates PXR, which primarily upregulates CYP3A4, leading to increased metabolism of other drugs.

The effect of clarithromycin (biaxin) is a bit more complicated. It inhibits CYP3A4, initially leading to less detoxification. The build up of toxins leads to repeated activation of PXR, causing upregulation of not only CYP3A4 but also a whole bunch of other liver enzymes.

https://en.wikipedia.org/wiki/pregnane_x_receptor

It's not a matter of oral vs injectable. Penicillin generally doesn't mess with kidney function or liver enzymes too much. Amoxicillin can be taken orally and I didn't have any trouble with it.

The adrenal problem (eg CYP3A4 from rifampin) feels like nervousness and adrenaline initially, but it also has an opiate-like effect, which I particularly noticed in the evening hours. This is due to ACTH and beta-endorphin being synthesized from the same precursor, so when ACTH goes up, there is some 'spill-over' into endorphins. It made it hard to sleep, and when I would sleep, I would wake up with a very full bladder (low aldosterone). Taking hydrocortisone and naltrexone helps with this, but I would still lose salt.

Bactrim just made me lose salt without causing the adrenal problems. I peed a lot and put salt on all my food and just peed it out. When my salt was low I would get a headache. When my salt went back up, I would feel pressure in my head and ears. When I had blood tests done, it showed that I had eaten enough salt to keep my sodium levels normal, but my creatinine went up.

Minocycline did not cause me any kidney or adrenal problems.

ElizKA26 said...
Would taking pregnenolone and DHEA support the adrenals with Rifampin/Rifabutin?

Maybe, but the problem is that the CYP3A4 will destroy that too. Also that won't directly suppress the increased adrenaline and endorphins that are interfering with your sleep.