Why do I react strongly to low dosages?
- 2 Dec 2017 by Leadore
- 2 February 2018
- lyrica, seizures, anxiety, gabapentin, dosage, medicine, medication, ssri, serotonin-norepinephrine reuptake inhibitors
I react very strongly on medications like SSRI, SNRI, Anti-seizure meds and so on.
For an example: 100 mg Gabapentin or 25 mg Lyrica feels like x10 the dosage. I can’t tolerate SSRIs bc if strong side effects like cramps, twitching and feeling hyper/stress. Even 5 mg of Fluoxetine. Propranolol and other non psyciatric meds doesn’t seem to do this.
You should get GeneSight testing. It helped me a lot. I had weird genes
I love answering this question because I get to sound so medical explaining Cytochrome P450 enzymes in the liver. I actually was employed as a medical prescriber.
Some people are fast metabolizers and some are slow metabolizers while the rest, I suppose, have no worries with this.
In the liver are enzymes that breakdown meds into their metabolites and then are filtered through the kidneys. These enzymes are called the Cytochrome P450 system. Each enzyme has a designation like 2D6 or 2C19. Different classes of meds fall into the different designations.
That gives an idea of how a person will metabolize a med and directs how to dose the med. People who are slow metabolizers are called Inhibitors. The med stays around in the body for too long and has the potential to build up quickly. This is a concern for toxicity. Other people who are fast metabolizers are called inducers. They breakdown and eliminate the med too quickly. That means these individuals may not be getting enough of what they need for the med to be effective.
Inhibitors require lower doses and Inducers require higher doses.
How can a practitioner know who is an Inhibitor or Inducer?
When patients are reporting needing more or report needing less than the standard dose, that is one indication. Patients may also report side effects that are more intensive than for the dosage prescribed.
Now, when you go to your medical providers, you can say, “Doc, as far as the meds go, my liver enzymes are those of an Inhibitor.” Watch doc smile. The average person has no idea about CYP450 enzymes.
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