Submitted by David Overton
Why are some people so sensitive to prescription drugs? What can be done about it? Have you been told ‘it’s all in your head’? Several groups are highly sensitive to medication side effects:
- Women, the elderly and children
- Those with decreased kidney function, easily diagnosed and managed with simple blood and urine tests
- Those with impaired liver functions, which is common but may not show on lab tests
Women, the elderly and children have smaller kidneys and livers and often need customized lower doses of prescription drugs. If you have impaired detoxification of drugs by the kidneys or liver, we can use drugs that have lower rates side effects and use alternative medicines to support or improve kidney and liver functions. You can find information about kidney impairments on my website.
In this article, we’ll cover cytochrome P450 enzymes (abbreviated as CYP) which are not included in routine blood tests. People commonly have CYP problems but are not tested for it. CYP enzymes are located in your mitochondria, inside of cells and in your liver and serve to:
- Breakdown and clear out toxins, such as drugs, hormones and wastes, such as bilirubin
- Synthesize and breakdown hormones, especially cortisol, estrogen and testosterone
- Synthesize cholesterol, vitamins A & D
- Affect blood clotting – this is where aspirin, Omega 3 supplements and some drugs work
Many drugs or substances increase or decrease the CYP enzymes, causing drug levels to increase or decrease and leading to adverse drug reactions or the drug failing to work. For example, compounds in grapefruit juice can increase the level of some drugs, tobacco reduces the levels of some psychiatric drugs and St. John’s Wort can increase or decrease the levels of some drugs. The following is a list of the most common problematic drugs:
- Acetominophen (Tylenol)
- Albuterol
- Antibiotics, especially Cipro, erythromycin and related drugs
- Antidepressants
- Anti-fungal drugs
- Anti-inflammatory drugs (ibuprofen, Naprosyn, many others)
- Benadryl or diphenhydramine
- Bipolar and manic depression drugs
- Caffeine – I always recommend limiting intake to 1-2 8 ounce daily servings
- Codeine, hydrocodone, oxycodone and other pain medicines
- Estrogens
- Methadone
- Nicotine
- PPI’s: Nexium, Prilosec, others
- Seizure drugs
- Some anti-coagulant drugs, especially warfarin
- Some cardiology drugs, especially ACE inhibitors, beta blocker calcium channel blockers
- Statin cholesterol drugs
- Steroids
- Tagamet
- Theophylline
Millions of Americans are taking multiple drugs without counseling or thorough monitoring and slowly develop side effects (which often are treated with more drugs). Do not stop these drugs, but do work with a clinician who will thoughtfully adjust drugs and use alternative approaches to minimize side effects. Most of the conditions for which these drugs are prescribed will improve with lifestyle changes and safer drugs, lower doses or alternative medicines can be used to reduce drug dependence and side effects.
David Overton, PA-C works at Natural Medicines & Family Practice providing integrated conventional and alternative treatments under the supervision of Dr. Richard Faiola, MD, ABFM. 360-357-8054
