caffeine competes with Zyprexa for metabolism
 

i just found this and emailed it to my pdoc.

i have been having caffeine in erratic amounts... and sometimes it seems to "work" other times seems to make things worse.... might be to do with whether i still have a lot of Zyprexa in my system...... sheeeesh. this is going to be hard.

it appears that olanzapine clearance can be significantly affected by caffeine intake, due to competitive metabolism.

http://psy.psychiatryonline.org/cgi/.../full/46/3/262
~ waves ~

what does mean?
bizi

caffeine "uses up" an enzyme needed to clear Zyprexa from the system
 

Dear Bizi

CYP1A2 is an enzyme that breaks down substances in the liver. Different substances are broken down by different types of enzymes. Both olanzapine (Zyprexa) and caffeine are CYP1A2 substrates - i.e. they get metabolized by it.

the excerpt is saying two things:

1. when you maintain a steady intake of both substrates, each will processed in a regular way daily. we do not need to worry about the proportion, because serum levels will be stable.

2. however if you suddenly increase or decrease the intake of caffeine, it will affect olanzapine clearance because it will "use up" a larger proportion of the available enzyme, thereby slowing clearance of the other substrate, thereby producing a higher serum level.

i haven't read the whole article to see if the reverse is also true - if increasing zyprexa slows caffeine metabolism. sometimes it only goes in one direction - caffeine may have a higher chemical (binding) affinity ie it may be like the big bully that says, MY ENZYME, ME TAKE! ya know? butttttt........

long story short, means that a sudden reduction/increase in caffeine intake will affect my Zyprexa levels.

this does explain why, in response to feeling groggy in the morning, the 5 cups of coffee i had seemed to do *NOTHING*. It seems to me that caffeine wins out in the liver but Zyprexa wins out in the brain! :o

~ waves ~

I'm sorry you are having to go through this, Waves...
I can relate a bit since I'm on a similar boat right now.
Sounds like the med balance continues to be a challenge. I'm glad that you stopped the long-acting benzo, as it posed yet another challenge.

Thanks for the info on zyprexa and caffeine. I did reduce my coffee intake in the beginning, but have been getting a steady stream. It's just good to know.

Hi Kay :)

yes, isn't the meddy-go-round a lovely place to be... :rolleyes::( grrrrr.

confused about the long acting benzo. i did not stop it nor do i plan to. i did reduce it to 1 mg (from 1.5). i am not even thinking about removing that, nor do i think pdoc is... i did have anxiety attacks before going manic, i think the ones i've had since were more migraine-associated. but this benzo is often given as a maintenance drug for bipolar... esp. mixed states.

i'm not confused about you getting that i reduced that med, from my posts. my posts about my meds are dang confusing! :o

but, given you thought i had stopped it....

............. i has Question!

why are you glad?:confused:
do you have the impression removing it could be helpful?:confused:

it is not very sedating... hardly at all. nowhere comparable to lorazepam, for instance.

anyway... if you have ideas.... i appreciate your input. i wish you were feeling better too. :hug::hug::hug:

~ waves ~

Waves,

I was glad because I thought it caused you to be late for work (2pm?) after you took it. That's all.

Med posts are confusing!
Honestly, I'm still confused but...
Don't wait for me to catch on. Sometimes I just can't. Part of my cog. problems. Sometimes my brain will just shut off if same/similar words/ideas are repeated. And...
My attention span is especially lacking right now :)

the 2.5 mg of the benzo is what she is referring to...at least that is what I think..it is short acting I think...heck I don't know for sure....
bizi

Dear Waves,
Yes, Lamictal really stinks in the generic. Some people find it works for them in the name brand even though the drug company pretty much manufactured its own studies.
'sOK because I rely on a med that is completely off label.

Anyway, this week you are going for consistency. Also, we are hoping that you are going to start to notice things working for you. (Underlining used to help me keep focus.)

Otherwise, the pdoc really needs to rethink the med plan in a week or so -- excuse me for being bossy but REALLY, you are working hard on the meds and the work and the getting to work and the dealing with work.

The meds need to be more helpful. ( and can I have a talk with the pdoc?? :confused:)

Good luck this week.

M.

Dear Waves,
Are you experiencing some bits of mixed type states?

I'm referring to your post last week when you said that you were over medicated and under medicated at the same time.

Can this long acting benzo be increased a bit? 'Just asking.
I know that you and the pdoc are thinking through the options.

M.

Mari i'd love for you to have a talk with Pdoc... haaaaa i can see it whooooeeeee .... :ROTFLMAO:

Bizi and Kay . . . yes, and yes, it was the 2.5 mg of lorazepam taken at bedtime on top of all the other junk where day i dragged my sorry tail in to work at 2pm. i did that only once - pdoc had said to add it but i d/c'd after the singular 2pm experience. i have a running prn script for lorazepam 2.5's, for anxiety attacks but that's different. if i am having an anxiety attack, it does not knock me out. although after it peaks it can make me a little snoozy.

the unspecified benzo that i take every night, 1.5 mg, is waaaaaaaaaaaaaaaay longer acting than lorazepam. it is unspecified because it isn't available in the US. and it's name might be confusing actually. the easier of its names is delorazepam. it is not nearly as sedating as lorazepam, esp when you consider the build up. lorazepam has a 10-20 hour half life. delorazepam has about 4-5 days half life

ok so i hope i haven't confused you more...

and back to Mari :)seems like it but seems to be improving. caffeine could have exacerbated things but i only started really overdoing that lately ... was already like that before the zyprexa...

my mom thinks - that i have been (ab)using caffeine in an effort to "manage" the med s/e and that i might do better using less ... case where less is more hehe. she says she finds me in a better mood tonight - truly, i am less irritables... and yes i told her thaz coz nobody bust my balls at work today :D

but ok, so gonna try and monitor the caffeine, and keep it sorta constant and hopefully spaced apart well enough.

yes it is possible and thank you for reminding me of that particular option....

as to the benzo - the delorazepam that is - it is given as a bandaid for pretty much all states of agitation. in the clinic it's the first thing they put me on - i was in for mixed state but anxiety was not one of my problems. lessee, i was on that, Trileptal, then added Zoloft 50 and an antipsychotic (amisulpride, n/a in US) that has a very broad range of applications. i'm derailing sorry......

at least finally my brain is in gear. today i felt like bashing my head really the dumbcluck stuff i was doing.... oh man... :Bang-Head:

did i leave offf anything? i'll go back and read... meanwhile

:grouphug:

thanks you guys! :)

~ waves ~