Metanx
 

I went to another neurologist today hoping for a new insight for my PN.

I was surprised that he prescribed me with a supplement called Metanx. I never heard of it so I was excited. After getting it from the local pharmacy, I immediately checked it online what's it for -- it's for the treatment of diabetic neuropathy. He said that he never prescribed it until more and more studies have come out for the past 10 years about the efficacy of the supplement. I'm not sure if I heard my new neurologist said about FDA approved but a prescription is needed to buy so I assume its FDA approved. He said about some patients who had success in using the supplement.

Although it says on the literature online that it should not be taken with antibiotic. But there was no mention of specific antibiotics. The doctor knew my antibiotics, so I guess it's safe to take it.

I will start tonight taking it...I hope it'll help me some.

If you search Metanx here you'll find posts on PN about it.

It is a medical food, and not a drug and does not have DRUG FDA approval. Medical foods are a separate category at the FDA.

It has high dose methylfolate, activated B6, and methylcobalamin in it. You should take it on empty stomach if you want the benefits of the B12. That is all it is.

Here is the insert:
http://www.metanx.com/helpful-resources/package-insert/

The antibiotic statement is near the end. I have not heard of this statement before.
I'll have to search this quote. B12 is excreted in the bile, and some may be reabsorbed in the intestine, but that has always been unclear in most of what I have read...not proven therefore.

It is always best to take methylB12 on an empty stomach...for best absorption.

Thank you Mrs D for your comments/insights, as usual. I am excited because its something new. At least something new is prescribed to me. Anything that is new gives me hope for improvement.
I am in a dilemma, though, to start because of the vit b12 component. I have bloodworks in May that include vitB12, I want to get my real numbers without supplementation.

Btw, I am taking vit d3 because Rifampin, one of my antibiotics affect the absorption of vit d3 and you know what my number last march 7---it's 66.5 (Vit D, 25-hydroxy). I'm taking 4000mg+. I'm happy that its a good number, unfortunately it does not help my pain. I still take it for my lungs.

Thank you for all your help.

That is great about your Vit D.

The reason Metanx is RX is that it has 1mg or more of folate in it.
That is the only reason. FDA requires an RX for 1mg or more of folic acid or folate.

It is up to you to decide when to start it. It should be taken on an empty stomach for best absorption.

You haven't been on B12 at all before?

I have been on Vit B12 methylcobalamin a few months after my PN started. Got it from you. The last b12 test I had was August 2012 and my result was 1999. Since then I take my vitb12 twice a week to comply the 5000mcg (mine at home is 2500mcg). I will have my b12 test in May so I want to stop it so I can see my real number without supplementation. I remember, though, in one of your posts that only 3 days is required to flush out all b12 in the system. I hope I remember your post right. :-)

Express Scripts dropping MetaNx
 

I have been on MetaNx for several years. Originally started because of homocysteine levels. Express Scripts has posted this message:

Drug Discontinued
Unfortunately, METANX 3-35-2MG has been discontinued by the manufacturer. By law, the Express Scripts Pharmacy can no longer fill prescriptions for this medication.

Recommended Next Step
We encourage you to discuss this issue with your doctor. Your doctor should be able to explain why METANX 3-35-2MG was discontinued and can recommend an alternative medication for your needs.

So, not quite sure what to do, I stopped taking it. Not sure if it is related (but am suspicious it is), but blood pressure has become elevated (especially systolic), mouth ulcers have appeared, and tingling/burning in feet is noticeable.

Fortunately, I have a supply and started retaking it last night. Last two BPs are much better. If all things improve then that will strongly suggest I need MetaNx or equivalent.

One of the things that concern me is the high level of folate in MetaNx, especially with some studies that suggest increased risk of colon cancer with MetaNx.

Assuming that things do improve, then what? Is there an alternative? From my reading here, my hope of finding another Rx solution is slim.

Does this make sense:

Ignore the folate component.

Find a supplement for activated P-5-P (which one and how much)?

Find a supplement for Methylcobalamin (which one and how much)?

Would something like Neuropathy Support Formula from the Neuropathy Treatment Group be a reasonable option?

For my situation, should I focus on B6, B12 or both?

First post -- great information here!

I am not surprised. This was way overpriced to begin with, and some insurances refused to pay for it.

All 3 ingredients are OTC anyway.

If you are not low in B12, you can use the B-right by Jarrow.

http://www.iherb.com/Jarrow-Formulas...eggie-Caps/110

Or if you want higher levels:
P5P separately-- one a day
http://www.iherb.com/Now-Foods-P-5-P...60-Tablets/740

Metafolin 800mcg-- one a day
http://www.iherb.com/Solgar-Folate-A...-Tablets/13961

Methylcobalamin 1mg any brand on an empty stomach -- one a day.

There was quite a bit of methylfolate in Metanx... you may not need that much. It is the reason it was on RX. FDA only allows less than 1mg OTC.

Metanx was a good idea, but they didn't enteric coat it...to protect the P5P. They didn't specify empty stomach for best absorption of the B12.

There have been some recent studies showing no effect on homocysteine etc, and that may have contributed to doctors declining to order it. However, the ingredients remain important for PN and some other neurological uses.

mrsD,

Thank you for the information. Things are noticeably improving for me. I have an appt tomorrow with my PCP and need to figure out what I want to do. As an aside, Express Scripts is making me go through loops to get my Benicar Rx refilled which adds to my anxiety. Why go to doctors when you can use bureaucrats in big government run health systems!

I am coming to grips with the fact that my MetaNx Rx will no longer be filled by Express Scripts. If I want to continue with MetaNx ordered directly, it looks like it will cost ~$150 for 90 day supply.

I think your suggestion to buying them individually makes more sense. Especially since B12 can then be taken on an empty stomach.

I have been taking 35mg B6 and 2mg B12 daily. I think I would like to keep that level since I know it works.

3000 mcg is a lot. Your suggestions are appreciated.

BTW, do the folks on the forum have a preferred B12 brand?

Thanks

Mike

Mike, I use Puritan's Pride methyB12. They came out with it
2 yrs ago, and I decided to test it out. So I took 5mg a day and had testing about 3 months later. I tested out at 1999 (which was the lab's highest calibrated amount). My doctor was stunned, as she told me B12 doesn't work orally!

I've been using that which I get from their big sales once a year.
This buy one get 2 free is the best deal. But recently a member here pointed out the Kirkland (Costco) brand just available at Costco for 250 tablets 5mg MethyB12 for $19.99! So we were almost out of Puritans, since both my hubby and I use it twice a week, and therefore, we bought the Costco one instead. The Costco one works out to 6 cents a pill! Can't beat that price!

The Puritan's sale has just started so take a look at those. They have both the 1mg and 5mg methylcobalamin in 30 ct bottles.
Read carefully because they also offer the cyano on the same page and they look very much alike on the monitor!
They are small soft cherry discs which dissolve very quickly. I just chew them up and swallow with a little water. (no food).

In the past we all used Jarrow brand, because that is all there was basically. But over the last 10 yrs, other places have now started making it more common to find. Walgreen's also has it in their stores now! That means there is knowledge and demand for it and that makes me happy...that people are learning more about it. (and hopefully their doctors, too! )

Puritan's Pride says, Directions: For adults, take one (1) microlozenge daily, preferably with a meal. Place microlozenge under tongue for 30 seconds before swallowing.

I thought B12 should be taken on empty stomach?

Also, they cost $12.99 for 120 - 5mg or 0.22 per pill which is pretty good?

Jarrow Has Xylitol as the first other ingredient in it of which I am not a big fan.

Wow - Kirkland Signature™ Sublingual B-12 5000 mcg., 300 Tablets $19.99. We do not have a CostCo -- gotta see what it costs to order online.

BTW, I have been taking MetaNx daily. I was going to do the same with B12, but double the dose. However, you say you take it twice a week. Will I be over doing it?

Thanks.

The studies done with B12 orally showing various absorption rates, were done on an EMPTY stomach.

One thing you will see as you investigate various supplements, is that the makers of them are imperfect. And Big Pharma who makes drugs, are also imperfect.

Do what you think is best. If you want the BEST results take your B12 on an empty stomach.

Metanx was NOT enteric coated either... and P5P is best protected from stomach acid with an enteric coating. The better manufacturers of it provide it this way.

Taking vitamins with food is a generalization. It reflects the need for acid in the stomach for many of them. But taking microgram doses of B12 (and this pertains to some RX drugs also), with food, loses the drug in the fiber of the food, and it won't get to the lining of the intestines adequately. So in the case of B12 you need an empty stomach with nothing in the small intestine, to absorb the tiny micrograms of the cobalamin.

You are not going to absorb 1000mcg of methylB12...per dose. If you are lucky and do it correctly, you may absorb 13 micrograms of that huge dose. (this was found in the study I provide on the B12 thread. 13mcg a day is about 3 times the RDA and over time is adequate to improve B12 status in most people).

So I suggest you do it the way that has been opened for you and disregard the makers of Metanx, who are in error on this factoid.

Thanks.

I ordered the Kirkland 5mg from CostCo. They had a $3.00 non-member surcharge, but since they do not have one where I live it was not worth $55 to join.

I was just surprised to see Puritan Pride say to take it with food. Empty stomach it will be :cool:.

I am thinking 5mg/day. Your 5mg/day maxed out your lab. What level should I be trying to obtain for PN and homocysteine control? Typically, what is the dosage used by most folks?

Your comments have been very helpful. Thank you very much!

Next is to look at P5P.

My Metanx prescription was also declined by Express Scripts for reason that my insurance does not cover it. But it's isn't so clear to me because when I bought it through my local pharmacy, they got approval from my insurance. I am not just sure if they will allow a refill. I started taking it last April 3 so i don't know yet if there will be an effect on my pain. I hope so..does it have a good effect on your neuropathy?

You mentioned about some studies that suggest increased risk of colon cancer with Metanx, did it mention which ingredient/s of Metanx that make it high risk?

I called an online pharmacy that sells Metanx (I forgot the name)- I asked if they have generic, the pharmacist said they do but these are not considered as AB generic.

If I could not get a refill next week, I might just try buying a separate folate to be combined with Vit B12 and Vit B6.

The tablet form of MetaNx was changed to a capsule. That is the reason it was listed as discontinued. I would need a new Rx for the capsule form. However, MetaNx is listed as a "medical food" which is not covered under any circumstances by my coverage. I have been taking MetaNx since ~1996 (originally prescribed because of high homocysteine). I did not realize I had PN until I stopped taking MetaNx -- shock! Yes it did help me.

It was folate; however, later studies concluded that no risk exists.

My local pharmacy told me that a generic was Foltanx manufactured by Breckenridge. My doctor has submitted a Rx to Express Scripts using the generic component formula - I expect to see it rejected too.

Based on the comments by mrsD that is my strategy. I ordered the CostCo Kirkland B12 5000 mcg, but have canceled the order (gotta find another source since Kirkland does not have 1000 mcg). I was getting 2mg with MetaNx and think I should start with 1mg tabs two a day. I have ordered Solgar - Folate (Metafolin) 800 Mcg and am thinking about the Solgar P5P.

I hate having to fix something that was really not broken.

You can still use the 5mg and just take it twice a WEEK, to get the dose you want.

I have to wonder about the studies also for homocysteine effects. Recently there have been studies (they quote them on the Mayo site) that vitamins don't work. I have to wonder if ANYONE in research learns from other studies on microgram dosing... EMPTY STOMACH!!! Also P5P should be enteric coated and saved from stomach acids. AND all 3 vitamins should be given in their activated states... so that best results can be had for the MTHFR patients. Sometimes it is like the left hand not knowing what the right hand is doing! ...sigh!
Putting P5P in there with two other ingredients that don't need enteric coating, doesn't make sense. An all in one pill was rather doomed IMO.

When reading "studies" on nutrients, which tend to have results all over the place, we never see what variables are controlled and which are not. I think this is the main reason for all the data which seems to be very hard to corroborate.

Upon reading the NEW ingredients for Metanx...one has to wonder???

Only thing missing is the kitchen sink?
from
http://www.metanx.com/helpful-resources/package-insert/

Mrs.D,

When i do my own combinations of vitamin bB12, Methylfolate and B6, do you think it would be okay if I take my usual VitB12 2500mcg (I used to take it 2x a week as you suggested after I had my 1999 blood result back in June 2012), B-Complex, then the Methylfolate that you suggested.

Before Metanx (prior to June 2013), I was not taking a separate vit b6 (I was only taking 1x a week B-Complex) because at one point in my treatment, one neuro told me to stop the b-complex. I remember he said that high b6 causes neuropathy. I think I get sufficient B6 from my diet so I just take the 2x a week b-complex.

I'm not sure if I'm making any sense....basically, my question is can I combine::)

1. Vitamin B12 2500 mcg at 2x week
2. Vitamin B-Complex at 2x a week
3. Methylfolate 800mg

Thank you.

Sounds okay to me. To get neuropathy from B6 you would have to consume 500mg a day or MORE (most of the studies had much more than 500mg a day) for a LONG time ....It is not really that common.

Why doctors fixate on this B6 issue, when statins and fluorquinolone antibiotics are right under their noses and pens, doing far more damage every day, is beyond me:rolleyes::confused: .

After thinking about my quote above with the LONG ingredient list for the new improved Metanx capsules... I've had an idea.

All that LONG list of other nutrients...would make it very hard to make a generic...since generics have to be identical to be AB rated. On the downside for patients, making a capsule is more expensive than a tablet, so the patient will end up paying more for the added ingredients and capsule formulation. :rolleyes:

It's money, money and more money... It's sad but its the way life is. Take us, MAC patients, big pharmaceuticals don't invest on new medicines to fight this bacteria because, they think their market is not that big:mad: meantime, we have not much options but to take the current available medications that even doctors admit that "side effects are worse than the disease". Tsk! Tsk!

methyl-b12
 

I think my options are

Puritan's Pride Methylcobalamin Vitamin B-12 1000 mcg 1000 mcg / 30 Microlozenges
24 bottles - 720 tables (2 people for 1 year) costs $47.92 @ $.07/ 1mg tablet

Source Naturals, MethylCobalamin, Cherry Flavored Sublingual, 1 mg, 120 Tablets
6 bottles - 720 tablets (2 people for 1 year) costs $53.70 @ $.07/ 1mg tablet

CostCo Kirkland Signature™ Sublingual B-12 5000 mcg., 300 Tablets
3 bottles - 900 tablets (2 people for ? year) costs $62.97 costs
@ $.07/ 5mg tablet - $.01/ 1mg tablet

So two Kirkland per week is 10mg or 7 other is 7 mg -- big cost difference.

My initial thinking was that it would be better to space it out to even out the absorption, but your comments suggest that is not necessary. So I take 5mg per day and see where is my B12 level. Please explain again why I should not take B12 for 4-7 days before the blood work?

Thank your for your assistance.

Mike

BTW, I know B12 is empty stomach - had to find with all my other medications. Any drug interactions?

When should B6 & Folate be taken and any drug interactions?

Mike

B6 cannot be used with certain medications for Parkinson's.

This link gives a pretty good overview of interactions with some common supplements.

Not all references mention the same things, so keep that in mind:

http://www.umm.edu/altmed/

Drug checkers also will match up your drugs with food/vitamins.

This one is good:
http://www.drugs.com/drug_interactions.html

Thank you for the references.

I use this one as well:

Medscape

PS - I sent you a PM.

Mike

Just the thread I needed...
 

Went to see the podiatrist today for my foot and he gave me samples of Metanx. I would rather bypass the added ingredients and the large price tag. Seriously, the more doctors I see the more faith I lose in conventional medicine. :rolleyes:

Sorry to hijack an old thread, but I don't think I'm allowed to start new posts on the forum yet (or, I'm just not bright enough to find the New Post button :) )

My endocrinologist recently suggested for me to start taking Metanx to help control homocysteine levels. I have a family history of heart disease. Quick history, I am 35 years old and have been Hypothyroid since age 12, I have low vit-D levels, and low-T.

I just cannot make myself pay the $50 a month for Metanx. I'm hoping to find a good alternative (hopefully cheaper) way to take these supplements. I was hoping I could get some good up-to-date suggestions from this forum. From what I can tell Mrs D has a good understanding of these things.

I've also found this supplement, and wanted opinions on this as well:
**

Thanks, and sorry for the thread hijack!

Sorry. I goofed on the link. I can't posts links yet either. It's a product called HSFighters, by BioActiv Health. Their website is basically the company name.

Welcome to NeuroTalk:

HS fighter is similar to Metanx... but less folate, and the unactivated B6 pyridoxine instead of P5P.

You could do it...if you choose. You should take any mixture with methylcobalamin in it on an empty stomach.

Post #7 on this thread here explains OTC alternatives.

Anyone can start a new thread topic on NeuroTalk. You have to be on the first page of each forum to see the New Thread Icon button on the left side of the page near the top.

This is the main index page:To find the forum you want:
http://neurotalk.psychcentral.com/index.php

And this is the link to the PN forum first page:
http://neurotalk.psychcentral.com/forum20.html

And this is the link to the informational subforum, with this thread in it:
http://neurotalk.psychcentral.com/forum119.html

Thanks for the quick response, mrsD. I see that I was just a page or so too deep to find the New Thread button. I do much more reading than posting in forums (obviously).

Do you or anyone you know have any experience with this HS Fighter supplement? Just curious if it's a pretty legit company, and if it works.

I had a pretty extensive diagnostic lab work done thru Oklahoma Heart Institute. (I went to see an Endo for low-T, and I guess I opened up a can of worms by revealing my family history of heart issues) My Endo says that I do not convert folate properly. So, this is the reason for the recommendation of the Metanx.

Would I best safe to try the HS Fighter stuff first? Or, would I be better off with the suggestions from the earlier thread?

There are many homocysteine formulas out there.

You just have to choose methylfolate, and methylcobalamin containing ones. The P5P is optional as it is not methylated.

All 3 ingredients are OTC. You can purchase them separately yourself if you want. Or get a mixture, which usually costs more.

Metanx is RX because it has more than 1mg of folate in it. FDA requires RX for high dose folate products.

Methylcobalamin requires empty stomach for absorption. But folate does not. P5P is acid sensitive and needs to be specially coated, and some labs do that, but not all provide it with an enteric coating. I don't believe Metanx does, as it is now a capsule.

Metanx on Wiki gives the formula if you need to see it.
You probably don't need the high folate, and OTC folate is 800mcg =.8mg

We've had many discussions on Metanx here over the years.
If you use our search function using it as a keyword a long list of the threads will appear.

mrsD, thanks again for your replies. One more question:

Whichever way I decide to go, either HS Fighter, or the seperate supplements (Jarrow B-Right, P5P & Solgar Folate)...when would be the optimal time to take them?

(I'm already taking my levothyroxine for my hypothyroidism in the evening before bed (well after food). And, I take Fish Oil and Vit-D in the morning just before breakfast....but, not long before.)

It doesn't matter much when to take them.

The only qualification is the methylcobalamin... needs empty stomach like your levothyroxine. Both are absorbed by food and won't get to the intestinal lining well because of their tiny microgram dose.

Oils like fish oil, vit E etc. go best with food. The majority of supplements can be taken with food. There are a few exceptions, but you are not there yet.;)

I think I'll be trying the HS Fighter, and see how that goes. I assume I'm ok to take it on an empty stomach with my Thyroid meds? I've started taking the Thyroid meds at night well after eating. I used to take it in the mornings before breakfast...but, I think I was eating too soon afterwards.

I'm just curious. Should I expect to feel any different (better) taking these new vitamins? I'm obviously going to start them based on my slightly elevated homosystiene levels. I was curious if I could potentially expect any relief from my hypothyroid symptoms? I've had fatigue, joint pain, etc for a long time now. I've basically been told to just live with it. I was hoping this might potentially help with those issues.

These 3 work on many systems...

B12 for example...just one example, ..methylcobalamin is involved in the synthesis of melatonin from serotonin. Melatonin is thought to now be involved in pancreatic functions, so besides better sleep there are other functions we may not even know about!

So yes, you may see some global improvements. People who have the MTHFR mutation see lots of benefits just from methylfolate.

The HS formulas also help the nervous system repair itself.

Metanx w/ normal homocysteine level
 

Hi! After a miscarriage my fertility Dr had me tested for MTHFR. Turns out Im heterozygous for MTHFR A1298C so he suggested Metanx. I then went to my primary Dr and requested a homocysteine level test, which came back normal at 6.6 umol/L.
Im taking: P5P 50mg; Metafolin 2400mcg; Methylcobalamin 2mg (equivalent to Metanx since insurance wont cover it) daily. Should I keep taking all this if my homocysteine levels are OK? Thank You!

That question is for your doctors to answer.

However the MTHFR mutation is sometimes not 100%...
you may be methylating "some", but not enough for other functions besides homocysteine.

Sorry to jump back into this thread yet again. But, I have a new question. Thought perhaps the experts on this forum might have some insight. I've been taking the HS Fighters supplements mentioned a few post above since the time of my last post. I noticed some relatively mild positive results. My energy levels, and just overall health seem to be a bit better.

I decided to add another supplement to my regime that I had been researching for a bit, ZMA. Thought it couldn't hurt to give it a go...my last Testosterone had me just on the plus side of low. I had previously been just on the outside looking in. I had read the T boosting properties of the ingredients in ZMA (Zinc, Magnesium, & B6). But, after a couple of weeks of use I started getting some strange symptoms. The other night I had a hard time getting to sleep. My body (mainly chest) started getting shaky/fluttery. There was no pain to speak of...just uncomfortable at worst. And, my energy level dipped pretty dramatically the following day. Any chance I'm just overdoing it on something? B6 perhaps?

Some people are very sensitive to B6.

I can get too energized on methylfolate, so I only take 800mcg a day of that, and even sometimes skip a day.

Check the magnesium in that ZMA product. If it is OXIDE then you are not going to get much benefit from it, because OXIDE is not absorbed and remains in the bowel.

Also if your HS fighter product has B12 in it, take that on an empty stomach. Food will greatly impair absorption of B12.

mrsD, thanks for the always prompt response. Here are the ingredients:

HS fighters:

Folate (Metafolin L-methylfolate) 800 mcg
Vit B12 (as methylcobalamin) 1,000 mcg
Vit B6 (as pyridoxine HCI) 30 mg

ZMA Tech ingredients:

Vit B6 (as pyridoxine HCI) 10.5 mg
Magnesium (as aspartate) 450 mg
Zinc (as monomethionine & aspartate) 30 mg

Could it be the B6 that's making me feel so rough? I'm almost in a fog..head feels kind of numb...and of course the weird chest flutters the other night. Oh, and I take these two supplements on an empty stomach before bed (along with my levothyroxine 125mcg)

I'd try taking the HS fighters in the morning on an empty stomach.
That folate would give ME the heebeejeebees at night! ;)
But not everyone has that reaction.

The magnesium in the ZMA product should help you relax some.
You could take that every other night and see if you notice any difference. Too much magnesium can over-relax you and make you sleepy.

However, I wonder about that thyroid medication. I had been on 75mcg levothyroxine for over 10 yrs and suddenly it was too much for me. Even at 1/2 dose it was waking me up and I was having rapid heart beats at night. So after a 3month hiatus, I got retested and was still in the normal range for me. Something changed therefore and my thyroid medication was making me very uncomfortable. (I had had hypo before and a goiter in the past). So now I am without and feeling much better. Go figure!