(10) Some Asian people have a "double whammy," and it's all about genetics. When step #2 does not occur, acetaldehyde, which is quite toxic, accumulates, and this makes you quite ill. Some Asian people cannot drink any alcohol at all because of this. A large percentage (about half, depending on geography) have low levels of the enzyme acetaldehyde dehydrogenase, which is responsible for the second of two steps in the metabolism of alcohol.
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The x-ray crystallographic structures of a CYP protein (left) and the same protein bound to an antifungal drug (right). The drug is shown in blue and red. Note that the drug fits tightly into a cleft of the protein, turning it "off." Source: PLOS.
There are also a few generalities. Not true. The term "drug-drug interaction" itself is misleading, which is why most people think that if you take a bunch of different medicines they somehow find each other in your body and do icky things to you. What really happens is that one drug will do something to the body—usually to the liver—that alters the blood level of the second drug, making them either higher or lower. Certain drugs, especially, anti-fungal medications are notorious for affecting the levels of other drugs you might be taking (8). Although there is no easy way to predict this a priori, there are easy lab tests to let you know early if this is going to be a problem with the drug you are trying to discover.
If you're going to run out of Ambien (3) in the middle of your planned vacation, you may be S.O.L. (4). But enough about this. In New York, you can't get a prescription for a restricted drug even one day early (2). The current masochistic war on drugs, uh, make that Americans, doesn't just pertain to Vicodin or Percocet. Getting a scheduled drug (like a sedative) is enough to make you need a sedative.
Dr. In 2014, Dr. Bloom was invited to become a featured writer for the site Science 2.0, where he wrote more than 75 pieces on topics ranging from to the pharmaceutical industry, medicine, quackery, junk science, or anything else that pissed him off. Bloom joined the American Council on Science and Health in 2010 as ACSH’s Director of Chemical and Pharmaceutical Sciences, and has written op-eds for numerous periodicals, including for The Wall Street Journal, Forbes, New Scientist, The New York Post, National Review Online, The Boston Herald, and The Chicago Tribune. That's a pretty long list.
The other reason that alcohol and Valium can be deadly is the same reason that opioids and Valium are. All three drugs depress respiration, and the effects are additive. It is physiological, not pharmacological. The more drugs, the more the effect. This is probably at least as important as the drug-drug interactions in this case.
Then it becomes anything but. So, the take home message here is that while Valium on its own is quite safe (11 ) do NOT combine it with other drugs.
(8) The mechanism that causes these interactions is the same one makes grapefruit juice plus certain drugs a bad idea. The are also CYP inhibitors. The offending chemicals in grapefruit juice are called furanocoumarins.
He is the author of 25 patents, and 35 academic papers, including a chapter on new therapies for hepatitis C in Burger’s Medicinal Chemistry, Drug Discovery and Development, 7th Edition (Wiley, 2010), and has given numerous invited lectures on how the pharmaceutical industry really works.
= Simply out of luck. (4) S.O.L. Any of you who thought otherwise probably have dirty minds.
Or maybe his dog. In New York, CVS won't let you order your Ambien online at one store and then switch the pickup to a more convenient store—something they routinely do for all prescriptions that are not scheduled. (2) This is a mish mash function of laws, insurance company restrictions, and pharmacy policies. Yeah, go ahead and try to make sense out of this. Or not. I was also told by them that it is left to the discretion of the individual pharmacist.
Other factors such as dependency and addiction, and withdrawal are issue that are not relevant to this discussion. (11) Safe as used in this article refers to acute dosages.
The chemical structure of Valium. When fused with another ring (sharing a bond between them) the term benzo is used. The red circle contains a 7-membered ring having two nitrogen atoms (a diazapine). All benzodiazepines contain this fused two-ring structure, and differ only by the absence or presence other atoms (e.g., the chlorine). The green circle contains a benzene ring.
Senior Director of Chemical and Pharmaceutical Sciences.
First, the word benzodiazepine is thrown around a lot. I would be remiss in my duty as a chemist (7) if I didn't try to make at least some sense out of it.
People have died from taking fluconazole with certain HIV drugs, antibiotics, and ulcer drugs, among others. Some of these interactions are very dangerous. For example, the common antifungal drug Diflucan (fluconazole) (9) comes with a list of 651 (!!) other drugs that it interacts with, including asthma drugs, antidepressants, antihistamines, cholesterol medications, analgesics. many more. You can add 900 dietary supplements and herbal remedies to that list as well.
Alcohol is an inhibitor of CYP2C19 (Source: Adverse Drug Interactions: A Handbook for Prescribers), and Valium is a substrate of it (is metabolized by it). But not when you add alcohol. This means that the metabolism and thus, elimination of Valium will be slower in the presence of alcohol, and more will remain in the blood. One CYP isoform is called CYP2C19 and it plays a part in the metabolic fate of both alcohol and Valium, but in different ways. Unlike the anti-fungals alcohol does not strongly inhibit multiple CYPs; the effect is still there- just more subtle. The alcohol makes the Valium more dangerous.
This explains why Valium is sometimes dangerous and sometimes not. The graph is not there simply to debunk a myth (5), but rather as a teaching tool for one of the main tenets of pharmacology—drug-drug interactions (6).
BY THE AMERICAN COUNCIL ON SCIENCE AND HEALTH.
They are not only very likely to be anti-fungal drugs, but also belong to the subclass of antifungals that is the worst offender—the azoles. (9) The suffix -azole is a dead giveaway.
Dr. He worked for more than two decades in new drug discovery research at Lederle Laboratories, which was acquired by Wyeth in 1994, which itself was acquired by Pfizer in 2009. in organic chemistry from the University of Virginia, followed by postdoctoral training at the University of Pennsylvania. Josh Bloom earned a Ph.D.
During this time he conducted research in a number of therapeutic areas, including diabetes and obesity, antibiotics, HIV/AIDS, hepatitis C, and oncology. His group discovered the novel antibiotic Tygacil, which was approved by the FDA for use against resistant bacterial infections in 2005.
(1) There are about 15 benzodiazepines available in the US. The major differences between them are how quickly they work and how long they stay in the body.
Don't know if I can say the same for this article. Notes:. So, if you don't get careless it is very unlikely that Valium will kill you.
But it's a lie of omission and it's misleading, because anyone examining this graph would conclude that people all of sudden started dropping dead from Valium (and other benzodiazepines) (1). This graph is a lie. Except they haven't.
Clearly, Valium is a poor choice for suicide. It is also one reason why Valium may or may not be deadly. It is too safe. (To put this in perspective, if you take that many aspirin, Advil, Tylenol, or NoDoz pills, you will end up being quite dead. In two case studies of suicide attempts using Valium, one person took 500 mg, and another took 2000 mg. Although both patients went into what was termed a "moderay deep coma," each of them woke up and were released from the hospital within two days. Depending on the dosage, the number of pills consumed ranged from 50-400.
(3) The DEA keeps a 14-page list of scheduled drugs, should you have nothing better to do with your life.
So can lower levels if the CYPs are activated, but this is less common. If one or more of the CYPs are inhibited by drugs, much higher, even lethal, levels of a normally safe drug can result. This is what really happens in a drug-drug interaction.
There is an interesting a genetic analogy. Asians are more likely to have a genetic variant of CYP2C19, which makes it less efficient in the metabolism of a number of drugs, including Valium (10). So it is not surprising that there is a rule of thumb when prescribing benzodiazepines to Asian people: “ Start low and go slow. ”.
(5) What the graph doesn't say is that the vast majority of benzodiazepine deaths result from the combination of these with other drugs or alcohol. The combination is the killer. The upward trend in deaths from is unquestionably a result of the concurrent rise in opioid use during the same time period.
By Josh Bloom. View the discussion thread.
(6) Drug-drug interactions are defined as "The combined effect of drugs taken concurrently. The result may be antagonism or synergism and may be lethal in some cases.".
Having things hanging out of your nose is optional. (7) Other chemist duties include: Dressing like you ran out of a burning ho room (and thinking you look fine), pocket pen holders are no longer required, but recommended, and, unfortunay these days, looking for a job. Chemists are not a glamorous bunch.
CYPs are ubiquitous, and have been found in all living organisms. The mechanism by which these effects take place is similar to the reason that Valium can either deadly or safe—inhibition or induction of a critical class of liver enzymes called cytochrome P450 (CYPs). There are an enormous number of subtypes (called isotypes), and they exist for one primary reason—metabolism, especially redox reactions.Ran out of ambien early