Cpnhelp.org

Hi Lori, I meant that I would really like to be able to swallow medications, supplementsi, and exotic foods without having a stomach reaction, such as nausea, severe nausea, vomiting, and or discomfort to stabbing pain.  When I heard about flagyli descriptions I assumed that it would not be easy on my stomach to say the least.

And there are many on flagyl that do really quite OK with the physical act of getting it past their stomach which was my first concern.   I may try it in the future and perhaps it will set OK for me.

I too am on Tindamax pulses.  And get some good energy after starting the pulse and some die off symptoms up to two weeks after.       Louise

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Louise  CFSi,CPNi+/Bb+(Lyme) Cholestyramine 1-2 pks @ HS for Porphyriai +fattyEndotoxins HS PRN, Wheldon CAPi 6/07,all supps, Doxyi 200QD, Roxi 300BID, Tinidazole 500 BIDx20day Pulses, VitD3-10,000IU,Iodoral25mg,SAM-e100mgQD+B-vits, Pyruvate3.75Gm at 1PM

Another poster did this for us.

http://www.cpnhelp.org/cytochrome_p450_drug_inte

If there's one you want me to look up, I'd be glad to - I have been researching this area quiet a bit and have references.

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Daisy - Husband on CAPi 5/07.  "When Going Thru Hell, Just Keep Going", Winston Churchill

Thanks Daisy, Yes that was the link that I had lost in the Great Bookmark Changeover.  I had it marked and scanning the thread I was the last to post to it.  Would like to see more posts from that contributor!

Hm, From taking a look at those charts Rifampin and Clarithro might be a good balance to be taken together?

Any international data that you have read regarding Roxi in this picture that you might have found in your readings?  As it is understandably not on this list. Thank God Daisy that you can read this biochemspeak, really.   I stretch to read this depth of pharacological information.  My background is thin so to speak in the biochem yet the info does intigue me, the chemical soup our our physical beingness.    

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Louise  CFSi,CPNi+/Bb+(Lyme) Cholestyramine 1-2 pks @ HS for Porphyriai +fattyEndotoxins HS PRN, Wheldon CAPi 6/07,all supps, Doxyi 200QD, Roxi 300BID, Tinidazole 500 BIDx20day Pulses, VitD3-10,000IU,Iodoral25mg,SAM-e100mgQD+B-vits, Pyruvate3.75Gm at 1PM

From Drug Metabolism and Distribution

"These results suggest that roxithromycin itself is not as potent an inhibitor of CYP3A4 activities as are troleandomycin and erythromycin, probably because of the slower metabolism of" this compound to metabolites M1, M2, and M3 in humans "

From Journal Toxicology

"These results suggested that roxithromycin and erythromycin were relatively less potent to inhibit CYP3A4-catalytic activities in human liver microsomes, because of their low capabilities to form P450.Fe(II)-metabolite complex"

From the french version of a PI

"Roxithromycin and other macrolide antibioticsi have the potential to interact with a large number of drugs through their action on hepatic cytochrome P450 isoenzymes, particularly CYP1A2 and CYP3A4. Macrolides inhibit drug metabolism by microsomal cytochromes by competitive inhibition and by the formation of inactive complexes.
Concomitant administrations contra-indicated:
Concomitant administration of roxithromycin with vasoconstrictive ergot (alkaloid) derivatives is contra-indicated since symptoms or ergotism have been described with other macrolides.
Roxithromycin may inhibit the metabolism of pimozide, resulting in increased serum concentrations of this agent. Elevated serum levels of pimozide have been associated with adverse cardiovascular effects including QT interval prolongation, torsades de pointes, cardiac arrhythmia, and sudden death. The concomitant administration of roxithromycin with pimozide is contra-indicated.
Concomitant administrations not recommended:
Terfenadine and Astemizole
Enzyme inhibiting drugs such as roxithromycin and other macrolides may lead to the decreased hepatic metabolism of terfenadine and astemizole resulting in increased serum concentrations of terfenadine and astemizole. This may result in prolonged QT intervals, severe ventricular arrhythmias, typically torsades de pointe.
Cisapride
Cisapride which is metabolized by hepatic CYP3A isoenzymes has been associated with QT interval prolongation and/or cardiac arrhythmias (typically torsades de pointe) as a result of an increase in its serum levels subsequent to interaction with significant inhibitors of the isoenzyme, including some macrolide antibiotics.
Although such a risk is not verified for roxithromycin, combination of roxithromycin with such drugs is not recommended.
Precautions for use:
Warfarin
Although roxithromycin has a lesser inhibiting effect on cytochrome P450 enzymes than other macrolide antibiotics, some reports have suggested that roxithromycin may potentiate the effects of warfarin when given concomitantly to severely ill, elderly or compromised patients. Therefore the concurrent administration of roxithromycin and warfarin may result in the inhibition of warfarin metabolism, and increase the risk of bleeding.
In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or international normalised ratio (INR) should be closely monitored with the addition and withdrawal of treatment with roxithromycin, and should be reassessed periodically during concurrent therapy. Adjustment of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation.
Disopyramide
Roxithromycin displaces disopyramide from protein-binding sites in vitro. Concurrent administration of these two drugs in vivo may result in increased disopyramide serum concentrations. Consequently ECG and, if possible disopyramide levels should be monitored.
Digoxin
In approximately 10% - 15% of patients, digoxin is degraded extensively by bacteria in the gastrointestinal tract. Roxithromycin has the potential to decrease the amount of gastrointestinal flora, resulting in decreased digoxin breakdown in these patients.
Thus, the co-administration of digoxin and roxithromycin may result in increased serum digoxin levels resulting in digoxin toxicity. Serum digoxin levels should be carefully monitored when roxithromycin is added to or withdrawn from therapy. Patients should be observed for signs and symptoms of digoxin toxicity (nausea, vomiting, and arrhythmias).
Midazolam
Macrolide antibiotics may inhibit hepatic enzymes responsible for benzodiazepine metabolism, leading to increased plasma concentrations of benzodiazepines through reduced clearance, prolonged half life and increased volume of distribution resulting in benzodiazepine toxicity (CNSi depression, ataxia, lethargy).
Patients receiving concurrent macrolide antibiotics and benzodiazepine must be observed for enhanced CNS effects. Patients should be warned regarding the potential for drug hangover. Smaller benzodiazepine doses (dose reduction by 25% to 50%) may be required if the patient is receiving concurrent macrolide antibiotic dosing.
Theophylline
Caution should be exercised with patients receiving concomitant theophylline therapy as roxithromycin may increase theophylline levels, which may lead to theophylline toxicity.
Others:
The concomitant administration of cimetidine may increase plasma concentration of roxithromycin. Cimetidine inhibits hepatic microsomal enzymes and may reduce the metabolism of roxithromycin, leading to increased effects.
Concomitant administration of roxithromycin and ranitidine does not alter the pharmacokinetic parameters of roxithromycin.

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Daisy - Husband on CAPi 5/07.  "When Going Thru Hell, Just Keep Going", Winston Churchill

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Louise  CFSi,CPNi+/Bb+(Lyme) Cholestyramine 1-2 pks @ HS for Porphyriai +fattyEndotoxins HS PRN, Wheldon CAPi 6/07,all supps, Doxyi 200QD, Roxi 300BID, Tinidazole 500 BIDx20day Pulses, VitD3-10,000IU,Iodoral25mg,SAM-e100mgQD+B-vits, Pyruvate3.75Gm at 1PM

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CAPi for Cpni 11/04. Dx: 25yrs CFSi & FMSi. Currently: 150mg BID Roxithromycin, Doxycycline 100mg BID, Tinii 1000mg/day pulses; Vit D2000 units, T4 & T3