View Full Version : Good ideas for poor metabolizers?

11-17-16, 07:19 PM

As I recently learned, Im a "poor metabolizer" because of "that p450 2D6-thing" now I have some good explanations for some very bad experiences I had in the past (with Ritalin and - worse - Dexamphetamin)

Maybe Im not alone with that?

My doc had me see a cardiologist, who told me everything is ok, and decided that I should start again with methylphenidat 1.25 mg/day..just to see what happens.

Honestly, Id prefer a more strategic approach.

Does anyone have an idea? Would be so awesome.

Thank You!

11-18-16, 05:48 AM
How did you find out you were a poor metabolizer?

11-18-16, 07:12 AM
By genetical analysis.

11-18-16, 10:37 AM
By genetical analysis.

Did you have to see a special kind of doctor for this?

11-18-16, 11:25 AM
No, my doc sent a blood sample to the laboratory and waited for the results.
(My doc is a psychiatrist)

11-18-16, 02:29 PM
No, my doc sent a blood sample to the laboratory and waited for the results.
(My doc is a psychiatrist)

Can any other members shed light on this? I am not too familiar with this sort of thing. Are the results accurate and is this testing scientifically supported?

11-18-16, 03:08 PM
Thank You for replying anyway

11-18-16, 05:05 PM
Are the results accurate and is this testing scientifically supported?
Yes. (Here's some technical info about CYP2D6. (

This metabolic pathway isn't the only factor influencing how medication works, but it is relevant.

Some medications are metabolized via this pathway, so being a poor metabolizer can mean an increase in side effects.

Other medications inhibit this pathway, even if they're not directly metabolized by it. This can cause problems for people taking combinations of medications (like ADHD meds and antidepressants) -- and possibly also for people who were poor metabolizers to begin with. I think methylphenidate is in this category (mild inhibitor), but would need to check.

11-18-16, 05:06 PM
How do Ritalin and/or dexamphetamin affect you?
Can you describe it?
Poor metabolizing should mean a modified half-life curve.
So you experience a very long lasting and also very strong
effectiveness of the meds?

Can you dissolve the meds in water for exact dosaging?

11-18-16, 05:10 PM
@ sarahsweets
sorry I wasnīt sure, if you asked me or the other forum members, but just in case.

As far as I got it, the test are very accurate in showing the ability of a persons body to deal with medication when specific enzymes are needed in the whole process (e.g. to activate a "prodrug" or to get stuff out of the system again)
And - again from my understanding - the concept itself is scientificly highly approved.

11-18-16, 06:01 PM
Hi! and thank You!

1. Yes i can describe it. Here is,what I experienced:

First I took Ritalin forabout 4 months (10 mg released+2-5 mg on occassion) and was feeeling fine.

Then I started to wonder if something felt strange - for about a week-and then experienced very unpleasant tachycardia.

My doc had me checked by a cardiologist and then recomended 5mg Ritalin+ Metoprolol -just to try.

That felt horrible aswell and so I only tried it once (but i dont know whether that was because of poor timing or panit me free of c,or whatsoever.)

I found another doc and he recomended Dextroamphetamine (1,25 mg/day)

The first and second day were good, on day three I got tachycardia again-not as severe as before but absolutely unacceptable whatsoever.

so I stopped taking the pills.

About ten days later - for really unknown reasons - tachycardia returned and my GP subscribed Metoprolol again (everytime I took it, the effect became stronger)

I then had another cardiological check - which was good and all the symptoms instantly disappeared (probably a little psychosomatic involved?)

Then my doc had me tested for 2D6 and ces1 and after all that Im still a little clueless.

2. Dissolving in water is a great idea!!! THANK YOU!

does it dissolve properly? that would be really worth to try,thats awesome.

3. just to mention, when I stopped taking Ritalin it took weeks before the add symptoms reoccured for the first time.....

11-18-16, 06:16 PM

yes, Methylphenidat is considered a "mild inhibitor"

11-22-16, 08:43 PM
I think your DEX should dissolve quick in water otherwise crush the pill with e.g. a spoon.
I drink my Vyvanse although it is absoulutely undissolvable in water. I stir it with a milk foam
rod put in a dremel in a measuring cup to get the water in a quick centrifugal rotation so the
meds powder is spread evenly in the water and it is still rotating when I fill pars of it to a glass.

I am not a poor metabolizer but I love experiments. I would try if your DEXs effects are more
comfortable if you drink it slow e.g. in five parts every 15 minutes (or a bit more) because I
remember the same DEX product had its full effect after 15 minutes. Thats a safe use while
adjusting the dosage but also could mean a comfortable way for a weaker start into daily
medication to prevent it to kick-in.

Your dosage of 1.25mg DEX might sound incredible low for others but it could still be too much
for you. Dissolving the pill in water means you can decrease your dosage to 0.25mg a day.

11-22-16, 11:16 PM
***Moderator Note***
Dividing doses of Extended Release Dextroamphetamine (Spanuals) is not a recommended or recognized method of administering according to the manufacturer and the FDA.

Since it is not a recognized method of dosing, it's discussion is prohibited on the forum according to our med. guidelines. Please discuss it with your Dr. if necessary and not on the forum. Thanks in advance.

11-23-16, 06:05 PM
well, thank you.

Unfortunately, Amphetamines donīt seem to be an option for me anyway.

As I said before I am a poor metabolizer, "poor" being an euphemism for "zero - not at all" in this context. so no matter how small the dosage would be, Iīd be still overdosed sooner or later.

At least, all docs I asked agree on that (they also agree that I really should find someone who knows what to do, and that this person is certainly someone else but them)

what I donīt understand is: statistically I should share this problem with 7% of all add-patients, so why doesnīt anybody know anything?
itīs so frustrating........