View Full Version : Rapidly absorbing medications, and a genetic test to prove it.


Pez814
01-24-17, 09:00 AM
Hello all, I was officially diagnosed last February for ADHD, Anxiety, Binge Eating Disorder, OCD, and Depression. I was put on Vyvanse and tested a few doses, along with Brintellix, now Trintellix. The Vyvanse at first worked amazing, but on 50mg after a few weeks of taking it at 5:30am by 3pm I would be done, no energy at all, so talked with the Dr, and they put my on 70mg of Vyvanse, well after a while I felt like that also was not working for me any longer, getting tired in the afternoons, and not being able to do much when I got off work. Vyvanse for me treated my ADHD and the Binge Eating Disorder, so talked with the Dr more and added Adderall 30 mg short acting as a booster in the morning then take Vyvanse later on to help control the eating and hopefully allow me to have energy to stay up and functioning until bed time. When I first took Vyvanse I could almost feel it start to work, almost like everything would shift into focus, if that makes sense. But that was in the beginning and I have not felt that mental clarity and focus in a while now.

In speaking with the Dr about the medications, we started talking about the possibility that my body rapidly absorbs some types of medications. I was being treated for low testosterone and was given injections that should have lasted for close to a month but the effects were wearing off much faster, even on a long term injected pellet medication the effects did not last, and it required me to get testosterone shots while on the pellets. I was told there is a company that can run a genetic test, and analyze DNA and see how certain medications react in your body, and if I am truly absorbing the meds too quickly, which is why I am not getting to full effects of certain medications. The problem is the test is not covered by my insurance and that means paying out of pocket, which coming up with extra money at the moment is not an easy thing to do, as I have a son who requires OT, meds, and dr visits for Autism, ADHD, and Anxiety of his own.

Has anyone heard of the test? Has anyone ever done a test like this? If so what did you think of the results? Did you find it helped dial in your medications, and doses? Just looking to see if this is something worth really looking into when I have the money for it, or should I pass and just see about trying a different medication, which is scary since I like that the Vyvanse helps at least in part with my Binge Eating.

C15H25N3O
01-24-17, 09:20 AM
http://www.addforums.com/forums/showthread.php?t=181489

This thread is about your opposite, the poor metabolizer. Maybe it helps a bit.

Faraway
01-24-17, 12:34 PM
Hi there!
yep! me!

I did such a test (in Germany -so I dont know about the companies doing so in the US, but I know, that there is more than one)

it helped me to understand why I reacted the way I did to e.g. amphetamines and itīs valuable knowledge to estimate the outcome future med-attempst (not only considering ADHD-meds but a lot more - might even be important to avoid severe med-"accidents")

Nevertheless I still havenīt found something that works for myself, so I donīt really consider it 100% sucess. and by know i wonder how I felt if i had spent money on that.

I heard of another approach from Switzerland where they give micro-doses of certain substances to patients and check out how much of it they find in the patients bodies after a defined period.
Probably that would be an option where you live, too?
finally you could ask yor doctor whether he can assume you metabolizer status by checking your blood level of vyvanse-specific stuff??

BUT: will writing that i remember that vyvanse is a pro drug which might make it difficult to determine whether itīs not yet there because itīs not yet metabolized in its active form or whether itīs allready gone?
i donīt know that.
but might be important in that scenario.

Faraway
01-24-17, 06:49 PM
I heard of another approach from Switzerland where they give micro-doses of certain substances to patients and check out how much of it they find in the patients bodies after a defined period.


that sounds strange i guess -like autopsy. (But eben the Swiss wouldnīt do that. you could guess so when you knew how they drive, however)

just to make it clear: they take a blood sample

ToneTone
01-25-17, 12:11 AM
How's your sleep?

You getting a good 8 hours a night?

The meds are no substitute for sleep ... Ample rest is required for optimal functioning ... the meds can cover fatigue for a short while ... but only for a short while ....

Tone

sarahsweets
01-25-17, 06:04 AM
Whenever I hear of a doc promoting or insisting on a test and its magically not covered by insurance, I am always skeptical. Especially because I want able to find out much about whether this is even reliable,.

Pez814
01-25-17, 08:55 AM
Yes I get about 7 or 8 hours of sleep a night. As for the quality of sleep I am unsure, as some nights my son comes into my bed then ninja kicks me throughout the night lol.

Pez814
01-25-17, 09:01 AM
When the doctor was talking to me about the test she said there was a form to fill out to see if my insurance would cover it. I guess Medicare or Medicaid covers the test, so we filled out the form and submitted it. It turns out my insurance did not cover the test but the company offers assistance with paying for the test out of pocket. My doctor wants to help me figure out my medication issues, and try to get me on the right path to success.

I remember when I first started taking Vyvanse last February I could almost feel it kick in, like the world snapped into focus, I was clear minded for the first time in many years, I was able to focus on the tasks I needed to do, I was doing more things around the house that I had neglected for years, I was happier, and able to keep my calm when dealing with my young children when they were screaming and fighting which used to make my ears bleed. But over time those effects started to dwindle away. The only way I know the medication is in my system is I get the urge to use the bathroom, sorry if that was over sharing. I am not looking for a "fix" like a drug seeker, I just liked how I was in the early days of Vyvanse, I was happier, losing weight for the first time in years, I had my Binge Eating under control, and I was more pleasant to be around. I don't know much about other medications as I have been on them for only a year, so I am just trying to see what others may have experienced.

Faraway
01-25-17, 01:11 PM
have you tried methylphenidate?

finallyfound10
01-25-17, 03:40 PM
Yes, our bodies have different rates that drugs are absorbed and distributed in the body. I learned about this concept in nursing school but I haven't had a patient in the 2.5 years that I've worked on a busy post op unit that experiences it.

Have you found that other drugs have had little effect as well?

The two below are part of a process called pharmacokinetics which is very cool to read about but hard to apply for tests!

Drug absorption: http://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-absorption

Drug distribution: http://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-distribution

I don't know of anywhere this can be found out. If you really wanted to know for free or maybe even get paid, you could join a clinical trial at Phase 1. There is a Phase 0 but I've only seen it used for oncology patients.

Good luck!!!! This stuff interests me so I'll check back!

sarahsweets
01-26-17, 05:25 AM
When the doctor was talking to me about the test she said there was a form to fill out to see if my insurance would cover it. I guess Medicare or Medicaid covers the test, so we filled out the form and submitted it. It turns out my insurance did not cover the test but the company offers assistance with paying for the test out of pocket. My doctor wants to help me figure out my medication issues, and try to get me on the right path to success.
The right path to success is a great goal, I am just not sure how this testing is part of that. As far as I know there is this one test that involves a swab of the cheek or something like that, and its supposed to be sent off and tell you which medications are more likely to work for you. I have not heard of a test that can help determine how you absorb meds- is it a blood test?


I remember when I first started taking Vyvanse last February I could almost feel it kick in, like the world snapped into focus, I was clear minded for the first time in many years, I was able to focus on the tasks I needed to do, I was doing more things around the house that I had neglected for years, I was happier, and able to keep my calm when dealing with my young children when they were screaming and fighting which used to make my ears bleed. But over time those effects started to dwindle away. The only way I know the medication is in my system is I get the urge to use the bathroom, sorry if that was over sharing. I am not looking for a "fix" like a drug seeker, I just liked how I was in the early days of Vyvanse, I was happier, losing weight for the first time in years, I had my Binge Eating under control, and I was more pleasant to be around. I don't know much about other medications as I have been on them for only a year, so I am just trying to see what others may have experienced.
Have you considered something other than vyvanse? I identify with needing to use the bathroom alot if you mean to pee. I dont know why it is but everyday around 4ish I start to need to go frequently up until I go to bed.

Faraway
01-26-17, 07:31 AM
As far as I know there is this one test that involves a swab of the cheek or something like that, and its supposed to be sent off and tell you which medications are more likely to work for you. I have not heard of a test that can help determine how you absorb meds- is it a blood test?


I think itīs not too important where they get the cells from (cheek, blood etc) they just need some cells and look at specific DNA sections

basically the reason why they can tell you which meds work is because they can predict the way they are absorbed via the individual set of enzymes.

sarahsweets
01-27-17, 05:31 AM
I think itīs not too important where they get the cells from (cheek, blood etc) they just need some cells and look at specific DNA sections

basically the reason why they can tell you which meds work is because they can predict the way they are absorbed via the individual set of enzymes.

Not trying to argue but is there science to back this up? It would seem like insurance companies would be all over this to somehow regulate how they have to pay for certain medications if it worked so well.

namazu
01-27-17, 05:56 AM
Not trying to argue but is there science to back this up? It would seem like insurance companies would be all over this to somehow regulate how they have to pay for certain medications if it worked so well.
Yes, there is science to back up the tests for specific gene variants that affect drug metabolism via specific pathways. Some people are very rapid or very poor metabolizers of substances through specific pathways as a result of these gene variants. That can result in serious side effects or poor efficacy for certain medications, or a greater likelihood of interactions. (I'm sure I've linked directly to some of the scientific sources on some of the other threads discussing genetic testing, but don't have time to do it again at the moment.)

No, those gene variants aren't the only relevant factors in determining a given person's response to medication. Many people do not have the specific gene variants known to be linked to rapid or poor metabolism. Some people may be poor or rapid metabolizers due to genes that aren't measured by the tests. Some people with the known gene variants may have other genes that partly mitigate the effects of the other genes.

It's complicated.

For many people, genetic testing will not provide much useful information. The scope of the testing is limited; it won't tell you all of the things that could be important.

For some people, including people with a history of poor response to meds or severe side effects from ordinary doses of several different medications, it might be worth looking into. To some extent, the response to medication itself may tell you what you need to know.

sarahsweets
01-27-17, 06:50 AM
I think it sucks that this isnt covered by insurance then. It could help so many of us avoid wasting our time taking meds that do not work, and help keep doctors from pushing meds for their own personal interest on us that wont work.


Yes, there is science to back up the tests for specific gene variants that affect drug metabolism via specific pathways. Some people are very rapid or very poor metabolizers of substances through specific pathways as a result of these gene variants. That can result in serious side effects or poor efficacy for certain medications, or a greater likelihood of interactions. (I'm sure I've linked directly to some of the scientific sources on some of the other threads discussing genetic testing, but don't have time to do it again at the moment.)

No, those gene variants aren't the only relevant factors in determining a given person's response to medication. Many people do not have the specific gene variants known to be linked to rapid or poor metabolism. Some people may be poor or rapid metabolizers due to genes that aren't measured by the tests. Some people with the known gene variants may have other genes that partly mitigate the effects of the other genes.

It's complicated.

For many people, genetic testing will not provide much useful information. The scope of the testing is limited; it won't tell you all of the things that could be important.

For some people, including people with a history of poor response to meds or severe side effects from ordinary doses of several different medications, it might be worth looking into. To some extent, the response to medication itself may tell you what you need to know.

namazu
01-27-17, 07:03 AM
I think it sucks that this isnt covered by insurance then. It could help so many of us avoid wasting our time taking meds that do not work, and help keep doctors from pushing meds for their own personal interest on us that wont work.
It would probably only help a few of us.

The gene variants they test for cover only a handful of the many, many genes (and non-genetic factors) that affect how we respond to medications. So, while the variants they're testing for legitimately do affect metabolism of medication -- the science does back that up! -- those gene variants aren't necessarily the only important ones. (Unfortunately, we don't know what all of the other are, nor how they interact.)

For what it's worth, I had this type of testing done several years ago. (It told me nothing useful.) At that time, it was pretty new, and the company was offering to limit people's out-of-pocket payment to no more than $100 if insurance didn't cover it. I don't think I paid anything for it, but I don't remember if that's because my insurance covered it or because the company ate the costs. I don't know if they still have this offer available, either.

Faraway
01-27-17, 10:09 AM
Not trying to argue but is there science to back this up? It would seem like insurance companies would be all over this to somehow regulate how they have to pay for certain medications if it worked so well.


as namazu wrote, those tests are scientifically approved.
actually the insurances in Germany cover them under some circumstances (and some people say that Germany is 10 years behind the US in ADHD treatment)

whatīs also interesting is that such tests are sometimes (but not due to ADHD) done in advance when med-failure is unacceptable.
(e.g. tamoxifen)

Pez814
01-30-17, 12:44 PM
I am a little skittish to leave the Vyvanse because of the help it gives me with my B.E.D. Sadly I was not referring to urination when I spoke of the bathroom need. I apologize if that was over sharing lol.

The testing is covered by medicare or medicaid currently I can not remember which one. I have had issues when being treated for low testosterone where a shot that was supposed to last for 2 weeks would wear off after a couple days, or a long acting implant faded out much faster than it should have requiring me to get booster shots of testosterone. So that is why I was looking into the testing to see which areas my body may hyper absorb and which areas meds will not work at all.
Here is a link to a company that does the testing, I am not sure if this is the exact one my Dr. recommended or not. But I am supposed to see her this week so I will talk with her more.
http://genomemag.com/whats-your-metabolizer-rate/#.WI9tKVMrKM8

Pez814
01-30-17, 01:36 PM
I posted the wrong link, the company is Genelex that does the testing.

Pez814
02-02-17, 08:31 AM
I went ahead and did the testing yesterday, and I should get the results on Monday. I can share my results when I get them. The company is called IdGenetix.

Pez814
02-08-17, 01:25 PM
Back again, got the results of the genetic testing in, and the doctor is making a few changes. I am stopping Vyvanse and Adderall, and will be starting dexedrine 10mg twice a day of instant acting to see how I do with it. I am also trying something like an abilify only slightly different to see if it helps my depression while taking 30mg of Trintellix. Although I have not seen the report myself I think the information that was acquired from it may be very useful.