Which promptly hoses up the finely-adjusted dosages, his symptoms suddenly get real weird, the situation spirals out of control, and he's dead in 4 days.
Doctors, please don't rush out of the room. Take time to talk to your patients, and take twice as much time to listen to them. I'm sure he would've mentioned that detail if he'd had time to find the English words.
The last physician I had any respect for was my own pediatrician and I had consulted him on various issues having gone through several GPs that got even simple diagnoses disastrously, hilariously wrong. Such as telling me the tiny red lump in my finger was an anthrax infection and notifying the health department when it was really a small benign vascularity that was removed in a fifteen minute procedure.
Since my pediatrician retired I just do all my own medical research and order my own lab tests. The advantage I have is that I have all the insight into my own body, history, and habits that no doctor these days ever takes the time to find out. You're just a money pinata. Thank you, here are some antibiotics for an unspecified pathogen I didn't culture, Alisha will see you at checkout. Examining the patient? Ain't nobody got time for that.
I have no affiliation with any of the above, they were just the first to pop up on Google (there are plenty more).
A lab is rarely going to advertise to consumers directly (some startups do this with mail in tests), but a smaller one will be happy for the bit of extra business.
Also, everywhere I’ve ever lived labs have been a very commercial business. They advertise constantly about it...
I agree that most doctors rush things (for whatever reason). But what does it have to do with this case ? the advice was solid- stop eating grapefruit.
Suddenly stopping grapefruit caused a drastic shift in the levels of those medications in his system and caused catastrophic problems.
In short: it works both ways. Grapefruit screws with levels. If your levels are tuned to a non-grapefruit diet you shouldn’t start eating it. If they are tuned to a grapefruit diet you shouldn’t stop eating it.
Either way his doctor should have spoken to him when he started the drugs and discussed the grapefruit factor, and absolutely should have been mindful of whether or not his patient had been eating grapefruit all along when telling him to stop eating it. It’s the same as being on another medication, he shouldn’t have discontinued it immediately, he should have tapered off.
My personal experience as someone on a lot of blood pressure medication has been that all my doctors have been very clear and up front with me about not eating grapefruit while on that kind of medication. When I asked why they were happy to explain the interactions. And it's not just blood pressure medication. The same type effect happened with my other meds too.
But English was the patient's second or third language, learned late in life, and he was never particularly fluent in it. Enough that they didn't feel like calling a translator, but not enough to really communicate as well as should've happened.
Waiting for him to come up with words didn't fit with modern medicine's idea of the doctor seeing another patient as promptly as possible, so instead, he's dead.
Over the two-week visit, my brother got harder and harder to be around - he'd always been surly, and he struggled with grandpa's wife, but we'd never experienced the level of emotional turmoil he went through on that trip. He self-harmed, sliced his arms up deeply. I stitched him up with the sewing kit that the resort had mercifully left in the room for us, and we kept the wounds dressed with neosporin until they healed.
The next stop on the trip was a visit to grandpa's wife's sister, a professor of neuroscience. She just happened to mention the interaction between antipsychotics and grapefruit, and it was like a light went on in my brother's mind. He stopped eating grapefruit and returned to his usual mental state within a few days.
Coupled with whatever substance du jour that college me was able to lay hands on, DXM was guaranteed to have me stumbling and hallucinating like the true futureless human I aspired to be, for the low low price of $7.65.
So, hats off to the NC state legislature for giving me some cheap thrills through college just outside my dorm room, while the state liquor store was a few miles away. You saved my liver, non-sarcastically, and allowed me to experience first hand the precipice of drug culture so I could willingly walk away from it based on personal exposure.
I also can't stand the sight of cherry flavored anything anymore :)
FWIW, it's not particularly difficult to cause liver damage with dextromethorphan at recreational dosages
It's also worth noting that DXM is being studied in research as an antidepressant. I'm aware of at least one company working on it in combination with wellbutrin: https://axsome.com/axs-pipeline/about-axs-05/
DXM has a pronounced antidepressant effect that lasts for days after a recreational dose. Users refer to it as an afterglow instead of a hangover. This effect is fairly well known but not currently commercialized. It's also a similar drug to ketamine, which is also being used as an antidepressant in medical settings now.
From my own anecdotal experience, I'd probably have killed myself in my early 20s without DXM to give some relief. Sometimes I'll still grab a bottle of it if I'm in a particularly dark place. It's sometimes a pleasant experience, sometimes an unpleasant one, but it always lifts depression for a few days.
From what I've been able to understand over the years from the literature, nobody's died on DXM alone without taking extreme doses (anything over 500mg is crazy IMO). Some people have died from taking products that contained other active ingredients. CCCs were common before people realized the antihistamine overdose is harmful. Tylenol is common in those products too and could be used by someone uninformed, though that's also true for most painkillers. Even in extreme cases of daily high dosages (which doesn't make sense because of tolerance, but people are crazy), organs don't seem to be harmed.
Obviously chugging cough syrup has a questionable reputation at best, but we'll be seeing more people become aware of it in the next few years as drugs get mixed with DXM and patented as anti-depressants.
There's also at least one company on Amazon selling 500mg+ bottles that look like they're "4 hour energy"-sized, with DXM as the only active ingredient, complete with headshop-aesthetic packaging: https://www.amazon.com/Cough-Suppressant-RoboCough-2-Pack/dp...
Questionable for sure, but definitely less sketchy than the extractions and powders of years ago. I feel like I've seen less about DXM as cannabis has become more legal and as more odd chemicals, both legal and illegal, have become easier to order online.
edit: just to be clear, I haven't tried that product on amazon, I was just amazed to see that it exists and has such positive reviews.
Back when I was on the forums at that time, we were much more worried about frying our minds with dosing 4000mg and disappearing for days at a time into the strangest and scariest hallucinations you could imagine.
I was pretty hungry after all this and glad the peak was behind me. Got a grapefruit out of the fridge. Wasn't even halfway through when I found myself back in the peak. Had to crawl back into my bed where the curtains were closed and endured another 20 minutes of that.
Grapefruit + <drug> has always been the source of superstitious arguments in uni among my drug-using friends. Does it enhance the effect? Kill the effect? Do anything at all? But my acid experience confirmed one pairing beyond all doubt.
And your experience matches mine. Washing down MDMA with grapefruit juice definitely makes it more intense.
In any case it's not something that plays out so quickly.
Waving in and out of tripping balls a couple hours in sounds pretty par for the course, I'd say :)
I read an interesting online report that claimed co-administration of black pepper and certain essential oils would produce psychoactive effects.
I've been taking turmeric for an inflammatory issue, will try adding pepper, thanks!
It's a fairly harsh drug with a narrow therapeutic window. Getting the right dosage is already hard enough, as there are some unpleasant (and common) side effects, and it can also be pretty dangerous to your health. Add something like grapefruit that throws off the concentration, and things get that much worse.
EDIT: This HN story link was updated. The list I was referring to above is the old link: https://en.wikipedia.org/wiki/Grapefruit–drug_interactions
We had to memorize major CYP4503A4 inducers and inhibitors for step exams back when I was in med school, and memorized metabolic pathways and involved cytochromes for most major drugs.
Granted, most docs don’t remember all the details long out of med school (because that’s literally what pharmacists are -for-), but we retain the broad brushstrokes.
Ain’t new. Just editorializing bs.
(luckily I never had a great liking for grapefruit)
So a breakfast of coffee and grapefruit is a medically proven stimulating start to the day?
>One study, by Maish and colleagues in Pharmacotherapy 1996, looked at whether grapefruit juice increased caffeine effects and found little or no difference in blood concentrations and blood pressure when caffeine was given with and without GFJ. Other research has confirmed these results. Since specific enzyme systems most often metabolize similar chemicals, one would not necessarily expect GFJ to affect other stimulants, but this is far from conclusive.
Edit: Now that I go looking again, there is also evidence against this conclusion: https://www.eurekalert.org/pub_releases/2003-04/aps-rsm04090...
So I suspect that grapefruit isn't the only issue. In that there may well be interactions among the drug classes listed.
The article links to research from 2012. I'm going to guess that the dangers turned out to be small and eat my grapefruit for breakfast tomorrow as planned.
Would be interesting to find some research in this area: most of what I can find warns of increased side effects from maintaining constant dosage.
Interesting related info: "Seville oranges, (often used in marmalades), limes and pomelos also produce this interaction. Varieties of sweet orange, such as navel or valencia, do not contain furanocoumarins and do not produce this interaction."
I don't know why, but this could be why.
Could grapefruit juice protect against diabetes?
Most generic drugs probably don't cost more than a few cents a pill to manufacture, assuming the pharmacy and manufacturer make a profit on it.
In other words, it's all in the R&D and compliance costs, which grapefruit couldn't help with.
And re: doctors prescribing a combination of active ingredients that hadn't had a pharma company spend a few billion dollars studying... well, just read this, about how some company is making big bucks selling $300 fish oil pill bottles that had a bit of FDA compliance work (and related studies) done about them because doctors would never prescribe the $30 pill bottles that weren't filed with the FDA.
I guess that might be medication depending how you view it.
There’s less impact on this enzyme as it exists elsewhere in the body (primarily the liver).