If it’s Not a Herx, is it an Overdose?

Ever wonder why your doc tells you not to drink grapefruit juice when you take prescription drugs? Or why cigarettes help people come down from overdoses? What the hell?

I’ll keep it short. Here are some points about drug metabolism that might explain why you feel like you are feeling crummy.

How Drugs Are Metabolized?

Drug metabolism usually occurs in the liver, which has all the necessary enzymes to metabolize drugs.

There are 2 phases of metabolism. Some drugs undergo both phases, while other drugs only undergo one of them.overdose

Phase 1 metabolism is when the cytochrome P450 enzymes in the liver oxidize the drugs. This makes the drugs smaller and thus easier to remove from the body.

Phase 2 metabolism is when an ionised group attaches to the drug. These groups include glutathione, methyl or acetyl groups. This make this drug more water soluble and thus easier to remove from the body.

Overdose

This can occur when there is not enough glutathione to detoxify a drug out of the body. The drug accumulates and causes toxicity or hepatitis. Taking glutathione can help metabolize the drugs and save your liver, but it will also remove the drugs out of your body quicker. Why not just take less drugs so that you do not tax your liver or waster your money on supplements that nullify your drugs? Sorry to go off topic but UGH, more glutathione is not always better!

Inducers, Inhibitors and Adverse Reactions

Inhibitors stop enzymes from working as well. In other words, a drug that inhibits enzymes from metabolizing it makes it (along with whatever other drugs you are taking) stay in the body longer.

Inducers make enzymes work better. So essentially, an inducer drug has the opposite effect of inhibitors and speeds up the process of getting it (and whatever other drugs you are taking) out of the body quicker.

So when you are taking a medication, you are not just taking a drug, but you are also taking an inhibitor or an inducer. This is how adverse drug reactions occur.

Let’s say you take the antibiotic Erythromycin (an inhibitor), and you also like to drink grapefruit juice everyday (also an inhibitor): what can happen is that last night’s dose of antibiotics can get stagnant in your liver by the time you pop more antibiotics on top of that. If you do not have enough glutathione (or other detoxifying agents) to compensate, a toxic overdose or liver damage can occur.

Other Factors

Sex, age, and even gut bacteria composition affect drug metabolism. Genetic deficiencies of particular enzymes can play a big role, as well. For example, some people suck at metabolizing codeine, while others metabolize it quickly. A small dose of codeine could kill the slow metabolizer, but do nothing for the quick ones.

Even the food you eat is a factor in how drugs are metabolized! Like I mentioned, grapefruit juice is an inhibitor. So is pomegranate. Brussels sprouts and garlic, on the other hand, are inducers.

And just one more to blow your mind: cigarette smoke is also an inducer.

So when CYP450 enzymes are inhibited or induced by drugs, clinically significant drug to drug interactions can cause adverse reactions. Knowing which ones inhibit and which ones induce your enzymes can minimize the possibility of negative interactions between all those pills you pop to feel normal. If they are not doing what they are supposed to – or if you think you are having a month long herx – then you may be having an adverse drug reaction.

Do you think some of your herxes may have actually been adverse drug reactions?

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