MikeO Posted March 3, 2022 Report Share Posted March 3, 2022 While digging into more info around Ranolazine i stumbled on a website that lists drug interactions. https://reference.medscape.com/drug/ranexa-aspruzyo-sprinkle-ranolazine-342284#3 It kinda raised my eyebrows that Ranolazine has a large list of meds to look out for. All of my meds but one are on the Monitor Closely (217) list. One of the warnings is with Carvedilol (Ranolazine will increase the level or affect of Carvedilol by affecting the hepatic enzyme CYP2D6 metabolism) so does this mean it will make the effect of the drug stronger? How would i know if i am affected or is there a test to monitor? This also has me a bit concerned with one of my statins (Rosuvastatin) as it is noted it can increase the toxicity. Quote Link to comment Share on other sites More sharing options...
Pistol Posted March 4, 2022 Report Share Posted March 4, 2022 @MikeO - I usually turn to my pharmacist and doctor for these types of questions. Normally as long as you keep your list of meds updated with your doctors and also get your prescriptions filled at the same pharmacy they will see a red flag if there are any interactions with other meds you take. If you are concerned I would recommend to check with the pharmacist and doctor to address any potential effects or interactions with your medications. Quote Link to comment Share on other sites More sharing options...
Sushi Posted March 4, 2022 Report Share Posted March 4, 2022 On 3/3/2022 at 7:46 AM, MikeO said: One of the warnings is with Carvedilol (Ranolazine will increase the level or affect of Carvedilol by affecting the hepatic enzyme CYP2D6 metabolism) so does this mean it will make the effect of the drug stronger? How would i know if i am affected or is there a test to monitor? This also has me a bit concerned with one of my statins (Rosuvastatin) as it is noted it can increase the toxicity. This brings up something that I have found important. If you have had any genetic testing done (23 & Me or whatever) the reports should identify any compromised pathways that you have genetically. I have had pharmacogenetics testing and I am a ‘poor metabolizer’ of CYP2D6. This means that there are some drugs that go through this pathway that I should never take (they gave me a list), and there are other drugs which need to be closely monitored and given at a reduced dose due to being poorly metabolized. CYP2D6 is the main metabolizer for many drugs so I check each new prescription to see if it uses this pathway. The genetic testing I had details my expected response level to several hundred common drugs with notes on whether lower doses than usual or higher should be considered by my physicians. This recently came into play for me when Flecainide (which I had taken for years and which is metabolized primarily by CYP2D6) began to cause heart block. This just highlighted for me the importance of genetic testing. Quote Link to comment Share on other sites More sharing options...
MikeO Posted March 4, 2022 Author Report Share Posted March 4, 2022 Hi @SushiThank You for queuing in. Somewhere i did post i felt i was loading up on drugs cocktails but my recent change in syncope episodes started me looking again, I do believe that Ranolazine does inhibit CYP2D6 and made my drug regiment much stronger. Just like eating grapefruit with certain drugs it will doubles the effects. I will bring up the genetic testing with my PCP Doc in a couple of weeks and see where that goes. Thank You so much! Quote Link to comment Share on other sites More sharing options...
MikeO Posted March 5, 2022 Author Report Share Posted March 5, 2022 Well i am going to ask my PCP for the cytochrome P450 (CYP450) genetic tests. Might give me some answers why i have such a rough time with medications. Here is a understandable explanation. https://www.mayoclinic.org/tests-procedures/cyp450-test/about/pac-20393711 Quote Link to comment Share on other sites More sharing options...
MikeO Posted March 5, 2022 Author Report Share Posted March 5, 2022 On 3/3/2022 at 6:43 PM, Pistol said: @MikeO - I usually turn to my pharmacist and doctor for these types of questions. Normally as long as you keep your list of meds updated with your doctors and also get your prescriptions filled at the same pharmacy they will see a red flag if there are any interactions with other meds you take. If you are concerned I would recommend to check with the pharmacist and doctor to address any potential effects or interactions with your medications. My pharmacy has been really good at catching any red flags (just happened not too long ago) when my PCP wanted to add a drug to augment my statin. The pharmacy deferred. I do trust my PCP but in my experience they are not all knowing. My previous PCP would just say i don't know i only prescribe the med talk to the pharmacy () Quote Link to comment Share on other sites More sharing options...
MikeO Posted March 5, 2022 Author Report Share Posted March 5, 2022 One more good data source. https://www.pharmgkb.org/ Quote Link to comment Share on other sites More sharing options...
Sushi Posted March 5, 2022 Report Share Posted March 5, 2022 3 hours ago, MikeO said: One more good data source. https://www.pharmgkb.org/ That is a really good site--thanks! And right, most docs no nothing about pharmacogenomics and discount it. I haven't found that pharmacists are much more knowledgeable unless they are willing to research a drug for you. Most of the CYP2D6 problems won't be flagged in their systems. I had the list of contraindicated drugs put in my medical record at the hospital where I have had a few procedures. Quote Link to comment Share on other sites More sharing options...
MikeO Posted March 6, 2022 Author Report Share Posted March 6, 2022 18 hours ago, Sushi said: most docs no nothing about pharmacogenomics Yeah i don't have a lot of faith that my Dr or even my health care orgs have any services to provide but i will ask (can't get what you want if you don't ask approach). So the dilemma for me is ordering a test online. The little bit i have looked seems to be overwhelming as to the options out there. I did find one more good resource to look up drugs. https://clinicalgenome.org/ Quote Link to comment Share on other sites More sharing options...
Sushi Posted March 7, 2022 Report Share Posted March 7, 2022 11 hours ago, MikeO said: I did find one more good resource to look up drugs. https://clinicalgenome.org/ Mine was done by Asperio Laboratory. They have a Facebook page but not sure whether they are still doing testing: https://www.facebook.com/asperiolabs/ Quote Link to comment Share on other sites More sharing options...
MikeO Posted March 7, 2022 Author Report Share Posted March 7, 2022 1 minute ago, Sushi said: Mine was done by Asperio Laboratory. They have a Facebook page but not sure whether they are still doing testing: https://www.facebook.com/asperiolabs/ Thanks Sushi!!! I will check it out. I did find a place in Milwaukee that does the entire WPS and also tests the full genome type. name is RPDX Diagnostics and was spun up by the medical college of wisconsin https://www.rprdx.com// Looking into what insurance pays for i may have to cherry pick what genomes i can get tested. Quote Link to comment Share on other sites More sharing options...
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