Ativan

[SherryKahn]

wanted to ask if Ativan is allowed for anxiety during treatment of Orgovyx and zytiga and cyclis. Thank you so much for input. I asked the Dr waiting to hear back .

[Spinel_Cutter]

Naturally, always ask you doc (onco) but if they look at you quizzically well..... YMMV

"Relugolix is metabolized by cytochrome p450 3A4" (search for source)

From this abstract:

pubmed.ncbi.nlm.nih.gov/128...

"Cytochrome P450(CYP)3A4 is one of the CYP enzymes catalyzing oxidative metabolism, and involved in the metabolism of many drugs. Among benzodiazepines, alprazolam, triazolam, brotizolam and midazolam are mainly metabolished by CYP3A4, and quazepam, diazepam and flunitrazepam are partly metabolised by this enzyme. Azole antifungals, macrolide antibiotics, calcium antagonists and grapefruit juice inhibit CYP3A4 activity, while antiepileptics and rifampicin induce the activity. The drugs affecting CYP3A4 activity inhibit or induce the metabolism of the benzodiazepines metabolised by this enzyme, and induce side effects or reduce therapeutic effects of these drugs. Therefore, the combination of the two groups of drugs should be avoided, and if it is unavoidable the dose of benzodiazepines should be adjusted."

"CYP3A4 is important in the biotransformation of both midazolam and diazepam."

"Alprazolam, diazepam, medazolam, temazepam, lorazepam and clonazepam are common benzodiazepine metabolized by CYP3A4"

So, what does this mean? Relugolix and Ativan uses the same "clearance" system. Therefore, it could be that one interferes with another leading to a higher blood level than anticipated if one were to be taken without the other.

Since you can't lower the amount of Orgovyx, you doc might say: try 1/4 of the normal dosage which in fact, may have the same effect as a full dose might. So, with both you are at risk of, for lack of a better word, "too high a dosage effect" on either or both.

A really wise doc/onco/PharmD might be able to actually look at the combo and make rational suggestions. Unfortunately, a lot of docs really cannot do that.

Example: 2008, I was taking the simvastatin for lipid control, no issues. Then, I developed community pneumonia and an idiot of a doc put me on Erythromycin. Both utilize the 3A4 enzymatic system but Erythromycin is an "inhibitor." Therefore the blood levels of the simvastatin soared. On the third day (the simvastatin was not being cleared because of the Erythromycin's effects on the 3A4 sytem) and I developed rhabdomyolysis. If the cause and effect was not made, and I had taken another days dosage of simvastatin, it would have destroyed my liver.

Note: In this case I'm talking about in inhibitor. The benzodiazepines are not an inhibitor they are, in a since, competitors, so one would not (or I would not) expect that sort of deadly reaction. [But who am I, not a Practitioner so my expectations do not count]

A wise Practitioner might address the anxiety using another med that is not competitive.

Btw...I"m on my 5th week of Orgo+Abi, and gosh darn, I had two out-of-the blue anxiety/panic attacks, for no valid reason, so I believe that anxiety/panic is a rational adverse effect.

We do live in a complex world, for better or worse.

Good luck and ask the Pharmacist, give them a letter with a, "when you get a chance," and you might get a good response.

Btw 2nd CVS filled that Erythromycin script--their system should have popped out a "contraindicated," because it knew that I was on Simvastatin--and it failed to do so. Ouch.

[SherryKahn in reply to Spinel_Cutter]

Thank you so much for such a detailed response and explanation. His Dr gave him the clearance to take Ativan if needed. They are pretty good so far to look up on drug interactions so far. But will keep your suggestions in mind when it comes to other meds including antibiotics.