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Dr. Maine: ADHD, metabolism, and medications
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An_223407 posted:
Dr. Maine, I am a chronic pain patient (Degenerative Disc Disease in neck) who also happens to have adult ADHD. My metabolism is very fast and I am petite (5'0", 88 lbs). For my size, it seems that I often require more pain medication than I should. I've been being treated for my condition since 2004. For the last 6 years, I was taking Lortab 10s, going from 60 a month to 90 a month before being put on Percocet 10s (90) and Oxycontin (20 mg) 1-2 times a day. With most all pain medications, the only way I know it's working is whether or not my pain is relieved. I've never gotten any kind of mental effects (thank God!) If I don't get relief and were to take an extra one (after having had to take 2 already), it might be too much and I'd know that because I'd start throwing up, not because my head was getting "foggy" or I got real sleepy. I was just wondering if my fast metabolism might actually have anything to do with me metabolizing medications faster than most people? I know that if I have any kind of alcoholic beverage, I can get completely snockered from even half of a drink ( very seldom drink at all so don't have a tolerance), but if I wait 30 minutes, I will be completely sober, as if I had just rapidly burned it all off. With pain medications, I don't feel it "kicking in", my pain simply goes away or gets better but the relief usually only lasts half as long as it should. From what I've read about drug metabolism, is it possible that a hyperactive person with a fast metabolism simply burns medications as fast as they burn calories and food? I know I have tolerance after being treated for 6 years but wouldn't my metabolism have as much to do with it as having some tolerance to pain meds?
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David Maine, MD responded:
I would talk to your docotor about genetic testing for the more common drug metabolizing enzyme genes - particularly CYP450 2D6 and CYP2C19. This can provide important information particularly to those who have an adverse drug reaction or a poor response to a medication by looking for the enzyme variant your body contains. CYP2D6 is one of the most important drug metabolizing enzyme genes as it metabolizes 25% to 30% of all prescribed drugs.
CYP2C19
metabolizes 15% of all prescribed drugs. I hope this helps. Good luck.
 
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CarolHenry99 replied to David Maine, MD's response:
Dr. Maine,

Can a 10 year old boy be tested for genetic testing on metabolizing enzyme genes and will a doctor do this testing for us on request? My son has tried just about every adhd medication on the market except for a few and every medication he has tried only last approximately 45 minutes in his system, regardless if taken twice a day.
I have asked for blood work to see why his body burns off medication quickly, but never recieved any help or information. I hope you can shine some light to the answer I have been searching for for so long.

Thank You Kindly for any response,
Carol Henry


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