CYP450 3A4 inducers

[RhondaH]

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I'm looking for opinions. I am currently on 60 mg of Phenobarbital for epilepsy (haven't had a seizure in years and those were only petite mal) and when trying to figure out if THIS drug could increase my liver enzymes, I found that it could, especially the GGT. I ALSO found out that this is also of the class of drugs called CYP 450 3A4 inducers which "CYP450 enzymes can be induced by drug treatment which may cause formation of toxic metabolites and/or decreased systemic drug levels resulting in loss of efficacy."

Should I:
A: stop taking it and pray I don't get another seizure
B: look for an alternative drug (any suggestions)
C: any other ideas

I am on Herceptin (I was dx 2/1/05 w/ Stage 1, Grade 3, no nodes, partial mastectomy on 2/7/05, finished 6 rounds of dose dense TEC on 5/18/05, finished 33 rads on 8/1/05, started every 3 week for 1 year Herceptin 8/18/05.


CYP450 3A4 inducers, including:
carbamazepine
phenobarbital
phenytoin
rifabutin
rifampin
rifapentine
St John's wort



Thank you.

Rhonda Hoffman


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[Gina]

Hi, Rhonda,

Still, given the levels of your other numbers..I would check my CA 27/29 and my serum her-2 before making any drastic decisions...Besides..you have been on the epilepsy drug for ages...my gut is telling me it is her-2 related..but that is just my opinion. It is just a common pattern I see all the time working mostly with her-2 mets folks and occasionally in the past, seeing these patterns in myself...charting them..and later...learning what they meant, the hard-headed way..sigh... unfortunately. The high GGT is so common with active her-2 and when the other numbers you mentioned start going up...9 times out of 10 your CA 27/29 and your serum her-2 numbers will not be far behind or perhaps..even leading the party. Keep digging though..you must TAKE all factors into consideration...just don't ignore the obvious..get your markers tested or see what they most recently were and what they have been doing....lots of times, oncs are taking the markers but not even telling you they are. But if the onc is REALLY not taking your markers...don't rule out getting the tumor markers taken by your primary care doctor or even your OB-GYN...any bonified doctor can write the names of the two tests down on their Rx pad and you can take the script to your insurance's lab and have the blood drawn there. The results will be sent to your primary doctor or who ever requested the test...in those silly cases where the onc "does not believe in tumor markers" all the better as this way they will never have to know..but at least YOU will and then and only then will you have a better understanding of what is or IS NOT really going on--might I add--in YOUR own body..not that the markers will be definitive but taken together..especially when viewed over time...they can be quite useful..

You ask for my take on this..smile...YOU GOT IT...

Take care of yourself, ya ' hear??
Gina