Question for Marianco

[mkl13]

Can you take arimidex and st. johns wort together? There seems to be conflicting information about using these two concurrent. Thanks!

[marianco]

Originally Posted by mkl13

Can you take arimidex and st. johns wort together? There seems to be conflicting information about using these two concurrent. Thanks!

Do the medications interact in some way - such as inhibiting each other's effects or the elimination of each other or the effects of other drugs?

There does not seem to be such an interaction between Arimidex and St. Johns Wort.

[Naturdoc]

Arimidex metabolism occurs by deaklyation, methylation, and glucoronidation. I don't believe it is metabolised through the CY P450 enzyme. If it were then it would be in your system a shorter time and be less effective because St Johns Wort increases P 450 enzyme action.
What is your conflicting source?

[mkl13]

One study with arimidex called for no st. johns along with some other drugs that increase cytocrome 450 (i.e. ant-convulsants, etc.). From what I can find, st. johns increases, while arimidex inhibits. I wanted to insure no interaction before starting the st. johns wort.

[marianco]

Originally Posted by mkl13

One study with arimidex called for no st. johns along with some other drugs that increase cytocrome 450 (i.e. ant-convulsants, etc.). From what I can find, st. johns increases, while arimidex inhibits. I wanted to insure no interaction before starting the st. johns wort.

Even when medications interact, the question would be what risk does that entail. If the benefits significantly outweigh the risks (since everything has risks), then a person may then decide what course of action may be of most benefit to oneself.

If a person wants absolutely no interaction between two medications, I think that person will find few such medications. Every intervention or non-intervention entails risks.

Let's look at Arimidex and St. John's Wort at a greater depth - i.e. more than the initial two-step chess answer that I gave before.

Arimidex blocks aromatase so that Estradiol and Estrone are reduced. However, this may force testosterone through other enzyme pathways such that total estrogens (with other forms of estrogen) may increase - albeit with much weaker estrogens.

Arimidex by reducing overall estrogen activity (since estradiol is the most potent estrogen), can lead to an increase in LH production and an increase in testosterone production.

Estradiol and other estrogens act like monoamine oxidase inhibitors - antidepressants. This means they can raise some neurotransmitter levels: Serotonin > Norepinephrine > Dopamine.

Estrogens have about 399 other actions.

Using Arimidex then will reduce overall levels of serotonin, norepinephrine and dopamine via reduction in estrogen activity.

However, the increase in testosterone will help increase dopamine activity.

The increase in testosterone may either reduce or increase thyroid hormone activity.

The increase in testosterone may also reduce cortisol production (via reduction of pituitary ACTH production and via direct inhibiting effects on the adrenal gland itself).

The reduction in cortisol production may lead to an increase in norepinephrine production to try to compensate for the energy loss. This may lead to an increase in anxiety.

These are some of the neurotransmitter and hormone cascades that may occur, without describing the immune system changes.

St. John's Wort apparently works by increasing serotonin and norepinephrine to reduce depression and/or anxiety.

Excessively increasing serotonin can lead to a decrease in dopamine production in dopamine-releasing cells. This can also then lead to an increase in norepinephrine production in norepinephrine-releasing cells, which were controlled by the dopamine-releasing neurons.

Increasing norepinephrine excessively can lead to adrenal fatigue - including deficiencies in the production of cortisol, DHEA, progesterone, aldosterone, and testosterone from the adrenal glands. This can lead to depression and anxiety symptoms.

St. John's Wort also increases the activity of Cytochrome P450 3A4 - the most common enzyme to metabolize (via oxidation) toxins, medications, and steroid hormones and other substances.

St. John's Wort and Arimidex (via reduction of estrogen activity) may potentially cancel each other out, depending on each other's dose, in regard to neurotransmitters. The medication with the dose which is more potent will decide the direction.

St. John's Wort (through increased Cytochormone P450 3A4 and oxidation of estrogens) and Arimidex may have additive effects in reducing estrogen activity.

St. John's Work, however may reduce testosterone levels as well as cortisol, progesterone, DHEA and other steroid hormones by increasing the activity of P450 3A4; while Arimidex increases testosterone level by increasing LH production.

These are just some of the potential interactions.

Whether or not to use both together depends on what one wants to accomplish and the dose of each to use, and vigilence to the interpretation of the side effects one experiences so one can interpret what is happening and modify treatment as necessary to improve functioning.

Perhaps St. John's Wort can then at some dose help reduce depression and anxiety, counteracting some of Arimidex's actions. However, of concern would be its effects on hormone levels with or without Arimidex. If those are significant enough - which depends on the person - it would give one pause. If those are not significant enough - which again depends on the person - then the use of St. John's Wort may be O.K., particularly if found effective.

If a person finds the potential benefits outweighing the risks, then it may be of benefit to give things a trial run - so long as one is willing to take the risk or take a leap of faith. The answer will depend on the individual.

The usual psychiatric answer is: "It depends."

[mkl13]

Thanks for such a detailed answer. I've been on a transdermal testosterone and arimidex for about a month. My anxiety has been at a all time high. So, I was looking to decrease this while my system tries to nomalize. Sounds to me like this could compromise the TRT, so I'll look else where. Thanks again!

[mkl13]

Marianco, this would also seem to apply to most medications that are metabolized via P450 pathway. Examples include, trazodone, dilantin, certain benzos, and a host of others. Should Individuals modify these types of medication to ensure maximal sucess in raising low testosterone (i.e. looking for alternatives that are metabolized differently)? Thanks again for all the great info.

[marianco]

Originally Posted by mkl13

Marianco, this would also seem to apply to most medications that are metabolized via P450 pathway. Examples include, trazodone, dilantin, certain benzos, and a host of others. Should Individuals modify these types of medication to ensure maximal sucess in raising low testosterone (i.e. looking for alternatives that are metabolized differently)? Thanks again for all the great info.

In an ideal world, we can have all the alternatives possible so we can maximize success by avoiding interactions, and that these alternatives are effective.

However, we do not live in an ideal world.

When interactions are possible, we work with them, for example: adjusting dosing as necessary depending on the interaction seen, when particular combinations are used.

[DAVID]

Originally Posted by marianco

Even when medications interact, the question would be what risk does that entail. If the benefits significantly outweigh the risks (since everything has risks), then a person may then decide what course of action may be of most benefit to oneself.

If a person wants absolutely no interaction between two medications, I think that person will find few such medications. Every intervention or non-intervention entails risks.

Let's look at Arimidex and St. John's Wort at a greater depth - i.e. more than the initial two-step chess answer that I gave before.

Arimidex blocks aromatase so that Estradiol and Estrone are reduced. However, this may force testosterone through other enzyme pathways such that total estrogens (with other forms of estrogen) may increase - albeit with much weaker estrogens.

Arimidex by reducing overall estrogen activity (since estradiol is the most potent estrogen), can lead to an increase in LH production and an increase in testosterone production.

Estradiol and other estrogens act like monoamine oxidase inhibitors - antidepressants. This means they can raise some neurotransmitter levels: Serotonin > Norepinephrine > Dopamine.

Estrogens have about 399 other actions.

Using Arimidex then will reduce overall levels of serotonin, norepinephrine and dopamine via reduction in estrogen activity.

However, the increase in testosterone will help increase dopamine activity.

The increase in testosterone may either reduce or increase thyroid hormone activity.

The increase in testosterone may also reduce cortisol production (via reduction of pituitary ACTH production and via direct inhibiting effects on the adrenal gland itself).

The reduction in cortisol production may lead to an increase in norepinephrine production to try to compensate for the energy loss. This may lead to an increase in anxiety.

These are some of the neurotransmitter and hormone cascades that may occur, without describing the immune system changes.

St. John's Wort apparently works by increasing serotonin and norepinephrine to reduce depression and/or anxiety.

Excessively increasing serotonin can lead to a decrease in dopamine production in dopamine-releasing cells. This can also then lead to an increase in norepinephrine production in norepinephrine-releasing cells, which were controlled by the dopamine-releasing neurons.

Increasing norepinephrine excessively can lead to adrenal fatigue - including deficiencies in the production of cortisol, DHEA, progesterone, aldosterone, and testosterone from the adrenal glands. This can lead to depression and anxiety symptoms.

St. John's Wort also increases the activity of Cytochrome P450 3A4 - the most common enzyme to metabolize (via oxidation) toxins, medications, and steroid hormones and other substances.

St. John's Wort and Arimidex (via reduction of estrogen activity) may potentially cancel each other out, depending on each other's dose, in regard to neurotransmitters. The medication with the dose which is more potent will decide the direction.

St. John's Wort (through increased Cytochormone P450 3A4 and oxidation of estrogens) and Arimidex may have additive effects in reducing estrogen activity.

St. John's Work, however may reduce testosterone levels as well as cortisol, progesterone, DHEA and other steroid hormones by increasing the activity of P450 3A4; while Arimidex increases testosterone level by increasing LH production.

These are just some of the potential interactions.

Whether or not to use both together depends on what one wants to accomplish and the dose of each to use, and vigilence to the interpretation of the side effects one experiences so one can interpret what is happening and modify treatment as necessary to improve functioning.

Perhaps St. John's Wort can then at some dose help reduce depression and anxiety, counteracting some of Arimidex's actions. However, of concern would be its effects on hormone levels with or without Arimidex. If those are significant enough - which depends on the person - it would give one pause. If those are not significant enough - which again depends on the person - then the use of St. John's Wort may be O.K., particularly if found effective.

If a person finds the potential benefits outweighing the risks, then it may be of benefit to give things a trial run - so long as one is willing to take the risk or take a leap of faith. The answer will depend on the individual.

The usual psychiatric answer is: "It depends."

I've reading in the medical book that that St. John's Wort inhibe the dopamine hydroxylase = less brain noradrenaline. Do you confirm that ?