#(bc they probably didn't read your list of medications for interactions! like they didn't even glance at it at all)

[werewolf4vampire]

love it when doctors prescribe you a medication that has potentially fatal side effects and/or some sort of black box warning and just. don't warn you about it at all

[somecunttookmyurl]

Hi sorry to bother you, but I just saw your post about not metabolising medication properly, I was trying to track back to any other mention of it on your blog to find out more because that is ringing a lot of bells with me and I didn't know it was a thing that could happen (I'm not jumping to conclusions I'm just curious), I'm chronically impossible to medicate (presumably what you mean by "Drug Goblin") so I was wondering if you could point me in the direction of the specific thing you're talking about? I tried doing straight to ye olde Google but without a decent starting point I just get vague anecdotal articles </3

oh no worries about not finding it i never tag anything and tumblr's search function is an eldrich horror that's not on you in the slightest

the basics of it (this is very simplified and i'm happy to send papers but they are like. pretty technical which involves "learning what all the words mean first")

- there's a bunch of different enzyme pathways in the liver. just so many.

- different drugs will be processed along different pathways. most drugs only go one way, but some take multiple routes and split off. paracetamol (acetiminophin) for example uses... iirc... three? so some of it goes there, some goes there, and some fucks off over there.

- the normal amount of functional copies of any of these things is 2. and 2 is what the vast majority of people have. if you've got 2 copies then the drugs that ride that highway work broadly as expected. like you know all the "starts working in x time, lasts this long" stuff? based on the normal range

- for any given one of those, it's possible to have 1 (or even 0) functional copies, or 3 (or more) copies. if you have fewer functional copies then your metabolism is slower. the drug sticks around longer, and will have a more pronounced effect. as such, you would need a lower dose. also your toxic dose level would be lower

- if you have 3 (or more) you metabolise faster. as i'm sure you can guess, that means it's processed too quickly and there is less effect because it's been yeeted out at the speed of sound. you need higher doses, administered more often. which is problematic for your poor kidneys who regrettably still have to deal with it.

- all of these enzymes can be either inhibited (metabolism slowed) or induced (metabolism sped up) by various substances. this is, primarily, what drug interaction warnings are. if drug a is inhibiting the enzyme used by drug b, you could have a problem on your hands

- for most though that list is pretty extensive! as such "defects" on most of them don't really go noticed so much because you're probably fixing it by accident by, like, drinking coffee or whatever

- however Local Problematic Bastard known as P450 CYP2D6 (i know. super catchy) is almost entirely genetic - meaning the list of external things that can either inhibit or induce it is fucking tiny

- unfortunately, Local Problematic Bastard P450 CYP2D6 is where an awful lot of very common drugs like to hang out. so if you've got too many functional copies of it there's a whole bunch of shit that Don't Work So Good and your ability to fix it is, uh, limited

- in the general population being an ultra-rapid metaboliser is pretty uncommon. worldwide it's something like 7% and in white people it's 1-2%. however for reasons that are still unclear, people with chronic pain (notably EDS but also stuff like fibromyalgia) have a frankly stupid 70-80% chance of something in there being broken in some way

- which is a fucking cruel joke bc Most Goddamn Painkillers chill on CYP2D6 If you look up CYP2D6 on wiki there's an (incomplete) list of substrates, inhibitors, and inducers. substrates are the drugs that are metabolised along it. if you read the substrate list like "wait a minute... this is all the shit that doesn't fucking work unless i practically OD on purpose" then my apologies but also same and i hate it

anyway a while back i had the thought "what if i added an inhibitor to biohack my own goddamn liver and make it talk to meth properly" which i studied with CBD (one of the few inihibitors that aren't obscure prescription drugs) and spoiler alert: yes. yes you fuckin' can. (i did research this extensively before trying and human studies on the exact same theory have been done before and the results were positive in all but one person, and that's only because that person had an adverse side effects to the inhibitor and had to drop out)

this is something that can only be properly officially verified with a genetic test but sometimes shit be So Blatantly Obvious you don't need to prove it.

[werewolf4vampire]

love it when doctors prescribe you a medication that has potentially fatal side effects and/or some sort of black box warning and just. don't warn you about it at all