Sunday, 11 October 2015

Ahmad's chemo cocktail

Hello Stephen and everyone..
I am sharing Ahmad's chemo cocktail..
Ahmad dx 12 October 2014..we had a recurrence and another surgery last June..
Finished radiation 19 August and started CCNU with a cocktail following Ben William's footsteps.

Drugs:
1.Ccnu
2.Tamoxifen 220 mg/day
3.Chloroquine phosphate 250 mg/day
4.Verapamil 480 mg/day bracketting CCNU
5.Prozac 20 mg/day
6.Lansoprasol, esomeprasole, omeprazole: alternatevely 1 each month..(protocol suggested by Anders: each week begins by high dose then standard then a day off)
7.Aspirin 200 mg/day
8.Accutane (still we did not start it) 120 mg/day 2 weeks on and 1 off except chemo weeks.


Supplements:
Milk thistle 900mg/day
Mushroom PSK 3g/day
Curcumin longvida 3600 mg/day
Omega 3 fish oil 3g/day
Pterostilbene 300 mg/day
Broccoli 1000 mg/day
Boswellia 1200mg/day
Green tea 4g/day
Selenium 200 mg/day
Genistein 5g/day
Garlic 6mg/day
Vitamin D3 2mcg/day
Vitamin C 2000 mg/day

Ahmad is following a ketogenic diet

Ahmad did not have any side effects..except recently when we introduced Prozac..I have the feeling this medication is making restless..and very nervous..I am not sure..
I need feedback from those taking Prozac (fluoxetine)..is this dose 20mg enough? And will the side effects reduce with time? I am also worried when using with verapamil..should I reduce the verapamil to 280 mg??

We will start Accutane after next round of CCNU..
God bless u all..and help us in our battle.







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8 comments:

  1. Stephen W11 October 2015 at 19:44

    Hi Sarah,


    Drugs.com mentions a possible interaction between fluoxetine and verapamil, namely increased plasma levels of calcium channel blockers, due to CYP3A4 inhibition by fluoxetine. However, the ability of fluoxetine to inhibit CYP3A4 is debatable:

    http://www.ncbi.nlm.nih.gov/pubmed/14709940

    A more significant interaction is between tamoxifen and fluoxetine, as fluoxetine is a strong inhibitor of CYP2D6, one of the important enzymes in tamoxifen metabolism. Taking them together would change the balance of tamoxifen and metabolites, probably raising concentrations of tamoxifen and N-desmethyltamoxifen and decreasing concentrations of metabolites such as endoxifen. This would probably make tamoxifen less effective for breast cancer given that endoxifen is probably the most active metabolite for estrogen-receptor positive breast cancer. I haven't seen any studies showing which is the most important metabolite in glioma treatment (tamoxifen itself? the N-desmethyl metabolite, or the 4-hydroxy N-desmethyl metabolite (aka endoxifen).

    To be safe you might consider dropping the fluoxetine while he's on tamoxifen, and hope that Keppra (which has few interactions with other drugs) is inhibiting MGMT and sensitizing the tumor to the CCNU. That might also take care of the side effects you mentioned (nervousness, restlessness).

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  2. Stephen W11 October 2015 at 19:53

    and for the record, sertraline is a less potent inhibitor of CYP2D6, but does not inhibit MGMT.

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  3. Stephen W12 October 2015 at 07:06

    Sarah,
    Ben told me that he was taking regular aspirin (325 mg) twice daily during high-dose tamoxifen. That might not only protect against blood clots but have positive immunological effects as well.

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    Replies
    1. Unknown13 October 2015 at 10:00

      Thx Stephen..I really appreciate your help and care..can't thank u enough..
      Update:
      We dropped Prozac..
      Did our first MRS 2 months after radiation ended..and it shows a spot..the Dr. Warned us b4 the scan not to worry if we saw an enhancement..as it might be radiation necrosis..but still I am so disappointed..
      I think I will start Accutane now and won't wait till second round of ccnu..
      Also I will start DCA after 2nd round ccnu. I just need your advice about adding dca to our cocktail..
      Which protocol u think we should follow?? And will he be allowed to drink coffee or not..?? I trust your advice and intuition...

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    2. Unknown14 October 2015 at 23:46

      And..a quick check I know this question. Is repeated but I get confused..sorry..
      U mean 325 mg total dose divided?? Or u mean total 650 mg??

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    3. Stephen W15 October 2015 at 00:38

      Ben said he took two regular aspirin a day. Since regular aspirin is 325 mg, that would be 650 mg per day. His intention in taking this was to reduce the blood clotting due to the high-dose tamoxifen, but I wonder if it also had positive immune effects as well, in combination with the PSK, melatonin etc.

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  4. Stephen W14 October 2015 at 11:48

    I would start with a lower dose of DCA (such as 6-7 mg/kg twice daily). DCA plasma concentrations tend to rise over the first couple months. So if he has no signs of peripheral neuropathy or other problems after the first month or two at that dose then he may be a fast metabolizer and you could increase to a somewhat higher dose.

    As for DCA and caffeine, the only source of information seems to be thedcasite.com. First they say that they noticed a correlation between response to DCA and consumption of caffeine, but then they go on to warn brain tumor patients that this combination might provoke to strong a reaction.

    http://www.thedcasite.com/DCA_protocol/DCA_Tea_Protocol.html
    http://www.thedcasite.com/DCA_protocol/Brain_cancer_risks.html

    These are not scientific reports, and I haven't found any scientific report on the potential mechanisms of interaction. Anders Ferry deliberately took strong coffee during his DCA-based protocol back in 2009-2010, without incident. If it were me, and I enjoyed coffee, I would cautiously start drinking coffee in small amounts and pay close attention to whatever effects it was having before drinking larger quantities.

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