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This topic contains 24 replies, has 5 voices, and was last updated by  PhilC 6 months ago.

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  • #461342
    jennamp
    Participant

    Dr. W. of HSS (NY) started treating my husband in Dec. of this year and has him on a non-normal MIRA dosage regime from what I can see from book and online research. Has anyone else deviated from MWF’s schedule?

    My husband’s schedule:
    3 weeks: 50mg 1x/day MWF
    2 weeks: 100mg 2x/day every day
    now: 150mg take 1 50mg in the am and 2 50mg WITH dinner daily except Wed. and Sat.

    We can’t get an answer from the doc who is vacationing and I’m concerned this plan isn’t effective. Help!

    RBFV Note: Please note edit to remove AP Doc’s name as per forum policy to protect physician privacy. Thanks for understanding.

    #461346
    richie
    Participant

    As a matter of fact the MIRA study called for 100 mg 2x daily –the doctor is working you up to that –The MWF dose evolved as time went on and is not the MIRA dose
    —Sounds like your doctor is really on the ball –Be patient !!!!!

    #461358
    PhilC
    Participant

    Hi,

    Is your husband on any other medication?

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #461364
    jennamp
    Participant

    He’s on sulfasalazine. 1 50mg tablet in the am and 2 50mg tablets in the pm. On the supplement side, he’s taking a compounded mix based on Nutreval deficiency test findings, including pre and probiotics. On the diet side, he’s gluten, dairy, and sugar free with an emphasis on grass finished, pasture raised, organic food heavy on the plant side.

    In the last few days on the increased MINO, he developed bursas on both big toes and his right elbow, along with swollen arches. I’m wondering if this is too much MINO. Doc also recommended he take the nightime dose with dinner. Everything I’ve read to date says take on an empty stomach!

    Speaking of the meds, he has Celiac, so we’re looking for gluten free MINO to boot. The doc doesn’t like any meds not from the US, Japan, or Israel for purity reasons. He disapproves of Ranbaxy specifically. Any recs on effective meds?

    looks like the FDA has concerns or at least did a few years ago based on sanctions and whistleblower’s accounts: https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/ucm118411.htm
    https://www.cbsnews.com/news/ranbaxy-whistleblower-reveals-how-he-exposed-massive-pharmaceutical-fraud/

    Thanks for all the help as we navigate towards recovery!

    #461365
    jennamp
    Participant

    I just called Par to see if their Mino is gluten free and the nurse said no, but I don’t see any gluten in the inactive ingredients. Any idea what would contain gluten?

    http://anchen.com/generics/index.php?option=com_products&product_id=49884051101&Itemid=90#

    Minocycline hydrochloride tablets for oral administration contain minocycline HCl equivalent to 50 mg, 75 mg or 100 mg of minocycline. In addition, 50 mg, 75 mg and 100 mg tablets contain the following inactive ingredients: Microcrystalline Cellulose NF, Lactose Anhydrous NF, Povidone USP, Colloidal Silicon Dioxide NF, Magnesium Stearate NF, and Sodium Starch Glycolate NF. The 50 mg, 75 mg and 100 mg tablets also contain Opadry White which contains: Titanium Dioxide USP, Hypromellose Type 2910 USP, Polyethylene Glycol 400 NF, and Polysorbate 80 NF.

    #461370
    PhilC
    Participant

    I believe that what the nurse told you is wrong. From what I can tell, there is no gluten in the Par minocycline tablets. The nurse might have thought that it possibly contains gluten because of the sodium starch glycolate. However, the sodium starch glycolate in Par minocycline tablets is derived from potato starch (not wheat starch).

    I’ll answer your other questions later when I have more time. This question was easy to answer, and I wanted you to have the answer ASAP in case you need to get your husband’s prescription refilled soon.

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #461372
    Spiffy1
    Moderator

    I cannot have gluten and I break out in a rash on PAR and Torrent. It could be another filler though. I did fine on Ranbaxy but have been unable to get it. Now I have it compounded with methyl-cellulose.
    Now I would not go back to Ranbaxy because I feel like what I am taking is so much cleaner. Of course it does cost me out of pocket 100$ a month and my LDN is 40$ a month.

    Flare fall of 2014...muscle aches, joint pains, fatigue, hair loss, rashes, etc.
    RA Factor 71 in Jan 2015 down to 25 as of September 2017
    DR4/DQ8 HLA...biotoxin illness
    IGG food allergy to wheat, egg, and dairy...probably all grains
    Vit. C&D, probiotics, milk thistle, turmeric, fish oil, methyl b 12, methyl folate, digestive enzymes, Candisol, Ubiquinol, berberine, chlorella, Moducare, LDN, monolaurin, Triphala, Patriot Greens, Paractin
    MTHFR compound heterozygous
    Igenex IGM positive Lyme, minoMWF

    #461376
    PhilC
    Participant

    In the last few days on the increased MINO, he developed bursas on both big toes and his right elbow, along with swollen arches. I’m wondering if this is too much MINO.

    Yes, it may be too much too soon. His doctor has ramped up the dose very quickly, and that’s likely to cause problems — it may be difficult to tolerate. By the way, the common idea that pulsed dosing is the best or optimal way to treat rheumatic disease with antibiotics is incorrect. Long term, pulsed dosing is a bad idea, but in the short term it is useful as a way to regulate or limit the severity of die-off reactions which tend to be worse during the first few months of treatment.

    Doc also recommended he take the nightime dose with dinner. Everything I’ve read to date says take on an empty stomach!

    It doesn’t matter. The important thing is to avoid taking minocycline with antacids or mineral supplements, especially minerals like calcium or magnesium that are usually taken in large doses. I never take mino on an empty stomach. The tetracyclines are irritating to the GI tract, and I don’t like to suffer. Lately I’ve been taking my mino with a capsule of fish oil and a bowl of dry rice cereal (no milk).

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #461386
    jennamp
    Participant

    Thanks Phil,

    We’re trying to determine where Par manufacturers their product and why it’s labeled non GF. I’ll let you know what I discover. In the meantime, I’m pursuing a compounding pharmacy option. If like spiffy1, we are pay only $100 out of pocket, I consider that a win.

    Re the dosing, based on your experience, would you take 2 50mg once per day on MWF or separate the pills to 1 50mg 2x/day on MWF?

    Re the timing: everything I’ve read mentions IRON avoidance and empty stomach as key. Not really in your experience?

    “Like other tetracyclines, food impairs its absorption. However, the absorption is much less impaired than with other tetracyclines. This is fortunate because some people cannot tolerate Minocin on an empty stomach and have to take it with a meal to avoid GI side effects. If you need to take it with a meal, you will still absorb 85 percent of the medication, whereas tetracycline is only 50 percent absorbed. In June of 1990, a pelletized version of Minocin also became available, which improved absorption when taken with meals.”

    and

    “Over 85 percent of the dose will bind to the iron and pass through your colon unabsorbed. If iron is taken, it should be at least one hour before Minocin, or two hours after.”

    Overall, I’m hoping for remission/cure and no longer needing to dose at all. Fingers crossed and thanks for the information.

    #461396
    PhilC
    Participant

    I don’t think you’re going to (easily) find drugs that are labeled as “gluten-free” even though I would not expect to find gluten in most drugs. If someone asked you to find a drug that contains gluten I think you would likely have a difficult time doing so. And based on what I have seen, putting “gluten-free” labels on pharmaceuticals isn’t something that’s normally done, so don’t assume that the absence of “gluten-free” on the label or data sheet for a particular drug means that it contains gluten.

    As for taking minocycline with food, this is from the “horse’s mouth”:

    “When minocycline hydrochloride tablets were given concomitantly with a meal, which included dairy products, the extent of absorption of minocycline hydrochloride tablets was slightly decreased (6%). The peak plasma concentrations were slightly decreased (12%) and delayed by 1.09 hours when administered with food, compared to dosing under fasting conditions. Minocycline HCl may be administered with or without food.”

    Source:
    http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=37baf13f-cc65-44a1-93d9-e5213875af1a

    Regarding taking minocycline with iron, I wrote this previously: “The important thing is to avoid taking minocycline with antacids or mineral supplements, especially minerals like calcium or magnesium that are usually taken in large doses.” That includes iron. If you are concerned about food possibly reducing the absorption of minocycline, then avoid taking minocycline with food that contains added minerals (usually calcium and/or iron). For a long time I took my minocycline with some white rice that was rinsed thoroughly before cooking. I’ve also taken my minocycline with some applesauce (from a glass jar, not canned).

    Phil

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #461397
    Spiffy1
    Moderator

    I take 2 50 milligrams tablets one time when I first wake up and do not eat for at least two hours on MWF.

    Flare fall of 2014...muscle aches, joint pains, fatigue, hair loss, rashes, etc.
    RA Factor 71 in Jan 2015 down to 25 as of September 2017
    DR4/DQ8 HLA...biotoxin illness
    IGG food allergy to wheat, egg, and dairy...probably all grains
    Vit. C&D, probiotics, milk thistle, turmeric, fish oil, methyl b 12, methyl folate, digestive enzymes, Candisol, Ubiquinol, berberine, chlorella, Moducare, LDN, monolaurin, Triphala, Patriot Greens, Paractin
    MTHFR compound heterozygous
    Igenex IGM positive Lyme, minoMWF

    #461398
    Maz
    Keymaster

    I don’t think you’re going to (easily) find drugs that are labeled as “gluten-free” even though I would not expect to find gluten in most drugs. If someone asked you to find a drug that contains gluten I think you would likely have a difficult time doing so.

    Yes, and here’s an irony: many people are unaware that generic thyroid meds may contain gluten! How ironic that gluten has been suspected as a potential cause of thyroid disease. As a result, I had to switch to brand name Tirosint, which is made by a Swiss company, I think, and is about the purest form of synthetic thyroid hormone on the market. Porcine or Bovine NDT, of course, is gluten-free. I also take the T3 med (liothyronine), but get this compounded in a modified-release form (gluten-free).

    As the percentage of rheumatics who also suffer from thyroid disease is estimated to be double that of the otherwise healthy population, maybe these links will help those with thyroid disease and want to be gluten-free.

    Is Your Medication Gluten Free?

    Is Gluten the Root Cause of Your Thyroid Condition?

    At this link, a Mass General gastroenterologist, discusses why gluten can produce leaky gut and inflammation in folks – he says “No human being completely digests gluten.”

    Gluten, Inflammation and Leaky Gut in Rheumatic Diseases

    Severe, swift onset RA as a result of Lyme disease
    Current Meds: Biaxin (500mg BID), Tetracycline (500mg BID), Tirosint (88mcg), Liothyronine (10 mcg), Compounded Liposomal Artemisinin, LDN (3mg), Topical Progesterone,
    Current Supps: Curcumin, Bovine Colostrum, ALA. NAC, Milk Thistle, Super Liquid Folate/B12/B-Complex, Probiotics, Vit D3
    Supportive Measures: IV Myer's Cocktails, IV Glutathione, FIR Sauna, Gluten-free diet, Gym.

    #461399
    jennamp
    Participant

    I’ve had my eyes opened as part of this search and am shocked by:

    1) How many drugs are made in India (and by company’s fined for unsanitary conditions, etc.) Doc says avoid all India meds if possible. Buy US, Japanese, or Israeli made products exclusively. Could explain why people’s results vary on this forum.

    2) How many drugs contain gluten as a filler, as well as other nasty dyes, etc.

    I’m not sure how much the minute gluten filler would impact my husband’s Celiac Disease, but I’d really prefer to avoid the filler if possible.

    So far, by calling the manufacturer’s I’ve learned the below for 50mg:

    NDC Code Pharma Manufacture location Gluten Free
    0591-5694-60 Actavis India Y
    49884-511 Par NJ N
    68382-0316 Zydus (TEVA) India Y

    #461401
    PhilC
    Participant

    Doc says avoid all India meds if possible. Buy US, Japanese, or Israeli made products exclusively. Could explain why people’s results vary on this forum.

    Even drugs made by American or Canadian companies can be problematic.

    Some examples:
    Apotex Inc.
    Caraco Pharmaceutical Laboratories, Ltd.
    Mutual Pharmaceutical Company, Inc.

    (Research those names to find the relevant information.)

    2) How many drugs contain gluten as a filler, as well as other nasty dyes, etc.

    Gluten is not used as a filler. If it is present, it is there as a contaminant, and likely present in very minute quantities.

    "Unthinking respect for authority is the greatest enemy of truth."
    - Albert Einstein

    #461403
    jennamp
    Participant

    Totally agree US versions could be problematic. I did confirm GF Torrent/Ranbaxy/SUN’s 13668485 – 50mg tablets &
    13668482 – 50mg capsules are made by OHM Labs in NJ.

    The deep dive is enlightening:

    – Apotex doesn’t make mino any longer.

    – Caraco now SUN: 57664-0851 (50mg) now made GF in India.

    – Mutual “affiliated” with Sun and does not make Minocycline.

    Guess who is divesting their NJ plants…https://www.fiercepharma.com/pharma/sun-looks-to-unload-ohm-labs-nj-plants-manufacturing-consolidation-cnbc

    Caraco Pharmaceutical Laboratories, Ltd. is now part of Sun Pharmaceutical Industries Ltd. (February 2011). Sun Pharma has complemented growth with select acquisitions over the last two decades. In 1996, Sun purchased a bulk drug manufacturing plant at Ahmednagar from Knoll Pharmaceuticals and MJ Pharma’s dosage plant at Halol that are both U.S. FDA approved today. In 1997, Sun acquired Tamil Nadu Dadha Pharmaceuticals Limited (TDPL) based in Chennai, mainly for their extensive gynaecology and oncology brands. Also in 1997, Sun Pharma initiated their first foray into the lucrative US market with the acquisition of Caraco Pharmaceuticals, based in Detroit.

    In 1998, Sun acquired a number of respiratory brands from Natco Pharma. Other notable acquisitions include Milmet Labs and Gujarat Lyka Organics (1999), Pradeep Drug Company (2000), Phlox Pharma (2004), a formulation plant at Bryan, Ohio and ICN, Hungary from Valeant Pharma and Able Labs (2005), and Chattem Chemicals (2008). In 2010, the company acquired a large stake in Taro Pharmaceuticals,[13] amongst the largest generic derma companies in the US, with operations across Canada and Israel. The company currently owns ~ 69% stake in Taro, for about $260 million.[14]

    In 2011, Sun Pharma entered into a joint venture with MSD to bring complex or differentiated generics to emerging markets (other than India).

    In 2012, Sun announced acquisitions of two US companies: DUSA Pharmaceuticals,[15] a dermatology device company; and generic pharma company URL Pharma [16] In 2013, the company announced an R&D joint venture for ophthalmology with the research company, Intrexon.[17]

    On 6 April 2014, Sun Pharma announced that it would acquire 100% of Ranbaxy Laboratories Ltd,[18] in an all-stock transaction, valued at $4 billion. Japan’s Daiichi Sankyo held 63.4% stake in Ranbaxy. After this acquisition, Sun Pharma has become the largest pharmaceutical company in India, the largest Indian Pharma company in the US, and the 5th largest generic company worldwide[19]

    In December 2014, the Competition Commission of India approved Sun Pharma’s $3.2 billion bid to buy Ranbaxy Laboratories, but ordered the firms to divest seven products to ensure the deal doesn’t harm competition.[20][21]

    In March 2015, Sun Pharma announced it had agreed to buy GlaxoSmithKline’s opiates business in Australia to strengthen its pain management portfolio.[21]

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