dialysis and medication?

[gothiclovemonkey]

Ok, so its my understanding that thngs build up in our system because we cant get rid of it, so it stands to reason that if u take a drug, medication or  street, or drink, on a daily basis, it too would build up on u?
What if ur on hemo? Would that one or two days ur not getting dialysis, would u then have a double dose in you?
Im asking because they want to put me on sleeping pills and some other mental medication lol i am worried ill want to sleep all the time (altho right now im not sleeping at all, so that might be better lol) Or that ill become falsely uphoric or something lol
Does this question even make sense? I havent slept in a few days so perhaps my brain has congered up some insanity here....

[RichardMEL]

I think I understand what you're getting at - if toxins build up between dialysis sessions than wouldn't medications? Yeah, I see the logic, but don't really think it works that way. you introduce the meds to your system to interact with your body and modify it in some way (make you sleep, lower BP, whatever) the meds will do their job. Maybe if they cause by products that are normally expelled via the kidneys that stuff might join the other toxins running around, but I don't think stuff like sleeping pills etc will "add up" in your system.

If you're at all concerned about it though, and seems that you are, just ask the neph!

[gothiclovemonkey]

asking my neph anything is like getting teeth pulled. he doesnt listen, doesnt care, and doesnt ever answer my questions.

[aharris2]

Do it yourself!

Check out the med on rxlist or go to the manufacturer's website and check the prescribing information. It will tell you how the dosage should be adjusted for people with impaired kidney function and it will tell you how it is metabolized.

[Restorer]

Some drugs wear off because they're excreted by the kidneys; some wear off because they're metabolized into inactive compounds by the liver. Yet others wear off (usually very quickly) because they're broken down by enzymes present throughout the body. Whether a certain medication builds up in people with low kidney function depends on how the body gets rid of them.

Anything your nephrologist prescribes should be safe, because he's taking into consideration your lack of kidney function. Most sleeping pills are fine. If your GP or another (non-kidney) specialist prescribes you something, you should clear it with your neph first. I guess if he doesn't answer any of your questions, then maybe ask the prescribing doctor if he knows that it's safe given your condition, and make sure your dialysis unit knows you're taking it. Or ask us here (disclaimer: we are (generally) not doctors, but maybe one of us is taking the same thing and had it cleared by a nephrologist).

Not all drugs are removed by dialysis, either, so it's a good idea to ask.

If you're up to reading the detailed drug insert, the kind of thing the doctors/pharmacists get, you can look them up on RxList.

Edited to add: Oooh, you beat me to that point, aharris2! 

[Jie]

There is a book out there to list the medicines that the dosages need to be changed based on kidney functions.

[RichardMEL]

asking my neph anything is like getting teeth pulled. he doesnt listen, doesnt care, and doesnt ever answer my questions.

Sounds like you need to change nephs to someone you CAN work well with and are comfortable with and who does answer your questions.

hey everyone else thanks for the comments - they are good ones - I didn't even think about drug guides etc.

[gothiclovemonkey]

Thank you all for ur replies!
 yes i do need a new neph, and i tried but to no avail

[Riki]

a good pharmacist will tell you if it will affect your kidney function as well, if you have any, or how it will be metabolized.

A few years ago, I had tendinitis, and I went to a clinic, to a doctor who didn't really know me. he prescribed a medication that we'd not had before.  We didn't think anything of it, but the pharmacist woudln't give it to us because it could diminish kidney function.  We had to ok it with the neph, who was in Halifax at the time.  It took a day or two for him to get back to us, but he said it was ok for me to use the medication because I had no function anyway.

[KICKSTART]

I can deffo tell you sleeping tablets DONT build up ! Ive been on them for ages now , in fact they dont even make me sleepy , you build up an immunity to them after a while !

[Hazmat35]

Just be careful what kind of sleeping pills they are.  Some are VERY addictive and then you have a whole new set of problems to deal with. 

Some sleeping pills have the "reverse" effect on people.  They make them Hyper and jittery and can't sleep. 

[gothiclovemonkey]

yikes that would suck, getting hyper when all u wish to do is get one restful night of sleep!

[RightSide]

There is a book out there to list the medicines that the dosages need to be changed based on kidney functions.

There's a website too:

Renal Dosing Database
http://www.globalrph.com/index_renal.htm

[cookie2008]

Sleeping pills my neph prescribed Lunesta, and for a mental meds he prescribed Zoloth, they didnt have any build up effects.  Talk with your pharmacist about your medications.

[Riki]

I was prescribed Lunesta too.  It worked once, and just the once.. after that, it had no effect on me at all.

[casper2636]

I don't sleep at all! The only time I can sleep is in dialysis. They have given me Ambien, but it does not work. They are giving me so much blood pressure medicine I can't stand up with out passing out, or bending over to prevent it!
These are the same doctors who continued to give me Epogen, while I itched so badly I took a knife to my skin and just scrapped all the blisters and bleed uncontrollably, my nails fell out, my hair fell out and I was so miserable, I just cried. This went on for a year, until my dermatologist finally suggested that they stop the Epogen. Thank God, within four days, the itching stopped. I'm still growing my nails back and my hair, but the scars will be there forever. I don't know about these doctors and their medication!

[gothiclovemonkey]

holy cow casper!
Thats really scary!
My hair started falling out hard core, but ive never had long hair before, so i assume this is normal? lol
Yes my dr at one point had me on something that didnt go with something else i was on... luckily the pharm caught it

[casper2636]

gothiclovemonl - That's. the problem! I used to have long, blond, wavey hair that was so thick. Now, I have little stubbs (I had to shave my head because it was coming out by the handful). Not to be rude, but even my pubic hair fell out. The hair on my legs has just started to grow back, but it looks fried... all squigley and burnt looking. They were giving blood transfusions every month because I was constantly anemic...a normal blood test was at a 6, then they would give me three units of blood (in the hospital because it would flood me out and I'd get flash pulminary edema). Just recently, they gave me a new drug called Aranesp to help me with my red blood cells...I'm keeping my fingers crossed!Meanwhile, I'm watching my hair and nails grow... S L O W L Y !!!!
Have you ever heard of anyone affected by Epogen this way? I so mad I had to suffer for a year before they stopped it. It was literally torture!

Meanwhile

[gothiclovemonkey]

wow im sorry u had to go thru all that, even for a day but a year? wow.
(although it must be nice to not have to shave "down yonder" lol) i have had alopecia brought on by meds before, only on my head though, and it was alot different than what im having now... so idk if thats what it is or not
i havent heard that, infact when i start having the 'mad itch' on the machine the dr says im just nuts and nothings wrong

[RichardMEL]

Yeah, that's so odd - I had never heard of that side effect of epo, or anything else common under dialysis (post transplant, well I understand that's a whole other story). And yeah how could a gal complain about not having to shave or wax? Sorry, just kidding... I'm just on the lovemoni (love that) wavelength! I'm sorry about the lack of hair though - that would suck big time - I can't imagine.

All I've found is my hair is going grey really quickly - not sure if that's D related or just the fate I'd have to suffer naturally. They say it's... distinguished.... ahem.

[gothiclovemonkey]

thats why there are wigs and best part, u can change it up every day if u wanted.

Richard.... Grey hair can be very handsome, also... a guy i know turned grayhaired before he turned 30!

[casper2636]

Guys, thanks for your replies!
Has anyone heard of or been on this new drug ARANESP? I've looked it up, but I want to hear results from someone first hand. I kind of feel like a test rat, as no one in my clinic has heard of it or been on it before. The side effects listed are scary and I'm a little skceezed out by it. They say it can make your body produce too much blood and you can stroke out. I'm concerned because my clinic only does blood tests once a month. A lot can happen in one month,and the way my medicines have been working on me , if I don't have bad luck, I have no luck!

[cariad]

Guys, thanks for your replies!
Has anyone heard of or been on this new drug ARANESP? I've looked it up, but I want to hear results from someone first hand. I kind of feel like a test rat, as no one in my clinic has heard of it or been on it before. The side effects listed are scary and I'm a little skceezed out by it. They say it can make your body produce too much blood and you can stroke out. I'm concerned because my clinic only does blood tests once a month. A lot can happen in one month,and the way my medicines have been working on me , if I don't have bad luck, I have no luck!

Have we heard of Aranesp?! Mais oui!

It is actually pretty well established now. I am absolutely stunned that your unit has never heard of it. It came out around 2005, and I took it then - at that point, it really was a drug that doctors scrambled to research every time I mentioned it, and most hospital labs could not acquire it and would offer me ProCrit instead (does not work for me).

Yes, it can indeed kill you if you get too much and your Hgb goes too high. Your doctor should make positively sure that this does not happen. I believe for women insurance/Medicare will no longer cover it if your level goes above 11, so that's a safeguard of sorts. Amgen, the makers of Aranesp, have been in and out of court for various reasons over this drug - none of them too encouraging when it comes to trusting this company. But the drug works, burns horribly when injected but no lingering pain. I would take it, as your options are few without it. (Frequent blood transfusions will quickly make the possibility of a transplant highly unlikely). If you do a search for Aranesp on this site, you will see many discussions, arguments, and horror stories about Amgen for your information. Still, it's a breakthrough drug for dialysis/renal failure patients.

Good luck!

[casper2636]

Cariad, thanks for your information. I got more from you than I did from my doctors. I don't know what rock my clinical nurses and doctors have been hiding  under!!!!! You didn't mention if you had any side effects or how long you were on it. And, yes, you are right, the more transfusions, the less likely of finding a match for a transplant. It has been getting harder and harder to even find a match for blood transfusions, so I'm terrified they won't be able to find a kidney to match me! What do you get now for red blood cells?

[cariad]

Cariad, thanks for your information. I got more from you than I did from my doctors. I don't know what rock my clinical nurses and doctors have been hiding  under!!!!! You didn't mention if you had any side effects or how long you were on it. And, yes, you are right, the more transfusions, the less likely of finding a match for a transplant. It has been getting harder and harder to even find a match for blood transfusions, so I'm terrified they won't be able to find a kidney to match me! What do you get now for red blood cells?

Your doctors sound like complete no-hopers, casper. I'm sorry.

I stopped taking Aranesp when I found out I was expecting in late 2005 (the perinatologist said that OBs are the absolute last to hear of new drugs because their patients can never take them.) Then I guess I took it every 2 weeks for about 18 months before transplant. I was never on dialysis - not at a unit, anyhow. Side effects were usually feeling really sleepy the day of the injection. That was it for me. I guess bone pain is a problem for some. I have had only 2 blood transfusions in the modern age, and they were both post-transplant. My sodium/wbc/rbc and many other labs were off kilter for quite a while after the operation. I supposedly received leukodepleted, irradiated blood. This reduces the chance of sensitization and sterlises the blood for the prevention of disease transmission and graft-vs-host. (GVHD was rather a large concern in my case.)

I read that America routinely leukodepletes all blood, but don't think this is actually true. If you need further transfusions, try to demand answers from those people who call themselves doctors. If you've been listed, you are most definitely an at-risk patient and should be getting treated bloods. Did I read in another discussion that you are allergic to EPO? If so, can you really take Aranesp? I always used the terms interchangeably.