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Doctors' Answers to "Frequently Asked Questions" - Homocysteine

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An indi vidual patient is always advised to consult their own physician.

[posted 04/12/2000]
Question: Does a high homocystene level caused by the use of lipid or cholesterol lowering drugs affect neurologic function and should we be supplementing B-12, folic acid and pyridoxine?

Answer: High homocysteine levels are usually thought to be an inherited phenomenon and not due to lipid lowering drugs. Smoking may also increase the levels according to some. Most would recommend fairly high dosages of B vitamins and folic acid to reduce the level, but it is not always effective.

[posted 04/8/2000]
Question: I have been taking prilosec for acid reflux for a couple of years and 600 mg of ibuprofen 2x/day for inflamed ligaments in my knee for 3 months. I have been diagnosed with high cholesterol, triglycerides and abnormal homocystene levels. The cardiologist has proscribed a baby asprin 1x/day, Lipitor, B6 @ 50mg 2x/day and folic acid @ 400mcg 2x/day.
I currently take vitamin c 1000mg/day, beta carotene 40,000IU ,vitamin E - 400 IU and selnium 200 mcg/day, Any problem with these combinations?
I have a family history of Heart disease- my father died at age 52, my brother just had a heart atttack at age 45. I am 42 and have had a problem with my weight all my life. I am currently at 300 lbs. Other than "watch what I eat" any specific advice for dealing with weight?
Thank you

Answer: You might try switching to Vioxx or Celebrex and see if your reflux improves. They will usually have less gi effects, but are more expensive. The others are common recommendations for patients in your situation and do not seem to have any interactional problems except liver toxicity. You should be getting liver function tests every 4-6 months. Having said that, the liver problem is uncommon. I assume they have rechecked your homocysteine and it is lower on the supplements? Most patients with elevated homocysteine need larger doses of B vitamins and folate to suppress it.

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