Thank you Dr. Lynch, This discussion is very helpful about when to back off, and how to prepare the body to respond the best before adding methylfolate. My son could not tolerate much methylfolate to begin with, so we backed off, added some of your optimal turmeric and optimal start for about 3 weeks, and then proceeded to start with the methylfolate and add slowly from there. He is on about to 3mgs currently. We would love to able to recommend to him a multivitamin, but I am concerned about giving him your multi because it combines niacin and methylfolate. Doesn’t that pose a problem together? Won’t the niacin cancel out the methylfolate in the vitamin as well as the excess methylfolate he already takes? What are your thoughts about this, and can you recommend what to do? Obviously, our son is getting niacin in his diet already, as well, but he really needs a multi. Thanks
Omeprazole acts as an inhibitor of CYP2C19. Omeprazole, given in doses of 40 mg daily for one week to 20 healthy subjects in cross-over study, increased Cmax and AUC of cilostazol by 18% and 26% respectively. C max and AUC of one of its active metabolites, 3,4-dihydro-cilostazol, which has 4-7 times the activity of cilostazol, were increased by 29% and 69% respectively. Co-administration of cilostazol with omeprazole is expected to increase concentrations of cilostazol and its above mentioned active metabolite. Therefore a dose reduction of cilostazol from 100 mg twice daily to 50 mg twice daily should be considered.