Drug Treatments

Susan Lillard-Roberts

Extreme remedies are most appropriate for extreme diseases.
Hippocrates

 

Commercial anti-fungals alone may not necessarily be the only answer.  In fact, after what the body has been through, anti-fungals may be an insane abuse, if not used correctly.  Most physicians are hesitant to prescribe them as they don't know how to use them correctly in the manner they need to be taken.

Perhaps we never ventured just how much Hippocrates really meant when we think of invasive mycotoxicosis.  In my opinion, the "ideal" antifungal remedy isn't available yet, but I believe we might on to something in the near future for the cases that cannot be treated with "traditional" treatments. Perhaps these diseases wouldn't languish if there were more public knowledge, but understanding a physician's role is very important as well.

The real problem is that fungal properties are so close to human properties, it's hard to effectively destroy one and not the other.  Money for medical research is usually funded for "important" things such as virology or bacteriology, but when scientists are still a bit leery about mycology, or funded by insurance companies who fund the research such matters. Most in the field of science think it's something that only something that the severely immuno-suppressed are prone to be victimized by, which simply isn't true.  Perhaps more public awareness, less denial, and more comprehension from the medical arena would help.  Still, we shall look at what the drug companies have:

The world's first useful antifungal antibiotic, Nystatin, was developed through a long-distance scientific collaboration. Working as researchers for the New York State Department of Health, Elizabeth Lee Hazen in New York City and Rachel Fuller Brown in Albany shared tests and samples through the U.S. mail. To Hazen's single-minded pursuit of an antifungal antibiotic, Brown added the skills needed to identify, characterize, and purify the various substances produced by culturing bacteria found in hundreds of soil samples. The antibiotic they developed, named 'Nystatin' for the New York State Department of Health, was first introduced in practical form in 1954 following Food and Drug Administration approval. Not only did it cure many disfiguring and disabling fungal infections of the skin, mouth, and throat, but it could be combined with antibacterial drugs to balance their effects.  Uses for Nystatin have been as varied as treating Dutch elm disease to rescuing water-damaged works of art from molds.  Nystatin, however, is not effective in killing fungi in the lungs or gut, which seems to be an emergent problem these days.

Fungi exists in two forms.  The first structure is the growing form, called the mycelial form.  The second form is the spore or dormant form.  According to Dr. Vincent Marinkovich, Harvard graduate and former clinical associate professor at Stanford Medical School, medical director for MAST Immunosystems, and private practitioner of immunology/allergy in Redwood City, California; "The only way one can destroy mold is in the mycelial form."  That is why it can take so long (a year at the very, very least) to conquer this repulsive ailment systemically. 

When effective treatment in the body occurs, one needs to be aware of the potential of the dead toxins that arise. The reaction is referred to as the Jarrisch-Herxheimer effect.  This is known as the mold die-off when the toxins are carried off by the bloodstream.  The reactions can be quite severe if one is not prepared for it, and also by the dosage of anti-fungal taken.  Some problems one might encounter are insomnia, hyperactivity, itching, rashes, emotional trauma, and cold sweats.  This, in time, will pass.  It takes a long time to decontaminate the body and unfortunately the detoxifying can occasionally be as bad as the ailment, although quite short lived.  It is necessary to become sound and healthy once again, however since the affects of fungal exposure are so very dangerous. 

Econazole, an effective antifungal topical cream has never been available in any other form to my knowledge until now.  Leiter's Pharmacy in California now carries Econazole oral powder available in 250 mg. capsules.  It is very inexpensive.  Leiter's has been compounding several types of anti-fungals for many years.  For more information, you may give your physician their number, 800-292-6773.  The also do mail order.

The FDA has very recently approved Voriconazole (especially effective for aspergilliosis),  in May of 2002.  It is otherwise known as anti-fungal chemotherapy.  This is usually prescribed in two successive treatments at a cost of about $11,000.  Voriconazole is also available in pill form at a cost of approximately $40 per capsule.  It is said to be highly effective and insurance has been known to pay for this procedure in some cases.  This protocol is only prescribed by highly trained specialists and in very extreme cases, however.

Flucytosine is the only available antimetabolite drug having antifungal activity. It inhibits fungal protein synthesis by replacing uracil with 5-flurouracil in fungal RNA. Flucytosine also inhibits thymidylate synthetase via 5-fluorodeoxy-uridine monophosphate and thus interferes with fungal DNA synthesis.  It is available in capsule form.  Clotrimazole is a modern broad spectrum antifungal which inhibits ergosterol synthesis, an essential component of fungal cell membranes. When ergosterol is lacking the cell membrane gets damaged, leading to the destruction of the fungus. 

The US Food and Drug Administration has approved Merck & Co.'s Cancidas (caspofungin acetate, although, according to the FDA, this drug is in very short supply right now) for treatment of invasive aspergillosis in patients who do not to respond to or cannot tolerate other antifungal therapies, amphotericin B, lipid formulations of amphotericin B and/or itraconazole.  Aspergillosis is a potentially fatal fungal infection, often seen in hospital patients, that carries a mortality rate as high as 95%, with about one-third of patients surviving only 3 months after becoming infected. Patients with compromised immune systems are particularly vulnerable to the deadly infection, such as those on chemotherapy, those with HIV and organ transplant patients.  According to Merck, the drug is the first from a new class of drugs, called echocandins or glucan synthesis inhibitors, that will reach the market.

Fremont, California-based Versicor intends to initiate a phase III study of its V-Echinocandin early this year.  Mehta Partners analyst Mark Ravera has estimated that Cancidas could garner sales of $400 million to $500 million by 2005-2006, but that number could be lower if the drug is used primarily as a rescue therapy for patients who have no alternative.

Another effective antifungal is in the form of a synthetic structure;  Itraconazole, the generic name for Sporanox, and Terbinafine, the generic name for Lamisil.  In May of 2001, the F.D.A. issued an additional health warning for both Sporanox and Lamisil.  Dr. Vincent Marinkovich, however, has successfully been using Sporanox for ten years and Lamisil for five.  He states that although Lamisil was created as anti-fungal fingernail and toenail drug, both Sporanox and Lamisil have been highly effective for the treatment for fungal disease and systemically in the lung and lower intestine.  There is also a risk with Lamisil actually destroying human bone marrow.

Many people often question the hepatic effects of these two synthetic drugs.  Some physicians have stated that they have reservations regarding prescribing these effective, yet somewhat risky drugs.  Interestingly enough, Dr. Marinkovich told me that these two drugs have been given a bad wrap for raising liver enzymes.  First of all, these two drugs have been used in severely immuno-compromised patients such as cancer, HIV, etc., with very grave fungal infections thus, it hasn't been an accurate opinion when a patient is suffering from a Herxheimer response.  Dr. Marinkovich told me that he has never seen a case of liver toxicity in any of his patients on either Sporanox or Lamisil and a protocol of this treatment can be tolerated quite well for a year or more.  The only pitfall with these drugs aside from a possible toxic side effect is price; these drugs are very expensive. Sporanox costs about $9.50 per pill.

Griseofulvin ketoconazole, etc., are  fungastatics; meaning since they are mold derivatives, these organic compounds will arrest the growth of mold, not kill it.  The synthetic anti-fungals (Sporanox, Lamisil) on the market were designed to actually kill mold, thus, they are naturally more effective if one's body is healthy enough to withstand these drugs for over a year of therapy. 

Some physicians are using a drug called *cholestyramine, the generic name for Questran; a cholesterol absorbing drug that the military has been using for decades on soldiers exposed to horrendous neurotoxins such as yellow rain.  There is a name to this affliction that San Francisco clinical ecologist, Dr. Al S. Levin calls Chemically Induced Immune Dysregulation. Many still question what the military personnel were exposed to.  The people who fought in the Gulf war disagree and thought there was a big cover up Cholestyramine has proven very successful if taken over a long period of time, with very few complications.  One major complaint is constipation and nausea.

The use of Cholestyramine has been highly controversial, and only very experienced physicians should be prescribing this.  One common mistake is the amount of time from mixing this powder to time of consumption, to alternative laxative agents to take as this treatment can be very binding.  In addition, a successful treatment of Cholestyramine in treating invasive mycotoxicosis generally takes several months, not 2 weeks.  This is why it should be overseen by an extremely experienced physician. (Important information about Cholestyramine and anoxenase below).

A controversial branch of medicine has evolved to treat those people who are acutely sensitive to environmental toxins.  Called Clinical Ecology, this branch of medicine treats people with allergies and more severe ailments as symptoms of poisoning.  Though Clinical Ecologists have few friends, acceptance in the scientific community is growing.  Arguing in its defense, Dr. Al Levin, a prominent San Francisco physician, told Science magazine (December 19,1986) that Clinical Ecology is only in the early stages of development, as radiation research was in the 1940s.  "It took 15 to 20 years for people to realize that ionizing radiation was linked to a higher incidence of cancer." 

There are many other prescription anti-fungals on the market and different situations warrant different protocols.  Your physician may or may not know what is best for your individual needs.  It takes knowledge on both your parts to fully understand this illness and keep up with modern technology as advances are always being discovered.  Mycotoxicosis can be a serious illness with many consequences and the effects can be very serious.  Keep an open line of communication with your doctor and make sure you have one who is educated and open minded enough to fully understand this syndrome and how to treat it.  The long term effects of this are still unknown and vary from person to person. 

Until one can manage to find the correct therapy, many people find comfort with high levels of B vitamins (including biotin, magnesium, alpha lipoic acid, thiamine and manganese), 2 oregano oil (a natural antifungal and antibacterial) capsules and 2 charcoal capsules twice a day.  8 glasses of distilled water should be consumed every day to flush the system of toxins, (preferably one to three glasses with 10 to 12 drops with grapefruit seed extract daily).  This is by no means a substitute for prescribed medication, only a quick stop gap measure until medication is available.

Another important factor to consider is the fact that some people inherit a gene from one or sometimes both parents that produces a chemical that assists in absorbing toxins called anoxenase.  Some people inherit none from either. The drug cholestyramine assists in producing this chemical, thus the reason why it is so successful.  Another natural method one can protect themselves in producing anoxenase is by taking a 1/2 tablespoon of psyllium hull powder twice a day in water.  One can also purchase the capsules, but they are not quite as effective.  They are also a natural diuretic which can also aid they blood pressure.  Many people continue this treatment while they are still taking an antifungal as the mold can only be destroyed in the mycelial form and this can take a very long time.

There are a variety of methods to treat this illness, as you can see by the index page that proceeds this article.  Location, severity of infection, immune dysfunction, and time constraints all play a major role on what therapy may be most effective.  Many patients who have been through such an ordeal often complain they do not have the financial means to treat this disease. If one does not have the economic resources to go to a physician, Dr. Vincent Marinkovich told me some important words of advice. Begin with the diet, if nothing else.  Within a few weeks one should already begin to feel some relief, that is, if one is at the point of no return.  When patients tell me they have been on the diet for a month and so far they do not feel any relief, I generally know one of three things are happening; either they are not following the diet correctly, not taking their prescribed medication, or they are being re-exposed to toxigenic mold and are having issues with hypersensitivity reactions.  For the latter I can do nothing, as diet alone is 70% of the wellness process in many cases. The old adage of vitamins, diet and exercise is actually a good one.  The important thing is to stay focused.  Stress can be very destructive to the immune system. 

 

Effective June 25, 2003, there has been a recall on cholestyramine.

 

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