In the past week I have decreased my dose of progesterone to 100 mg twice daily (200 mg total). I have not had one incident of my brain feeling like it was on fire. Additionally, I am now taking my dose two hours away from any food. Because pharmacokinetics.
There seemed to be conflicting information in the Consumer Medicines Information (CMI) leaflet I was provided for my compounded progesterone compared with the commercially available Prometrium.
Exhibit one, CMI for compounded progesterone. Delivered straight to my door from somewhere in Hinchinbrook.
Certain types of food may affect the way medicines work.
Exhibit two, CMI for commercially available progesterone (brand Prometrium).
Do not take Prometrium with food as this may affect the way Prometrium works.
I remember reading both of these when starting progesterone and thinking, those are not the same. But with most medications I’ve taken in the past taking with food smooths out the release of medication. But it turns out when taken with food oral progesterone doubles the peak concentration. Whoops?
What’s worse is that the metabolites of progesterone, such as allopregnanolone, can increase even further in a completely disproportionate fashion. Great! Throw in short half lives and you’re in for a treat.
Probably worth noting that allopregnanolone does interact with the glutamate system by reducing glutamate release. What happens when the allopregnanolone levels drop rapidly then? Brain fire. This may explain why it felt like excitotoxicity.
Realistically I need to consider an alternate route of administration to dodge all the neurosteroids. I guess I’ll have a word to my endocrinologist sometime in the near future. Stay tuned! 🙃
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