jeromewilson: Oh strewth, and I was just thinking 'I must get me some of that pyritinol stuff'. I wonder if milk thistle would protect against any adverse effects on the liver.
charisma:Hmm, I was just about to add Pyritinol to my stack too. Now I'm not quite so sure.
I suggest that you guys take a step back and look at the big picture here. I am guessing that none of you have a life-threatening disease for which more conventional therapies have failed leaving pyritinol as your sole hope, but that you are instead essentially healthy life extension and/or nootropic enthusiasts looking to get some kind of brain buzz. However small you rate the risk, is even so small a chance of destroying your chance of reaching actuarial escape velocity (1) a good tradeoff for the miniscule, likely largely placebo-effect-driven benefits you will get from this stuff -- benefits likely minimally distinguishable from the rest of your nootropic stack or even a good mug of java?
Priorities, people! As the study authors noted,
BMJ: the most striking feature in these patients was the severe and prolonged nature of the cholestasis that required admission to hospital in four previously healthy young individuals. The seriousness of this adverse reaction contrasts with the relatively small clinical importance of the problem that led to its prescription. Therefore, the cases reported here justify a reassessment of the risk and benefit of pyritinol.
cesium: I still am not especially concerned as this reaction still appears to be quite rare. Pyritinol has been around for a long time and the risk appears negligible.
This is the problem with 'natural' or nearly-natural supplements, often sold OTC with little formal drug surveillance: we rarely have any clear idea of their safety profile. As the study authors noted,
BMJ: Ascribing severe adverse reactions to drugs such as pyritinol—generally considered innocuous by patients and doctors—is particularly difficult as a link with such drugs is not usually considered ... Interestingly, the doctors who referred the patients to our unit did not consider pyritinol to be a likely cause of hepatitis, so it is possible that this non-dose dependent drug hepatotoxicity may have been substantially under-reported during these years.
cesium: Also, as physician commenting on this study noted:
Ioana Vlad: I was surprised to read about the liver toxicity of pyritinol in these 6 patients when 5 of them were taking medicines that are well known to cause toxic hepatitis (paracetamol), cholestatic hepatitis (nitrofurantoin, oral contraceptives, erythromycin) or even acute liver failure (nimesulide). How can one say how much is the effect of these medicines and how much is the effect of pyritinol?
I would say that, while we can't be
certain, the answer is pretty obvious from the case histories:
BMJ:
Case 1—A 23 year old female student complained of nausea, malaise, and jaundice one month after starting pyritinol 600 mg a day for "memory improvement." She had also been taking paracetamol with codeine sporadically for some years because of headache. Discontinuation of pyritinol led to rapid clinical improvement and to normalisation of liver function five months later.
Case 2—An 18 year old female student was prescribed nitrofurantoin 400 mg a day for cystitis and pyritinol 600 mg a day for "memory improvement." Five days later she was admitted to hospital with pruritus and jaundice ... One year earlier she had been taking pyritinol at the same dose for 20 days with no known adverse effects. Improvement of her condition was observed after she stopped taking pyritinol, and liver function returned to normal five months later.
Case 3—A 27 year old woman presented at the out-patient clinic with jaundice and abnormal liver function tests. She had been taking oral contraceptives for three years and had started taking pyritinol 400 mg a day 25 days before presenting at the clinic. Liver function returned to normal more than six months after she stopped taking pyritinol.
Case 4—A 21 year old woman was admitted to hospital with malaise, vomiting, and fever of three days' duration and abnormal results for liver function tests. She had been taking pyritinol 600 mg a day for a month and was also taking nimesulide (one or two pills a month) for dysmenorrhoea. After she stopped taking pyritinol, liver function improved but did not return to normal for nine months.
Case 5—Ten days after starting to take pyritinol 600 mg a day, a 41 year old man was admitted to hospital with nausea, vomiting, jaundice, and abnormal liver function. Complete clinical and biochemical normalisation was seen two months after he stopped taking the drug.
Case 6—A 24 year old woman had nausea, vomiting, abdominal pain, fever, and jaundice 14 days after starting to take pyritinol 400 mg a day for "memory improvement." She had also been taking erythromycin 500 mg every six hours during the previous eight days for a sore throat. Liver function returned to normal within a month. When she inadvertently took pyritinol again six months later, she developed the same symptoms and blood tests gave similar results.
You pays your money and you takes your pick, but in a world of ALCAR, piracetam, pyroglutamate, DMAE, and other nontoxic, well-established nootropics, I can't fathom why a person would take a risk on pyritinol after reading the above report.
-Michael
1. de Grey AD
Escape velocity: why the prospect of extreme human life extension matters now.PLoS Biol. 2004 Jun;2(6):723-6.
Edited by LifeMirage, 25 May 2005 - 12:36 PM.