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MEDICATIONS to be avoided when on the Marshall Protocol

(contraindicated medications)

This list is not comprehensive.

The medications recommended on the MP have excellent safety profiles but we do not know how they might interact with all other medications. It was not possible for us to review every medication that a patient might be taking. You may be taking a medication that interacts in a negative way with Benicar or minocycline. Be sure to ask your doctor or pharmacist to review your medications with this in mind.

Review your medications
You should review all your medications with your doctor. If you are taking a contraindicated medication, ask if it can be discontinued or a safer medication substituted. Ask why you are taking each medication and if it could be safely discontinued. Sometimes medications or supplements are being taken for symptom relief. They may be continued if the symptoms are intolerable, the medication is effective and is not contraindicated. Please see Should I stop taking any of my medications? and Why should I avoid hormone supplementation?

If you are taking medications/supplements that are part of another protocol to resolve your disease process, and that is their only purpose, you will need to discontinue those. Combining other protocols with the MP is contraindicated. See Why do I have to stop my alternative treatment and avoid most supplements?

The MP phase one guideline advises:

5. Attention: If you are taking any other antibacterials (Sulfusalazene, Plaquenil, Methotrexate Isoniazid, Rifampin, pyrazinamide, ethambutol are antibacterials) you MUST discontinue all antibiotics and antibacterials BEFORE you start Benicar. This is because Benicar greatly potentiates the action of many antibiotics, and consequently a severe or life-threatening immune system reaction may result." If you need to use another palliative agent to cope with your symptoms please consult your physician.

Plaquenil is an antimicrobial which lingers in the system at least 50 days and cannot be taken while on the MP. Dr. Blaney reports he starts his patients on Benicar while they are waiting for Plaquenil to clear their system and has seen no adverse events. He prefers to wait a couple months before starting minocycline.

If you need to take a short course of an antibiotic that is not on the Marshall Protocol, you must discontinue Benicar and any MP antibiotics you are taking. Most non-MP antibiotics do not provoke immunopathology but Benicar may potentiate its action and cause intolerable symptoms so it's best to be cautious.
I need to take a different antibiotic for awhile. What should I do?

It's a good idea to ask your pharmacist to check all your medications for possible interactions or contraindications. Or you may wish to use the Drug Digest website to learn if any of the medications you are taking interact negatively with each other.

There are many medications contraindicated for use by patients with Th1 inflammatory diseases. They are listed below with some of their alternate names. If you do not understand the kind of medication you are taking or its purpose, ask your doctor or pharmacist. Because it isn’t possible to include detailed explanations about each category of drug here, a link is provided to the appropriate information.

Vitamin D- Rx or OTC as:

ergocalciferol (vitamin D2, from plant sources)
cholecalciferol (vitamin D3, from animal sources)
Calciferol
Calcitriol
Calcijex
Calderol (calcifediol)
calcipotriol and calcipotriene (brand name Dovonex) This psoriasis cream is a vitamin D analog.
Delta-D
Drisdol
Radiostol
Radiostol Forte
Rocaltrol
-->Read: Vitamin D
-->Read: Vitamin D
Avoid all fish-oil products at all cost.

Avoid all vitamin D analogs.

Corticosteroids- Rx & OTC
Steroids are contraindicated in the presence of bacterial infections and are proven to cause relapse rather than cure. All oral and inhaled steroids are to be discontinued before starting the MP. Limited use of sniffed and topical steroids is allowed for intolerable symptoms of nasal congestion or itching.

Prednisone
Prednisolone
Beclomethasone
Beclomethasone (Beconase)
Betamethasone
Cortef/cortisol
Cortisone
Deflazacort
Dexamethasone
Dexamethasone (Decadron)
DHEA
Fluticazone (Flonase)
Fludrocortisone (Florinef)
Hydrocortisone
Methylprednisolone
Triamcinolone

-->Read: Steroids cause hip and joint failure
-->Read: Inhaled steroids not necessarily any better
-->Read: Steroids cause Avascular necrosis
see Document: WEANING FROM STEROIDS

Steroid hormones

Pregnenolone
Estrogens
Progestin
Progesterone
Testerosterone
Why should I avoid hormone supplementation?

Epinephrine (adrenaline)
(particularly in Dental injections, also in local anesthetics) Causes local inflammation, nullifies local anesthestic and may cause adverse systemic biochemical reaction such as migraine
-->Read: Why do I need to ask for a local anesthetic without epinephrine?

Thiazide Diuretics

chlorothiazide (Diuril)
chlorthalidone (Hygroton)
indapamide (Lozol)
Hydrochlorothiazide (HCT, HCTZ) (Esidrix, HydroDiuril)

Persons with Th1 inflammation may have occult kidney inflammation. Thiazide diuretics are hard on the kidneys.
Please read: Paul J. Rosch: Diuretics and Diabetes

HCT is added to a lot of other combination blood pressure drugs, and these should not be used

Hydrochlorothiazide (HCT) is too hard on the kidneys and liver, and these are organs were people with Th1 disease may have undetected problems. You can read the precautions about HCT on the internet drug index.

Here are some of the HCT and HCT-containing combinations to avoid:
Accuretic
Aldactazide
Apresoline/HCT
Aquatensen
Aquazide
Atacand/HCT
Avalide
Benazepril/HCT
Benicar/HCT (Benicar without the HCT is the form you should take)
Bendroflumethiazide
Benicar/HCT you need the normal benicar (without the HCT)
Benzthiazide
Bisoprolol/HCT
Candesartan/HCT
Capozide
Captopril/HCT
Chlorothiazide
Diovan/HCT
Diucardin
Diuril
Dyazide
Enalapril/HCT
Enduron
Esidrix
Exna
Ezide
Fosinopril/HCT
Hydrocot
HydroDIURIL
Hydroflumethiazide
Hydromox
Hyzaar
Inderide
Irbesartan/HCT
Lisinopril/HCT
Losartan/HCT
Lotensin/HCT
Maxzide
Metahydrin
Methyclothiazide
Micardis/HCT
Microzide
Moexipril/HCT
Naqua
Naturetin
Oretic
Polythiazide
Prinzide
Propranolol/HCT
Quinapril/HCT
Quinethazone
Renese
Saluron
Spironolactone/HCT
Telmisartan/HCT
Triamterene/HCT
Trichlormethiazide
Uniretic
Valsartan/HCT
Vaseretic 10-25
Vaseretic 5-12.5
Zestoretic
Ziac

These diuretics are contraindiated because they are potassium-sparing and might result in hyperkalemia.
-spironolactone (Aldactone, Novospironton, Spiractin)
-triamterene (Dyrenium)
-amiloride (Midamor)
Lasix (furosemide) however, does not cause potassium-retention and is compatible with the MP. Anyone on Lasix with cardiorespiratory sx exacerbation should be evaluated by their Dr for CHF to see if their cardiac medications need to be adjusted.


Spironolactone (Aldactone) is also contraindicated because it is an ntiandrogen with steroid structure which inhibits 5 alpha-dihydrotestosterone (5-alpha-DHT) receptors by blocking androgen receptors.

Apresoline (hydralazine) This study reports that "Olmesartan significantly decreased myocardial inflammation compared with controls, whereas hydralazine significantly increased this". You will want to discuss this with your doctor.

Antifungal agents (oral)
fluconazole (Diflucan)
itraconazole (Sporonox)
griseofulvin (Fulvicin)
terfinabine (Lamisil)

All antifungals profoundly affect the immune system. Do not take an antifungal unless it is absolutely necessary.

Cholesterol Drugs

statins
Lipitor (atorvastatin)
Lescol (fluvastatin)
Mevacor (lovastatin)
Omacor (Avoid fish-oil products at all cost)
Pravachol (pravastatin)
Zocor (simvastatin)
Rosuvastatin (Crestor)
Vytorin (ezetimibe and simvastatin)

Other drugs used to affect cholesterol levels:

Cholestipol (Cholestid)
Colesevalam (Welchol)
Fenofibrate (Tricor)
Zetia (ezetimibe) blocks the actions of PPARgamma and Glucocorticoid receptors.
Gemfibrozil (Lopid, Gemcor) to reduce triglycerides
Omacor (made from fish-oil)
Niacin (vitamin B3)
Pantethine
Cholestyramine (Questran)
Red yeast rice (monascus purpureus)

All these may interfere with normal function of the immune system. For details, see What should I do about my high cholesterol and/or triglycerides?

Hypoglycemics
Actos (pioglitazone)
Avandia (rosiglitazone)
Avandamet (contains rosiglitazone)
These thiazolidinediones adversely affect TNF-alpha secretion and atherosclerotic development.
exenatide (Byetta)...may cause acute pancreatitis
metformin This source says metformin may interact with other medicines including angiotensin-receptor blockers (Benicar)

Provigil (modafinil)

Provigil, a stimulant-like drug, enhances the expression of CYP3A4, the enzyme which breaks down 1,25-D. Provigil will therefore upset the D metabolism. Unless someone has narcolepsy, we would not recommend the use of Provigil.

Diet Medication

Acomplia (rimonabant)

Antiseizure and sedative
Phenobarbital... Prolonged therapy with phenobarbital may cause vitamin D deficiency or osteomalacia.

Immunosuppressants- Rx-

Azathioprine (Imuran)
Amevive (Alefacept)
Basiliximab
Chlorambucil
Cyclosporine
Cyclophosphamide
Enbrel (etanercept)
Humera (adalimumab)
Imuran(azathioprine)
Methotrexate
Muromonab-CD3
Remicade (inflixamab)
Sirolimus
Tacrolimus
Trental (pentoxifylline
These immunusuppressants may be discontinued without weaning

Allergy shots: (immunotherapy) stimulate the immune system. They are to be avoided while on the Marshall Protocol.
It is okay to take antihistamines to treat intolerable symptoms.

Folic acid- Rx or OTC as

Apo-Folic
Folate
Folvite,
Novofolacid
Vitamin B-9
Folic Acid in your bloodstream makes it easier for the bacteria to replicate and create new DNA.

Fluoroquinolones-Rx- Do not take these antibiotics with steroids; they may be used for acute infections.

Cipro (ciprofloxacin)
Levaquin/Quixin (levofloxacin)
Tequin (gatifloxacin)
Avelox (moxifloxacin)
Ocuflox/Floxin/Floxacin (ofloxacin)
Noroxin (norfloxacin)
-->Read: Fluoroquinolone Antibiotics

Calcium supplements should be avoided in the presence of hypercalciuria or hypercalcemia. Sarcoidosis patients should take no more than the RDA including both supplements and food.
-->Read: Calcium

Bisphosphonates-When patients with an elevated level of 1,25-D are given Fosamax (or other biphosphanates), it can cause calcium deposition into the soft tissues, reduced organ function and possible osteonecrosis of the jaw (ONJ). All these meds have some effect on the immune or endocrine system and are, therefore, to be avoided.

01/07/08 FDA Issues Warning of Potential Side Effects of Bisphosphonates
Bisphosphonates and inflammation
4/13/06 Fosamax causes osteonecrosis of the jaw lawsuit

http://tinyurl.com/qharu
8/27/07 Avascular mandibular osteonecrosis in association with bisphosphonate therapy: a report on four patients. (Moderator Note: one of these patients had sarcoidosis.)
Anticancer Res. 2007 Jul-Aug;27(4A):1841-5.
PMID: 17649782 [PubMed - in process]
"The case report of an osteonecrosis of the jaw following multi-drug therapy for sarcoidosis adds a further and non-cancerous condition to the newly described entity of bisphosphonate-associated jaw necrosis."

Brand and generic names for bisphosphonates:
Actonel (risedronate)
Aredia (pamidronate)
Boniva (ibandronate)
Didronel (etidronate)
Fosamax (alendronate)
Skelid (tiludronate)

Evista (raloxifene)

Forteo (teriparatide) is a hormonal injection of PTH touted to increase Bone Mineral Density. PTH contols many other hormones, it may cause deposition of calcium into soft tissues, the pulsed delivery of Forteo is different than exognenous PTH and Forteo has some serious side effects. For these reasons, we do not recommend it's use.

Miacalcin nasal spray (calcitonin) is a synthetic hormone used to treat osteoporosis. It is contraindicated because it's effect on the immune system is unknown.

All OTC supplements: vitamins, herbs, minerals, antioxidants, oils, nutrients, amino acids, fatty acids, digestive aids, etc., should be considered suspect sources of hidden Vitamin D even if it is not listed on the label.
-->Read: supplements

Bromelain--affects many body functions, including the immune system, in unknown ways and is a potent anticoagulant.

Tumeric "Twelve scientific, peer-reviewed publications since 1999 suggest that curcumin, the major yellow pigment in tumeric, curry and mustard, may potentiate apoptosis or inhibit growth of selected cancer cells or function as a COX-2 inhibitor several in-vitro and animal models." http://tinyurl.com/nflgz

Iron supplements-do not resolve anemia due to Th1 inflammation and iron 'feeds' the inflammation. Do not take unless your doctor has diagnosed an iron deficiency anemia. See My doctor says I'm anemic. What should I do?

Benzodiazapenes:
Clonazepam
Dr Marshall recommends: try to keep all the Benzos to lowest effective dose (1mg, or so, p.r.n.) to achieve tolerable symptoms, reducing slowly as symptoms allow/ resolve.

COX-2 Inhibitors
COX-2 inhibitors have generally fallen out of favor because of their side effects. Some have found that their immune response has increased when reducing Celebrex, so that also needs to be discussed with your Doctor. Your doctor will assess the risk/benefit ratio. If he has determined your pain medication is safe for you to take, it is not contraindicated on the MP.

CAUTION These drugs may interact with Benicar:
•blood pressure medications----your blood pressure may become too low if you continue taking your usual antihypertensives; monitor your blood pressure if you are talking other antihypertensives.
•hawthorn
•lithium--lithium toxicity may occur when taking Benicar or verapamil (due to slow renal clearing) blood levels should be monitored very closely
•potassium supplements--potassium level may become too high due to renal resorption. Do not take unless serum potassium is low and then monitor serum potassium closely.
•water pills (diuretics)--may cause blood pressure to become too low; monitor your blood pressure if you are taking them.

The phase one guideline states:

5. ATTENTION: If you are taking ANY OTHER ANTIBACTERIALS (Sulfusalazene, Plaquenil and Methotrexate are antibacterials) you MUST discontinue all antibiotics and antibacterials BEFORE you start Benicar. This is because Benicar greatly potentiates the action of many antibiotics, and consequently a severe or life-threatening immune system reaction may result.

Consult your doctor or pharmacist to determine the length of time the antibacterial is likely to remain in tissues or blood so you will know when it has dissipated and you can safely start the Benicar blockade.

It is important to mount a full A-II blockade, and suboptimal doses of Benicar will exacerbate undesirable symptoms. If you need to use another palliative agent to cope with your symptoms please consult your physician.

PRIMAXIN I.M. (Imipenem and Cilastatin for Injectable Suspension) is a formulation of imipenem (a thienamycin antibiotic) and cilastatin sodium (the inhibitor of the renal dipeptidase, dehydropeptidase I). PRIMAXIN I.M. is a potent broad spectrum antibacterial agent for intramuscular administration. Primaxin is also given IV and should be avoided because of its serious side effect of leukopenia (low white blood cell count)

REMINDER re DRUG INTERACTIONS:
If you are taking warfarin (coumadin), you cannot take Quercetin because it interferes with its action.

If you are taking dexamethasone (Decadron), do not use Ketoconazole cream.

Antacids should be taken 3-4 hours after any MP medication to avoid interfering with absorption from the GI tract.

Meds whose doses are determined by blood levels (thyroid supplementation, lithium, potassium, depakote) need more frequent serum measurements to monitor possible changing needs as inflammation resolves and biochemistry changes.


DMARDs

Disease-modifying antirheumatic drugs (DMARDs) is a category of drugs used in many autoimmune disorders to slow down disease progression. Their use was first propagated in rheumatoid arthritis (hence their name) but has come to include many other diseases, such as Crohn's disease, lupus erythematosus (SLE), idiopathic thrombocytopenic purpura (ITP), myasthenia gravis and various others.

Some of these drugs are also used in the treatment of ulcerative colitis. Some DMARDs are mild chemotherapeutics but use a side-effect of chemotherapy - immunosuppression - as its main therapeutical benefit.

All drugs that inhibit T and B cell function are to be weaned off; and leflunomide(Arava) is one. Its use with methotrexate has been questioned for some time as well as for use in those with liver involvement. Its normal half life in those with typical hepatic function is 14-15 days; so it can take some time to clear. Its presence will be of some significance to the MP but as tissue and serum levels drop its ability to block immune functions will diminish. I see no reason to specifically attempt to "flush-out" this medication as you will slowly eliminate it; but you should discuss this with your MP physician for his or her opinion. ~P.Bear R.N.

Last edited on Sat Oct 4th, 2008 02:46 by Meg Mangin R.N.

Last edited on Wed Jun 4th, 2008 16:32 by