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BDD Moderators: Keif’ Richards | negrogesic
Suboxone and sulfa
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T. Calderone
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The active ingredients in Suboxone are buprenorphine and naloxone. As far as inactive ingredients, some of the formulations have flavorings and a sweetener, acesulphane K.
Limpet_Chicken
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The only sulfur is that in the sweetener, acesulfame-K. Otherwise no. And it is, as mentioned spelled 'sulfur' (or sulphur, depending on where the speaker is from, US and UK have different spellings, I just spell it sulfur, its what I'm used to and I CBF trying to change the force of habit if I ever find out I'm on the 'wrong continent)
There ARE however 'sulfa' drugs, spelling as written, these are a class of antibiotics for the most part, based on, as a family, a sulfonamide backbone. Not all of them are antibiotics, there are other sulfonamide drugs however.
And some people are allergic to sulfa drugs as this class of compounds, IIRC has a similar rate of allergies to penicillins, about 3%. (I'm not trying to imply a correlation btw, between penicillin allergies and to sulfonamide antibiotics and other sulfonamides (the 'sulfa drugs' and the anticonvulsant sultiame, by which I mean, I am saying only that the rate of people being allergic, is approximately three percent, for penicillins, IIRC, and likewise, three percent for sulfa drugs, and not that one who is allergic to penicillin (beta-lactam group) antibiotics, is liable to cross-react. I suppose there are certain similarities, viewed with a certain slant, but thats just my chemical musing, and not relevant to allergies.
Also some unexpected sulfonamide sulfa drugs occur, , the anti-seizure drug sultiame, and more expectably, the thiazide diuretics (thio-, thia- and similar, indicate that there is a sulfur atom in a compound somewhere. In the case of the likes of the sulfa drug hydrochlorothiazide, one of the most wellknown thiazide diuretics, it has two sulfonamido moieties in its structure, and also, the -oxicam NSAIDs are all sulfonamides. Which appears to be, afaik, the moiety that acts as the 'trigger' pattern recognition entity, as with the beta-lactam group, its a sub-part of the penicillins and carbapenem antibiotics (a lactam being a cyclic amide, like a lactone is a cyclic ester, like GBL, but with an internal (cyclic) amide, that looks like, structurally, a cyclic carbon chain featuring -CCCCCR-NH-R(C=O)CCCCC- where - would be where the two ends loop together in a ring, and the carbonyl group of the amide, is of course, ortho to the nitrogen center.), and this sub-part is the bit, the beta-lactam group, that is unwelcomely
recognized by the immune system as a problem which must be assaulted and wiped out. Causing people to be damaged in the process, if one who is allergic to penicillins, or to sulfa drugs, takes the drug they are allergic to (drug class, rather)
There ARE however 'sulfa' drugs, spelling as written, these are a class of antibiotics for the most part, based on, as a family, a sulfonamide backbone. Not all of them are antibiotics, there are other sulfonamide drugs however.
And some people are allergic to sulfa drugs as this class of compounds, IIRC has a similar rate of allergies to penicillins, about 3%. (I'm not trying to imply a correlation btw, between penicillin allergies and to sulfonamide antibiotics and other sulfonamides (the 'sulfa drugs' and the anticonvulsant sultiame, by which I mean, I am saying only that the rate of people being allergic, is approximately three percent, for penicillins, IIRC, and likewise, three percent for sulfa drugs, and not that one who is allergic to penicillin (beta-lactam group) antibiotics, is liable to cross-react. I suppose there are certain similarities, viewed with a certain slant, but thats just my chemical musing, and not relevant to allergies.
Also some unexpected sulfonamide sulfa drugs occur, , the anti-seizure drug sultiame, and more expectably, the thiazide diuretics (thio-, thia- and similar, indicate that there is a sulfur atom in a compound somewhere. In the case of the likes of the sulfa drug hydrochlorothiazide, one of the most wellknown thiazide diuretics, it has two sulfonamido moieties in its structure, and also, the -oxicam NSAIDs are all sulfonamides. Which appears to be, afaik, the moiety that acts as the 'trigger' pattern recognition entity, as with the beta-lactam group, its a sub-part of the penicillins and carbapenem antibiotics (a lactam being a cyclic amide, like a lactone is a cyclic ester, like GBL, but with an internal (cyclic) amide, that looks like, structurally, a cyclic carbon chain featuring -CCCCCR-NH-R(C=O)CCCCC- where - would be where the two ends loop together in a ring, and the carbonyl group of the amide, is of course, ortho to the nitrogen center.), and this sub-part is the bit, the beta-lactam group, that is unwelcomely
recognized by the immune system as a problem which must be assaulted and wiped out. Causing people to be damaged in the process, if one who is allergic to penicillins, or to sulfa drugs, takes the drug they are allergic to (drug class, rather)
Limpet_Chicken
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How wide of a scope is there for cross-reaction to other sulfonamides in those with an allergy to to sulfonamide antibiotics?
Not allergic to them myself, just wondering because the cross-reaction between penicillins, carbapenems and cephalosporins is not complete. Not even close, I am alright with cephalexin for example, but penicillins could do me in.
And if I hadn't made it clear myself, I apologize. Coolwhip is quite correct in the above, sulfur the element is not allergenic, or toxic (although it can produce stifling, choking, acidic fumes when ignited, and it is quite flammable.) the element itself is pretty much well-behaved. Simply because a compound contains a given element does not necessarily make it toxic, although some compounds very probably will be, such as organometallics of heavy metals, arsenic/selenium/tellurium, and other toxic elements, although it isn't always the case. And vice-vers, a generally nontoxic element may be found in some horrendously toxic substances. Sulfur, carbon, hydrogen, oxygen, all innocuous more or less, can be found in VX nerve agent)
Not allergic to them myself, just wondering because the cross-reaction between penicillins, carbapenems and cephalosporins is not complete. Not even close, I am alright with cephalexin for example, but penicillins could do me in.
And if I hadn't made it clear myself, I apologize. Coolwhip is quite correct in the above, sulfur the element is not allergenic, or toxic (although it can produce stifling, choking, acidic fumes when ignited, and it is quite flammable.) the element itself is pretty much well-behaved. Simply because a compound contains a given element does not necessarily make it toxic, although some compounds very probably will be, such as organometallics of heavy metals, arsenic/selenium/tellurium, and other toxic elements, although it isn't always the case. And vice-vers, a generally nontoxic element may be found in some horrendously toxic substances. Sulfur, carbon, hydrogen, oxygen, all innocuous more or less, can be found in VX nerve agent)
That's a good question, I was wondering the exact same thing as I read your post(which I thought was clear enough, and informative as always) and didn't even realize sulfonamides were employed as anything but antibiotics. Made me wonder if the 'allergy' were related to its antibiotic function or its structure, if a true allergy you would think a reaction would occur no matter what the drug class. I am allergic to them, but AFAIK the only reason I have ever had to use one was as an antibiotic.
Limpet_Chicken
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Allergies are not due to bodily recognition of the mode of action of a drug or other chemical entity, but rather to specific structures within a molecule which essentially serve as a pattern recognition 'template', I guess one could say, these are known as 'epitopes', often, but not always, proteins.
Immunocytes, T- and B-cells latch on to these epitopes and present them for antigen recognition, and when such an entity is presented to the immune system and is recognized as non-self, this triggers the subsequent immune response. I could if anyone wants, go into more detail on the immunological mechanics of the process, all anyone need do is ask, although otherwise I'll leave it at that, since it conveys the general process well enough as an overview of the process.
For example, in the case of penicillins, an allergy has nothing whatsoever to do with the fact that the drugs have action as antibacterials, if that were the case then ALL antibiotics would have to trigger an allergic response in those taking them and who are allergic to any antibiotic.
Rather, in the case of penicillins, carbapenems and cephalosporins for example, it is the beta-lactam ring portion of the molecules which is recognized as an allergen, the rest of the structure doesn't matter, the beta-lactam ring serves as the epitope which is presented to the immune system and which is then designated as a foreign invader to be targeted for immunological attack. In the case of sulfa drugs then it is the sulfonamide group. The immunological response has nothing to do with the action of the substance, if any, upon the body. Just look at allergenic substances which are not drugs, there are enough them, animal venom proteins, allergens within nuts, pollen.
Cross-reactivity isn't always complete, however. Not everybody will react, if allergic to one compound/series of compounds containing such an epitope, for example, I'm allergic, severely so, to penicillins, a group of beta-lactam antibiotics, but I am not allergic to cephalosporins, such as cephalexin, another group of beta-lactam antibiotics.
Immunocytes, T- and B-cells latch on to these epitopes and present them for antigen recognition, and when such an entity is presented to the immune system and is recognized as non-self, this triggers the subsequent immune response. I could if anyone wants, go into more detail on the immunological mechanics of the process, all anyone need do is ask, although otherwise I'll leave it at that, since it conveys the general process well enough as an overview of the process.
For example, in the case of penicillins, an allergy has nothing whatsoever to do with the fact that the drugs have action as antibacterials, if that were the case then ALL antibiotics would have to trigger an allergic response in those taking them and who are allergic to any antibiotic.
Rather, in the case of penicillins, carbapenems and cephalosporins for example, it is the beta-lactam ring portion of the molecules which is recognized as an allergen, the rest of the structure doesn't matter, the beta-lactam ring serves as the epitope which is presented to the immune system and which is then designated as a foreign invader to be targeted for immunological attack. In the case of sulfa drugs then it is the sulfonamide group. The immunological response has nothing to do with the action of the substance, if any, upon the body. Just look at allergenic substances which are not drugs, there are enough them, animal venom proteins, allergens within nuts, pollen.
Cross-reactivity isn't always complete, however. Not everybody will react, if allergic to one compound/series of compounds containing such an epitope, for example, I'm allergic, severely so, to penicillins, a group of beta-lactam antibiotics, but I am not allergic to cephalosporins, such as cephalexin, another group of beta-lactam antibiotics.
I get that, hence my use of ' around the term allergy. Guess I should have used double quotes to make it more obvious. I don't remember what my reaction to sulfanomide antibiotics even was, just something I've been telling doctors nearly my whole life now. When I read your post it made me curious as to whether I was having a true allergic reaction, or if it was a side effect somehow related to its mechanism of action. My thought had less to do with cross-reactivity, and more whether I was having an allergic reaction at all.
Your question more comes down to if changing where and how the sulfonamide group appears on the molecule affects our bodies ability to recognize it.
I doubt doctors know not to give lasix to people who have had allergic reactions to sulfamethoxazole, and given the prevalence of allergies to sulfamethoxazole and the widespread use without incidence of lasix, you might be on to something.(or side effects from the antibiotics are being labelled as allergic reactions)
Your question more comes down to if changing where and how the sulfonamide group appears on the molecule affects our bodies ability to recognize it.
I doubt doctors know not to give lasix to people who have had allergic reactions to sulfamethoxazole, and given the prevalence of allergies to sulfamethoxazole and the widespread use without incidence of lasix, you might be on to something.(or side effects from the antibiotics are being labelled as allergic reactions)
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