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5-htp and L-tryptophan: Sleep Aids for Many People with FM

Miriam Ehrlich Williamson

5-htp (5-hydroxytryptophan) is the breakdown product of tryptophan, an essential amino acid present in most protein foods. It is a precursor to serotonin (5-HT), so people with a serotonin deficiency, or too-rapid uptake of serotonin can probably benefit from 5-htp. I use it for sleep in place of the psychoactive drugs so commonly prescribed for people with fibromyalgia. It has the delightful side effect of reducing carbohydrate cravings. (I believe this is because people with sufficient serotonin don't have to load up on tryptophan-containing carbohydrates.)

5-htp is classified by the FDA as an orphan drug. No pharmaceutical house has the patent, hence it is not in the PDR or Physicians GenRx (published by Mosby, this is a better, less biased drug guide.) 5-htp is being used for Parkinson's, myoclonus, depression, Alzheimer's, anxiety disorders, autism, dementia, and more.

It is also classed as an investigational new drug (IND); a doctor who wants to obtain and dispense it as part of a clinical investigation can get information from the Food and Drug Administration. The person to contact for an IND# is Terry Martin, FDA Center for Drug Evaluation and Research, 301 594 5460. I understand that the FDA will supply it to your physician free, or nearly so, for three months. Then, if your doctor is willing to prescribe it, you can get it at one of the pharmacies listed below. You call on the phone, get their fax number and give your address and credit card number, fax the prescription, and then mail them the original. After that you can renew by phone.

5-htp works best if taken 3 or more hours after your last protein-containing meal or snack. Washing it down with fruit juice also gives it a boost.

People who are taking SSRIs (especially Wellbutrin and Zoloft) should exercise caution in taking 5-htp. The result may be an overdose of serotonin; the effects are not pleasant. I know of one person who experienced severe nausea on taking her first 100mg dose. This does not happen to everyone, and I have not heard of it happening to people on Prozac, but it might, and you should weigh the risk of an episode of severe nausea against the benefit of obtaining restful sleep in making your decison. I have heard of some people experiencing nausea when they begin taking 5-htp, but have no personal knowledge of any other adverse effects, although the papers abstracted below mention that some exist.

Usual dose for sleep is 100-600mg at bedtime. For people who had success with L-tryptophan in years past, the ratio of tryptophan to 5-htp seems to be about 5:1. Thus, if you used to take 1500 mg of L-tryptophan, you'd probably take 300 mg of 5-htp.

If you can't get a prescription but want to try 5-htp anyway, there are two sources that don't require a prescription. They are more expensive than the prescription sources listed here.

Since November 1995 a few compounding pharmacies have been selling 5-htp's precursor, L-tryptophan, by prescription. The actions of both are similar, with one exception explained below. Suggestions for heightening their effectiveness are identical. L-tryptophan is also available in powder form from sources listed below. Some people sprinkle it on their food; others buy a capsule filling machine and roll their own. To do this, a well-calibrated gram scale might also be necessary. The rule-of-thumb dose is 25mg per kilogram (2.2 lbs) of body weight.

The difference between L-tryptophan and 5-htp is this: L-tryptophan breaks down into 5-htp and kynurenin. I have so far been unable to determine the purpose of kynurenin, but there is no suggestion that it is useful for sleep or pain relief.

There is some evidence to suggest that people with FM may be deficient in serotonin because the tryptophan they obtain from food metabolizes into kynurenin rather than both it and 5-htp. Therefore, 5-htp seems likely to be more efficient than L-tryptophan in boosting serotonin.

Here are two abstracts that you and your doctor may find of interest..

Puttini PS; Caruso I Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. Rheumatology Unit, L Sacco Hospital, Milan, Italy. J Int Med Res 1992 Apr;20(2):182-9 Unique Identifier: MEDLINE 92394366

Abstract: The efficacy and tolerability of 5-hydroxy-L-tryptophan (5-HTP) were studied in an open 90-day study in 50 patients affected by primary fibromyalgia syndrome. When all the clinical variables studied throughout the trial (number of tender points, anxiety, pain intensity, quality of sleep, fatigue) were compared with baseline results, they all showed a significant improvement (P less than 0.001). The overall evaluation of the patient condition assessed by the patient and the investigator indicated a 'good' or 'fair' clinical improvement in nearly 50% of the patients during the treatment period. A total of 15 (30%) patients reported side-effects but only one patient was withdrawn from the treatment for this reason. No abnormality in the laboratory evaluation was observed. It is concluded that 5-HTP is effective in improving the symptoms of primary fibromyalgia syndrome and that it maintains its efficacy throughout the 90-day period of treatment.

Byerley WF; Judd LL; Reimherr FW; Grosser BI 5-Hydroxytryptophan: a review of its antidepressant efficacy and adverse effects. J Clin Psychopharmacol (HUD), 1987 Jun; 7 (3): 127-37

Abstract: Alterations in serotonin metabolism may be an important factor in the etiology and treatment of depression. In this regard, 5-hydroxytryptophan (5-HTP), a serotonin precursor, has been given to patients with depression. Although a review of these studies suggests that 5-HTP possesses antidepressant properties, additional trials are clearly indicated. Following a discussion of the pharmacology of 5- HTP, the authors highlight adverse effects associated with its administration to depressed patients, neurologic subjects, and normal individuals.

Relatively few adverse effects are associated with its use in the treatment of depressed patients. [Contains 59 references.]

Sources of 5-htp: capsules, by prescription [Prices are in US dollars. Current prices may differ.]

Super Value Pharmacy 720 N. Industrial Euless TX 76039 817 283 5308 (ok to call collect) Fax: 817 283 2821 Internet:

College Pharmacy 833 No. Tejon St Colorado Springs CO 80903 800 888 9358 or 719 634 4861 Fax: 800 556-5893 or 719 634 4513

Hopewell Pharmacy and Compounding Center 1 West Broad St. Hopewell, NJ 08525 800 792-6670 Fax 800 417 3864

Medical Center Pharmacy 3675 S. Rainbow Blvd., #103 Las Vegas NV 89103 800 723 7455 Fax 800 238 8239

Pathway, Inc. Ron Keech, R.Ph. 5415 Cedar Lane Bethesda, MD 20814 (301) 530-1112 (800) 869-9160

Source of 5-htp: capsules, no prescription

Cosmic Sales and Marketing 800 359 9896

Life Link 445 Lierly Lane Arroyo Grande CA 805-473-1389

L-tryptophan sources: capsules, by prescription (500 mg of tryptophan, 10 mg of 5-htp)

Medical Center Pharmacy 3675 S. Rainbow Blvd., #103 Las Vegas NV 89103 800 723 7455 Fax 800 238 8239

Hopewell Pharmacy and Compounding Center 1 West Broad St. Hopewell, NJ 08525 800 792-6670 Fax 800 417 3864

Belmar Pharmacy, 12860 W. Cedar Drive #210, Lakewood CO 80228, 800 525 9473,

Nutral, Sioux City, Iowa, 800 468 8725. The label will read " indoamino proprionic acid 360mg, passion flower 40 mg." Indoamino proprionic acid is another name for tryptophan. Passion flower is supposed to make it more effective. This is USP grade tryptophan.

L-tryptophan sources: powder, no prescription

Ronald Sturtz BIOS Biochemicals 8987-309 E. Tanque Verde #340 Tucson, AZ 85749. 520 326 7610 Inernet:

Chem-Lab Supplies 1060 Ortega Way, Unit C Placentia, California 92670 (714) 630-7902

Copyright 1997, Miryam Ehrlich Williamson - ALL RIGHTS RESERVED. You are welcome to share this with others, as long as you don't sell it.

Last update 6/11/97

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