Drug interactions/side effects[posted 1/5/99]
Question: My doctor first put me on Zestril (20 mg once/day) for hypertension. Subsequently, due to high triglycerides, he prescribed Lopid (600 mg twice/day, as the generic Gemfibrozil). Subsequent to that, for high blood sugar (240, fasting) I am taking Glyburide (2.5 mg once/day) and after 10 days my blood sugar was 211. The dose has now been increased to 5 mg once/day. Could the ineffectiveness of the Glyburide be due to some interaction with my other medications or is it due to an unforeseen shortcoming of the generic medication? Also, for about the past two months I have been experiencing a numbness in my big toes. The symptoms, while bilateral, are not of equal severity in both feet, will vary during the day (less in the morning, most noticeable in the evening) and will sometimes "flip" in the scope from left to right or vice-versa. Any possibility of drug problems? I also supplement my diet with selenium, chromium picolinate, and garlic tablets.

Answer: Doubt that it is due to the generic. However, you may be developing diabetes that will need insulin versus oral agents. I doubt the drugs would give the numbness, I'd check out your lower back.

  NSAID's & Anitdepressants   [posted 12/09/98]
Question: Is it safe to talke nsaids while taking antideppressants: elavil & effexor & klonopin?

Answer: Yes.

Buproprion & Prozac  [posted 12/09/98]
Question: Does buproprion cause depression? Any problems taking prozac AND buproion? Have  fibromyalgia also, any contrandictions? Feeling absolutely awful, lethargic, no motivation, down, can't sleep. Any suggestions?

Answer: Not usually, these can be combined, but, must be watched closely. Not commonly done, but probably ok. There shouldn't be any specific problem with the fibromyalgia.

Zocor, Lipitor & Sodium Levels  [posted 12/08/98]
Question: What affect do atorvastantin drugs have on serum sodium, namely Zocor and Lipitor? My sodium has been dropping from 130mg in Aug. to 115mg in Oct. (it was 140 in Dec.) Now its only 129mg. I am very concerned about my heart since I've had a 95 percent and an 80 percent with stint blockages in heart, also recent collapse and emergency room/hospitalization due to weakness and lightheadedness. Any help would be appreciated.

Answer: Shouldn't be any, keep looking.

Buspar & Ambien  [posted 12/08/98]
Question: Can Buspar be safely taken with Ambien?

Lescol Fluvastatin  [posted 12/08/98]
Question: Please advise if Lescol fluvastatin has many side affects and what they are.

Estrace & Provera  [posted 12/04/98]
Question: When I started estrace and provera 5 years ago I noticed stomach pains, gas and nausea. The gyn said it could be the hormones and suggested an over the counter antacid. As the problems continued I sought help from a gastroenterologist who eliminated ulcers and  announced   "gastritis". Problems continued on and off, and then I was diagnosed in Nov. 1997 with Crohn's disease. Ended up with small bowel resection Dec. 1998. Meanwhile, my stomach upsets continue,  apparently diff. from the Crohn's. And in keeping a log I notice that almost exactly  every 3 weeks I get so gassy and nauseous that I vomit for 1 to 7 hours. Then I am fine again. (I am also constipated, and prune juice seems to be helping). Do you think the hormone replacement is the culprit, given the 3 week cycle? Thanks.

Augmentin & Antidepressants  [posted 12/04/98]
Question: Does augmentin have any effect on antidepressants given ie. decreasing effectiveness of antidepressants?

Answer: No.

Multiple Medication Concerns [posted 12/04/98]
Question: My 82 year old father is being treated for migraines and REM S Sleep disorder with the following medications - Depakote 250 mg 3x day, Florinef 1mg/day, Prilosec 20 mg./day, Synthroid .05 mg/day, Zyrtec, 10 mg/day, Occuvite, Calcium, Aspirin 1/day At night he takes 1 mg Clonazepam for the REM Sleep disorder. He is increasingly confused and still up several times a night and not sleeping well. Several anti-depressants were also tried to relax him at night and he has severe reactions to the combination. Are there any drug interactions possible with his list of meds? Will Advil interact with any of the meds?

Prozac & Ibuprofen [posted 12/02/98]
Question: Is it safe to take Ibuprofen with Prozac at the same time?, because I did that last night and I was having problems with my breathing.

Answer: Shouldn't be a problem.

Procardia, Prevacid, & Premarin Concerns [posted 12/02/98]
Question: I am on Procardia XL 30mg, Prevacid 30mg, and Premarin 1.25mg. I am 42 years old. What can I expect in my future as far as health related problems from these drugs. Can they interact?

Answer: Shouldn't be any particular interaction problem over time that you don't see in the short term. Long term risks of Premarin are cancer of the uterus and possibly breast. The other two don't have any currently identified long term risks.

Percodan & Zyprexa [posted 12/1/98]
Question: My grandmother has been taking percodan for two weeks for pain for her back. She also is taking zyprexa and is becoming very disoriented- I am very concerned about this. Do these two drugs counteract each other? Are they harmful together?

Answer: No, but both can cause disorientation especially in the elderly. I suspect she is getting drug toxic.

Toprol & Accupril [posted 12/1/98]
Question: Recently my doctor has added Accupril to my daily medication. I had five coronary rafts almost two years ago and have been taking Toprol since then. I think it was to lower my BP and to help the work load on my heart. Since I've been taking Accupril in addition to the Toprol(about a month) I've had occasional slight angina attacks in my lower throat area. I've also had a sore throat, and I've been lightheaded occasionally. Is there another drug to supplement the Toprol that would be less likely to cause these apparent side-effects?

Answer: Either less milligrams of the Accupril or an Angiotensin Blocker like Cozaar.

Cholesterol Drugs & Tendon Problems [posted 11/25/98]
Question: I have been taking Lipitor, 20 Mg daily for over a year and a half with no noticeable side effects. My total cholesterol was lowered from around 280 to 180. The blood tests did not indicate any elevated levels from the liver panel test. The last blood test I had was about 1 year ago. I recently tore my achilles tendon playing indoor soccer and have had surgery to repair this. My surgeon asked me again today if I have been taking cholesterol lowering drugs, and commented that lately several of his patients with torn achilles or other tendons were also taking either Lipitor or other Cholesterol lowering drugs. He did not know of any connection, but was going to look into the possible connection. Have there been any studies to determine if Cholesterol lowering drugs cause any weakening of the tendons?

Answer: Not to my knowledge.

Methadone & Viagra [posted 11/25/98]
Question:  If a man is taking 70 mg.of Methadone,(liquid a day) should he be taking Viagra 25mg.? If a man is taking Albudural pills and Dilanten should he be taking Viagra? Thank-you for any answers you may be able to give me.

Answer: There is no clear drug interaction data available on Viagra currently. However, drugs which dilate the circulation (nitroglycerin) appear to have potential interactions on blood pressure in these patients.

Relafen & Trazadone [posted 11/24/98]
Question: I am taking 1000 MG of relafen (for arthritic knees) amd 25 MG of trazadone (for fibromyalgia) per day. Is it possible that either of/or the combination of these two drugs can be causing stomach cramps and diarrea?

Answer: Pretty common with all the nsaids (relafen belongs to this class).

Phentermine, While on Depakote & Imipramine [posted 11/24/98]
Question: I'm wondering if taking Phentermine, while on Depakote & Imipramine for Migraines, is safe?

Answer: Hard to know. The combination of fenfluramine with phenteramine was a potential problem. Whether the phenteramine is by itself is unclear. There is no data on the combination of Depakoe and Imipramine.

Any Concerns Regarding Taking Synthroid & Coumadin [posted 11/24/98]
Question: If my 69 year old mother in law leaves the hospital after her bypass surgery and TIA stroke, with a prescription for coumadin, will there be any interaction with the synthroid medication she takes for hypothyroidism?

Answer:  No.

Mixing Metabolife 356 with St. John's Wort & Fiornol [posted 11/19/98]
Question: I am beginning to start a Metabolife 356 program. I currently taking St. John's Wort. I was told that is a Mao Inhibitor and I should not take these two together. I am worried about the effects on my body. Could you please let me know what the effects can be and if this is dangerous? One of the ingredients in the Metabolife 356 id Ma Huang Concentrate, this is a naturally occuring ephedrines. Could you please explain what that is in english? What effects do ephedrines have on your body? Should I not be mixing these two together? I also take Fiornol for migraines, is this not to be mixed? I really appreciate your prompt response, thank you.

Answer:  Do not mix these two. You may have few side effects;but, you are potentially risking a major hypertensive crisis with the combo. Fiornial should be no problem.

Cefaclor with Asthma Medications [posted 11/19/98]
Question: My doctor prescribed Cefaclor (250mg) for a sinus infection. What, if any, side-effects are related to this drug? Also, suffer from chronic Asthma so naturally I'm concerned with taking a new drug that may interact with the Asthma medications I am currently taking which are: Accolate, Meprobamate, Claritin-D, breathing treatments three times daily, an allergy shot once weekly, inhalers Serevent, Flovent and Combivent.

Answer: Usually diarrhea, possible allergies etc. Nothing any different from the others-except more expensive.

St. John's Wort with Metoprolol [posted 11/19/98]
Question: I have been taking 50mg of Metoprolol a day for years for tachychardia. Would there be anything dangerous about taking St. John's Wort with Metoprolol? Sometimes I feel tired, or depressed, and I heard those are side effects of Metoprolol. Thanks.

Answer: Probably not, St. Johns is a mild MAO inhibitor which should be tolerated with beta blockers. However, get a list of foods from your md to avoid on mao inhibitors. These in conjunction with St. Johns wort could cause tachycardia. This is theorectical and I haven't seen it in practice, still something to be aware of.

Multiple Medications for Pain Management [posted 11/18/98]
Question: I take the following medications for pain management of severe congenital scoliosis ... nortriptyline (80mg) & Relafen (1500mg). I take Premarin/Provera for HRT. I use a provental inhaler for exercise induced asthma. My asthma is no-longer exercise induced. I lost lung capacity from scoliosis surgery performed last fall which fused C6-L2 anterior and posterior. The pulmonologist started me on Singulair and Azmacort. This is working OK, except the insurance is refusing to cover Singulair, but will cover Accolate although neither Singulair or Accolate are on their formulary. Both Relafen and Accolate have cautions about metabolizing in the liver. Accolate has additional cautions about tri-cyclic anti-depressants. Do you think that introducing Accolate in place of Singulair will create risks that I wouldn't have if I was taking Singulair instead of Accolate? Thank you.

Answer:  Actually, Singular probably has somewhat more liver problems than Accolate. Both should have liver functions checked regularly and you should also get levels of nortriptyline until everything is balanced. However, probably not a big deal as long as your doctor is familiar with these drugs and keeps an eye on things.

Dapro & Claritin with Chlortrimeton [posted 11/18/98]
Question: Can chlortrimeton be taken with Dapro 600mg and/or Claritan?

Answer: Not with Claritin, Dapro is ok.

Desogen/Claritin/Prozac [posted 11/11/98]
Question: I have been taking the above three medications for over a year. I think I have gained about 20 pounds in the last 3 years or so. Could any of these cause the weight gain? I have always been a small female but now I am about 140 pounds at 5'2". I have heard that taking the "pill" always puts on about 10 pounds, but I am unsure of the rumor. Please also advise on long term use on all three drugs. Thank you for your quick response.

Answer: SRI drugs cause weight gain in about 40% of my patients.

Depakote and Zyprexa [posted 11/11/98]
Question: My mother has been on depakote and zyprexa for over 45 days and now has mysterious swelling in hands and feet, and a fever over 104. The regular dr. said just some new virus and did not run a test one just gave us another pill...Should I be concerned.? I have fever under control, but hands and feet stay etreemly swollen and painfull for her.

Answer: Hard to know, but, if it persists not a virus and you should consider a drug reaction first. There is a medical condition with elevated temperature and drugs like zyprea.

Pravachol & Doxycycline [posted 11/11/98]
Question: My doctor has put me on pravachol. Im also taking doxycycline do these drugs interact ok?

Answer:Shouldn't be a problem.

Multiple Medications & Fatigue [posted 11/10/98]
Question: My mother, age65 currently takes the following prescriptions: for depression and anxiety: loreazepam 3 mg/day, imipramine 100 mg/day,metoprolol 50 mg/day, prozac 10mg/day, synthroid .1mg/day. For recent hip replacement surgery: darvocet as needed (not on a regular schedule), and for cholesterol: zocor 40 mg/day. Currently experiencing fatigue and memory loss. Can you advise as to interaction problems and side effects.

Answer: She is taking 4 different drugs that can cause fatigue and/or mental confusion. Lorazepam, imipramine, prozac and darvocet. They tend to be additive in terms of the above problems with prozac probably being the least problem. She should discuss decreasing the dosage with her physician. Metaprolol is notorious for causing fatigue without mental status changes. She looks overmedicated .

Vitamins & Tri-cyclin [posted 11/6/98]
Question: Im on tricyclen and want to know if there are any problems with taking vitamins B6, B12, B1 Biotin , Riboflavin, Inositol, or L-Carntine with it. I've looked all over and cant find the answer. thanks! Also are there any reasons I should think of not taking any of these vitamins.

Answer: No clear problem.

THC & Antidepressants [posted 11/6/98]
Question: I would like some information on drug interaction between THC and antidepressents(serzone),if you would be so kind.

Answer: I don't have specific information. I would check with Bristol Myers Squibb's medical research department 800-321-1335. They usually have this type of information.

Coumadin, Luvox, Klonopin [posted 11/6/98]
Question: I first want to say that I find your site extremely helpful. I've been scouring the web for the past two hours, searching for resources that can answer my mother's distress, and I find the opportunity to interact with someone about this most encouraging. My mother has been on coumadin for the past month, and, because she also has an extreme case of OCD and depression, she is literally going nuts. I think, also, since she has been taken off her estrogen patch (she received three surgeries last fall--a hysterectomy and two hernia operations), she is not in the best of moods. She says she can barely get out of bed, and the slightest hit results in bleeding. The other day, she cut her toenails and subsequently bled for three days--the doctor told her not to wash her feet, and she lives in a Southern rural town! She continuously complains of feeling weird, as if her body is gradually shutting down. Can she be suffering from drug interactions? Her doctor says that there shouldn't be a problem with taking coumadin, luvox and klonopin--yet, in my recent research, I saw that there is a high clinical possibility for interaction between luvox and warfarin. Her recent INR stats have been 1.5 and 1.325--and she's been on the drug for a little more than a month. She feels a lump in her right leg (where she had three huge clots and several smaller ones), and the doctor says she could not have any clots. Her protime is about 25. I'm trying to find solutions so that she can get back on the great progress track she was on. Thank you for any advice you can give.

Answer: The interaction of these drugs would be to change the metabolism of coumadin by the liver;but, this is measured by the INR, so as long as your md watches that there shouldn't be bleeding. One can still get clots on coumadin, less likely as the INR rises-but, still possible. I would try returning the estrogen although there is a distinct risk of further clotting and see if her mental status improves. Risky and needs close supervision;but, sounds like she is obsessing with the coumadin.

Cortisione Use for person with Bipolar Disorder [posted 11/5/98]
Question: What effect would cortisone have on someone who is a manic depressive?

Answer: Depends on the dosage and the method of delivery. In general, very little.

Could a Facial Skin Discoloration be Due to Drug Interaction [posted 11/4/98]
Question: I am on multiple medications. Recently, I have been taking Pamelor(for the past month). I also take regularly: inderal, periactin, dilantin, premarin (post hysterectomy), neurotin, synthroid,robaxin,daypro,darvocet(for past 2 months due to car accident). My facial skin has begun to discolor recently. It is turning brown in areas. I do not go in the sun at all, and have never had this problem before.

Answer: Premarin or dilantin would be the first drugs to check.

Ultram & Zoloft [posted 11/3/98]
Question: I would like to know more about the ultram's half life being extended by the zoloft (due to its acting upon the enzyme in the liver that breaks metabolizes the ultram). Can zoloft intensify or prolong the presence and or effect of the ultram? What are the suggestions for recognizing and stopping the physical addiction? Does the same type of problems exist with tylenol/codeine#3 and zoloft? I'm a medical assistant and a Graduate student in Marriage and Family Therapy; so if you could point me to some journal articles and other medical research, it would be very welcome. Still, even the simplest response if it has the info I need is great... and very welcome.

Answer: I'm unaware of the Zoloft /Ultram interaction, I would check with the scientific dept of Ortho-McNeil(makers of ultram) 800-682-6532, they are usually very helpful. I know of no interaction between zoloft and Tyl # 3. As to the addiction potential, it is hard to recognize with Ultram. It tends to be similar to regular narcotic addiction in terms of wierd feelings, nausea and some gi symptoms on withdrawal.

Taking Epilepsy & BiPolar Medications [posted 10/30/98]
Question: I take Mysoline, Depakene and Tegretol for epilepsy and have not had a seizure in many, many years. I am also bipolar and have found no success with Wellbutrin and Paxil so I have just begun a trial period with Lithobid. Are there any interactions between these drugs I should be concerned about? Will Lithobid reduce my seizure threshold?

Answer: Probably no interaction, but, I would watch the tegretol, lithium levels very closely.

Allergies & Multiple Medications [posted 10/30/98]
Question: I have a severe allergie to codine, and I am very sensitive to most Medication I have taken, since becoming allergic to codine. I have arthritis, and it is not in one place,it seems to roam around. But so far, most of the muscle relaxers,and anti-inflamatory drugs I am sensitive to. Last week, I went to the Dr., and they put me on ULTRAM 50MG Tablrts, and SKELAXIN 400mg. The next day, I was back to the Dr. because I was up all night Itching, and clawing . They gave me another prescription for HYDROXYZINE HCL 25MG to counter the other drug. My skin felt like I had chill bumps all over. The drug the gave me to counter the other drug, was effective, so I was afraid to take the other drug, and chose to suffer through the pain. This week, I had to go to my Brothers, and they have dogs, and cats they allow in the house, and I had another reaction to them, only it was with my breathing, sneezing, coughing, and wheezing. The Dr. put me on SMZ/TMP DS**TAB Also,Palgic-DSyrup. What could these drugs have in common as to cause the same reaction? Itching, clawing, and no sleep. Why wouldn' t they make some connection, to the ingreadents? I would appreciate any info you could give me.

Answer: Ultram is a sythetic type of narcotic, so if you are experiencing itching with codeine you would be expected to get it with Ultram also. You are experiencing a histamine release reaction from the narcotics, pretty common by the way. It can sometimes be blocked with antihistamines. SMZTMP is an antibiotic and the "allergy" would be completely different at the cellular level. This is a true allergy, versus a histamine reaction.

Concerns About Concurrent Use of Prozac and Amitriptyline [posted 10/29/98]
Question: I am a 42 year old women suffering from Fibromyalgia. For several years I have been taking Prozac ( 20mg, 1/day) and Amitriptyline ( 10mg, 1/day). This past year I have been experiencing some heart palpatations ( nothing real serious ) and have been told that the combination of these two drugs may be the cause. Can you give any advise?

Answer: Amitriptyline is prone to causing cardiac irregularities, not prozac. Stop or decrease the dosage and see what results. If it is drug dependent, I would stop it.

Any Danger Taking Wellbutrin and Alparazolam Together [posted 10/29/98]
Question: My girlfriend is currently taking both wellbutrin & alprazolam. Are there any side effects? She is trying to quit smoking and using "Nicoderm" patches as well.

Answer: Don't seem to be if doses are watched and not exceeded. We combine these all the time without any big problems.

Hyzaar & Atenolol [posted 10/28/98]
Question: I am on Hyzaar 1 1/2 tablets daily and atenolol 25 mg daily. I seem to have a problem with heat. If I get too hot I experience dizzy spells and almost pass out. Could this be caused by one of these drugs?

Answer: Probably, sounds like your bp drops too much if you are vasodilated. Check your blood pressure sitting, lying and standing. I suspect it is too low during these periods. Decreasing your bp meds would usually fix the problem.

Neurontin & Palfium [posted 9/29/98]
Question: I was recently prescribed Neurontin 300mg twice each evening in order to assist in chronic pain relief, however, unfortunately there was no information with the capsules and a search via my BNF and Mimms although they do give some indications of side effects to expect, neither was very helpful when it comes to drug interactions, hence the reason for this letter. My problem is that I also take 20mg of Palfium (dextromoramide) every 3 hours, and I have done for many months now. Can anyone tell me if taking the Neurontin will react with the Palfium and if so in what way !.

Answer: Sorry, not familiar with Palfium or dextromoramide, must not be approved in the US. You might contact the scientific department of the manufacturer, Parke-Davis 800-223-0432 they are usually very helpful.

Drug Interactions - Local Dental Anesthetics and Newer Medications [posted 8/14/98]
Question: I have many patients on anti-depressants, allergy medications, etc., and I was curious to know if the recommendation for local dental anesthetics has any new contraindications with any newer medications. I have several patients on Prozac, Wellbutrin, Zoloft, etc., so anti-depressants are a particular concern for me. Should I just stick with using a local anesthetic without epinephrine for these patients?

Answer: No contraindications. However, there are some patients taking St. John's Wort who could develop problems. This drug has similar profiles to an MAO inhibitor for which epinephrine could be a real problem.

Drug Interaction - Premarin and Fosamax [posted 8/14/98]
Question: My doctor prescribed Premarin 0.625 mg to be taken along with Fosamax 10 mg to prevent heart attacks and Alzheimer's Disease. Are there any problems taking both together, and what about the dosage?

Answer: No problem with the combination. The dosage is generally the dose that one gives to post-menopausal women. Are you taking it every day or alternating with progesterone? Generally, one takes progesterone if your uterus is intact and does not if you have had a hysterectomy.

Drug Interaction - Feldene / Amoxil [posted 8/13/98]
Question: I need information on Piroxicam (Feldene) and amoxicillin (amoxil) when taken together. What are the side affects? Also what are the side affects of each individual drug taken separately.

Answer: Feldene (piroxicam) is a non steroidal anti inflammatory. This class of drugs has mainly GI side effects. Diarrhea, gastritis, ulcers, etc. Amoxicillin is an antibiotic that can also produce nausea and diarrhea. This is the only potential overlap toxicity.

Drug Interaction - Atenolol and Posicor [posted 8/12/98]
Question: I was taking atenolol and norvasc to lower my blood pressure. I had quite a bit of swelling of my ankles due to the norvasc, so my doctor switched me to posicor (mibefradil 2HCI) and I have read that this should not be taken with a beta blocker. Is this okay for me?

Answer: Watch your pulse rate. I usually don't mix these two, but if you are young it's probably ok. Older patients get much slower with beta blockers and younger patients can often tolerate two rate reducing medications. Use with caution, watch your pulse rate like a hawk.

Drug Interaction - Benzonatate and Dicyclomine [posted 8/12/98]
Question: Please give me information on a bottle of medication that I found prescribed to me in 1994 and have reason to believe my son has been taking it. The name on one bottle is I/C PHC Benzonatate 100 mg and the other bottle is I/C CHE Dicyclomine 20 mg. What type of effect would this have on a 15 year old if too many are taken? He is 120 lbs and we are not sure what he may mix it with. If the two drugs combined are mixed together, what would the effects be?

Answer: Benzonatate is sold under the brand name Tessalon. It can cause sedation, headache, mental confusion and occasional hallucinations. This is probably the reason that it is occasionally abused by teens. Dicyclomine is sold under the brand name Bentyl . This is generally an antispasmodic, but also can cause confusion, hallucinations, ataxia, euphoria, etc. The combo is occasionally used to achieve altered mental states, but is generally of low toxicity and not addicting physically.

Drug Interaction - Trazadone and St. John's Wort [posted 8/11/98]
Question: I have been taking trazadone as a sleep aid for four years. I range between 50 to 150 mg a night. About a week ago I began taking St. John's Wort for depression. I just read about side effects of combining two anti-depressants. Should I stop taking one or both of these two?

Answer: I wouldn't unless you check with your doctor. St. John's is supposedly a weak MAO inhibitor and we generally do not combine Trazadone and MAO inhibitors unless there is very close follow up.

Imuran/Tamoxifen Interaction [posted 8/11/98]
Question: I am doing research on the above captioned drugs. Specifically, if there is any contraindication to these drugs being taken together. The Imuran is being prescribed for the treatment of idiopathic pulmonary fibrosis and the patient wishes to be included in a clinical trial of Tamoxifen for the prevention of breast cancer.

Answer: No obvious interaction listed in the PDR.

Drug Interaction [posted 8/7/98]
Question: I am 78 years of age and have an aortic valve that doesn’t function properly. I take atenolol (50 mg) and cardura (12 mg) each day. I also take rezulin (200 mg) and Norvasc (5 mg). Is there any ill effects that could arise for the combination of these drugs? I wonder if I am over-medicated?

Answer: There is no obvious drug interaction with these drugs. Of the drugs you are taking, they are generally at the lower end of the dosing range - except cardura. Whether you are overdosed would depend more on your symptoms and your blood pressure. I suspect that you blood pressure is the limiting factor in this combination.

Prescription Combination [posted 8/7/98]
Question: I have a friend who is taking phentermine, a water pill, a pill for metabolism and also St. John's Wort. Is it okay to use these together? Any side effects of long time use?

Answer: I would not recommend phentermine and St. John's Wort together. The rest are ok What is the metabolism pill's name?

Effect of a 3 Drug Combination [posted 8/4/98]
Question: What effect would taking these three medications have short/long term? Maxide - once a day (30 mg), Clonidine - twice daily (2 mg), Lotrel - once daily (5 mg).

Answer: Maxide is a diuretic - potassium sparing. Long term side effects appear pretty minimal. Clonidine is usually a blood pressure pill. It works in the central nervous system, also, long term side effects appear minimal. Lotrel is a combination of an ACE inhibitor and a calcium channel blocker. Long term side effects are less well known than the others since they have not been available as long, but appear minimal after about 12 years of use.

Drug Interactions [posted 8/4/98]
Question: I am taking the following drugs: lipitor starting new, replacing zocor, isordil 40 mg, procardia XL 30 mg, tenormin 50 mg, xanax 0.5 mg, and univasc 7.5. I am interested in your opinion on any interactions.

Answer: Should be the same as zocor and I doubt that there would be any.

Drug Interaction - Xanax and Wellbutrin [posted 7/31/98]
Question: I currently take: Effexor, Pravachol and occasionally, Xanax. My doctor recently prescribed Wellbutrin, even though the drug interaction report stated that Wellbutrin and Xanax may interact, and that concurrent therapy should be undertaken with extreme caution. He offered no explanation or further information. I have searched the Internet to determine why the two should not be taken together, to no avail. Can you help?

Answer: It's really not a big deal - we combine them all the time. Both can be sedating, but the interaction problems are really pretty minimal.

Parnate Interaction with Interferon / Ribavirin [posted 7/31/98]
Question: I am considering entering a research program for the treatment of hepatitis c with interferon and ribavirin. It is highly recommended I take Parnate (the only drug effective for my depression). Is it safe to use Parnate with these drugs?

Answer: No obvious contraindication, however I have never used this combination. You'll have to try it and watch closely for any problems.

Many Drug Interactions [posted 7/31/98]
Question: My mother is currently taking several prescription drugs. They are as follows: cardarone 200 mg, lopressor 50 mg, prilosec 20 mg, coumadin 1 mg, zocor 40 mg, magnesium oxide 400 mg and nitro-dur patch 0.4 mg. Are there any long term side effects of taking all these drugs together? And why is she always nauseous.

Answer: No obvious long term side effects, except for possibly cordarone. This drug can cause pulmonary problems and low thyroid output - with or without the other drugs. Most physicians would recommend regular pulmonary tests on this drug. As to the nausea, it's most likely either the cardarone or the lopressor. Occasionally seen with coumadin.

Many Drug Interactions [posted 7/31/98]
Question: Are there any drug interactions for the following: Famvir, Prozac, Prevacid, Prempro, and Miacalcin?

Answer: Nothing obvious, prevacid has the most potential drug interactions - sharing a metabolic pathway, but none of these drugs uses this pathway.

Many Drug Interactions [posted 7/30/98]
Question: I am a 42 year old male with Diabetes, high blood pressure and on the borderline of high cholesterol. I am taking several different drugs to combat these problems, are they safe to take together? Morning doses include: 1 tablet Prinivil 20 mg, 1 tablet Triamterene/hctz 75/ 75-50, 1 insulin dose of nph U100 16 units and 2 units regular, 1 insulin dose of nph U100 18 units and 2 units regular at Dinner (5:00 pm). Bedtime doses include: 1 tablet Hytrin 2 mg, 1 capsule Lescol 20 mg.

Answer: No obvious interaction problem, although hctz will elevate your blood glucose slightly.

Drug Interaction - Tegretol and Propecia [posted 7/30/98]
Question: Is it safe to take tegretol and propecia at the same time?

Answer: Shouldn't be a problem, but keep a close eye on your Tegretol levels to ensure there is no competition between the two.

Drug Interaction - Adverse Reaction [posted 7/30/98]
Question: I am currently taking ziac 5 mg and have been on it for 2 years without any side effects and it has been keeping my blood pressure under control. I started taking a drug called guanfacine last Monday 2/2, for a sinus problem and have been experiencing a tightness in the chest. Is this a possible side effect? I stopped the guanfacine 600 mg two weeks ago and the tightness is subsiding. It only happens when I walk briskly. I am also taking sinequan 25 mg twice a day far a panic disorder. I would like to know if this is a possible drug adverse reaction.

Answer: I'm not aware of any interaction, but the drug clearly produced the problem. It clearly is a problem with you, as the possibility of a drug reaction, nothing obvious.

Many Drug Interactions [posted 7/27/98]
Questions: I am 36 years old with an 18 year history of migraines, tension headaches, and chronic back pain. I have been on more medications than I can count. I am currently taking: Ultram 50 mg, 2 pills 3 times a day, Robaxin 500 mg 3 pills 3 times a day, Fiorinal 3 pills anytime for severe pain. For depression: Taking for about 3 months Paxil 25 mg once a day Buspirone 15 mg twice a day To sleep: Taking for about 3 months, Elavil 50 mg 2-3 pills a night. For acid reflux: taking for 2 months, Prilosec 20 mg once a day. I feel like a walking medicine cabinet. I have no sex drive at all and cannot achieve an orgasm. I have put on 30 lbs. in two months, and sometimes I'm just pinging at night and the Elavil does not help. I am very concerned about the side effects (most of which I don't even know) of all these medications and the compatibility of each one with the other. For all I know, one medicine could be causing a problem that I'm taking medication for. I have heard so much about St. John's Wort and want to try it, but am not sure if I can just quit take Paxil without having to gradually decrease my strengths. I see a psychiatrist monthly for medication management but each time I go, I am just told to increase my doses. I am also very concerned about long term usage of each of these drugs. I know that these questions may be hard to answer in your FAQ, so if you could give me a personal reply, I would greatly appreciate.

Answer: Correct, you are a walking pharmacy. Unfortunately, several of these medications could cause the problems you describe. The paxil is probably the cause of the sexual dysfunction, but there are other potential culprits. You can stop the paxil cold, but some patients experience strange feelings. I usually advocate a taper, although not technically necessary. Let the paxil (and Elavil by the way) get out of your system for 1 week at least before starting the St. John's Wort. The SJW will take 3-5 weeks to be effective at 300 mg three times a day. In the meantime, try some non-traditional means of pain relief like massage and acupuncture to try to decrease the other medications as well.

Drug Interaction - Amitriptyline and Paxil [posted 7/27/98]
Question: Approximately 1 year ago, I was diagnosed with Clark's Level 4 Malignant Melanoma. It was located on the back of my upper right arm. I went through 4 weeks of intensive Interferon therapy, and then my dosage was reduced and continued for 48 weeks of Interferon therapy. I have been off of my medication for approximately 3 months now, and seem quite depressed. Although I experienced severe mood swings and other behavioral changes (including weight gain) after treatment began, one of my doctors now recommends that I start on 10 mg of amitriptyline twice daily and has given me a prescription for 20 mg of Paxil twice daily. One is for depression and one is taken to reduce the pain I have from the surgery where nerves were severed. Are these okay taken together? What side effects can I expect? I have also been told that my sex drive may be decreased, and I may be unable to reach orgasm. This is a large concern to me in part because I am only 21 years old. What do you suggest?

Answer: First see a pain specialist to see if an injection will decrease the pain. This is certainly contributing to the depression. I would start with one antidepressant at a time, although they can be taken together. This is to ensure that you can identify side effects clearly. The side effects of amitriptyline are mainly drowsiness. Also, there is a drug called Serzone, which is similar to prozac which tends to have less effect on sex drive. However, most young males have less trouble with prozac than other groups.

Drug Interactions - Depakote and Amitriptyline [posted 7/27/98]
Question: I am a 32 year old female. Since mid-August of 1997 I have had headaches on the right top side of my head. At first I was told that I was having migraines. I told them that I was not affected by light or by sound, and no squiggly lines in my vision. The only problem I had with my vision was loss of peripheral vision on the right side. I was treated with all the migraine medications. I had my vision tested and that came back with the possibility of a vascular problem of the optic nerve. My doctor prescribed beta-blockers: Proboatanol with Amitriptyline. I was taken off the Proboatanol and given Verapamil 40 mg 3 times a day and Amitriptyline 25 mg 2 times at bedtime. A few weeks ago I noticed that my heart was pounding. I went and had my BP checked it was 134/98 and my pulse was 151. I called my doctor and I was then hooked to a Holter-Monitor for 24 hours. My doctor called and said to stop the Verapamil immediately. He said that at times my heart rate went down below 50. I had a stress test done. My heart rate goal was 159, when I started my heart rate was 131. Since then I have seen a Neurologist who has prescribed Depakote starting dose is 250 mg 3 times a day. My question is are there any interactions with the drugs: Depakote 250 mg 3 times a day and Amitriptyline 25 mg 2 times at bedtime?

Answer: Sleepiness is about the only one. However, be aware that amitriptyline causes irregular heart beats in occasional patients.

Drug Interaction - Wellbutrin and Lariam [posted 7/24/98]
Question: I am currently taking 350 mg of wellbutrin a day. I am traveling to a country that it is recommended that I take some precaution for malaria. Is there any known interaction between wellbutrin sr and lariam?

Answer: I am not aware of any, but I'd check with the makers of both. Wellbutrin is made by Glaxo: 800-334-0089, Lariam by Roche: 800-526-6367.

Drug Interaction - Accolate, Depakote and Zoloft [posted 7/23/98]
Question: My ten year old son is currently being treated for chronic asthma with accolate, and for a seizure disorder with depakote. He has recently come under the care of a psychiatrist for depression, and the doctor has recommended that zoloft be considered. What are the possible drug interactions that we should be concerned about? Also, could either the accolate or the depakote be contributing to the depression?

Answer: The accolate shouldn't be having any effect, but I would suspect the depakote. A two or three week trial of another seizure medication would probably give you your answer. I'd try this before piling up the medications. I am not aware of any specific interactions between depakote and zoloft either.

Drug Interaction with Etoh and Caffeine [posted 7/22/98]
Question: Can you please tell me if Etoh and Caffeine have an interaction with the following drugs? Tenormin, Fosamax, Climara, and Provera. If they do what are they?

Answer: These drugs do not have an appreciable effect directly on the drugs you mention. However, ethanol can raise blood pressure in about 30% of whites - presumably why you are on Tenormin. So, check your blood pressure after etoh ingestion.

Grapefruit/Drug Interaction [posted 7/22/98]
Question: It has been shown that grapefruit can cause interaction. Can "Pummelo"(Citrus maxima)[Sunkist # 3129] and "Oroblanco" [Sunkist # 3092] also cause problems?

Answer: Not sure. It seems that grapefruit is the culprit, but I don't know the ingredients in these medications.

Drug Interaction - Coumadin and acetaminophen [posted 7/21/98]
Question: I heard a quick news byte last week stating that anticoagulants (such as Coumadin, which my husband takes daily) can be fatal when taken in combination with acetaminophen. We are concerned, because we have been told that acetaminophen is the only painkiller he should take. He has cardiomyopathy, and also takes Lasix, Digoxin, and Amiodarone.

Answer: An interesting, but probably pointless study. The media played this into a big deal because patients/families would take note and be concerned. The study was published in JAMA and only included patients who presented with elevated INR values. There was an association between taking tylenol, but I suspect the study shows an underlying liver problem in patients - not a problem with tylenol. I have no clinical suspicions of a problem and I have about 200 patients on coumadin for the last 12 years. Studies need to be done prospectively to define the problem. In the meantime, I would limit it to 6 per day and watch liver functions and INR more closely until the research gets done. However, this looks like a bogus finding to me.

Drug Interaction - Zestril and Cardura [posted 7/21/98]
Question: What do you think of combining Zestril 20 mg per day with Cardura 1 mg per day on a newly diagnosed hypertensive patient?

Answer: Would be no problem if it works.

Albuterol and Ipratropium Bromide administered together [posted 7/17/98]
Question: Can these be administered concomitantly?

Answer: Yes - quite effectively. There is a inhaler on the market that combines these two, called Combivent that most patients like a lot.

Prescription Drug Interactions and Reactions [posted 7/17/98]
Question: My mother who is 78 years old had a series of congestive heart failure for the past 2 years. She also had about 3 heart attacks and at least 1 stroke in the last 5 years. The doctors say that only 30 percent of her heart works. She also has emphysema and is incontinent. The following is a list of drugs she takes. Please tell me if there are any adverse interactions. Aspirin 81mg per day, Axid 150mg twice a day, Coumadin 1 mg per day twice a week and 2.5 mg per day 5 days per week, Imdur 60 mg per day, K-Dur 20 mEq twice a day, Lanoxin 0.125mg per day 3 times per week and 0.25 mg per day 4 times per week, Lasix 80 mg twice a day, Paxil 10 mg per day, Zestril 10mg per day, Zocor 10 mg per day. She also inhales Albuterol and Ipratropium twice a day from a nebulizer.

Answer: Nothing particular about interactive risk. Aspirin and coumadin should be used together with great caution, but sometimes is necessary. Also, the digoxin level seems a little high for a woman of her age (depending on her weight), but should be checked with a blood level from time to time.

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