Interactions of Oxycontin & Other Drugs [posted 10/28/98]
Question: My father is currently taking a combination of Oxycontin (40 mg, 1 pill - 2times daily), Norco (10/325, 4 pills - twice daily), Prozac (20mg, 1 pill - 4 times daily), Ibuprofen (800mg, 1 pill - three times daily) and Trazadone (50mg, 1 pill at bedtime). These prescriptions are to reduce the pain involved with a back injury which occurred about 11 years ago. We understand that one of the sideffects of the Oxycontin is "drowsiness", however since my father has added this particular prescription to his daily routine he is suffering from something along the lines of Narcolepsy. He will be relatively fine when all of a sudden he finds that he "awakens" just before his head hits the table (literally). We'd be very curious to know your thoughts on this matter, as we are a bit concerned. He is so afraid of this sleepiness that comes out of nowhere that he has confined himself to the house for the most part and worries about driving. Any information you may have would be most appreciated!

Answer: Sounds like you need to stop the oxycontin, another possiblity is seeing a physician who specializes in sleep disorders. He is on lots of different analgesics, maybe simplification would also help.

Embolism Post-Surgery & Possible Drug Interactions [posted 10/28/98]
Question: I recently had plastic surgery and developed a blood clot and was hospitalized for the blood clot treated with hephren . My question is once I go off of the coumadin will I have another blood clot since they said it was from having the surgery and not moving around like I should have after the surgery. Also I noticed that some drugs are not to be taken when using coumadin can you advise me on the drugs that I have listed in case I am not supposed to take certain drugs, the aldactone and tagamet are used in conjuction with each other for a hair, testerone, and polycystic ovary problem.

Answer: Where was the clot? Usually 3(occasionally 6)months of anticoagulation are necessary after a clot in the leg. There is an extensive list of potential drug interactions, these two would be minor-but best to take the same dosage of drug each day, varying doses are more trouble than steady intake.

Determining Which Drug is Causing the Nausea Side Effect [posted 10/28/98]
Question: Nausea every morning-61 yr old male. Procardiaxl, normodyne, lipitor, flurbiprofen, cytotec, cozaar, prilosec, hytrin, imdur taken daily, history of ulcer, back surgery, high blood pressure, etc. Dr. says it may be drug reaction, but doesn't seem to be alarmed. It is getting so severe it sometimes lasts all day. Please help.

Answer: Hard to say since you are on so many drugs. None leaps out as the cause. But, I would try to selectively stop(after telling your doctor) one drug at a time to see if you can find the culprit.

Klonopin & Butalbital [posted 10/23/98]
Question: I have a female friend who was in a car wreck some 15 years ago. As a result of a head injury, she has been on KLONOPIN (1.5 mgs)daily for the past 12 years. What are the long term side effects of this use of this drug? Can continued use cause her to get bladder and/or vaginal infections? Is there also another less addictive or non-addictive drug that she can use instead of the KLONOPIN? Second question...same person...Was taking BUTALBITAL for migranes....hers seem to last two weeks at a time. Will be simulataneous use of these drugs cause any harm/side effect and is there another less addictive drug she may be able to use to manage the migranes? Thank you for you time and response...

Answer: Klonopin is a good drug for muscle spasm, but, addicting over time. There are several muscle relaxants, like Flexeral which may help. Massage therapy and physical therapy are usually good. Accupunture is also useful in selected cases. As to the migraines, it would be unusual for a migraine to last two weeks. I suspect it relates to her back trauma from the MVA. However, there are preventive as well as acute treatment drugs available. The klonopin would have no effect on causing infections.

Prozac, Elavil, & Zestril [posted 10/21/98]
Question: I have been taking 40mgm of Prozac for about 7 years for depression. I am not currently depressed, but have oseoarthritis and probably fibromyalgia--pain everywhere. Will 25mgm of Elavil at night to sleep better interfere with the Prozac? Also what is arthrotec and would it interfere with the zestril I take for hypertension.

Answer: Shouldn't be a problem;but, needs to be followed closely. Arthotec is a nsaid and can cause fluid retention in some(hence elevating your bp). But, you'd need to check it after you started the Arthotec.

Sansert, Tylenol and Morphine Injections [posted 10/21/98]
Question: I am looking for some information regarding side effects of sansert,tylenol and morphine injections. What is a safe number of sansert and tylenol to be used for a migraine headache. If one consumes 10-14 tylenol per day along with approx 5 sansert what is the potential side effects of combining two drugs. Is this an excessive amount to deal with a migraine. Is a morphine shot safe way to deal with migraines?

Answer: First, have you tried Imitrex? Very effective if you haven't at least for classical migraines. Sansert can cause retroperitoneal fibrosis in some patients. This occurs over time with chronic use and does not occur in all patients. I would avoid this drug if possible. You should limit yourself to 8-10 tylenol a day depending on your weight since it can be hepatotoxic in larger doses. Adding codeine or morphine to the tylenol is very effective as is adding caffeine(why excedrin is approved for migraine-a combo of aspirin, acetaminophen and caffeine). Morphine is fine as long as you don't use it continually and become dependent.

Glucophage & Furosemide [posted 10/21/98]
Question: My mom takes 900mg glucophage twice a day. She also takes 40 mg furosemide once a day. I read someplace that diuretics and glucophage is not a good mix. Could they cause hot flashes? She has been suffering from severe night sweats and hot flashes during the day. She is 82 so I don't think we can blame them on her age.

Answer: The only problem would be that diuretics tend to elevate glucose a little. Not of clinical significance. These drugs are combined all the time without problems.

Concerns About Side Effects While Taking A Variety of Medications [posted 10/21/98]
Question: Could you tell me if you see any problems with these medicines? My dad was treated for congestive heart failure for a year now his kidneys are failing I believe these medicines are causing the problems: Lisinipril, Fuersemide, Metolozone, Glucophage, Glyburide, Potassium, Lansoprazole, Sulcralfate, aspirin, and he just started Humilin insulin. He has had sleep problems stomach hurts constant swelling in the feet and legs. Getting extremely weak and has been looking extremely thin. He has been anemic also for along time. The doctor thinks he may increase the Lasixs. Thank-you for your information.

Answer: Lisinopril can reduce renal function and should be attempted to stop and see what effect that has. He is also on a large dose of furosemide-although if his kidneys are not working this may be necessary. It can occasionally show the kidneys to be worse off than they are. Start with the lisinopril first.

Concerns About Xanax & Antabuse [posted 10/20/98]
Question: What if you take xanax w/antabuse?

Answer: No obvious interaction unless you take ethanol with antabuse.

Can a Change in Meds Cause a Psychotic Reaction? [posted 10/20/98]
Question: Can the combination of Paxil, Zoloft and Depakote cause a psychotic reaction? Recently a family member was taken off of Paxil (while taking Depakote) and was given Zoloft (while still taking Depakote) and possibly had a psychotic reaction. Is this a side effect of the combination of the meds?

Answer: Always possible, but, doubt it. Zoloft and Paxil are too similar to see much difference with the substitution. What was the depakote level?

Drowsiness and Queasy Stomach: Which drugs Are Responsible ? [posted 10/16/98]
Question: I am being treated for two conditions. I have RLS and have been switched from Restoril to Ambien for RLS and sleep assistance. I also have a bone spur (acromial impingement syndrome and have been put on Ultram (usually just one pill at bedtime)until surgery. I have taken both pills for about 5 months (the only other pill I take regularly is Prilosec at bedtime). The pills seem to help the RLS/Sleep (ambien) and the pain (ultram) but I have been experiencing 2 things: I am drowsy until about noon each day..... and I have a "cold, queasy stomach" several times a week. Sometimes this to lead to mild chills during the day (even though the room 78 degrees and normally comfortable for me. Any comments, or suggestions?

Answer: The queasy stomach is probably due to nausea induced by the Ultram, a potential side effect of this medication. Either can cause the drowsiness,but, the Ambien is more likely.

Headaches as Side Effect From Multiple Drugs [posted 10/14/98]
Question: I have been on Cozaar 50 mg twice a day for blood pressure and since November and 10/6.25 Ziac once a day six weeks ago. I am recently experiencing a headache in the neck muscles in the back of my head often and puffy eyes. I am also taking BuSpar, 10 mg. twice a day and tamoxifin. I have been on the BuSpar since last July and Tamoxifin for 3 years. Could the sore neck muscle headache and puffy eyes be side effects of any of these medications especially the Cozaar or Ziac? I appreciate your comments.

Answer: People have occasional headaches with beta blockers(one of the ingredients of Ziac);but, not clear whether these are incidental or not. Probably not related.

Paxil & Toprol: Ok to Take Together [posted 10/13/98]
Question: Can you take toprol xl 100mg and paxil 20 mg together. I use toprol for high blood pressure and I suffer from panic attacks. I have been using klonopin for a couple of years and would like to stop taking it.

Answer: Yes

Effects of Fioricet & Flexeril Combination [posted 10/13/98]
Question: I was prescribed fioricet yesterday and took 5 tablets. The latest At 11pm. The next day i received flexeril and took 1 tablet at 9:30am. What effects can this have on me?

Answer: Usually sleepiness, difficulty concentrating, occasional dizziness. Nothing long term.

Aspirin & Tylenol Combinations [posted 10/13/98]
Question: Are there any negative effects of combining asprin with Tylenol? For example, I get regular headaches and, periodically, migrane headaches. I will take Tylenol to control a headache but after an hour or so I realize that I need Fiornal. Will the asprin in the Fiorinal reacte badly with the Tylenol?

Answer: No. Check the ingredients on Excedrin-its aspirin, acetaminophen(tylenol) and caffeine. Long term use of any analgesia will affect your kidneys, this is about the only potential interaction.

Drug Interactions
Question:I am on a lot of medication . About 2-3 months ago my Dr. added on neurontin @ 3600mg a day. Since then, I have gained a significant amount of weight . He said it couldnt be from the neurontin But I didnt start gaining until I started taking it . I also take xanax 3mg a day, paxil 40mg, prilisec 40mg, bentel 80mg and advil daily . Could it be interacting with any of these medications to cause the weight gain?

Answer: I'd suspect the Paxil.

Drug Interactions [posted 10/10/98]
Question:My aunt takes on a daily basis, synthroid, prmarin, provera, 2 prozac, 2 elavil and voltaren twice a week. She is constipated, tired, can't sleep, has chest pains once in a while, and has an upset stomach. Could these medications be causing any of these symptions?

Answer: All of these drugs have the potential to cause their own speficic side effects. Prozac in general causes trouble sleeping and constipation, elavil drowsiness and constipation, premarin has several problems-especially with blood pressure and phlebitis, provera commonly causes constipation, and voltaren usually affects the stomach. Synthroid rarely causes problems in the correct dosage. This is a situation where she needs to contact her physicians and try stopping one drug at a time and see what the effect on her overall condition is. Do not try to do this without some outside interaction-figuring out multiple drug interactions is very difficult.

Side Effects
Question:If an individual takes the following drugs in a 24 hour period are there likely to be any interactions or dangerous side effects? Would it be safe to drive a motor vehicle if all these drugs were taken within a 24 hour period? The medications are as follows: (1)Micronase 5mg twice a day (2)Mevacor 20 mg per day (3)Premarin .625 mg per day (4)Provera 5 mg per day (5)Talwin 50 mg twice a day (6)Toprol 50 mg per day (7)Ketaprophen 75 mg twice a day (8)Paxil 20 mg per day.

Answer: I wouldn't expect any specific interactions;but, like most complicated medicine regimens you just can't make accurate predictions without adding one drug at a time and observing for any effects. In general, Talwin should not be used with extended use of machinery. The other drugs could be a problem, especially Paxil.

Lodine & Prilosec
Question: Are there any contraindications when using Lodine 400 XL with Prilosec on a long term basis?

Answer: None that I'm aware of.
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