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Drug InfoNet Doctors' Answers to Frequently Asked Questions - Drug Interactions
Doctors' Answers to "Frequently Asked Questions" - Drug Interaction 2
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Drug Interaction -
Glipizide/Inderal [posted 1/5/99]
Question: Thank you for your generous contribution of time
and effort in your web site. The mysterious world of Latin names and medical mysticism can
be frightening to an ailing person and sometimes the doctors are less than communicative.
My wife, age 68, has been diagnosed (in August 1998) with early Diabetes. In reading it
seems she may have type 2 and the consensus seems to be the disease is so case sensitive
it is hard to regulate. She immediately entered a strict diet and has been very faithful
to it. She is trying to eat regularly and do the right things. She had taken Inderal for
twenty some years for irregular heart rate and though a couple of doctors she had over the
years wanted her to get off of it, none told her why. Attempts to switch her have result
in unhappy episodes and dropped. Her dosages through the years have ranged from 120 mg to
the current 20 mg. I just recently learned that Inderal is an insulin production inhibitor
(Beta blocker) and now this doctor who suspects early Diabetes has prescribed Glipizide,
which I learned stimulates the Beta cells to produce more insulin. Do we have a conflict
of interest here? She has had several bad bouts of fever, weakness, dizziness, depression,
and Panic. She has left the Glipizide and is trying to get off of Inderal so she can take
the Glipizide. The doctor gave her the medication and wants to see her in three months.
She has gotten a Glucometer and we determined a blood sugar count of not more than 150. At
least she can know when she needs extra sugar and when she might need the Glipizide, but
she is afraid to take it. Any help you could advise would be appreciated.
Answer: These medications can be taken together
without much risk. There is a theoretical blockage of insulin production, but in clinical
practice, it seems pretty small. There doesn't seem to be any risk combining the
medications in clinical practice. As long as you check the glucose with your home meter
and keep in touch with your doctor with the levels, you shouldn't have too much trouble.
Drug interactions/side effects[posted
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.
Anitdepressants [posted 12/09/98]
Question: Is it safe to talke nsaids while taking antideppressants: elavil &
effexor & klonopin?
Buproprion & Prozac [posted
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.
& 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
Question: Can Buspar be safely taken with Ambien?
Answer: Yes, but, may result in a lot of sedation. I'd avoid the mix
Fluvastatin [posted 12/08/98]
Question: Please advise if Lescol fluvastatin has many side
affects and what they are.
Answer: Most are pretty minimal. It can affect liver function and this
should be monitored 2-4 times a year. It can cause muscle inflammation(1% or so of
patients) and a CPK should be checked at least once. Generally, very well tolerated with
minimal problems. Some patients will have mild gi complaints, nausea, diarrhea etc. Most
don't know they're taking the pill.
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.
Answer: Sexual steroids have a profound effect on smooth muscle,
especially progesterone. Most women will experience a change in gi motility as their
progesterone levels rise, usually constipation. Lower doses of progesterone would probably
help. Also, start something a few days before the progesterone part of your hormones to
help with the constipation.
Antidepressants [posted 12/04/98]
Question: Does augmentin have any effect on antidepressants
given ie. decreasing effectiveness of antidepressants?
Multiple Medication Concerns [posted
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?
Answer: With patients of this age, I find that they are over medicated
more often than undermedicated. Stop everything you can and start over. Focus on drugs
like melatonin which will have minimal side effects. Ensure his sleep disorder is not his
prostate getting him up to urinate. Lastly, see a gerontologist if this doesn't work, this
is a lot of medications for an older man.
Prozac & Ibuprofen [posted
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
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.
& 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
Answer: Either less milligrams of the Accupril or an Angiotensin
Blocker like Cozaar.
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.
& 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.
& 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
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?
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
Cefaclor with Asthma Medications
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
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.
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
Answer: SRI drugs cause weight gain in about 40% of my patients.
Depakote and Zyprexa [posted
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
Pravachol & Doxycycline
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
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
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
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
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
Coumadin, Luvox, Klonopin [posted
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
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
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
Answer: Probably no interaction, but, I would watch the tegretol, lithium levels
Allergies & Multiple Medications [posted
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
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
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
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
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
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.
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 doesnt 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
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
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
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
Many Drug Interactions [posted
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
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
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
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
Many Drug Interactions [posted
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.
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
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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