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Drug Infonet provides drug and disease information for your healthcare needs. Visit our FAQ page to find answers to common health questions. Look on the Manufacturer Info page to link to pharmaceutical company pages. Click to Health Info and Health News for the latest in healthcare developments.

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Doctors' Answers to "Frequently Asked Questions" - Drug Interactions (Page 3)

Related Info: Drug Interactions - Page 1
Related Info: Drug Interactions - Page 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.

Interaction - Prozac and Valium [posted 1/14/99]
Question: Doctor has prescribed a prescription for an elderly person 83 years of age, who suffers from mild depression (I would assume natural for the age). In any case, she has been given prozac 10 mg. She was doing very well, more upbeat, happy. A family member who disperses the medication, does not feel that she should have to take it and only gives it to her when he feels it is necessary. Instead he is giving her his valium, and sometimes giving both at the same time. I have seen her shaky when she wakes up from naps sometimes, and then she is automatically given the valium. I do not know much about the interactions of both of the medications, but since valium is addicting I cannot believe that it would be good for her to take. She is also on high blood medication and nitro patches.

Answer: Valium should be avoided, if possible, since it is a depressant and poorly tolerated in the elderly. Prozac is not addicting and generally well tolerated. The blood pressure and nitro patches probably have little interaction with either.

Many Drug Interactions [posted 1/14/99]
Question: I would like to know the drug interactions for these drugs. They are taken by my mother, and she seems to be suffering from more physical fatigue then she ever has.
Morning medication:
1, 0.125 mg, Synthroid
2, 500 mg, Tylenol
1, 50 mg, Ultram
1, 10 mg, Zocor
1, 500 mg, Naproxen
Night medication:
1/2, 25 mg, Maxide
1, 550 mg, Naproxen Sodium 1, 50 mg, Ultram
1, 75 mg, Doxepin
2, 500 mg, Tylenol

Answer: No obvious interactions except somnolence and constipation.

Taking Wellbutrin and Prozac Together [posted 1/14/99]
Question: I have been taking Wellbutrin and Prozac (a time released tablet and 20 mg of Prozac) in the mornings to help me deal with stress at work. Can you please tell me of any concerns, side effects, etc. that I should be aware of?

Answer: Decreased sexual drive, dry mouth, constipation, occasional sleep disorders.

Depakote with Serzone [posted 1/14/99]
Question: My brother is being treated for bipolar disorder. He has seen two doctors that have prescribed two different medications. One medication is Depakote, the other Serzone. It seems that every possible side effect that can be caused by both medications has hit my brother all at once and the poor man cannot physically get out of bed. Are these medications safe to use together? I have read that Serzone should not be combined with monoamine oxidasenhibitios. Does Depakote fall into this category?

Answer: Depakote is not an MAO drug, but an anti-seizure medication used to treat a lot of other problems. Ensure his level has been checked.

Lipitor and Coumadin [posted 1/14/99]
Question: I am currently taking Lipitor and would like to know if any drug interactions between Lipitor and Coumadin (which I am also taking) have been reported.

Answer: No, but if you take both regularly, there won't be any problem adjusting the dosage of coumadin. The problem with coumadin is intermittent interactions. Daily interactions are easily treated.

Prednisone/Synthroid Interaction [posted 1/14/99]
Question: I would like information on possible interaction contraindications for prednisone and synthroid taken for hypothyroidism. I have had pain/discomfort in my throat for about 2 1/2 weeks, and my ENT diagnosed inflammation of the lingual tonsils. He did a culture, but the results are not in yet. He prescribed a 2 week tapered schedule of Prednisone for the inflammation. (I had a tonsillectomy when I was child). I am concerned of the effect of prednisone in combination with the synthroid. I am a little reluctant to take the prednisone. Isn't an antibiotic the better choice, assuming there is an infection?

Answer: Well, there shouldn't be an interaction between the two. As to the best treatment choice, antibiotics would be what most would use, but I haven't seen your tonsils.

Drug Interaction - Zestril Triamterene/Hctz [posted 1/13/99]
Question: I take a daily dose of Zestril and Triamterene/Hctz for hypertension. Is there any potential interaction problem with this drug combination?

Answer: Can elevate the potassium level. Most physicians would be very careful or would avoid potassium sparing diuretics(the Triamterene part) with any ACE inhibitor. However, if monitored closely would be ok.

Many Drug Interactions [posted 1/13/99]
Question: I have been diagnosed with IBS. One doctor gave me lomotil, and another gave me Bentyl. I currently take Lithium, Xanax, Doxepin, Thorazine and Tegretol. Will these cause a problem with Bentyl?

Answer: Sedation.

Drug Interaction - Desimpramine and DHEA [posted 1/13/99]
Question: I'm presently taking 100 mg of Desimpramine and 100 mg of Trazadone in the evening to sleep. I want to know if there would be any obvious complications if I take DHEA in 25 mg doses along with the other antidepressants I am taking?

Answer: There is no study of this possible interaction, you'll need to try it. However, I doubt you'd see a problem.

Drug Interaction - Prozac and Zyban [posted 1/13/99]
Question: What danger, if any, is there in taking Prozac and Zyban at the same time?

Answer: Excessive somnolence, constipation, etc. Should be monitored, but probably won't be a problem.

Prozac and Ultram [posted 1/13/99]
Question: I have been on Prozac 20 mg for 7 years or so and it is a wonder drug to me. Recently I have been taking more naps. Could this be remedied with an increase in the dose. In addition, I recently received Ultram for a foot injury. When I looked up the drug both the Ultram and the Prozac had similar actions, however I hit a bottom of sadness that can only be explained by some sort of clash with the two drugs. I thought going into the treatment I would feel really good, but went crashing the other direction. Once I stopped the Ultram and gave myself an extra dose of Prozac I was back to normal. Any thoughts?

Answer: Avoid ultram.

Interaction? - Lipitor and Dilacor [posted 1/12/99]
Question: I take a combination of 20 mg of Lipitor (since 1997) and 180 mg of Dilacor XR (since 1990), daily. Can this combination cause tiredness or lack of enthusiasm? I've always been a rather lazy person, but lately I've noticed a deepening of disinterest in just about everything.

Answer: It should have started as you started the drug, not later. I would suspect something else.

Many Drug Interactions [posted 1/11/99]
Question: My 72 year old mother is currently taking the below medications on a daily basis. Please let us know if there are any potential adverse drug interactions.
Lanoxin - .125 mg once a day
Toprol XL - 50 mg three times a day
Coumadin - 2.5 mg two to three times a day
Vasotec - 10 mg two times a day
Zoloft - 100 mg once a day
Premarin - .625 mg once a day
Triam/HC - 37.5/25 once a day
(Chlorzoxazone - as needed)

Answer: Nothing big, the Toprol and the digoxin can both slow the pulse and together can produce slow pulses in some patients. The diuretic triam/hc can produce low potassium levels (although this one is less likely than most), which can aggravate the digoxin. In general, shouldn't be a problem for most patients.

Glucophage and Rezulin [posted 1/11/99]
Question: Should Glucophage And Rezulin be taken together, I heard someone say on TV that Rezulin is good and Glucophage is good, but together they are better.

Answer: No problem taking them together and they do appear somewhat synergistic.

Cardura and Vasotec [posted 1/8/99]
Question: My dad recently had a heart attack. After quadruple by-pass surgery, his doctor prescribed 10 mg Vasotec, 2 times a day. He was already taking Cardura once a day (starts with 2 mg and dosage goes up to 4 mg). Should he be taking both of these drugs?

Answer: They are for different things. Both affect the blood pressure, but in different ways. If his blood pressure is ok and he isn't having side effects there is no reason not to combine these drugs. Cardura is often used in men to avoid prostate surgery as well as bp control.

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 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?

Answer: Yes, but, may result in a lot of sedation. I'd avoid the mix if possible.

Lescol 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.

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.

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.

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?

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 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.



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