Adverse Drug Interactions

[purple]

Just love the VA (insert sarcasm here) and docs in general who don't pay attention. I'm on 12 different meds currently. I went to a web-site I use to check interactions and found the following...I'm pretty sure this is why I have been feeling like crapola for so long.

Warning....this is a long post, but I encourage everyone to check their meds!!! Just put "drug drug interaction" in Google and several sites will come up. Here's mine:

<H2 itxtvisited="1">Interactions between your selected drugs</H2>traZODONE and Maxalt-MLT (rizatriptan) (Major Drug-Drug)

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for the development of serotonin syndrome, which may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

BuSpar (busPIRone) and traZODONE (Major Drug-Drug)

MONITOR CLOSELY: Concomitant use of agents with serotonergic activity such as serotonin reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants, 5-HT1 receptor agonists, ergot alkaloids, lithium, St. John's wort, phenylpiperidine opioids, dextromethorphan, and 5-hydroxytryptophan may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors.

MANAGEMENT: In general, the concomitant use of multiple serotonergic agents should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients should be closely monitored for the development of serotonin syndrome, which may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Particular caution is advised when increasing the dosages of these agents.

potassium chloride and spironolactone (Major Drug-Drug)

GENERALLY AVOID: The combination of potassium-sparing diuretics and potassium preparations may result in hyperkalemia. Death has been reported. These agents should not be used together unless the patient has documented hypokalemia while taking either agent alone.

MANAGEMENT: If this combination is used, patients should be monitored very closely for hyperkalemia. Patients should be given dietary counseling and advised to report any possible symptoms of hyperkalemia such as weakness, listlessness, confusion, tingling of the extremities, or feelings of heaviness in the legs to their physician.

Flexeril (cyclobenzaprine) and Topamax (topiramate) (Major Drug-Drug)

MONITOR CLOSELY: Certain drugs such as carbonic anhydrase inhibitors and drugs with anticholinergic activity (e.g., antihistamines, antispasmodics, neuroleptics, phenothiazines, skeletal muscle relaxants, tricyclic antidepressants, disopyramide) may potentiate the risk of oligohidrosis and hyperthermia associated occasionally with the use of topiramate, particularly in pediatric patients. These agents may alter electrolyte and fluid balance (carbonic anhydrase inhibition), inhibit peripheral sweating mechanisms (anticholinergic effect), and/or interfere with core body temperature regulation in the hypothalamus (neuroleptics and phenothiazines), resulting in the inability to adjust to temperature changes, especially in hot weather. Also, agents with anticholinergic activity frequently cause drowsiness and other central nervous system-depressant effects, which may be additively or synergistically increased in patients also treated with topiramate.

MANAGEMENT: Caution is advised when topiramate is prescribed with other drugs that predispose patients to heat-related disorders, including carbonic anhydrase inhibitors and drugs with anticholinergic activity. Patients, particularly pediatric patients, should be monitored closely for evidence of decreased sweating and increased body temperature, especially in warm or hot weather. Proper hydration before and during vigorous activities or exposure to warm temperatures is recommended. Patients (or their guardians or caregivers) should contact their physician immediately if they are not sweating as usual, with or without a fever. Ambulatory patients treated with topiramate and agents with anticholinergic activity should also be made aware of the possibility of additive CNS effects (e.g., drowsiness, dizziness, lightheadedness, confusion) and counseled to avoid activities requiring mental alertness until they know how these agents affect them.

potassium chloride and Flexeril (cyclobenzaprine) (Major Drug-Drug)

CONTRAINDICATED: Concomitant use of agents with anticholinergic properties (e.g., antihistamines, antispasmodics, neuroleptics, phenothiazines, skeletal muscle relaxants, tricyclic antidepressants, the class IA antiarrhythmic disopyramide) may potentiate the risk of upper gastrointestinal injury associated with oral solid formulations of potassium chloride. Solid formulations of potassium chloride have been associated with upper GI bleeding and small bowel ulceration, stenosis, perforation, and obstruction. Deaths have been reported rarely.

MANAGEMENT: The use of oral solid formulations of potassium chloride is considered contraindicated in patients receiving agents with anticholinergic properties at sufficient doses to exert anticholinergic effects. Patients prescribed a solid oral formulation should be advised to discontinue potassium therapy and contact their physician if they experience potential symptoms of upper GI injury such as severe vomiting, abdominal pain, distention, and gastrointestinal bleeding.

traZODONE and Topamax (topiramate) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

BuSpar (busPIRone) and Topamax (topiramate) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

Flexeril (cyclobenzaprine) and hydrocodone (Ingredient of Vicodin) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

hydrocodone (Ingredient of Vicodin) and Topamax (topiramate) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

traZODONE and hydrocodone (Ingredient of Vicodin) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

BuSpar (busPIRone) and hydrocodone (Ingredient of Vicodin) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

traZODONE and Flexeril (cyclobenzaprine) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

BuSpar (busPIRone) and Flexeril (cyclobenzaprine) (Moderate Drug-Drug)

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

spironolactone and traZODONE (Moderate Drug-Drug)

MONITOR: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics), narcotic analgesics, alcohol, or muscle relaxants may additively increase hypotensive and/or central nervous system depressant effects.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for hypotension and excessive or prolonged CNS depression. Ambulatory patients should be made aware of the possibility of additive effects (e.g., drowsiness, dizziness, lightheadedness, confusion, orthostasis, fainting) and be cautioned about driving, operating machinery, or performing other hazardous tasks, and to arise slowly from a sitting or lying position. Patients should also be advised to notify their doctor if they experience excessive side effects that interfere with their normal activities, or dizziness and fainting.

nitroglycerin and traZODONE (Moderate Drug-Drug)

MONITOR: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics), narcotic analgesics, alcohol, or muscle relaxants may additively increase hypotensive and/or central nervous system depressant effects.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for hypotension and excessive or prolonged CNS depression. Ambulatory patients should be made aware of the possibility of additive effects (e.g., drowsiness, dizziness, lightheadedness, confusion, orthostasis, fainting) and be cautioned about driving, operating machinery, or performing other hazardous tasks, and to arise slowly from a sitting or lying position. Patients should also be advised to notify their doctor if they experience excessive side effects that interfere with their normal activities, or dizziness and fainting.

BuSpar (busPIRone) and spironolactone (Moderate Drug-Drug)

MONITOR: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics), narcotic analgesics, alcohol, or muscle relaxants may additively increase hypotensive and/or central nervous system depressant effects.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for hypotension and excessive or prolonged CNS depression. Ambulatory patients should be made aware of the possibility of additive effects (e.g., drowsiness, dizziness, lightheadedness, confusion, orthostasis, fainting) and be cautioned about driving, operating machinery, or performing other hazardous tasks, and to arise slowly from a sitting or lying position. Patients should also be advised to notify their doctor if they experience excessive side effects that interfere with their normal activities, or dizziness and fainting.

Naprosyn (naproxen) and spironolactone (Moderate Drug-Drug)

MONITOR: Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics may adversely affect renal function due to NSAID inhibition of the renal synthesis of prostaglandins that help maintain renal perfusion in dehydrated states. The risk may be increased in patients on dietary sodium restriction. Natriuretic and diuretic effects may also be reduced, as NSAIDs have been reported to cause sodium and water retention, which may account for the increased risk of congestive heart failure associated with the combination. One study showed an increase in the incidence density of congestive heart failure (in patients over 55 years of age) from 9.3 per 1,000 person-years in patients on diuretics to 23.3 per 1,000 person-years in patients on both diuretic and NSAID therapy. NSAIDs may also increase the risk of hyperkalemia associated with potassium-sparing diuretics.

MANAGEMENT: In patients receiving both diuretic and NSAID therapy, management consists of avoiding dehydration and carefully monitoring the patient's renal function and blood pressure. If renal insufficiency or hyperkalemia develops, both drugs should be discontinued until the condition is corrected.

BuSpar (busPIRone) and nitroglycerin (Moderate Drug-Drug)

MONITOR: The concomitant administration of agents with hypotensive effects and psychotherapeutic agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics), narcotic analgesics, alcohol, or muscle relaxants may additively increase hypotensive and/or central nervous system depressant effects.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for hypotension and excessive or prolonged CNS depression. Ambulatory patients should be made aware of the possibility of additive effects (e.g., drowsiness, dizziness, lightheadedness, confusion, orthostasis, fainting) and be cautioned about driving, operating machinery, or performing other hazardous tasks, and to arise slowly from a sitting or lying position. Patients should also be advised to notify their doctor if they experience excessive side effects that interfere with their normal activities, or dizziness and fainting.

verapamil and nitroglycerin (Moderate Drug-Drug)

MONITOR: Marked, symptomatic orthostatic hypotension has been reported when calcium channel blockers were used in combination with oral controlled-release nitroglycerin.

MANAGEMENT: Dosage adjustments of either class of agents may be necessary. All patients treated with nitroglycerin--with or without calcium channel blockers--should be made aware of possible adverse effects such as dizziness, lightheadedness, and orthostasis, and advised to arise slowly from a sitting or recumbent position.

verapamil and BuSpar (busPIRone) (Moderate Drug-Drug)

MONITOR: The concomitant administration of verapamil may increase plasma buspirone concentrations. In one study with healthy subjects, buspirone area under the plasma concentration-time curve (AUC) and peak plasma concentrations increased by more than 3-fold. The proposed mechanism is inhibition of CYP3A4 mediated first pass metabolism by verapamil.

MANAGEMENT: If this combination is to be used, the patient should be monitored carefully for signs of buspirone toxicity. Alternatively, use of a dihydropyridine calcium channel blocker or an anxiolytic which is not a substrate of CYP3A4 metabolism may be appropriate. Patients should be monitored for increased sedation and dizziness, and cautioned about possible impaired psychomotor performance.

Naprosyn (naproxen) and verapamil (Moderate Drug-Drug)

MONITOR: When a nonsteroidal anti-inflammatory drug (NSAID) is added to the regimen of a patient who is already taking a calcium channel blocker, increased blood pressure may result. Also, the clinician should be aware that the risk of hypotension is increased when NSAIDs are withdrawn from the regimen.

MANAGEMENT: Monitoring for altered blood pressure control is recommended.

So.....should I print this off and take it to the pharmacy and ask "WTF?", or just take it straight to the director's office???? 3 of these meds (Vicodin, Flexeril, and Naprosin) were given to me in the ER the night of my car crash....and the ER doc knew of all of my other meds! Something has to change because I've had zero energy and dizziness and messed up blood pressure and heart rates for far too long.

<H2 itxtvisited="1"> </H2>

[Pete53]

It has been my experience that the VA is a very poor manager of medicine prescribed in either quantity or adverse reactions and horrible about prescribing medications that are not properly indicated for the symptoms.

The fact is that VA does not prescribe the medicine that is most effective and often substitutes cheaper and ineffective medicine to treat a symptom or illness that could be better managed by the proper prescription.

It has always been the cost over the ethics of properly taking care of Veterans

[allan]

A few years ago they almost killed me from a toxic mixture of meds.

Trazadone, Zoloft, Gabapentin, Flexeral, Morphine. Than forgot to send any of it for nearly a month. Went to the VAMC ER to get some of the meds to stop the withdrawal symptoms. They turned me away and accused me of trying to just get narcotics. I won't bother going to any VAMC ER again after what they did.

[john999]

Hey, you PCP has about 10-15 minutes with you. If you have more than a few meds how can they properly screen for adverse interactions. Also many of us get meds from private doctors. If you taking anything that ends in "set" you are getting tylenol. That stuff will make you sick. Heaven help you if you take a drink of alcohol. You can take drugs just like the VA or your pain doctor says and kill yourself especially when you take more powerful pain meds.

[purple]

the PCP and the pharmacy is supposed to have in place an automated system that when they put in a new med it automatically checks against the meds you are already on for any adverse reactions. i've seen it work a couple of times at the VA, but apparently they can easily override this system as well.

the VA is aware of all of my meds (even the ones given to me by the civlian ER doc)...they are just too lazy and/or don't care to check the interactions themselves.

[broncovet]

My advice:  "Take charge" of your own health care.  Don't depend on your doctor, your pharmacist, etc.  YOU be proactive.  It means you say things like, "Doc Smith, I looked up the Trazadone your prescribed and it conflicted with xxxx drug, so I quit taking Trazadone.  You are gonna have to figure something else out".  

 

I had a similar thing with Finasteride and Tamulosin.  Finasteride is a steroid often used to shrink the prostate.  While it sort of did that, it caused all kinds of other problems.  So, I looked up "herbal" treatments of prostate that work.  

I found an herbal supplement made by NOW called "Prostate Health" which is "clinical strength".  The herbs work better than the finasteride.  But, the herbs do have a side effect.  The side effect?  They lowered my cholesterol so I quit the doc's cholesterol meds, as I no longer need them.  

I will not take that many meds.  According to Harvard University, 840,000 people have died from side effects of prescription drugs.  And 2.4 million were hospitalized.  

https://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-few-offsetting-advantages

Before I take ANY pill, I look it up:  Its easy to do a google search just type in (name of drug) side effects.  And "I" use a risk/benefit analysis:

1.  How bad are the side effects?  Are the side effects worse than what they are trying to cure?  

2.  Are there alternatives, such as meds with fewer side effects, or herbals, or diet based treatments?  

     In other words, what could happen if I take this pill and what could happen if I dont.  If I cant see a clear benefit to taking it, I decline to take pills.  Your doctor can not "force" you to take pills.  This is America..  (Of course there are exceptions if you are unconscious, and family members cant be contacted. Then the doctor has to make a choice). 

    But, when you wake up, you can decline to take pills.  The VA does not have what we used to use for cattle:  

It was a tube which we opened the cows mouth and pushed a lever forcing the pill down the cows throat. Its called a "bolus gun".  Cows cant understand what pills they should or should not take, so the cattle rancher , in consultation with the Veternarian, makes that decision for them.  You can see a video on a bolus gun, here:  The VA doc cant use a bolus gun on us without our permission.