The Dangers of Mixing Medication
Many of the patients who come to my clinic are there because other doctors have given up on them. If you’ve ever had a physician tell you, “There’s nothing wrong with you,” – even though you know there is – then you know how these patients feel: lost, alone, and frustrated.
This is exactly what happened to a patient I’ll call Terry, who began experiencing serious stomach problems a few years ago.
“Whatever is making me sick causes such pain, it feels like the worst sort of flu. I’m feverish and sometimes chilly, and my stomach is tied in a knot like someone is twisting it. Sometimes, I’m sick to my stomach, too,” she told me. “It happens about once a week, so it can’t be the flu. And all I can do is lie flat in bed and moan every once in a while.”
Various doctors had suggested Terry try prescription antacids, tranquilizers, antidepressants, and antibiotics. But she was leery of taking those medications and really wanted to determine the root cause of what was making her sick..
“I think it must be something I’m eating,” she said, “but I can’t tell what. I’ve even kept track of everything I eat with a food diary, but there’s no pattern there that I can see.”
I looked over Terry’s food diary and could not find any connections there, either. We talked about other possibilities, but Terry did not drink alcohol, energy beverages, or soft drinks, nor did she take any medication. She had not moved to a new home or office, had not traveled abroad, was not particularly stressed out, exercised every day, and – aside from the illness that brought her to my office – rarely got sick. After thoroughly discussing her situation and finding so little to go on, I was intrigued. Something was causing Terry’s illness, but what could it be?
Drugs and Delayed Reactions
“What about aspirin?” I asked.
“I never take them,” she replied. “As soon as I do, my stomach feels like something is trying to chew its way out. Once in a while, I take an ibuprofen, and I seem to be okay with those.”
As soon as Terry said “ibuprofen” I had a strong hunch about what was going on. Ibuprofen and other non-steroidal, anti-inflammatory (NSAIDs) pain relievers – like aspirin, acetaminophen (Tylenol), and naproxen (Aleve) – are widely considered safe. But the truth is, side effects from these drugs send more than 100,000 people to the hospital each year, and thousands die from the complications, which include kidney failure, stomach or intestinal bleeding, liver problems, and high blood pressure.
For some patients, like Terry, those side effects don’t appear until well after the drug is in their system, so the connection is not obvious. I suggested we try an experiment in which Terry would take an ibuprofen in the afternoon, and we would see how she felt the next day. Sure enough, late the next morning, her husband, James, called to say she was in bed with the same stomachache and flu-like symptoms that had been troubling her.
“She’s so sick, she can barely even sit up,” James told me. “And she took the pill in the early afternoon yesterday, so we never even connected the two things. Shouldn’t the drug companies tell people this could happen?”
Actually, the drug companies do list the possible side effects in the inserts that come with both over-the-counter medications and prescriptions. Here, for example, are a few of the side effects caused by ibuprofen:
- Chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance
- Black, bloody, or tarry stools, coughing up blood or vomit that looks like coffee grounds
- Swelling or rapid weight gain
- Urinating less than usual or not at all
- Nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
- Fever, sore throat, and headache with a severe blistering, peeling, and red skin rash
- Bruising, severe tingling, numbness, pain, muscle weakness
- Severe headache, neck stiffness, chills, increased sensitivity to light, and/or seizure (convulsions)
Unfortunately, in my 20-plus years as a practicing doctor, only a handful of patients have told me that they’ve read the drug inserts. Don’t get me wrong – I’m not blaming the victims. Taking medication is based on trust. You trust your doctor and the drug companies to provide you with safe medication. Like Terry, most of us would never imagine that a single dose of a hugely popular, widely available medication could have such harsh consequences for an otherwise healthy person. And when the side effects appear well after the medication was taken, it’s even more difficult to figure out what’s gone wrong. Yet I’ve seen patients appear to do well with a drug, such as a statin, only to develop side effects after taking it for months.
Here again, most people don’t connect the complications they’re experiencing with the drug they’ve been consuming. Often, physicians fail to recognize the cause, too, so the patient ends up getting a new prescription to solve the problems caused by the first one. And so it goes, with millions of Americans now taking multiple prescription drugs and mixing those with over-the-counter medications. In my opinion, this is a recipe for disaster.
Five Ways To Minimize Drug Interactions
As the number of chronic health problems grows, more people are mixing prescription drugs with over-the-counter medication in combinations that have never been tested for safety. In addition, drug interactions with food, beverages, and nutritional supplements could create additional complications. And nutrient depletions caused by drugs – such as the way statins deplete the body of Coenzyme Q10 (CoQ10) – are a whole other concern.
What can you do to protect yourself from a health issues like these? Be aware that every time you take a drug – whether it’s over-the-counter or prescribed – there is some risk involved. You can reduce that risk with these five suggestions.
1. Talk about it
Get in the habit of discussing prescription medications with your pharmacist. These highly trained professionals are usually happy to answer questions, talk about side effects, and provide you with detailed instructions about how drugs should be taken. In addition, arrange to have all your prescriptions filled at the same pharmacy. Then your pharmacist will have all your information available and be better able to help you avoid dangerous drug interactions
2. Take notes
Keeping track of multiple drug instructions can get confusing. That’s why I suggest writing down details from your doctor, nurse, or pharmacist. If you are on several medications, please keep a notebook or slip of paper with you just for this purpose. The notebook is also a good place to list everything you are currently taking, including nutritional supplements. If you have a health emergency, that notebook or list could save your life. One of the biggest frustrations in emergency medicine is trying to figure out what drugs an individual is taking when that person is not able to answer questions.
3. Hold the alcohol
Many people are aware that mixing alcohol with sedatives is a recipe for disaster. But did you know that combining alcohol with acetaminophen (Tylenol) could be lethal? Recent statistics show that more than 50,000 people land in the emergency room each year due to acetaminophen-related liver problems, and nearly 500 of them die as a result. While the liver can recover from some types of damage, it cannot heal after acetaminophen poisoning, leaving a liver transplant as the only option.
Please don’t be lulled into a false sense of security about the safety of these over-the-counter medications. For example, liver damage usually only occurs with a fairly high dosage. But it’s easy to lose track of just how much acetaminophen you’re taking, since the drug is an ingredient in more than 300 products, including everything from pain remedies to cough suppressants to sleep medications, and it is often combined with pain-easing opioids in prescription medicines.
Furthermore, you should know that drinking alcohol while taking certain antibiotics could make you very sick. Bactrim, for example, is a popular antibiotic for treating ear infections, pneumonia, urinary tract infections, and similar problems. Drinking alcohol while taking Bactrim can cause vomiting, headache, shortness of breath, rapid heartbeat, fatigue, serious bone pain, and skin rashes. Even a cough remedy or mouthwash containing a bit of alcohol can cause this type of reaction. So if you like to enjoy a cocktail or glass of wine at the end of the day, and if you have been prescribed an antibiotic or other medication, be sure to ask your physician about the possibility of an alcohol-drug interaction.
Alcohol interacts with many drugs, as you can see from the partial list below, and sometimes the consequences can be quite serious, especially for anyone with kidney or liver complications.
Some drugs that may interact with alcohol include:
- Certain antibiotics, including Flagyl (metronidazole) and Furoxone (furazolidone)
- Anticoagulants, such as Coumadin (warfarin)
- Antidepressants, especially tricyclic antidepressants like Elavil (amitriptyline)
- Antihistamines, such as Benadryl (diphenhydramine)
- Heart and high blood pressure medications, including nitroglycerin and Inderal (propranolol)
- Pain relievers, both prescription and nonprescription, including aspirin
- Sleep aids and tranquilizers, such as Ativan (lorazepam) and Dalmane (flurazepam)
This is only part of a much longer list of drugs that interact with alcohol. That’s why it’s so important to talk to your physician or pharmacist about potential alcohol-medication interactions before combining the two.
4. Skip the citrus
Several types of citrus fruits, especially grapefruit and its juice, along with a grapefruit relative known as pomelo and Seville oranges, contain compounds that affect the way the body processes certain drugs, including some immunosuppressants that are often given to transplant patients. Combining medications with these citrus fruits could cause the drug to remain in the body. As you continue taking your regular dose, the amount of the drug accumulates. Eventually, drug levels could reach the point of causing an inadvertent overdose.
If you are taking medication that interacts with grapefruit or other citrus fruit, stop eating or drinking the citrus completely. Taking the drug at a different time than the food or drink is not enough to prevent this potentially serious side effect.
Here is a partial list of drugs that can interact with grapefruit:
- Zoloft (an antidepressant also sold as sertraline)
- Allegra (an antihistamine also known as fexofenadine)
- Procardia, Nimotop, Sular (calcium channel blockers also sold as nifedipine, nimodipine, and nisoldipine)
- Lipitor, Zocor, Mevacor (also known as atorvastatin, simvastatin, and lovastatin, respectively)
5. Avoid Foods That Are Not Drug-Friendly
There are a number of other drug-food combinations you should know about. Be aware that this is only a partial list, since it’s just not possible to name all of the potentially harmful drug-food combinations. But those below are fairly common and may help you avoid complications later on.
- Warfarin (Coumadin) and foods high in vitamin K: Foods high in vitamin K (spinach, broccoli, kale, and other leafy greens) may interfere with the effectiveness of the blood thinner warfarin (also known as Coumadin). If you’re a regular salad eater, it’s fine to continue. But a sudden increase in leafy greens could cancel out the drug’s benefits.
- Antibiotics and dairy products or calcium supplements: Dairy products or calcium supplements may inhibit the absorption of antibiotics, particularly those in the group known as quinolones (sold as Cipro, Avelox, Factive, Tequin, Floxin, and Levaquin). To maximize antibiotic effectiveness, take them at least two hours prior to taking dairy or calcium supplements or four to six hours afterward.
- Blood pressure medications and potassium supplements: Taking potassium supplements with any of several different blood pressure medications (including ACE inhibitors, diuretics, or beta-blockers) could lead to dangerously high potassium levels, a condition known as hyperkalemia. Symptoms include nausea, weakness, heart arrhythmia, and fatigue. If you’re taking blood pressure medications, talk with your health-care provider before adding potassium supplements.
- Blood thinners and garlic, ginger, curcumin, or ginkgo biloba: Combining these supplements with blood thinners such as Plavix or warfarin (brand name Coumadin) may cause blood to become too thin.
- The diabetes medication chlorpropamide and garlic supplements: Mixing garlic supplements with chlorpropamide could cause blood sugar levels to drop.
- Corticosteroids and licorice supplements: Taking licorice supplements, a natural cough or cold remedy, with corticosteroids may increase blood pressure and can also amplify the effects of the corticosteroids. Licorice raises blood pressure, so I warn anyone with high BP to avoid it.
Since research is ongoing, be sure to check with your pharmacist about new warnings and/or interactions every time you fill a prescription. For example, the Food and Drug Administration (FDA) recently issued a new warning that Tylenol (acetaminophen) can cause rare but serious skin reactions, such as a rash and blisters.
Monitoring your medication is an excellent place to start taking charge of your own health and playing an active role in your wellness. Start by taking a few minutes to look over the drug insert next time you get a prescription refilled or purchase an over-the-counter medication, especially the sections on dosage and possible side effects. As I mentioned earlier, side effects sometimes do not appear for months after starting a drug. So, if you do experience a new symptom, ask your physician or pharmacist if it could be a side effect of a drug you’re already taking, or check the website drugs.com where side effects and other cautions are listed.
Remember, too, that there are alternative substances available to treat many conditions without the punishing side effects of synthetic drugs. Terry, for example, found that curcumin supplements relieved his occasional joint ache without the awful side effects of ibuprofen. In fact, clinical trials have repeatedly found that curcumin effectively controls pain from such serious conditions as burns, wounds, inflammation, and even nerve damage, such as that experienced by diabetics – without harmful side effects.
As I’ve said before, drugs are lifesavers in certain situations, such as treating an infection. But many people are convinced they need medications day in and day out for the rest of their lives, even though the medicine does nothing but mask symptoms. If you’re among them, please be aware that there are effective natural alternatives to many drugs that are easier on the body, get the same results, and could eliminate concerns about drug interactions and complications.