Consider, for example, the drug ephedrine, a synthetic version of ephedra used for weight loss and workout enhancement. Steve Bechler, an up-and-coming pitcher for the Baltimore Orioles, died of heatstroke in February 2003 shortly after taking the drug. Although the Federal Drug Administration has since banned ephedra and its synthetic counterparts, the potential for another commonly used medication to become deadly, if misused, remains. Items found in your own medicine cabinet, when taken in combination with other medicines, may prove dangerous.
“The risk for drug interactions increases with the number of medications taken, and the number of health conditions someone has,” says NeighborCare pharmacist Cherokee Layson-Wolf, Pharm.D.
She explains that there are three common interactions to watch out for:
- Drug-to-drug interactions: Occur when a medication interferes with another medication.
- Drug-to-disease interactions: Occur when a medication can affect a disease state (or vice versa).
- Drug-to-nutrient interactions: Occur when a vitamin or mineral (or even a food) interferes with a medication.
Probably the easiest mistake to make is with over-the-counter (OTC) products, Layson-Wolf says. “It is extremely important to read the product labeling so that you are aware of any precautions and warnings.” When in doubt, ask your physician or pharmacist before taking the product.
Here’s an example. Say you have arthritis and you are using acetaminophen to control the pain. You are also seeking relief from allergy symptoms so you pick up a combination cold and allergy product containing acetaminophen. If taken with your usual pain regimen, it may put you at risk for exceeding the safe daily dose of acetaminophen, Layson-Wolf says.
Rule of thumb? Avoid combining OTC products and treat only the symptoms you have.
What about drug-disease interactions? Consider this example: A patient who has high blood pressure also has a cold. This patient picks up an OTC cold product that contains pseudoephedrine, a nasal decongestant. A side effect of pseudoephedrine is an increase in blood pressure.
What to do? “Your physician or pharmacist can suggest alternate ways to treat your cold, such as nasal sprays,” says Layson-Wolf.
Nutritional supplements have many benefits, but you still have to be careful when using them. Here’s an example. Many women who take calcium supplements for bone health may also take thyroid medications such as levothyroxine. Calcium supplements interfere with the absorption of this medication and, therefore, the medication needs to be taken either one hour before or four hours after taking a calcium supplement, Layson-Wolf explains. Unless your physician or pharmacist knows what other non-prescription drugs or supplements you are taking, you might not learn this vital information.
“It’s best to have all your prescription medications at one pharmacy so that they can be screened for interactions when you get a new prescription. This makes it easier for pharmacists to make recommendations to their patients about over-the-counter medications,” Layson-Wolf says. She also recommends keeping a list of your medications with you at all times.
For more information on drug, disease and nutrient interactions, see your pharmacist.
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Here’s just a few other drugs, foods and nutrients that may interfere with medical conditions or prescription drugs. Please ask your physician for a list of examples specific to your medical circumstances.
Diphenhydramine: Found in both cough/cold/allergy and sleep-aid preparations and, if taken in multiple products, can cause severe drowsiness. Elderly people and patients with benign prostatic hypertrophy (BPH) should also avoid using this product.
Glucosamine: Taken for arthritis, it may increase blood sugar levels in persons with diabetes mellitus. Let your physician know you are taking this supplement and monitor your blood sugar.
Niacin: Taken for cholesterol, it may increase blood sugar levels of patients with diabetes mellitus. Let your physician know you are taking this supplement and monitor your blood sugar.
Grapefruit juice: People who take statin cholesterol medications (atorvastatin, lovastatin, simvastatin) or antibiotics (clarithromycin or erythromycin, carbamazepine, etc.) may experience increased drug levels if they also drink grapefruit juice on a regular basis. If you are taking these medications and also drink grapefruit juice, consult with your physician before stopping or changing your drug therapy.
Calcium or iron: May decrease the absorption of antibiotics such as tetracycline and doxycycline. Therefore, these medications should be taken either one hour before or four hours after taking calcium or iron supplements.
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