Drug Interactions: Dangerous Liasions


1) Lortab, Lorcet, Percocet and Vicodin are brand name products used to treat short term pain. They contain acetaminophen in varying doses. Many over the counter (OTC) products including Tylenol also contain acetaminophen. Acetaminophen is one of the most common drugs associated with overdose.

Acetaminophen is processed by the liver at an approximate maximum rate of 4 grams per day for a healthy liver and substantially less than that for chronic alcohol drinkers or those with liver disease.

To avoid overdose, do not supplement your prescription pain medicine with OTC Tylenol without first asking your pharmacist or prescriber. No outward symptoms are reliable for self-diagnosing your risk of overdose.

2) Coumadin or warfarin is a prescription medicine used to prevent strokes and clotting. Combining warfarin with OTC products commonly used to treat fever and pain like aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) potentiates its effects and can lead to unwanted bleeding episodes.

Quarter and dime size bruises with even a slight bump are common when taking warfarin and are signs of bleeding under the skin. Bruises larger than a quarter, or bruises which do not go away may be signs of a bleeding event and needprofessional evaluation.

Also coughing up blood, having black tarry stools, or bright red blood in the stool are signs of bleeding episodes and shouldbe immediately reported to a medical professional. Avoid these OTC products when taking warfarin unless recommended by your doctor.

3) Crestor, Lipitor, Zocor (simvastatin) and Mevacor (lovastatin) are blockbuster medicines used to control cholesterol and reduc eth risk of coronary events. When taken with common grapefruit juice, the levels of these medicines can become levated in the body and increase a patient’s risk of untoward side effects.

One of the more serious possible side effects in this case is rhabdomyolysis — a usually painful muscle deteriorating syndrome. Signs of this syndrome include pain and fatigue in the mjaor muscle groups of the body such as the back, upper arms, or thighs. Even small amounts of grapefruit juice taken days apart from the medicine may have negative effects.

Do not eat grapefruit or drink grapefruit juice within one week of taking any of these medicines. If you experience the symptoms mentioned above, notify your prescriber so that they may further evaluate you.

4) Many antibiotics used to treat infectious diseases interact with aluminum, magnesium, calcium and iron to yield inefficacy and possibly contribute to general drug resistance in the population.

If you are prescribed Levanquin, Cipro (ciprofloxacin), Zithromax (azithromycin) or tetracycline, do not combine them with Tums, Rolaids, Mylanta, calcium or iron supplements or multivitamins with minerals. Combining these medicines prevents absorption of the antibiotics into the body and leads to failed treatments.

On a larger scale, this type of activity leads to drug resistance in the general population and makes the treament of infection more difficult and more expensive.

5) Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram) and Lexapro are used to treat symptoms of depression, anxiety and mood disorders. They interact with a cough suppressant called dextrmethorphan that is contained in many cough and cold products including Robitussin DM and Nyquil.

A rare, but serious effect called serotonin syndrome may result. Serotonin syndrome is an imbalance in one of the primary nerve transmitters in the body and may lead to death if not treated prompty.

The risk of serotonin syndrome is increased in patients who are also taking phentermine for appetite suppression or a number of drugs including amitriptyline, desipramine, imipramine, nortriptyline or trazodone to promote sleep. If you are taking some combination of these medicines and experience severe flu-like symptoms which do not resolve, contact your


For more information, visit your nearby HealthMart pharmacy, locally owned community pharamcies, offering the special care and service you can only get from a member of your community. Visit the Birch Family HealthMart Pharmacies located at 758 North Main in Tooele, Utah.
Call them at 435 882-7775.

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