Medication Interactions

Could you accidentally poison yourself by taking over-the-counter (OTC) products?  Last year, hundreds of senior citizens in Tennessee called Tennessee Poison Center after taking herbal medications, dietary supplements, vitamins, pain relievers, antihistamines, cough/cold therapies or gastrointestinal remedies.   Why did those people call? Reasons included:
* Feeling ill after taking OTC products with prescription medicine
* Taking an extra dose
* Taking someone else’s medicine
* Discontinuing prescription medicine and substituting OTC medicine
* Taking higher-than-recommended doses of OTC medicine.

 Info about Interactions
An “interaction” refers to a problem that occurs when a medication is combined with another medication, food or alcohol.  That doesn’t just refer to combinations taken at exactly the same time.  Some interactions can occur even if the two items are spaced many hours apart. 

 Grapefruit and medication interactions
Avoid grapefruit or grapefruit juice unless approved by your pharmacist.  Grapefruit juice interferes with enzymes that break down certain drugs in your digestive system. If components of your medicines build up, you may have abnormally high blood levels of these drugs and an increased risk of serious side effects.  The exact chemical or chemicals in grapefruit juice that cause this interaction can be in the pulp, peel and juice of grapefruit as well as in dietary supplements that contain grapefruit bioflavonoids.  Until proven safe, do not take grapefruit if you are on the following medications:

* Carbamazepine (Carbatrol, Tegretol)

* Buspirone (BuSpar) clomipramine (Anafranil) and sertraline (Zoloft)

* Diazepam (Valium), triazolam (Halcion)

* Felodipine (Plendil), nifedipine (Adalat, Procardia), nimodipine (Nimotop), nisoldipine (Sular) and possibly verapamil (Isoptin, Verelan)

* Saquinavir (Fortovase, Invirase) and indinavir (Crixivan)

* Simvastatin (Zocor), lovastatin (Mevacor) and atorvastatin (Lipitor), simvastatin-ezetimibe (Vytorin)

* Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf) and sirolimus (Rapamune)

* Amiodarone (Cordarone)

* Sildenafil (Viagra)

 Herbal and Prescription Medicine Interactions

“Herbal Products and Prescription Medicine” shows combinations of herbal products and prescription drugs and the medical problems that could result.

Herbal Products and Prescription Medicine
 If you take these combinations, this could happen:

Aloe + digoxin heart medicine     

Lowers potassium in the blood

Aloe + steroids or blood pressure meds

Lowers potassium in the blood

Cat’s Claw + blood pressure meds

Dangerously low blood pressure

Cat’s Claw + immunosuppressants

Immunosuppressant doesn’t work well

Chondroitin + blood-thinners  

Risk of bleeding

Echinacea + immunosuppressants   

Immunosuppressant doesn’t work well

Fish oil capsules + blood thinners

Risk of bleeding

Garlic pills + blood-thinners, aspirin

Risk of bleeding

Garlic pills + Diabetes medicines

Dangerously low blood sugar

Garlic pills + cyclosporine

Organ rejection

Gingko Biloba + blood-thinners

Risk of bleeding

Gingko + diuretic blood pressure pills

Higher blood pressure

Gingko + anticonvulsants

Risk of seizures

Ginseng + blood-thinners

Risk of bleeding

Glucosamine + Diabetes medicines                     

May raise blood sugar

Glucosamine + cancer meds                                

Cancer medicine doesn’t work well

Hawthorn + digoxin heart medicine                        

Irregular heartbeat

St. John’s Wort + Digoxin                                    

Digoxin doesn’t work well

St. John’s Wort + psychiatric meds                      

Toxic side effects

St. John’s Wort + Cyclosporine                             

Organ rejection

St. John’s Wort + blood thinners                            

Blood thinners don’t work well

 Resources for more information about medicine interactions
There are many, many more interactions than can be listed here.  Get in the habit of asking your pharmacist or physician before starting a new OTC product. Or you can look on-line at reputable medical websites such as http://my.webmd.com/medical_information/drug_and_herb or http://nccam.nih.gov/health/. 

Tennessee Poison Center (1-800-222-1222) is a free source of information just a phone call away. Nurses, pharmacists and physicians answer questions on the hotline 24 hours a day.  If someone feels unwell after mixing up medications, Tennessee Poison Center can help in a matter of minutes. In most cases, the caller can be taken care of in their own home while following the poison center’s advice. The statewide toll-free Poison Help number is 1-800-222-1222.

* Reprinted – original article by JoAnn Chambers-Emerson, RN, BSN, CSPI

Certified Specialist in Poison Information

Florida Poison Information Center – Tampa



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