Possible Pill Problems

admin — Wed, 26 May 2010 12:58:19 +0000

What to know when mixing prescription medication with over-the-counter drugs

By Fred Cicetti

Q: What is acetaminophen and why do I see it listed on so many products in my medicine cabinet?

A: Acetaminophen is the most widely used pain-reliever and fever-reducer in the world. It is contained in more than 100 products. Tylenol is the best-known over-the-counter (OTC) acetaminophen product. The drug is also a component of well-known prescription drugs such as Darvocet and Percocet. Acetaminophen also is known as paracetamol and N-acetyl-p-aminophenol (APAP).

Acetaminophen is available without a prescription. Follow the directions on the package label carefully. If your doctor prescribes it for you, the prescription label will tell you how often to take it.

Taking too much acetaminophen can lead to liver damage. The risk for liver damage may be increased if you drink three or more alcoholic drinks while using medicines that contain acetaminophen.

The maximum daily dose of acetaminophen is 4 grams in adults. The toxic dose of acetaminophen after a single acute ingestion is about 7 grams in adults. The at-risk dose may be lower in some susceptible populations, such as alcohol abusers. When dosing recommendations are followed, the risk of liver toxicity is extremely small.

Acetaminophen is one of the most common pharmaceutical agents involved in overdose, as reported to the American Association of Poison Control Centers.

One of the problems with acetaminophen is its widespread use. You have to check your medicine cabinet to see what products contain acetaminophen. Then, if you’re taking more than one medication, be sure you don’t exceed the maximum daily dose.

Adults should not take acetaminophen for pain for more than 10 days without talking to a doctor. Acetaminophen should not be taken for high fever, for a fever lasting more than three days or for a recurrent fever without a doctor’s supervision.

There are basically two types of over-the-counter pain relievers. Some contain acetaminophen and others contain non-
steroidal anti-inflammatory drugs, often called NSAIDs. Examples of over-the-counter types of these drugs are aspirin, ibuprofen (Advil), naproxen sodium (Aleve) and ketoprofen (Orudis).

NSAIDs are associated with stomach distress. You should talk to your doctor before using NSAIDS if you are older than 60, taking prescription blood thinners or if you have stomach ulcers or other bleeding problems.

NSAIDs can also cause reversible damage to the kidneys. The risk of kidney damage may increase in people who are older than 60, have high blood pressure, heart disease or pre-existing kidney disease, and people who are taking a diuretic.

You should talk with your healthcare professional if you have questions about using an over-the-counter medicine before using it in combination with other medicines—either other over-the-counter drugs or prescription medicine. Combining these two types of medicines can lead to problematic drug interactions.

All older adults should consult their doctors before taking any over-the-counter medication or herbal supplement.

Often, older adults use many drugs at the same time, including prescription and over-the-counter drugs. They also process drugs differently than younger adults. This is why older adults need to be especially careful about drug-drug interactions.

If you’re a senior, talk with your doctor about all of the drugs and herbal health products you take. He or she can tell you whether you are at risk for having a bad reaction from taking an over-the-counter drug.

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If you have a question, please write to fred@healthygeezer.com.

THE PROZAC COCKTAIL

admin — Thu, 16 Oct 2008 21:39:19 +0000

Soon after I started taking antidepressants in my early twenties, I moved to Paris, armed with my pills and a note from my doctor for airport security explaining why I had enough medication in my suitcase to cheer up a small country.
I don’t remember what I was taking at the time—probably Paxil or Prozac—but I do remember sitting on a barstool in the Young and Happy youth hostel about a week later (subconsciously, I must have believed moving into the Young and Happy would mean moving to a place packed with people whose boundless joy would rub off on me) talking to an Australian guy who wanted to split a bottle of red wine.
Pairing red wine with the Australian should have been the beginning of a fast friendship, but I’d just starting feeling not-so-depressed weeks earlier, and the “do not drink alcoholic beverages” warning on the orange bottles in my suitcase flashed in my mind.
“I can’t drink,” I told him.
“Why not?”
It was as if I’d told him I had herpes.
“It gives me migraines,” I said, stating my rehearsed excuse.
So the Australian drank a beer, I drank soda, and the night fizzled out in the way nights tend to fizzle—apparently—when two strangers meet and there’s no alcohol to act as social lubricant.
Soon, I felt like a grandma: I had always depended on beer and wine to help out when I wasn’t having any fun at all. Within weeks of moving into a new Paris apartment with new friends who liked to party, I gave up and started pouring myself glasses of wine. When I didn’t black out or throw up or flip out, I decided that “do not drink” while taking antidepressants really meant, “do not get completely and utterly shitfaced” while taking your pills. Years later, I’ve maintained this policy, and I’d all but forgotten about my prohibition days in Paris until this weekend, at a close friend’s wedding.
Early in the evening at the wedding, my date—an old friend—told me he couldn’t drink. “Why?” I asked him. Suddenly I was the dumbfounded, Australian critic and my friend was put in my awkward place. “I just started taking a new antidepressant,” he answered, more honestly than I ever had this question. “Oh,” I said, wanting to add, that’s never really stopped me.
Nor has it stopped most Americans, it seems. Antidepressants are now the most commonly prescribed medications in America, according to a 2007 Center for Disease Control study, and there’s no evidence to suggest that a rise in prescriptions has curbed our American drinking habits. The Canadian Medical Association Journal did report in a 2007 study that for men, antidepressants slightly reduced alcohol consumption, but strangely, the prescriptions did not reduce consumption for women.
In any case, most of us know what we’re supposed to do when we’re depressed: get out of bed, go to the gym, eat healthy food, see friends, sleep well, talk to a therapist and, in general, do all of the things we don’t feel like doing because we’re depressed. Getting drunk isn’t on the list. However, like staying in bed all day, it’s one of those bad-for-you activities that’s especially alluring to a person feeling down. And while it’s clear that smoking leads to lung cancer and fast food leads to obesity, most people are unclear of the true dangers associated with a Prozac-laced-cocktail.
Not surprisingly, the health risks of drinking on antidepressants really depend on what antidepressant you’re taking. Dr. Kelly Brogan, a Manhattan-based psychiatrist, explains that drinking increases the side effects of antidepressant medications because alcohol competes with the medication for enzymes in the liver responsible for eliminating the medication from the body. While SSRI medications such as Prozac, Celexa and Zoloft are not likely to have “serious adverse effects” in combination with alcohol, Brogan said drinking does increase the sedating effect of tricyclics like Elavil and Pamelor.
Perhaps most importantly, Brogan added, is that alcohol can counteract the work of an antidepressant because it’s a psychoactive substance associated with depression and anxiety.
I guess this means that drinking that Prozac-laced cocktail is not so much dangerous as it is stupid—like following a Weight Watchers plan by day and scarfing down cupcakes by night.
Still, even if many of us know that the short-term high of the cupcake or the beer probably defeats our long-term health goal, we often lack the discipline to say no to Australians who want to split bottles of red wine with us. And besides, I could have ordered up the bottle of red wine that night and just had a few sips, right? Unless we’re alcoholics who need to sober up entirely, a plan to drink more responsibly is perhaps more realistic than a plan to not drink at all.
As for my friend at the wedding this weekend, he managed to avoid the open bar through the cocktail hour, but that was the extent of his sticking to his no-drinking plan. Later, I asked him what made him change his mind about drinking at the wedding and he just stated, definitively: “Weddings are more fun when you drink.”

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Possible Pill Problems

THE PROZAC COCKTAIL