Question: My father in law  takes a lot of medication and we are concerned that no one is keeping an eye on the big picture to make sure the medicines are all compatible.  The list of what he takes is below.  Are you aware of any possible problems associated with this combination of drugs. 
Glyburide 5mg Take 2 tablets twice a day.   Metformin 500mg Take one tablet twice a day   Simvastatin 40mg take one tablet once a day. Cozaar 50 mg take one tablet daily . Doxazosin 4mg   take one & half tablet at bedtime.
Thanks!

Here is my response:

Hi!  Thanks for contacting us!

Glyburide 5mg -2 tablets twice a day–Diabetes
Metformin 500mg -one tablet twice a day–Diabetes
Simvastatin 40mg -one tablet once a day –Cholesterol
Cozaar 50 mg -one tablet daily –Blood Pressure/kidney protectant
Doxazosin 4mg- one & half tablet at bedtime –BPH/ Blood Pressure

There aren’t any major interactions here.  Use of Cozaar, Doxazosin and Glyburide together can increase risk of blood pressure and blood sugar being too LOW.  This is easily monitored with testing blood pressure and sugar.
Also, he can monitor how he feels -low blood pressure: dizzy, fatigue, light-headed especially upon standing up.  Low blood sugar -light-headed, dizzy, sweating, headache.

He may want to consider adding…
1.  OTC CoEnzyme Q10.  This will help replace the CoQ10 that is decreased from the simvastatin.
2.  OTC B12 (or B-complex).  This will replace the B12 that is decreased from metformin
3.  Talk to physician about adding OTC calcium and vitamin D supplements -for general health and to counteract calcium depletion by Cozaar.

Lastly, are these medications working for him?  Are they controlling his
blood pressure, cholesterol and blood sugar/ A1c?

Hope this helps!  Please contact us with any questions/comments.

There you have it!  Of course, this is quite specific for this patient but if you have questions about your or your family member’s medications -please leave us a comment, submit a question or send an email at nova@getpharmacyadvice.com .

I hope you’re ready for this very long post!  I think it’s a good one to throw at you because it provides you with the a perfect example of how Nova and I can evaluate your list of meds.  Okay, I know you’re dying to see what this post is all about, so I will cut the jibber-jabber!

Question from reader:

Could these drugs make me more sick?
A.M.
Cymbalta 90mg.
Singulair 10mg.
Prozac 20mg.
Synthroid 50mcg.
Topamax 25mg.
Bentyl 20mg.
Adderall30mg.
midday…Adderall 30mg.
Klonopin 1mg.
P.M.  Geodon 40mg. Klonopin 1mg.
Estrace 1mg. Topamax25mg
Bentyl 20mg.  fish oil a.m. multi. p.m.

This is what I had to say to the reader:

1.  Prozac and Cymbalta used together strikes some concern in me.  They both increase levels of serotonin in your system.  Too much sertontin in your bloodstream can lead to serotonin-related adverse effects (like nausea/vomiting, diarrhea, nervousness, dry mouth, insomnia), including serotonin syndrome (a serious problem). 

Serotonin Syndrome would appear rapidly and would include such symptoms as confusion, increased blood pressure or heart rate, muscle weakness, dizziness, loss of coordination, excessive dry mouth, restlessness, sweating, tremor, vomiting, and other serious side effects.

Also, Adderall may cause the release of serotonin into your central nervous system.  Even though I don’t think the use of Adderall with just Prozac or Cymbalta would be a problem, the 3 meds together might be too much.

You could ask your physician if they think there is a different medication that could replace Prozac or Cymbalta that does not cause increased serotonin levels.  Or you could ask your physician if they think you still need both anti-depressants.  Hey, it can’t hurt to ask!

Whatever you do, be cautious of the abovementioned symptoms of serotonin syndrome.  You never know what may happen!

2.  You are taking more than a few medications that cause a decrease in function of your central nervous system.  These medications include: Geodon, Cymbalta, Klonopin, Topamax, and Prozac.  Because they all cause a decrease in function of the central nervous system they are going to have very similar side effects.  These side effects are: drowsiness, confusion, weakness, respiratory depression, and loss of muscle coordination.

Oh yeah, Bentyl can add to the drowsiness effect, and Prozac may decrease the elimination of Klonopin, increasing your chance of feeling Klonopin’s side effects!

Experiencing these side effects would probably make you feel crappy and give you a general feeling of being not well.  If you already feel the symptoms, I urge you to approach your physician about whether all the medications are definitely needed!

3.  Taking Geodon with Prozac may pose a problem for a couple of reasons. They can both cause an irregular heartbeat, and Prozac may decrease the breakdown of Geodon, leading to increased levels of Geodon in your system. Greater levels of Geodon in the bloodstream will increase the chance of experiencing side effects, including the very serious irregular heartbeat effect! 

Now, specific studies on the signficance of the interaction between Prozac and Geodon are lacking, but Pfizer (the manufacturer of Geodon) still thinks it’s a major interaction.

I don’t think you should panic (unless you have an underlying heart condition), but make sure your physician has an eye on using the two meds together!

4.  Estrace may decrease the beneficial effect of Synthroid when taken together.  If your thyroid levels are under control and at goal, then you shouldn’t have to worry about this.  You would need to monitor your thyroid
levels or the therapeutic effects of Synthroid if your Estrace dose is changed (increased or decreased) or if you discontinue taking Estrace.

And last, but not least:

5.  And this one is only important if you suffer from seizures!  Since you’re taking Topamax and Klonopin, there is a chance you experience seizures without medications to prevent them.  Again, I’m mentioning this because I have no idea why you are taking Topamax and Klonopin.  Could be for something else, but just in case, Adderall can increase your risk of having seizures so you would want to use caution.

That’s that!  I hope this helps a little and isn’t too confusing.  If you need me to clear something up, just let me know! 

Please don’t forget to approach your physician with any concerns, especially if I prompted some uneasiness with my response.  Also, definitely do not stop taking any of your medications without speaking with your physician first!

END OF RESPONSE

Send us your list of meds so we can help you out too!  It would be extra helpful  if you also told us what you are taking each medication for – helps with the evaluation process! 

You can e-mail me at Cate@getpharmacyadvice.com or submit your medication list by clicking here.

Also, we would be extra excited if you became a member of our blog family! You can do so by using the “Subsribe Now” form.  You can do it!   And for doing so, you’ll get a FREE video on how to save money on your medications.

Hope to hear from you soon!

In the meantime..here is a quick video about the interaction between Quinolone antibiotics (Cipro, Avelox, Levaquin) and dairy/antacids.  Did you know that taking Maalox and Cipro together can cause the antibiotic to be completely ineffective?  True that!

Please leave a comment about your experience!

And click here for access to your FREE video course on 90 Ways to Save Money on Your Prescription Drugs!