Director, Emergency Services, Bikur Cholim Hospital
I am constantly asked about natural remedies and indeed, I
always express concern. These medications are rarely tested
like conventional drugs, and we do not know if they are safe.
A further problem, and one I want to speak about today, is
combining these medications with other drugs. We do not know
what could happen with a lot of these medications.
Probably the most famous case of mixing medications with bad
results was the Libby Zion case. Libby Zion was taking an
antidepressant that can not be taken with many medications
and even foods. She was mistakenly given a pain reliever that
does not mix and died soon after. Her father was a writer for
a big New York newspaper and the story led to many changes in
medicine.
The first question one should always ask when being
prescribed a drug is: Is it safe in pregnancy and in nursing?
We have discussed this before.
Afterwards, let your doctor know about all medications you
take, even an occasional pain reliever, so he will not
prescribe a combination that will be harmful.
One of the most common combinations that are harmful is
combining the blood thinner coumadin with any number of
medications that can make it either ineffective or over-
effective.
We mustn't limit our discussion to combining drugs. The use
of alcohol is very harmful when combined with some
medications, and did you know that grapefruit juice can
affect the metabolism of other medications? To go through the
lists of these things would be beyond the scope of this
column (and not interesting either) but you should keep in
touch with your doctor or look up information on your
computer or in books. I personally think it is never a good
idea to take medication without knowing what it causes and
what side effects it has.
This reminds me of a humorous story about an old chavrusa
of mine. He was once very tired, so in the middle of
seder he went to drink coffee. It must have been very
strong, because a little later he was "bouncing off the
walls" and he took an antihistamine to calm himself down. But
that affected him too much, so he had more coffee. This cycle
just went on and on.
Now there is a new harmful combination. Anti-migraine
medications have been around for about ten years. These
medications are pain relievers for migraine and nothing else.
(Imitrex was the first and was produced by GlaxoSmithKline.)
They are very effective, but when used with SSRIs they can
cause trouble. What are SSRIs? These are the new generation
of antidepressants. Effective as the old ones but much less
dangerous in side effects and in overdose. However, an
overdose of them can cause the heart to race and high fever
— what is termed the Serotinin syndrome. It can,
rarely, cause death. Apparently, the FDA now feels that this
combination can make this syndrome happen more frequently.
In the USA, to prevent medication problems, many physicians
have palm pilots. There are also automatic computer programs
that dispense pills only when warnings are given to a
physician. For example: CAUTION — DO NOT TAKE WITH . .
.
While internists are supposedly well-versed in medications,
even they many times make mistakes especially with
medications that are used for psychiatry and ophthalmology,
as they have their own classes and internists are less
exposed to them.
The problem is also in the surgical fields where doctors are
less likely to read and get updated about drug warnings. If
your doctor does not read, he will not know. If he is sure of
himself without a doubt, he probably has many doubts. If he
is stubborn, take a step back and try to think why. Write me
in care of the Yated.
