Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

7 Av 5766 - August 1, 2006 | Mordecai Plaut, director Published Weekly










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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

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.


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