Tuesday, Feb. 27, 2 p.m. ET

Dangers of Drug Interaction

January Payne
Washington Post Staff Writer
Tuesday, February 27, 2007; 2:00 PM

Health section staff writer January Payne was online Tuesday, Feb. 27 at 2 p.m. to take your questions and comments about researching drug interactions and prescription medications online.

A transcript follows.


January Payne: Good afternoon, and thanks for joining me today to discuss my story about avoiding potentially harmful drug interactions. It's always best to talk with your doctors and pharmacists anytime you're wondering whether it's safe to take a new medication -- and there are also many online resources that can be helpful as well (which are described in my story and sidebar).

With that said, I'm happy to take your questions about medications and drug interactions. I'm not able to provide specific medical advice, however -- those are best left to your personal doctors and pharmacists.


Alexandria, Va.: Thank you very much for addressing the potential problem of drug interactions and for providing so many Web sites for researching medications. In May 2006, my husband took me to an emergency room on a Sunday afternoon because I had a fever of 103, was coughing and had flushed cheeks. A doctor told me I had pneumonia and gave me a prescription for Zithromax. I took it that night at bedtime along with my usual dosage of Seroquel and Depakote. An hour later I woke up talking in my sleep. I called to my husband who was still up. When I got out of bed I lost my balance and fell backward onto my behind on the floor. He gave me a glass of water, but I had trouble placing it on the edge of a table. I saw objects where none existed. I had never had hallucinations before and hope I never do again. In the fall I chose not to get a flu shot, not wanting to take a chance on another drug reaction.

January Payne: Thanks for sharing your experience with us. It just illustrates that we all respond differently to medications and you never know how your body will react.


Media, Pa.: Could you name Web sites where one types in one's medication and gets a report as to whether those pills are compatible? Thanks.

January Payne: There are several Web sites that offer what they call "drug interaction checkers." I list several at the end of a sidebar that ran with my story today. I'll include a link to that sidebar below.


washingtonpost.com: Internet Offers Many Ways to Avoid Harmful Drug Mixtures (Post, Feb. 27)

January Payne: Here is the sidebar, which lists many online tools for researching medications and checking for potential interactions.


Los Angeles: Interesting topic, thank you.

Is there a place where I can input all the medications I may be taking and find out if there could be a reaction?

January Payne: Yes -- Please see the link I just posted for a list of such sites.


Burke, Va.: I am interested in the why and how of grapefruit interaction with medicines. I love grapefruit juice but I've heard that it and pomegranate juice and a number of other ordinary foods interferes with certain "pathways" and either allow certain drugs to be enhanced in its efficacy or neutralized. I think it involves a "pathway" for excretion through liver. Can you explain this mechanism and what we should look out for? Does it relate to the fact that certain drugs have to be taken BEFORE food is eaten and other drugs have to be taken while eating.

January Payne: I talked briefly about grapefruit juice with one of the pharmacists I interviewed. It seems that it's not totally understood how/why grapefruit juice can pose a problem with some medications. I'm including a link below to a Mayo Clinic article that better explains theories as to why it can interact with some medications and provides a chart listing medications that grapefruit juice shouldn't be taken with.


washingtonpost.com: Grapefruit juice: Can it cause drug interactions? (MayoClinic.com)

January Payne: Here is the Mayo Clinic story that discusses grapefruit juice and drug interactions.


Washington, D.C.: What are your thoughts on the new study released showing the Advils and Tylenols may lead to heart disease?

January Payne: I think it's very interesting, and for those who haven't read the story, it's about the American Heart Association's new guidelines for doctors to use medications for chronic pain only as a last resort.

The past couple of years have brought much news about NSAIDs and Cox-2 inhibitor medications and if they could be harmful for those with heart disease or at risk for heart disease. These new recommendations signify action after a few years of speculation. It'll be interesting to see where it goes from here and what the reaction from patients and doctors will be. I definitely plan to watch it closely.


San Francisco: I think what's also important is to consider vitamins, herbs and supplements that could potentially interact with prescribed meds (including birth control). Physicians/pharmacists don't often think to ask us what vitamins we take everyday.

January Payne: Absolutely. This is very important and something that patients often don't think about. I discuss this in my story as well, and the sidebar lists a few resources for researching potential herbal interactions.


January Payne: Also, just to clarify and correct something from the question about the American Heart Association's new guidelines -- Those are mainly expressing concern about a class of drugs called NSAIDs (with the exception of aspirin) and a related class called COX-2 inhibitors. Acetaminophen (Tylenol) isn't in either one of those classes of drugs.


Fredrick, Md.: Patients should understand that taking certain antibiotics/long term can damage there immune systems and weaken there health. Taking several medications at a time with a compromised immune system, hormone fluctuations, illness from the flu- sinus- urinary- etc., can bring out several dangerous outcomes, i.e. the shingles in many different and sometime deadly forms. Doctors do not advise or speak about such warnings with patients -- there should be preventative information given to the patient regarding long-term use and combinations of medications prescribed. Patients should also take the time to call upon the physician and tell them about additional symptoms or any type of cold/virus experienced and what medications are safe and can be used together or long term.

January Payne: Thanks for your comment. I post this just to say that patients should always feel comfortable asking their doctors about the medications they're taking -- and what the possible short- and long-term consequences may be. All medications have possible side effects, though not everyone will experience them. Still, you should know what you're up against so that you and your doctor together can determine if the benefits outweigh the potential negatives.


Washington, D.C.: Presently I am taking an iron supplement, valtrex 500 mg on ocassion, etodolac 500 mg a day, and micardis 40 mg a day. Is it okay to take all of these in one day?

January Payne: The best thing for you to do is to ask your doctor and/or pharmacist if it's okay to take the medications and supplement together. I can't give you medical advice, so that is the best advice I can provide.

You can also attempt to plug in the supplement and medications you're taking into one of the online drug interaction tools that I list in the sidebar I wrote and linked to earlier.


Temple, Tex.: Comment: With today's advanced technology, there is no logical or legitimate reason for any pharmacist/patient not to be made aware of potential drug interactions before a prescription is filled. In fact, the technology to provide this service has been in place for domestic (U.S.) pharmacies for more than 20 years and for correlation between domestic pharmacies and credentialed international pharmacies for more than five years.

January Payne: Thanks for your comment. And yes, there are many tools available to consumers, doctors and pharmacists. For consumers, it can be a little tricky navigating which tools provide the most trustworthy information, however, so the best advice is always when in doubt (or even if you don't think you're in doubt), always consult your doctor and/or pharmacist.


Fairfax, Va.: I'm surprised that you don't recommend as first source the pharmacist. Although I have a lot of issues with my insurer I will say that their pharmacists are great -- if you have any questions they will talk at length with you, provide you with detailed information and even do some extra research (in my case they calculated a drug's half-life -- how long it stays in the body after you stop taking it.) Also in my case they were a lot more responsive than my loser doc who it turns out had prescribed a drug that causes birth defects even though I had adamantly told him that was my primary concern. The pharmacist was a Godsend.

January Payne: Thanks for sharing your experience with us. The story recommends talking with your doctor and/or pharmacist -- but the most important thing is that you consult someone in a position to give you a knowledgeable, expert opinion. Pharmacists are certainly in the position to do so.


Indianapolis: Regarding the AHA study's new recommendations for using NSAIDs as a second-tier therapy for chronic pain, I rather think that this may represent a total paradigm shift in treatment of any kind of condition. Namely that physicians and patients are being asked to use lifestyle change as the primary treatment, and go to medications when said change has not sufficiently affected the condition for which the patient is seeking treatment. We don't do that in general, I think. It seems the first line of treatment is to throw a pill at it...patients expect it, clinicians do it, and all the while we make half-hearted (no pun intended) attempts at the lifestyle changes that may do better for us in the long run. I'm curious whether anyone (clinicians or their patients) will follow these guidelines with any rigor...

January Payne: Thanks for sharing your thoughts with us. I agree that it will certainly be interesting to see what's done in practice on the heels of this new advice.


Washington, D.C.: Your drug interaction piece sparked a question: How does one environmentally dispose of leftover prescriptions? Having depression, I've tried a variety of meds to find the one that works, and those that didn't are merely sitting in near-full bottles in my cabinet.

I know there are many horrid things filling our landfills, but I'd like to minimize my contribution. What to do?

January Payne: This is a good question but it's not something I've researched/written about before, so I'm going to yield to another resource to answer your question. About.com has a Q&A on this topic that I'm linking to below.


washingtonpost.com: How To Safely Dispose of Unused Medications (about.com)

January Payne: Here is an About.com Q&A about disposing of old medicines.


Washington, D.C.: Since the late '90s, GSK's Wellbutrin (Bupropion) antidepressant was promoted and highly prescribed OFF-Label as an add-on to other anti-depressants, and in doing so, it became the number 1 prescribed antidepressant in psychiatry. What safety data is available on anti-depressant cocktails with Wellbutrin and other antidepressants?

January Payne: You can start by checking out the FDA's Web site to research individual data provided to the agency by the drug companies to get the drugs in question approved. Then I'd suggest you check out the links provided in the sidebar that I linked to at the top of this chat, including the drug interaction checkers, to find info on the specific mixture of medications you're curious about.


January Payne: Thanks for joining me, everyone. I enjoyed taking your questions. There are many online resources for researching medications (prescription & OTC) and supplements -- so those sites in combination with (and most importantly) talking with your doctor and/or pharmacist should provide you with plenty of info to ensure your combination of medications is safe.


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