More hidden dangers!
Wednesday, 5 May 2010.
Originally from express article 5 May 2010
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| Diana Rands from CADS. |
In my last column I wrote about the perils of mixing recreational drugs with each other, but what about prescribed drugs? What are the combinations that could really mess with you?
For anyone who is on serotonin reuptake inhibitors like SSRIs anti-depressant medications (e.g. Prozac, Citalopram, Zoloft, Paxil) and SNRI’s (e.g. venlafaxine), TCAs (tricyclic antidepressants e.g. amitriptyline, dothiepin) or MAOIs (e.g. Nardil, Parnate) the term you need to be familiar with is Serotonin Syndrome.
SSRI’s and SNRI’s, block the reuptake of serotonin in the brain and MAOIs inhibit the breakdown of serotonin. The combination of MAOIs and SSRIs can lead to dangerously high levels of serotonin in the brain, which can be potentially fatal.
Symptoms of Serotonin Syndrome may include restlessness, hallucinations, blackouts, memory loss, loss of coordination, fast heart beat, rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea.
It does not stop there however! Other substances that can trigger the syndrome if taken in conjunction with an SSRI, SNRI or a MAOI are:
- Narcotic painkillers – e.g. fentanyl and tramadol
- Cold remedies that contain dextomethoorphan
- Migraine medication containing triptans
- Anti-nausea drugs
- Dietry supplements – tryptophan
- Diet drugs - like phentermine, fenfluramine (Redux),
- Non-drowsy antihistamines (allergy medicines) like Allegra, Seldane, or Hisminal.
- St Johns Wort
- Ginseng
- Ecstasy
- LSD
- Amphetamines
- Cocaine
- Anti-psychotic drugs prescribed for depression
The other substance that does not mix well with prescription drugs is alcohol. Drinking to excess can reduces the effect of antibiotics. Mixing these two can also result in nausea, vomiting and headaches.
Some antibiotics must not be used with any amount of alcohol (as they react with them), such as:
- Metronidazole
- Tinidazole
- Furazolidone (Furoxone)
- Griseofulvin (Grisactin)
- Antimalarial Quinacrine (Atabrine)
Alcohol is a depressant, so of course drinking in excess often results in depressed mood. Mixing alcohol and antidepressants increases the sedative effects of the antidepressants, and in some cases can result in a dangerous rise in blood pressure. It can also make you more intoxicated than usual and increase the side effects of your medication i.e. drowsiness.
Mixing alcohol with antihistamines (e.g phenergan) can also increase the sedative effects, causing slower reaction times and poor judgement. With antipsychotic drugs, once again alcohol increases the sedative effects and can result in poor judgement, impaired coordination and dizziness.
Benzodiazepines are also sedative drugs (e.g. diazepam, lorazepam, clonazepam) and even if they are prescribed for you, they may cause trouble if combined with other depressant drugs like alcohol and/or GHB.
It is also important to be aware of the possible damage to your liver from mixing alcohol with medications – some combinations may affect your livers ability to metabolise the medication (leading to dangerously high levels in your system) and it can decrease the medications’ effectiveness. If in doubt, ask your health professional about how much it is safe to drink or what is safe to use with your prescribed medication
GHB is another one that is not a good mixer – it is an extremely potent depressant and if mixed with other depressants, there can be fatal consequences! This is especially true for benozodiazepines (e.g. Valium, Lorazepam), phenothiazines (e.g. Stellazine), painkillers that contain opiates (e.g. Tramadol, Codeine), and anti-convulsants (e.g. Dilantin and Phenobarbital).
For those in our community on antiretroviral therapy, it is best to avoid the combination of ecstasy or GHB with ritonavir or other potent CYP2D6 inhibitors. Some recreational drugs have been known to increase the proliferation of the virus in your body.
Hopefully all the above information will be supplied when you receive your prescription (unless you did not have a prescription). It is important to read and understand all information fully – and be honest and open with your doctor or pharmacist. And if you still have questions, don't be afraid to ask! They are there to answer all your questions about possible drug interactions.
If you have concerns about your own or someone else's alcohol or other drug use contact CADS on 8451818 to discuss this or you can call in to any CADS unit without appointment any weekday morning between 10am and 1pm and see someone face to face. Or visit our website www.cads.org.nz. If you live outside Auckland contact the Alcohol and Drug Helpline 0800 787 797.
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