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What is a drug-drug interaction?
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Drug-drug interactions occur when a drug interacts,
or interferes, with another drug. This can alter the
way one or both of the drugs act in the body, or cause
unexpected side effects. The drugs involved can be prescription
medications, over-the-counter medicines and even vitamins
and herbal products.
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Are all drug-drug interactions
the same?
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Not all drug-drug interactions are equal. Sometimes
when two drugs interact, the overall effect of one or
both of the drugs may be greater than desired. For example,
both aspirin and blood-thinners like warfarin Coumadin
- used to protect against heart attack - help to prevent
blood clots from forming. Using these medications together,
however, may cause excessive bleeding.
Other times, the overall effect of one or both of the
drugs may be less than desired. For example, certain
antacids can prevent many medicines (such as antibiotics,
blood- thinners and heart medications) from being absorbed
into the blood stream. If this happens, the medicine
may not work as well - or may not work at all.
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What are some of the most
common symptoms of a drug-drug interaction?
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The worst feared is a potentially deadly drug-drug
interaction, such as one which results in a dangerous
drop in blood pressure, a fast-paced, irregular heart
beat, a buildup of toxins that damage the heart or liver,
etc. However, most drug-drug interactions are considerably
less severe.
Some of the more common symptoms of drug-drug interactions
include nausea or stomach upset, headache, heartburn
and dizziness. However, if you experience any reaction
- after taking prescription or over-the-counter medicine
- that seems out of the ordinary, you should consult
your local pharmacist and make him or her aware of all
of the medicines you're taking. In the case of a serious
reaction, you should not hesitate to seek medical treatment.
Drug-drug interactions can have serious consequences.
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Are drug-drug interactions
limited to prescription medications?
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No. A common misperception is that only prescription
medications have the potential to interact with each
other. The truth is, over-the-counter medicines also
may result in drug-drug interactions when combined with
prescription medications or with other over-the-counter
medicines, vitamins or herbal products. When taken as
directed, over-the-counter medications are safe, cost-efficient
and convenient.
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What can I do to help avoid
a drug-drug interaction?
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There are four key things to remember in avoiding drug-drug
interactions:
First, thoroughly read the labels of all over-the-counter
and prescription medicines. Without reading the label,
you may be taking the incorrect dosage or overlooking
potential side effects.
Second, make sure you know the benefits as well as
the potential risks of both prescription and over-the-counter
medications you are taking. Look specifically for the
section called "Warnings" on the labels of
over-the-counter medicines.
Third, talk to your doctor or pharmacist before taking
any new medication - prescription or over-the-counter.
Ask whether it is safe to take the new medicine with
other over-the-counter medicines, prescription medications,
vitamins or herbal products you are already taking -
regularly or even occasionally. Also, keep a record
listing both your over-the-counter and prescription
drugs and share it with your doctors and your pharmacist.
Finally, use one pharmacy for all of your family's
prescription and over-the-counter medication needs.
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How serious can a drug-drug
interaction become? What factors can increase the chances
of one occurring?
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Again, the worst feared is a potentially deadly drug-drug
interaction, however, such occurrences are rare. Even
drug interactions that aren't life-threatening, however,
can decrease one or both drugs' effectiveness - resulting
in insufficient therapy, sometimes creating unnecessary
costs and complications.
Some people are at increased risk for significant -
and sometimes serious - drug interactions involving
over-the-counter medications. These groups include patients
with chronic medical conditions, such as diabetes, heart
disease or high blood pressure. Elderly patients - 75%
of whom take prescription drugs and 82% of whom use
over-the-counter products regularly - are at greater
risk because they are combining more medications than
the younger individuals.
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What are some of the worst/most dangerous drug-drug
interactions involving over-the-counter medications?
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Combining aspirin with blood-thinners like warfarin
(Coumadin) can lead to excessive bleeding. Certain antacids
may prevent many medications, like antibiotics, blood-thinners
and heart medications from being absorbed into the blood
as they should. This may cause the medication to be
less effective or not work at all. Decongestants, which
are found in many cold remedies, may cause harmful increases
in blood pressure for people taking anti-hypertension
medications or MAO inhibitors, a type of antidepressant.
While these are just a handful of examples, there are
many potential drug-drug interactions involving over-the-counter
medicines. And, as over-the-counter drug use grows -
as more become available on the market - the potential
for drug interactions involving them only increases.
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Can vitamins or herbal remedies
interact with an over-the-counter or prescription medication?
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The worst feared is a potentially deadly drug-drug
interaction, such as one which results in a dangerous
drop in blood pressure, a fast-paced, irregular heart
beat, a buildup of toxins that damage the heart or liver,
etc. However, most drug-drug interactions are considerably
less severe.
Some of the more common symptoms of drug-drug interactions
include nausea or stomach upset, headache, heartburn
and dizziness. However, if you experience any reaction
- after taking prescription or over-the-counter medicine
- that seems out of the ordinary, you should consult
your local pharmacist and make him or her aware of all
of the medicines you're taking. In the case of a serious
reaction, you should not hesitate to seek medical treatment.
Drug-drug interactions can have serious consequences.
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Are drug-drug interactions
limited to prescription medications?
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Herbal supplements, which have grown significantly
in availability and popularity in recent years, can
add to the risk of drug-drug interactions. No one knows
precisely how many Americans regularly use herbal products,
and they are not subject to the same requirements as
over-the-counter medications. However, some of the popular
remedies appear to interact with both prescription and
over-the-counter drugs.
For example, ginkgo - which inhibits blood clotting
- may cause trouble if it's taken with anticoagulants
or blood-thinners, such as warfarin (Coumadin). Kava
kava - a popular herbal taken to reduce stress - may
have
additive effects if taken with muscle relaxants, sedatives
or antidepressants.
Vitamins and minerals also have the potential to interact
with medications you're taking. For example, ferrous
sulfate - essentially iron - can negate the effects
of tetracycline, a commonly used antibiotic.
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Do certain foods have the
potential to interact with over-the-counter medications?
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Yes, certain foods and beverages can interact with
medicines - potentially making them less effective or
causing side effects. Changes in a medicine's effect
due to an interaction can be significant, however, there
are many individual factors that influence the potential
for variations, such as dosage, age, weight, sex and
overall health.
Calcium-rich dairy products (such as milk, cheese and
ice cream), antacids and vitamins containing iron can
all lessen the effectiveness of antibiotics, particularly
tetracycline. Mixing any of these with a prescription
antibiotic can cause a much slower absorption rate of
the antibiotic into the blood stream/body, causing it
to have a decreased effect.
Grapefruit juice blocks enzymes that normally metabolize
certain drugs, leaving more of the compounds to be absorbed
and thus increasing blood levels of the medications.
For example, grapefruit juice should not be taken with
certain blood pressure-lowering medications, the antihistamine
terfenadine and cyclosporine, a drug taken to prevent
organ transplant rejection.
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