Some drug combos can be lethal — (The Spokesman Review)

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The Spokesman Review

Joe Graedon and Teresa Graedon

April 10, 2007

Q. My mother was admitted to the hospital a few weeks ago for dehydration, acute bronchitis and pneumonia. During the admission, they checked her blood level of Coumadin [warfarin, a blood-thinner – Ed] and discovered that it was about 10 times higher than normal.

The doctors in the emergency room were shocked, as were Mom and I. The doctor said that had Mom fallen, she could have bled to death in a couple of minutes. The ambulance would never have arrived in time.

My mother was taking Cymbalta as well as Coumadin. The doctor who prescribed this new antidepressant for my mother didn’t know about this interaction. It is not listed in the prescribing information. Please warn others of this drug interaction, as it may save someone’s life.

A. Taking the wrong combination of medicines can be lethal. Thank you for alerting us to the potential danger of mixing the blood thinner Coumadin (warfarin) with the antidepressant Cymbalta.

Q. My doctor said that I should be taking an aspirin every day, but my pharmacist said that aspirin doesn’t protect women the way it does men. Who’s right, and what’s the best dose?

A. A new study of almost 80,000 women who were followed for more than 20 years suggests that women do indeed benefit from aspirin (Archives of Internal Medicine, March 26, 2007). The nurses who participated had a lower likelihood of dying of a heart attack if they took aspirin regularly for at least five years. After 10 years, they were also less likely to develop cancer.

Doses ranged anywhere from one to 14 standard aspirin tablets a week. Some experts have suggested that the optimal dose to protect against heart attacks is around 160 mg daily – half a regular tablet. No one should take aspirin daily without medical supervision, since it can damage the digestive tract and interact with other medications.

Q. I was diagnosed with “depression,” and for several years I took a series of different antidepressant drugs. The results were unsatisfactory, and I experienced many unpleasant side effects.

Then one year I was hospitalized for an unrelated medical problem. During the tests I was found to be suffering from severe hypothyroidism. I needed Synthroid, not Zoloft.

If any of your readers are being treated for depression and have not had a complete physical exam and a thyroid test, they should ask for this immediately.

A. People with underactive thyroid glands may experience a range of symptoms, including depression, apathy and fatigue, as well as weakness, anemia, high cholesterol or mental slowness. Treating such symptoms with an antidepressant instead of thyroid hormone could be counterproductive. Certain antidepressants (particularly lithium, but drugs such as Paxil or Zoloft in rare cases) have been associated with thyroid imbalances.

For more information on testing, interactions and therapy, we offer our Guide to Thyroid Hormones. We also discuss psychological issues related to hypothyroidism and creative treatment approaches in an hour-long radio interview with thyroid experts Mary Shomon and Ken Blanchard, M.D. Anyone who would like a CD and a guide may send $18 in check or money order with your address to: Graedons’ People’s Pharmacy, No. T-605, P.O. Box 52027, Durham, NC 27717-2027.