Mixing pills (prescription and over-the-counter)

[Taviterry]

A frequent query is about the effect of pills and how one might interact with another. The usual advice is to read the leaflet and check with one's pharmacist or GP. On occasion I've suggested that Googling and consulting authoritative websites should also be considered, as I wonder to what extent even a health professional can be aware of all the effects of countless combinations.

I've mentioned before how my heart surgeon and GP disagreed about whether I should take one product. It turned out that the GP was correct, but initially she prescribed something that every authority warned was not ideal. I've also recounted how one nutritionist friend has given me NINE sales talks for a popular supplement that I would need to be very careful with.

Ever since my heart op, I've spent a lot of time researching the interaction of pills, when to take them and when not to take them. I take two popular vitamins that seem to be safe and a supplement (now on prescription) that can lead to problems.

I've just bought a very popular vitamin which, my research suggested, seems to be the only supplement that might alleviate one condition. I Googled again, and this time found that it could give a false low reading in a very specific blood test.

I've almost got to the stage of drawing up a chart to list all the possibilities!

At the risk of appearing immodest, I have decades of experience to an academic level of researching facts - and fallacies - and analysing their veracity , though not in a medical context.

It's all very confusing ... 😮‍💨

[BeKind28-]

Hello

I can see you like researching things personally I find that confuses me even more when I do as you do get conflicting answers plus I am not medically trained so I do and would always advise to stick with what your Doctor or pharmacist says just the way I see it as they have spent years training and are qualified unlike someone like me that is not medically trained and can only share my experiences

Maybe researching to much is making you even more confused but everyone should talk to a professional before they start to draw up their own plan even if now and again the professionals disagree with each other and one is right and one is wrong but it is still their job x

[Happyrosie]

and indeed, Taviterry, what is a side effect for you when combining x with y might not be a side effect for me! So many variables.

My solution - such as it is - is to talk to one of the pharmacists employed by my doc’s group of surgeries.

[Nelson71]

listen to your GP and pharmacist, they’ve spent years learning all this stuff and the background data so you don’t have to. Although it’s nice to have this information at your fingertips sometimes a little knowledge can be very dangerous

[Granthamgeezer]

Hi Taviterry. Personally I go by how I feel regards my medication. 2 hours after taking a new prescription I felt like I was going to die so I stopped them immediately. Whether they were interacting with another medocation I was on or not I don't know. We are all different and I believe it's a case of trial and error and see how you feel on certain meds whatever the so called experts suggest.

[Taviterry]

But what if two medical professionals disagree, as did my surgeon and GP? The former was twice adamant that I did not need an antacid (often prescribed to counteract the effects of Clopidogrel), the GP was adamant that I did - and prescribed Omeprazole! Google the two together, as I did, for universal warnings against mixing them. At the same time I was resisting hard-sell talks from a nutritionist friend to take Omega 3. My GP's pharmacist agreed with me that I shouldn't, but urged that I take an antacid, with my GP then offering me a choice of Omeprazaole or Lansoprazole and eventually issuing a prescription for the latter. I didn't take the pills for several weeks, but within a few days of doing so my stomach discomfort all but vanished.

At the time I was having a deep massage very week, until alerted about the risks by this forum. I shudder a little when I think what might have happened had I been taking Omeprazole and Omega 3 at that time ...

Forty years ago, a terrible GP prescribed some pills that made me feel worse. (No information leaflets in those days!) A consultant immediately changed them. And when my dad went into hospital on a regime of eight different pills, the consultant there winced and immediately changed two of them.

[Ringoutwildbells in reply to Taviterry]

A little while ago I was non-exec (unpaid!) on the local Health Trust Finance and Performance board sub committee. The Trust ran many projects designed to improve performance/effectiveness and patient experience. One was a project to assess the impact of medication. It found that over 50% of elderly patients were in hospital because of medication problems; either they were on wrong meds (or didn’t need them), the dose wasn’t correct, they reacted with their other meds or were prescribed by GPs incorrectly.

They found that over 50% of elderly patients were in hospital because of problems with meds. Even 30% of younger patients were in hospital for same reason.

This was brought home to me at a recent appointment with my liver consultant. I have several serious health conditions and so take 13 or more tablets a day. She asked when I took my meds. Whilst taking all my meds, I hadn’t been as careful with when I took them. She gave my husband and I a list of when to take meds (1/2 hour before any food, some before 8pm, some with/without food etc). I now get the full effect of my meds by taking them correctly.

[Taviterry]

Post-TAVI I wrote down a few notes on a sheet of paper the best times to take the various pills, but that soon disappeared. Now I'm word-processing a document listing them all, best time to take, interactions etc.

[Taviterry]

Just to add to my confusion: recent blood tests produced some results that were slightly outside the recommended thresholds and one that was double it, for lactose dehydrogenase (LDH or lactic acid), leading me to yet more research on which foods and supplements to take and to avoid. Frustratingly, some of those I've been favouring do not help with LDH and some of those that might should not be taken with Clopidogrel! One of the latter is Magnesium, yet taking a PPI such as Omeprazole can deplete Magnesium levels (and indeed can slightly reduce the effectiveness of Clopidogrel), and supplementation may be desirable after a year or so!

At least drinking plenty of water is safe for everything.

(Disclaimer: the assumptions above are entirely mine, based on checking a number of authoritative websites.)

[scentedgardener]

It's a minefield, especially when you add in people like me who have the oddest reactions to things like a change of brand.Currently I'm on one medication for a problem that appears to be doing the opposite of what it is intended for, and has a knock on effect on my heart issues. I have an appointment to discuss this with my GP, and will pass on the relevant info. This medication is also contraindicated with 2 of my heart meds, so do I assume they've noted that and consider the benefits outweigh the risks?

I always consult with a doctor and/or a pharmacist because although I know my body best I don't have the knowledge or experience of the drugs.

[Ringoutwildbells in reply to scentedgardener]

Always check and talk to your GP or pharmacy.

[Taviterry in reply to Ringoutwildbells]

I suspect that a GP or pharmacist would be hard-pressed to advise on many of the countless permutations of food, medication, supplements and conditions. And, following my GP's prescribing Omeprazole with Clopidogrel, my confidence in her is limited.

[scentedgardener in reply to Taviterry]

I know what you mean. After first heart issues I was required to take 75 mg aspirin daily, much against my will as it means I bleed like a stuck pig, and have spectacular nosebleeds. After a week I was back in A&E, this time they prescribed clopidogrel as well. A few days later that was changed to rivaroxaban, and despite telling them all the medication I was taking they only looked at the prescribed stuff, and omitted to tell me to discontinue the aspirin.

[scentedgardener in reply to Ringoutwildbells]

As I said I always do.

[Taviterry]

Another factor are the strengths of the medication and supplements, and I suspect my GP won't take too kindly to my suggesting that I have lower doses of statins etc to see how I get on. I've just discovered that sodium bicarbonate can help with LDH, and that counts as an antacid, raising the question in my mind about how much Lansoprazole I need to take as well.