Drug interactions/conflicts

[quanglewangle]

Hi everyone

I am Coeliac and also have Essential Thrombocythemia for which I take Hydroxycarbamide. Amongst the many side effects from HC my regular blood tests have shown me to be borderline anaemic and my regular GP has monitored this for years - checking kidney & liver function, and also on Folate & B12 levels.

I visited my GP surgery today and saw a locum about Rosacea expecting to be switched from a wrongly prescribed Rozex Gel and he prescribed oxytetracycline.

Looking at my bloods he announced that I should take Ferrous Fumarate because of the anaemia.

I am convinced that at some point I had read/heard that ferrous fumarate was contra-indicated for me and the EMC states "Absorption of both iron and antibiotic may be reduced if Fersamal (Ferrous Fumarate) is given with tetracycline."

I also take Edoxaban, Bisoprolol, Diclofenac, Finasteride and Omeprazole.

So should I take either or both of these medications ?

[hunter5582]

You are correct that anemia is a potential adverse effect from hydroxycarbamide. Your care team should also be monitoring your iron levels. Note that iron deficiency and anemia are not the same thing. The question of whether iron supplements are appropriate in your case is not a question for a GP. Many doctors are unfamiliar with the needs of MPN patients. This is something to review with a MPN Specialist.

Regarding your medication, here is the list of potential interactions from ePocrates. Note that the presence of a potential interaction does not mean these drugs cannot be taken together. It does mean that doses may need to be modified and that there are things to monitor for. This is an issue that should be reviewed with your care team. Your pharmacist can also be very helpful regarding drug interactions.

Monitor/Modify Tx - bisoprolol + diclofenac monitor BP: combo may decr. antihypertensive agent efficacy (antagonistic effects)

Monitor/Modify Tx - bisoprolol + edoxaban monitor bleeding s/sx; decr. edoxaban dose to 30 mg/day in DVT/PE pts; no dose adjustment recommended in atrial fibrillation pts: combo may incr. edoxaban levels, risk of bleeding, other adverse effects (P-gp-mediated transport inhibited)

Monitor/Modify Tx - diclofenac + edoxaban monitor bleeding s/sx: combo may incr. risk of GI or other bleeding, incl. life-threatening (additive effects)

Note that diclofenac comes in both oral and topical. It makes a difference in adverse effect risk.

online.epocrates.com/intera...

None of us are competent to advise you whether you should take any of these medications singly or in combination. That is an issue to review with your care team. It is reasonable to have concerns. Suggest making a specific list of concerns and questions to your providers and review them in detail.

All the best.

[Joetcalr]

Can I suggest going to see your local pharmacist, their training is very focused on drugs and drug interactions, And certainly much easier to get to see them than the GP

[MAP44]

Hi

If you have not visited with an MPN specialist you need to make an appointment. Sadly when reading these questions and answers many GP’s know how to help many MPN patients but most don’t have any idea. I am not familiar with these meds so can only advise you to seek help so you are well taken care of. 🍻

[Mazcd Partner MPNVoice]

hi quanglewangle, your local pharmacist will be able to advise you on any contra-indications with medicines you are taking, if you take a list of them, or take the boxes with you then the pharmacist will advise you. Best wishes, Maz

[PhysAssist]

I agree with Hunter and MAP44, that an MPN ought to be at least onboard to oversee your care, despite your long history of success w/ your GP- especially if an unvetted temporary provider is covering his service, so that your GP's not seeing you themself.

Here is a list of recognized MPN specialists:

mpnforum.com/list-hem./

It's where I found my Heme/Onc MD's listing.

Best,

PA