Top 9 Ways to Prevent a Deadly Drug Interaction

You should not be afraid to take your medications because of the possibility of drug interactions. Drug interactions can be intimidating for anyone who regularly takes prescription medications, but you can learn how to manage and prevent them.

Drugs with a narrow therapeutic index (that is, having little difference between toxic and therapeutic doses), and certain disease states like epilepsy or depression are especially prone to serious drug interactions. In addition, multiple interactions may occur when someone is taking several drugs, as is often the case with older patients.

While most interactions are usually not life-threatening, some mixtures of medications can lead to serious — and even fatal — consequences. Pharmacists and doctors are well-trained to review and predict drug interactions. You can also use online tools to help gauge the risk.

Education and communication is key. You should consult with your health care providers, research reliable drug information, and empower yourself to lower the risk of interactions and maximize your medical treatments. Here are nine tips to achieve that goal.

1. Communicate frequently
Tell your pharmacist each time you start or stop a medication, including any over-the-counter (OTC) drug, herbal supplement, or vitamin. Keep an updated list of meds, including nonprescription drugs — and share with your health care providers, including your dentist, anytime you start or stop a medication.

Prescription drugs are not the only medicines that can interact. Non-prescription drugs can have serious consequences, too. For example, the herbal St. John’s Wort is commonly used as an OTC supplement for depression. If combined with other antidepressants such as the SSRIs like fluoxetine (Prozac) or sertraline (Zoloft), the risk of a rare but serious and potentially fatal condition called serotonin syndrome can occur, with symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, and even death.

Read your Medication Guide each time you get a new prescription or refill. The FDA updates prescription drug labels frequently, and there could be changes in your Medication Guide. Review your possible interactions and ask questions if you are concerned or don’t quite understand the medical jargon.

If you discover that you are at risk for an interaction, call your doctor. It may be that the interaction is minor, and no action is needed. On the other hand, you may need to avoid the drug or have an alternative medicine prescribed. NEVER stop a medication without first speaking to your doctor.

2. Research your meds yourself.
Use a reliable online drug interaction tool like the Interaction Checker to become engaged in your health and learn about your medications. If you need help understanding the information, be sure to call your pharmacist. Always check for drug interactions even when you purchase OTC medications, herbal supplements or vitamins.

The Drug Interaction Checker explains the mechanism of each drug interaction, the level of significance of the interaction (major, moderate or minor), and in certain cases, can provide the recommended course of action to manage the interaction. The Drug Interaction Checker will also display any interactions between your chosen drug(s), food or beverages, and even other diseases.

To see all possible drug interactions, just enter one drug name and select “check for interactions.” Information is provided for all interactions at both the consumer and professional level.

3. Keep all of your prescriptions at one pharmacy
By keeping all of your prescriptions at one pharmacy, a regular drug review and drug interaction screen can be done electronically that incorporates all of your medicines. Talk with your pharmacist and doctor and communicate new and discontinued medications with all of your health care providers. Communication is key to preventing drug interactions.

When you buy OTCs or herbal supplements, ask your pharmacist to double check for interactions and ask if  they can add the agent to your regular drug profile for future drug interaction checks. If your pharmacist does not know that you are taking OTC products, they can’t check for drug interactions with prescription medication. Be sure to read the Drug Facts label on each OTC product you use, too.

4. Take any food and beverage drug interactions seriously
Your pharmacist or doctor may ask about specific foods or drinks you consume dependent upon which drugs you take. Common food items involved in drug interactions include foods rich in vitamin K, which can interact with blood thinners and make them less effective, possibly leading to a clot. Certain tropical juices are notorious for changing blood levels of some drugs, too.

Calcium can bind with some drugs and prevent absorption.
For example, if you take the blood thinner warfarin, increasing vitamin K levels in the body can increase clotting and reduce the effectiveness of warfarin, which could result in a stroke. Foods rich in vitamin K include beef liver, broccoli, brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and several other foods. While there is no need to avoid products that contain vitamin K, you should maintain a consistent level of consumption of these products.

Grapefruit or grapefruit juice consumption can also result in drug interactions that may increase the level of the medicine in your blood, possibly causing drug toxicity. For example, blood levels of some cholesterol drugs known as statins — for example, atorvastatin, lovastatin, or simvastatin —  can be affected by drinking grapefruit juice, and lead to severe muscle injury known as rhabdomyolysis. Not all medicines contained in a class of drugs like the statins may lead to the interaction, so your doctor will be able to prescribe another drug. Cranberry juice, orange juice, and even garlic can lead to interactions with drugs, too.

5. Tell your doctor about your caffeine use, alcohol consumption and use of illicit drugs
Socially-used drugs can have an especially harsh effect with other drugs. For example, some asthma drugs like the beta-2 agonist albuterol (Proventil HFA, Ventolin HFA) can have a stimulant effect, and if combined with caffeine, can interfere with sleep or lead to a rapid heart rate, which can be dangerous in people woth heart disease. The stimulant effect from caffeine can be additive to stimulation from decongestants, too.

Alcohol can worsen drowsiness, especially when mixed with other drugs that cause sedation, which may put you at a higher risk for a fall or a car accident. Alcohol should never be combined with opioid painkillers or anxiety medications like benzodiazepines. Life-threatening respiratory depression can occur.

A particularly concerning, yet often unknown interaction between alcohol and cocaine has been reported. The National Institute on Drug Abuse (NIDA) has found that the human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, that intensifies cocaine’s euphoric effects but may increase the risk of sudden death. According to the NIDA, this drug-drug interaction, between cocaine and alcohol, is the most common two-drug combination that results in drug-related deaths.

Illicit drugs combined with other illicit drugs can be particularly dangerous. Combining heroin and cocaine into one syringe, often called a “speedball”, is a mixture that is used by some injecting drug users, often with fatal results.

6. Don’t take a medication prescribed for someone else
Medications are prescribed specifically for an individual person, often based on their age, weight, and specific type of medical condition. In addition, when you take medications that are not prescribed for you, there is no health care provider involved to review for potential interactions or safety based on your medical conditions.

For example, taking someone else’s antibiotic for a sore throat might not only lead to a possible drug interaction, it might worsen your infection. The antibiotic might not be the appropriate drug to treat the bacterial strain, and you probably won’t have a full course of antibiotic which can result in antibiotic resistance and failed treatment.

7. Follow all dosing recommendations on your prescription bottle
Your prescription bottle will have specific directions for taking your medicine. For example, you may need to space the timing of when you take your medications. Some drug interactions involve binding of one drug to the other in the stomach. Antacids are commonly linked to this type of interaction. Your pharmacist will put a sticker on the your bottle to warn you of this interaction. To avoid the interaction you may space the timing of your doses, taking each drug 2 hours before or 4 hours after the other drug.

Antacids can also raise the pH in your stomach, and may result in an early dissolution of enteric coatings — for example, enteric-coated aspirin or ibuprofen — which should normally dissolve in the intestine. This could lead to severe stomach bleeding or lowered absorption of the drug. Your pharmacist will provide specific instructions.

DO NOT change the dose of your medication unless approved by your doctor. If your warning sticker suggests that you avoid a drug, or a certain class of drugs altogether, be sure to follow these instructions. Many patients that take blood thinners like warfarin need to avoid over-the-counter and prescription drugs that may increase the risk of bleeding; for example, NSAIDs (ibuprofen, naproxen) or aspirin.

8. Be sure your health care providers know all of your medical diagnoses to help avoid drug-disease interactions
In people who have high blood pressure, OTC oral decongestants like pseudoephedrine (Sudafed) or phenylephrine (Sudafed PE) may increase blood pressure, even if their blood pressure is controlled with a medication. People with uncontrolled or severe high blood pressure need to avoid these medications.
Another common example of a disease-drug interaction is the use of the antihistamine diphenhydramine (Benadryl) in patients with certain types of glaucoma known as acute angle-closure (narrow-angle) glaucoma. For example, diphenhydramine can exhibit anticholinergic effects which can dilate the pupil and provoke angle closure in people with narrow angles. Antihistamines should be avoided in people with angle-closure glaucoma or only used under the supervision of a physician.

9. Do NOT buy drugs from online pharmacies
While it may be a tempting way to save money on medications, buying medications — prescription or OTC — from foreign countries or from unreliable websites on the Internet can be costly to your health. According to the U.S. Food and Drug Administration “the safety and effectiveness of imported drugs have not been reviewed by the FDA, and their identity and potency can’t be assured.” You could receive the wrong drug, the wrong strength, or even outdated, expired medications. If you are not sure what’s in your medication, you can’t run a reliable drug interaction check to look for any serious problems.