Can anyone help me make sense of this ?

[clairedcat]

Does anyone know where I can get accurate info regarding how medications interact with each other.

 

Bit of a long story, will try to keep it brief !

 

My partners grandma is 69 yrs old and has suffered severe mental health problems for the last 20yrs.

 

She has been diagnosed with alsorts over the years, schizophenia, severe depression, paranoia, bi-polar

 

and every sort of mania you can imagine. Some of these have been undiagnosed, then diagnosed again.

 

(No wonder the poor woman is suffering !)

 

During this time, the vast amount of medication she's been prescribed has been increased, decreased,

 

halved, doubled, stopped, restarted, well you get the picture.

 

My partner and I have recently started looking after her and her quality of life is appalling. She is taking

 

quite a lot of very strong tablets and seems to suffer every possible side effect to extreme proportion, as

 

well as still having the symtoms these tablets suppose to help with.

 

To be fair though, whenever asked by medical staff she says she's ''fine''.

 

Having said that, she has a CPN and various other people who help her at home, who have witnessed

 

the way she behaves, but all they say is they dont know what more they can do, and put it down to her

 

medication.

 

We have arranged an appointment with the consultant for a medication review. In the meantime ive

 

tried researching her medication. Some websites say that one drug shouldnt be given with another and

 

other websites say the opposite etc etc, it's so confusing.

 

I dont want to go in and tell the doc how to do her job, I just want some decent background knowledge

 

of what these drugs taken together are doing to her (if anything)

 

Most people wouldnt even let an animal suffer the way she does. Im also keeping a diary of symtoms

 

and possible side effects. Medically she also suffers from Angina, high blood pressure, high cholestrol

 

and acid reflux, oh and a bad back.

 

The tablets she takes are :-

 

Adalat (nifededipine) - one 30mg tablet once a day and one 60mg tablet once a day.

 

Trazadone - 100mg at night.

 

Ramipril - 5mg once a day.

 

Chlorpromazine - one 50mg tablet twice a day and one 25mg tablet twice a day.

 

Simvastatin - 40mgs at night

 

Atenolol - 50mgs once a day.

 

Lanzsoprazole - 30mgs once a day.

 

Olanzapine (zyprexia) - two 10mg tablets at night.

 

Venlafaxine (Rodomel & alventa) - 150mg once a day

 

Asprin - 75mg daily

 

Paracetamol - two 500mg tablets 4 times a day.

 

Tramadol - 50mgs 4 times a day.

 

I dont know what else to do other than take her to the consultant. If anyone knows where I can get

 

more info one how the tablets interact, or even advice in general how to handle this situation id be very

 

grateful

[BankFodder]

There seems to be a lot of websites which offer this kind of thing - for instance http://www.drugs.com/drug_interactions.html

[yorklass2009]

You could buy yourself a bnf which is the British nursing formulary as I used to be a student nurse I have one but it is a few years out of date. You can acquire a copy from whsmiths to have a look but an expert opinion is probably the sensible option without causing you offence. Hope that helps

[Conniff]

I dont want to go in and tell the doc how to do her job, I just want some decent background knowledge

 

of what these drugs taken together are doing to her (if anything)

 

It won't be telling her how to do her job by voicing concern for ther health. All you have to say is that she isn't very well and as the drugs have increased over the years, you were wondering if there was any that are reacting with another that is making her as she is.

[clairedcat]

thankyou bankfodder and yorklass, youve both been really helpful, will check out both suggestions. Total nightmare really, my partner was under the impression his

 

grandma was been well looked after by his mum and everything was under control, turns out it's progessively got worse and his mum's ''few drinks at the end of the

 

day'' turned into few at beginning, middle and end. But im sure she'll not be first or last to buckle under the strain. Let's just hope we can get his grandma's long term

 

care sorted. the medication just seems to be tip of iceburg. I hazard a guess this may well be just the start. I really apprieciate both replies so far, but any advice on

 

how to access any services to help would be welcomed. I really am a bit naive with this. Thanks again !

[clairedcat]

thanks conniff, Just reading what youve said is giving me confidence to try and sort it.

[**Tilly**]

Hi

 

You've taken the first step,getting your Grandma's meds reviewed..have a look at the link below it explains the services

available,have a word with the Doctor he should help to get the ball rolling for you.Good luck x

 

Health and Social Care

[watchinginvestigation2011]

Thats why I stopped the mental health medication some years ago for me when realised it was not recomended with my epilepsy meds. Have found it hard to trust what given since then so hoping when put on new meds they will check it is safe for me. Must admit though it is amazing when you read the side effects of some meds to help a conditon, some of the side effects seem to contradict the benefits as in even down to an asthma med, it can effect asthmatics on the negative in some cases, suppose they have to cover their backs xx

 

Good to hear you are looking in to the issue proactive for your family member, hope you get it sorted and feel confident you have done all you can, you appear to me a very caring person, good on you for that xx

[leemack]

Statins have been shown to have no benefit at all to mortality in women, are known to cause memory and neurological deficits in the elderly and lower cholesterol has been found to be associated with a higher risk of stroke, and statins with damage to heart muscle. Find out what her total cholesterol is - it may be it isn't that high. What is considered high cholesterol has been consistently lowered with no scientific basis whatsoever. This may be one drug she can get rid of.

 

http://www.spacedoc.com/women_statins.htm

 

 

http://www.greenmedinfo.com/toxic-article/statin-therapy-decreases-myocardial-heart-function

 

 

http://www.second-opinions.co.uk/statins-adverse-effects-reports.html

 

http://www.second-opinions.co.uk/statins-[problem].html

 

Also, does she really need the paracetemol - she's on a much stronger painkiller, and that's a lot of load on her liver - if at all possible she shouldn't be taking paracetemol long term.

 

Also what does she eat? Malnutrition is very common in older persons and it can be that they are missing certain vitamins, minerals and macronutrients or having these things robbed by an overly processed diet. Also reactions to gluten can cause neurological and mental health issues. This is a great blog on mental health issues and gluten. Unfortunately, GP's only firefight and most of the time don't look to the possible underlying causes of things in diet, lifestyle and environment

 

http://evolutionarypsychiatry.blogspot.com/2010/09/woe-is-wheat.html

 

http://evolutionarypsychiatry.blogspot.com/2011/02/more-on-wheat-and-serious-mental.html

 

Be aware that GP's are often resistant to the removal of medications - and are not up to date on the most current research.

[Nystagmite]

I'm sure your local chemist can give advice. There is something called yellow card (I think) which is a website. You can report any side effects which aren't listed in leaflet you get with the medication.

 

Must admit though it is amazing when you read the side effects of some meds to help a conditon, some of the side effects seem to contradict the benefits

 

Indeed. I was given some medication for a mild allergic reaction. One side effect was "may cause a rash" - exactly the thing I wanted to get rid of!

[zippygbr]

Also, does she really need the paracetemol - she's on a much stronger painkiller, and that's a lot of load on her liver - if at all possible she shouldn't be taking paracetemol long term.

 

WHO analgesic ladder ?

 

if anything i'd be looking at reducing / removing the tramadol

 

what is clear is that the lady needs a comprehensive medication review

 

also as Nystagmite points out the lists of side effects are very hard to actually make sense of as sometimes changing symptoms of the problem the medication is being taken for are attributed as side effects of the medication ...

 

beware some of the stuff aobut 'food intolerances' etc becasue it's often from people like 'that awful poo women' Ms McKeith ...

[leemack]

WHO analgesic ladder ?

 

if anything i'd be looking at reducing / removing the tramadol

 

 

Surely this depends on the level of pain and what alternative pain relief is an option. Just because someone needs a stronger painkiller, doesn't mean they still need to take the weaker analgesic as well, and she still may need a strong pankiller. Though I agree that tramadol has significant side effects and would be interested in what was tried in between tramadol and paracetemol, and whether any non pharmacological alternatives had been tried.

 

Just to add on a different point. A work colleague's grandmother had been said to be close to death, she was admitted to hospital and an enlightened doctor took her off all the medications - she recovered so quickly it made the family's heads spin.

[zippygbr]

Surely this depends on the level of pain and what alternative pain relief is an option. Just because someone needs a stronger painkiller, doesn't mean they still need to take the weaker analgesic as well, and she still may need a strong pankiller. Though I agree that tramadol has significant side effects and would be interested in what was tried in between tramadol and paracetemol, and whether any non pharmacological alternatives had been tried.

 

Just to add on a different point. A work colleague's grandmother had been said to be close to death, she was admitted to hospital and an enlightened doctor took her off all the medications - she recovered so quickly it made the family's heads spin.

 

you do not remove paracetamol just because someone is taking a 2nd or 3rd step analgesic,

 

polypharmacy is an issue and sometimes a dramatic reviewof medication and a 'year zero' approach is what is needed...

[leemack]

you do not remove paracetamol just because someone is taking a 2nd or 3rd step analgesic,

 

polypharmacy is an issue and sometimes a dramatic reviewof medication and a 'year zero' approach is what is needed...

 

This depends on your view of the toxicity of paracetemol, but I've said what I thought, I won't get into this further with you.

[clairedcat]

Apparently, she was prescribed paracetamol for general wear and tear on her back. Considering she worked 3 cleaning jobs most of her life Im not surprised she had

 

back ache. When her mental health, according to her Doctor, got worse, she became almost house bound. She gets no exercise, even though I cook healthy low fat

 

meals for her, she is overweight. She was then prescribed tramadol due to her back getting worse. Nothing was given inbetween.

 

We have arranged the medication review for 3rd of August. Ive been very grateful for everyones comments and advice. When Ive looked at the drug interactions the

 

evidence is shocking, it's extremely complex and im far from stupid. Does anyone know if I could request a toxicologist and dietician to get involved as I also think her

 

medication needs a serious review. I think changes to her diet and maybe some light exercise would also help.

[leemack]

low fat isn't as healthy as has been suggested. Newest (good) research suggests lower carb and in particular low sugar is better for health.

[clairedcat]

Thanks leemack, So maybe a dietician would be a good idea once her medication has been sorted. Just dont know where to start really. Thinking of keeping a diary

 

until she has appointment so consultant can see how poor her behaviour and general wellbeing have become. Maybe this will help the consultant be a bit more

 

receptive to the effects of her medication and other possible factors. In general the anti psychotics and anti depressants do not seem to be controlling her

 

symtoms. She does however seem to have almost every side effect of them alone and side effects stated when they interact.

[PinkPixy]

Hi,

 

Just a quick glance at your grandma's meds and I saw she is taking trazodone and tramadol, I had the most horrendous experience after taking both of these together (woke up in the middle of the night on the bathroom floor confused, foggy headed, sweating but freezing, horrible). I take trazodone all the time and the tramadol was the only change when it was prescribed for pain. I've recently seen another GP for something else and he was suggesting tramadol and I said 'I can't take that because I'm on trazodone' and he didn't say I was wrong (or right to be fair, but did find an alternative).

 

Have you looked up serotonin syndrome? You may be able to pinpoint some of the meds that are causing problems like this. Also, I would definitely ask for a meds review. In the meantime, have you thought of going to a chemist and asking to have a chat with the pharmacist and asking them to look over the list and see if any interactions stand out that you could then go to your GP with? I think all Boots pharmacies have a little booth now where you can talk in private to the pharmacist.

 

I hope that your grandmother's meds are sorted and that her quality of life improves, it must be very difficult for both of you,

 

Pixy

[PinkPixy]

Just read the whole thread and just a point on the jumping from paracetamol to tramadol question. Mostly if paracetamol isn't cutting it for pain GPs tend to prescribe one from the NSAIDs so things like Ibuprofen, diclofenic but my mum can't take these because she is on warfarin and because of some of her heart medication. She was also prescribed tramadol as a first option when paracetamol wasn't helping severe toothache (she had a bad reaction to it too and became so confused she thought she hadn't taken a dose then took another...). I can't take painkillers like codeine because it causes constipation and I have diverticular disease and have to avoid constipation otherwise it flares up badly...particularly when you have a range of medical problems it can be hard to find a painkiller that is effective that doesn't interact with another or make an existing condition worse.

 

I hope they find the right balance for her,

 

Pixy

[leemack]

Thanks leemack, So maybe a dietician would be a good idea once her medication has been sorted. Just dont know where to start really. Thinking of keeping a diary

 

until she has appointment so consultant can see how poor her behaviour and general wellbeing have become. Maybe this will help the consultant be a bit more

 

receptive to the effects of her medication and other possible factors. In general the anti psychotics and anti depressants do not seem to be controlling her

 

symtoms. She does however seem to have almost every side effect of them alone and side effects stated when they interact.

 

Many dieticians are stuck in the old dogma so be careful with who you pick - a good one won't want to limit good fats - and as most vitamins are fat soluble, this is important.

[leemack]

Hi,

 

Just a quick glance at your grandma's meds and I saw she is taking trazodone and tramadol, I had the most horrendous experience after taking both of these together (woke up in the middle of the night on the bathroom floor confused, foggy headed, sweating but freezing, horrible). I take trazodone all the time and the tramadol was the only change when it was prescribed for pain. I've recently seen another GP for something else and he was suggesting tramadol and I said 'I can't take that because I'm on trazodone' and he didn't say I was wrong (or right to be fair, but did find an alternative).

 

Have you looked up serotonin syndrome? You may be able to pinpoint some of the meds that are causing problems like this. Also, I would definitely ask for a meds review. In the meantime, have you thought of going to a chemist and asking to have a chat with the pharmacist and asking them to look over the list and see if any interactions stand out that you could then go to your GP with? I think all Boots pharmacies have a little booth now where you can talk in private to the pharmacist.

 

I hope that your grandmother's meds are sorted and that her quality of life improves, it must be very difficult for both of you,

 

Pixy

 

This is actually a really great suggestion - to take the list of meds to a pharmacist - they know far more than doctors about possible drug interactions.

[clairedcat]

Ive printed off loads of shocking stuff about drug interactions that bankfodder very kindly posted a link

 

to. Ive also printed off the stuff others have sent me links to. I will def go to chemist as well. I am so

 

grateful to every single person whose posted on here. If anyone has any suggestions on how to present

 

all the info to the consultant that would be great. Like I said Im keeping a diary of her day to day

 

symtoms and behaviour. I also have a lot of info regarding drug interactions that fit in with the problems

 

she's having. Im just concerned now that the consultant might dismiss all the evidence

[jessicar-car]

Hi,

You could ask the gp to send her to the doc (psychiatrist?)who prescibes these tablets, and go with her, and get doc to review meds. Also pharmacist at local chemists may be able to help. Good luck.