Some Words on: Drug Interactions

Being on psychiatric medication will force you to question some of your habits. It might also make you wary about other drugs that had seemed harmless to you so far. Little things you took for granted may suddenly become big no-nos. I am talking about interactions your medication may have with other substances. For example, if you are taking a tricyclic antidepressant, popping an Aspirin against your headache is out of the question. You may have to renounce to alcoholic beverages and quit smoking bong. Possibly, you can’t even have caffeinated drinks.

Before you consider suicide, I wish to stress that despite the many restrictions your medication imposes on you, you will still find ways of enjoying life. I am just saying you need to be careful. The first step you need to take is to find out about the interactions your medicines may have with other prescription and over the counter drugs. Personally, I am on Quetiapine (Seroquel) and Sertraline (Zoloft). As a result, when I have pain from flu, from a migraine or caused by some lesion, I pretty much have to rely on Acetaminophen to fix it. It is the only analgesic and anti-inflammatory I can use without putting myself at risk. Every time I am about to try a new medicine I have to check and double-check if it is really safe for me to take. I admit to feeling quite nervous whenever I experiment with a new drug, although it is reported not to interact with my psychiatric medication. However, sometimes there is no way around playing guinea pig. Once I have successfully tried out a new drug I usually stick to it like glue. My list of compatible drugs is still short. Luckily, I don’t get ill often. Yet, eventually I should definitely make a list of all the medications I have found work fine for me.

It can be frustrating to find an entire group of medications is counter indicated for you, especially when you’re having an acute and debilitating health problem. You may have read in my withdrawal diary that I had been suffering from back pain. Unfortunately, I had to stick it out because there seemed to be no compatible muscle-relaxants. Usually, though, in every medication family, there should be at least one variety you can use. For example, there are several antibiotics which would interact with my psychiatric medication, but some are alright for me. The same goes for anti-allergic drugs. A couple of them would be dangerous for me to use, but Fexofenadine (Allegra) is harmless.

Not just other drugs can interact with your medication. Natural substances and food products can, too. All beverages containing caffeine are stimulants, meaning that, if your psychiatric treatment is aimed at calming you down, you will have to cut those out at least for a while. It is no coincidence that mental clinics usually offer their patients decaffeinated coffee and tea throughout the day. This may sound off-putting to the coffee-gourmets among you, but the nice thing about non-stimulating coffee is that you can literally have it around the clock and as much of it as you like. Personally, I love having several cups of coffee and tea per day. Yet, in order not to let it disturb my sleep, I stop consuming caffeine before 5 pm. Alcohol, on the other hand, is a potent depressant. So, if you are already down, having a few shots at your neighborhood bar will dig your grave a bit deeper. Doctors will generally recommend you to abstain from alcohol while taking psychiatric medications, or to enjoy moderate quantities on rare occasions. Your medications are broken down by the liver, so anything that would affect its functioning or strain it unnecessarily should be avoided. Now, alcohol is often a staple at social events. For many, having a glass of wine, a beer or a cocktail is part of the fun of hanging out with friends or colleagues. Probably, you can drink a glass or two without risking any negative effects. As for myself, I can have a few drinks without difficulty. I have never been a heavy drinker, not even a regular one. When I am at a party or at a restaurant, I like my share of red wine or a round of sake at sushi places. I never have booze on an empty stomach and also never let myself get drunk. If you decide you’d like to try a drink, accompany it with a glass of water to dilute and help you flush it out. An exotic item on the list of forbidden foods is the grapefruit. It alters liver function and therefore should not be consumed in combination with any drug at all – psychiatric or not.

Then, there are psychoactive natural remedies, such as Saint John’s Worth or Valerian. Extracts made from those plants are tranquilizing. In other words, they act on your brain. Only use them if you can make sure they won’t interfere with the therapeutic purpose of your current treatment. For the ladies, it might be an interesting fact that Saint John’s Worth, on top of its psycho-activity, also diminishes the effectiveness of hormonal contraceptives. So, hands off this shrub if you would like to enjoy your freedom for a bit longer!

Talking of natural psychotropic substances, there is a host of them. Probably the most commonly used is marijuana. Although it is illegal in most places, it is probably less dangerous than many psychiatric drugs. Still, it should not be used in combination with them. I am acquainted with people who are on anti-psychotics and smoke weed at the same time, but it is risky and therefore not recommendable. It can go well, or it can go wrong, without there being any way of telling beforehand. Unfortunately, little data is to be found about the risk factor here. It appears to be that recreational drugs can actually trigger mental illnesses. During my last stay at a mental clinic, I came across fellow patients whose diagnosis of schizophrenia or psychosis followed the use of marijuana, heroin or other illegal substances. Spontaneously, I can recall four or five cases, just out of the people I got in closer contact with. There is no way for me of knowing whether the physicians at the clinic recognized the cause of mental illness correctly, or whether factors other than recreational drugs were in play. Still, it is a possibility.

Sometimes, an illness or injury can require extra medication with great urgency. If it so happens, you will have to grind your teeth and weigh possible interaction symptoms against the gravity of your condition, then choose the least compromising of the two. Note that not all drug interactions are necessarily dangerous. Depending on their severity, they are usually categorized as major and minor interactions. Hence, if you are seriously ill, you may be willing to risk interactions as long as they are not menacing to your life. Just as side effects, interactions may occur in some individuals and in others not. If an undesired symptom is expressed in a very small percentage of the sample population, the odds are on your side.

Most importantly, you need to find reliable information on the interactions your medication may have. The package inserts (or PILs – Package Information Leaflets), usually only contain a basic paragraph on the subject. You can, of course, ask your prescriber, but he or she will likely not be familiar enough with the specific combination of drugs you are going to take. Remember your doctor sees dozens of patients every day, all of them with their specific medication plan. It is virtually impossible to bear all possible drug interactions in mind. Then, there is the internet. Several sites offer interaction finders where you can type in the combination of drugs you wish to check for safety. It is hard to say whether these webpages have complete data at their disposition. New medications are thrown onto the market and new studies with already existing medications are conducted all the time, so there is a constant need for updates. The advantage of online interaction finders is that you can type in any number of substances, which allows you to learn about the safety of multiple drug use. You can also find interaction lists on the internet. But be warned: the number of interactions for your psychiatric drug can literally be in the hundreds, so prepare for a Sisyphean task.

Last, but not least, your using psychiatric medication may be socially and professionally compromising. Not because you may have to turn down friendly offers of alcoholic or stimulating beverages, but because your medication may render you unresponsive to everyday situations. One day, instead of taking my antidepressant in the morning, I accidentally took the anti-psychotic. What a knockout! That day, I had visits coming over. Later in the afternoon I was supposed to shop for a birthday present and attend a theater rehearsal. I am hard headed as a ram, so I forced myself to pull through with my agenda, but it felt like attempting to pull myself out of a swamp. I won’t forget that day so easily. Normally, I am supposed to use my anti-psychotic right before going to bed at night. Now, there are some evenings where you have no intention of going to bed any time before the early morning hours of the following day. New Year’s Eve is one of those occasions. As a consequence, you may end up flushing your sedating medication down with a fruit punch at 2 am or so. As long as you have nothing important to do the next day, it’s not a problem. Just make sure you have no job interviews, driving lessons or college admission tests coming up, because you will be feeling quite heavy. Luckily, I am not much of a night owl, so the anti-psychotic does not really get in my way much. If you are into clubbing or have to work graveyard shifts, you will need to make adjustments either to your activity schedule or to your medication plan. Discuss this in depth with your prescribing physician. You may have to modify your lifestyle in some regards, but do not feel discouraged. If an aspect of your life is really important to you, there should be ways to conserve it. Stay motivated and think outside of the box.

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One thought on “Some Words on: Drug Interactions

  1. Pingback: When Meds Get in The Way | Getting off - A Life without Psychiatric Medication?

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