Q. I take Zoloft (sertraline) for depression, but I had a
frightening experience recently. I am in excellent physical health.
To relieve a cold, I took one dose of a cold formula that contains
dextromethorphan. The box warned about MAOI class antidepressants.
It said nothing about Zoloft.
About an hour later, I began to experience chest pain, shortness
of breath, shaking and tingling. Paramedics were called and found
my EKG and blood pressure were fine, but my heart was racing. I had
a textbook panic attack. I've never had one before.
When I refilled the Zoloft, I read the fine print the pharmacist
supplied. I noticed, buried in a long list of drug names, that
dextromethorphan was listed as harmful in combination with Zoloft.
With so many Americans taking SSRI antidepressants, shouldn't there
be a warning about this interaction?
A. You may have suffered serotonin syndrome. When too much of
this brain chemical accumulates, symptoms may include agitation,
rapid heartbeat, muscle twitching, sweating, shivering, nausea,
diarrhea, elevated body temperature, changes in blood pressure and
mental confusion.
Dextromethorphan (DM) is found in many cough and cold medicines,
including Robitussin DM and NyQuil. Although there is a warning
about interactions with monoamine oxidase inhibitors (MAOIs), there
is no mention of SSRI antidepressants such as Prozac (fluoxetine)
or Zoloft. Nevertheless, serotonin syndrome has been reported when
DM is taken with this type of antidepressant (Clinical Toxicology,
September 2008).
Q. I suffered both flatulence and abdominal pain for more than
three years to a degree of misery I'd like to forget. I had lots of
tests for digestive problems, but they showed no problem, and my
doctors could offer no help.
Eventually I figured out that my prescription medicine was
causing the problem and stopped taking it, with my doctor's
permission. I am now pain-free and no longer suffer from excessive
gas.
A. Congratulations on superb problem solving. Many medications
can cause stomach upset and flatulence. Some include osteoporosis
drugs like Fosamax, cholesterol-lowering drugs like Tricor and even
pain relievers like naproxen (Aleve, Naprosyn).
Q. I was diagnosed with an overactive bladder six months ago. The
urologist prescribed VESIcare and handed me a pamphlet on the main
offenders that cause the symptoms.
After reading it, I eliminated caffeine, chocolate and alcohol
from my diet. Voila -- I make no more nightly visits to the
bathroom. As an added benefit, I no longer need any medication for
reflux. Sometimes giving up something that is harmful to health is
better and less expensive than taking medicine.
A. Not everyone will get as much benefit from the kind of
changes you made, but this is a low-risk approach. Chocolate,
caffeine and alcohol all have been implicated as possible culprits
in triggering reflux.
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