One of the scariest moments of my life happened in 2022 when my father, Tom Donvito, then 75 and unaware of any allergies, experienced an anaphylactic reaction to a hornet sting.
After he passed out, my panicked mother called 911, but when the emergency medical technicians arrived, the shot of epinephrine they gave my dad didn’t work — and neither did the second.
Why? My dad was on beta blockers, which reduce the effectiveness of epinephrine. Luckily, doctors were able to stabilize him at the hospital.
Looking back now, my father doesn’t remember if there was a warning on the safety insert that came with his beta blockers. The EMTs didn’t ask if he was on beta blockers either.
“Neither Mom nor I knew anything about beta blockers and epinephrine. Afterwards in the hospital, one of the doctors told us that beta blockers can counter the effect of epinephrine,” he says.
What’s more, he didn’t even really need to be on them.
My dad’s cardiologist prescribed beta blockers to keep his heart from beating too fast after he was hospitalized with pericarditis, a fluid buildup in his chest, several years prior.
He then just kept renewing it. “After the hornet incident, I told my cardiologist what happened and asked if I still needed the beta blocker. He said I didn’t, but I think he should have taken me off it sooner if I didn’t need it.”
Unfortunately, my father’s story is scarily common. A Centers for Disease Control and Prevention survey found that about a third of people ages 60 to 79 use five or more prescription drugs, a practice known as polypharmacy, which increases the risk of adverse drug interactions.
But it’s not just prescription drug interactions that can be a problem: Some drugs can also interact with certain foods, over-the-counter meds, vitamins, herbal supplements and other health conditions.
So, how can you know what’s safe?
“The best way to avoid harmful drug interactions is through communication and awareness,” says Sterling Elliott, a pharmacist at Northwestern Medicine and an assistant professor at the Feinberg School of Medicine at Northwestern University in Chicago.
Make sure your doctors and pharmacists know all the medications you’re taking, and ask them about any interactions you should know about when they prescribe new meds.
In addition to knowing how to check for drug interactions, it’s helpful to be aware of some of the major problem combinations from our useful list below.
[READ: Understanding the Impact of Health Conditions and Medications on Seniors]
Drug-Drug Interactions
Taking certain drugs together can either increase or decrease their effects.
“All medications are metabolized by our bodies differently,” says Mandy Leonard, system director of drug use policy and formulary management at Cleveland Clinic. “The most common drug interactions occur when one medication impacts the metabolism of another.”
One common misconception is that interactions just apply to prescription drugs.
Many assume that because a product is sold without a prescription, it is completely safe, but this isn’t always the case. Drug interactions with other over-the-counter medications, vitamins and herbal medicines can occur.
Another misconception is that if two drugs interact, they absolutely can’t be taken together.
“We can manage interactions with dose adjustments, timing changes and close monitoring,” Elliott says.
[8 Questions to Ask a Geriatrician at Your First Appointment]
1. Opioids and benzodiazepines
Opioid pain relievers can have fatal interactions with depressants called benzodiazepines, such as Xanax and Valium, because both types of drugs cause sedation and suppress breathing.
Suzi Stolte, director of marketing and communications at JP Opioid Interaction Awareness Alliance, lost her adult daughter, Heidi, to mixed drug toxicity. She had taken a combination of an opioid prescribed for neck and back pain from a car accident and a benzodiazepine prescribed by a different doctor for depression, as well as a new muscle relaxant prescribed for her pain and a Benadryl for seasonal allergies.
“When anyone is prescribed an opioid or a benzodiazepine, they need to be very honest with their doctor about any other drugs — prescribed or over-the-counter — they are taking,” Stolte says.”Losing our daughter was an indescribable pain that left a hole in our family that can never be replaced. We do not want other families to suffer this same loss.”
2. Pain relievers and blood thinners
Non-steroidal anti-inflammatories (NSAIDs) — such as ibuprofen (Advil) and naproxen (Aleve) — can increase the risk of bleeding when taken with blood thinners such as warfarin. However, they may still be used in certain cases with careful monitoring.
Aspirin, another over-the-counter pain reliever, is also a blood thinner, so ibuprofen can increase the risk of bleeding when taken concurrently with aspirin and warfarin.
3. Blood thinners and antibiotics
Blood thinners like warfarin can also be affected by antibiotics, which may either increase or decrease the risk of bleeding, but doctors can adjust the dose of the blood thinning medication accordingly to prevent adverse side effects and interactions.
4. Statins and antibiotics
“Certain cholesterol-lowering drugs, such as statins, can interact with some antibiotics, increasing the risk of muscle damage, but alternative statins or temporary medication changes can be used,” Elliott says.
Before taking antibiotics, make sure your doctor knows you’re on statins, so they can prescribe one that doesn’t interact.
5. Antacids and antibiotics
Drug interactions can occur also when one medication binds to another in the gastrointestinal tract, reducing absorption, Leonard says. The calcium, magnesium and other minerals in antacids reduce stomach acid by binding to and neutralizing the acid, but these minerals can also bind to antibiotics, lowering their effectiveness.
Spacing them a few hours apart can resolve the issue.
6. St. John’s wort and antidepressants, birth control and others
Although there isn’t a lot of evidence to support its use, St. John’s wort is a plant used in herbal medicine to treat depression and menopausal symptoms. However, it can interact with a variety of medications.
“Herbal supplements such as St. John’s wort can decrease the effectiveness of some medications, including antidepressants and birth control, but a provider may adjust the dose or choose an alternative therapy,” Elliott says.
St John’s wort reduces potency by increasing the metabolism of the drugs, causing lower blood concentrations. It also decreases the blood concentration of cyclosporine, an immunosuppressive drug commonly prescribed to transplant patients to prevent organ rejection and to rheumatoid arthritis patients.
7. Antidepressants and migraine meds
Depression and anxiety are common among people who get migraines, but their treatments involve some medications that interact.
“Antidepressants that affect serotonin levels can interact with other drugs that influence serotonin, like migraine medications, but these combinations are sometimes necessary and can be used safely with proper monitoring,” Elliott says.
8. Cough suppressants and SSRIs
If you’re taking an antidepressant, use caution with cold medicines.
“Dextromethorphan, a common cough suppressant agent in cough and cold preparations, can increase serotonin levels in patients taking SSRIs (selective serotonin reuptake inhibitors) such as Prozac or Lexapro, and can increase the risk of serotonin syndrome,” Leonard says.
This serious drug reaction happens when your body has too much serotonin, which can cause organ damage or even death if not treated promptly.
9. Beta blockers and epinephrine
Beta blockers lower blood pressure by reducing the effects of epinephrine, also called adrenaline, in the body.
As my father found out, if you have an allergic reaction and need to receive epinephrine, it might not be effective.
If you carry an EpiPen for a serious allergy, talk to your doctor about whether or not you should be taking beta blockers.
[READ: How Medicare Beneficiaries Can Save Money on Prescription Drugs]
Drug-Food and Drug-Beverage Interactions
Food and drug interactions aren’t always obvious — you might ask your doctor if you can drink alcohol on a medication, but you probably wouldn’t think to ask if you can eat grapefruit or spinach.
A better approach to drug-food interactions is to ask your doctor if there are any foods or drinks you should avoid.
You likely won’t have to stop consuming your favorite foods altogether.
“Food-drug interactions do not always require elimination. We can help patients manage them instead of avoiding the foods and drinks they like. Adjustments in diet or timing can allow patients to continue their normal habits safely,” Elliott says.
10. Grapefruit and cholesterol or blood pressure drugs
Grapefruit or grapefruit juice can increase levels of some medications that lower cholesterol and blood pressure by altering the rate the body processes the drugs.
“Blood concentrations of the statin become elevated, increasing the risk of adverse effects such as muscle pain,” Leonard says.
However, patients don’t need to completely eliminate grapefruit from their diet.
“They may simply need to take their medication at a different time,” Elliott says.
11. Alcohol and antidepressants
If you take an SSRI such as Prozac, Lexapro or Zoloft, you may think you can have a few drinks, but it’s usually not recommended; neither is skipping doses in order to imbibe.
“Alcohol is an important consideration when taken with antidepressants, as it can increase drowsiness and affect mood. Because it is a depressant it can blunt the effect of the drug,” Elliott says.
Talk about alcohol use with your doctor if you’re on an SSRI.
12. Dairy and antibiotics
Eating yogurt while taking antibiotics can help maintain gut health and prevent yeast infections. But you shouldn’t pop your antibiotic while you’re consuming yogurt. The calcium in dairy products can reduce the absorption of certain antibiotics.
“Spacing them a few hours apart allows the antibiotic to work effectively,” Elliott says.
13. Green leafy vegetables and blood thinners
Patients taking blood thinners such as warfarin should be consistent in their intake of food containing vitamin K, such as kale, spinach and other green leafy vegetables. Eat the same amount regularly so your dose can be adjusted properly.
“Warfarin works in the body by depleting vitamin K-dependent blood clotting factors,” Leonard says. “Therefore, when patients consume too much vitamin K in their diet, they can decrease the efficacy of warfarin, leading to an increased risk of blood clots.”
Patients who are on warfarin are monitored closely to measure the warfarin in the blood to help mitigate the impact of fluctuations in a patient’s diet, she says.
14. MAOIs and foods containing tyramine
Monoamine oxidase inhibitors (MAOIs), an older class of antidepressants, are usually only used today when other drugs haven’t worked, partly because MAOIs interact with some foods.
“Patients on MAOIs need to avoid ingestion of foods and beverages rich in (the amino acid) tyramine, as it may cause severe high blood pressure,” Leonard says.
Specifically, avoid beverages that contain tyramine and foods that have undergone protein breakdown by aging, fermentation, pickling, smoking or bacterial contamination, including:
— Beer
— Wine
— Cured meat
— Aged cheeses
— Yogurt
— Pickled herring
— Sauerkraut
— Yeast extract
Drug-Condition Interactions
Certain medical conditions can affect how some drugs — both prescription and over-the-counter — work in the body. This might preclude you from taking them, but it depends on the medications.
“In some cases, it’s best to avoid a medication. In other circumstances, you can use a medication with management by your health care team,” Elliott says.
15. High blood pressure and decongestants
Patients with high blood pressure should avoid decongestant medications that contain pseudoephedrine, a common ingredient in cold medicine like Sudafed, as it can increase blood pressure.
16. Asthma and ibuprofen
Although doctors aren’t exactly sure why, ibuprofen may trigger an asthma attack, with shortness of breath and wheezing.
“People with asthma may experience worsened symptoms with certain pain relievers like ibuprofen, but alternatives like acetaminophen are usually safe,” Elliott says.
17. Diabetes and beta blockers
High blood pressure and diabetes often appear together, but the treatments don’t always mix well.
“If you have diabetes, beta blockers (to lower blood pressure) can mask the signs and symptoms of low blood sugar. You can still use them, but your blood sugar levels may need closer monitoring,” Elliott says.
18. Kidney disease and NSAIDs
If you have kidney disease, you should avoid or limit NSAIDs because they constrict blood vessels and blood flow to already damaged kidneys.
“These drugs can worsen kidney function. Very often, a provider may recommend a different pain relief strategy,” Elliott says.
19. Thyroid cancer and GLP-1s
Drugs for diabetes and weight loss called GLP-1s — including Ozempic and Wegovy — shouldn’t be used in patients with a personal or family history of a certain endocrine disorder (MEN2, a tumor-causing syndrome) or a certain type of thyroid cancer, Elliott says.
The connection between GLP-1s and thyroid cancer isn’t totally clear, but your doctor can advise for your individual case.
20. Older age and muscle relaxants
As we age, our bodies are not able to handle medications in the same way. For this reason, the American Geriatric Society releases a report called the Beers Criteria, a guide to medications older patients should not be prescribed. For example, most muscle relaxants are on the “avoid” list because they can cause confusion, increasing the risks of falls, sedation, constipation, dry mouth and other negative side effects in older patients.
Alice Brennan, 88, died after being given Flexeril, a muscle relaxant her regular doctor had told her not to take, while recovering from gout in a rehab facility. The medication left her confused, hallucinating, prone to falls and dehydrated, leading to a cascade of interventions and, eventually, death.
After Alice’s death, her daughter Mary Brennan-Taylor partnered with researchers at the University of Buffalo to form Team Alice, which focuses on medication safety for older adults.
If you’re a senior, ask your doctor which medications are no longer safe.
Tips for Preventing Adverse Drug Interactions
Follow these additional tips to help prevent drug interactions:
Talk to your doctor
Doctors and pharmacists now have computer systems that record patients’ medications and history to find any possible drug interactions, but it’s still crucial to communicate openly with your medical team.
“The most important step patients can take is to inform their health care providers about all medications, OTC drugs, vitamins and supplements they use so potential interactions can be managed safely,” Elliott says.
Use one pharmacy
Filling all your scripts at the same place allows pharmacists to catch potential interactions.
“If they identify an interaction, they can recommend a mitigation strategy which may include spacing the timing of medications, increasing or decreasing doses, monitoring drug levels in the body on a routine basis, or recommending an alternative medication,” Leonard says.
Keep yourself informed
Be your own proactive advocate by knowing the conditions you have and checking the prescription drug interaction warnings on any meds you’re taking.
“Read medication labels, ask questions when starting new medications and be cautious with changes in diet that may impact how drugs work,” Elliott says.
Don’t just stop taking medications
“Rather than stopping or avoiding medications out of fear of interactions, patients should keep their health care providers informed,” Elliott says. “Many interactions can be safely managed rather than requiring complete avoidance.”
Bottom Line
Drug interactions come in many forms and are more common than people think, Elliott says. By working with your health care team, patients can take medications safely while minimizing risks.
“The bottom line is these medications require caution,” Elliott adds. “It’s best to share your complete health history, including medications, so you can work with a health care provider to find a safe and effective approach.”
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20 Drug Interactions You Should Know About originally appeared on usnews.com
