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 paramedics 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.
“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.
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?
[READ: Everything You Need to Know About Common Food Allergies]
10 Common Drug-Drug Interactions to Avoid
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.
Here are 10 common drug-drug interactions to avoid:
— Opioids and benzodiazepines
— Pain relievers and blood thinners
— Blood thinners and antibiotics
— Statins and antibiotics
— Antacids and antibiotics
— St. John’s wort and antidepressants, birth control and others
— Antidepressants and migraine meds
— Cough suppressants and SSRIs
— Beta blockers and epinephrine
— Green tea and raloxifene
[READ: Medications That Increase Fall Risk in Older Adults]
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 Benadryl.
“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.”
[READ: How to Save Money on Prescription Drugs]
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
While often used in herbal medicine to treat depression and menopausal symptoms, St. John’s wort has significant potential for drug interactions. It has been shown to increase the body’s metabolism of certain drugs, reducing their concentration in the bloodstream and diminishing their therapeutic effect.
These drugs include:
— 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.
[READ: Migraine Hacks and Remedies for Fast Relief]
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.
10. Green tea and raloxifene
Although drinking green tea can have health benefits, consuming large amounts of it may prevent absorption of the drug raloxifene.
Raloxifene (Evista) modulates estrogen in the body to manage osteoporosis in women after menopause and reduce the risk of breast cancer.
Recent studies have demonstrated green tea reduces the solubility of raloxifene, possibly due to the antioxidants it contains called catechins, although the exact mechanism isn’t completely understood.
[Read: Deprescribing Medications for Seniors]
7 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.
Here are seven drug-food and drug-beverage interactions:
— Cholesterol or blood pressure drugs and grapefruit
— Antidepressants and alcohol
— Antibiotics and dairy
— Blood thinners and green leafy vegetables
— MAOIs and foods containing tyramine
— ACE inhibitors and bananas
— Levodopa and high protein foods
11. Cholesterol or blood pressure drugs and grapefruit
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.
12. Antidepressants and alcohol
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.
13. Antibiotics and dairy
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.
14. Blood thinners and green leafy vegetables
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.
15. 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
16. ACE inhibitors and bananas
The potassium in bananas is healthy in part because it can lower blood pressure, but if you’re already taking blood pressure medication, such as lisinopril or ramipril, you may end up having too high a level of potassium, called hyperkalemia, which can cause abnormal, life-threatening heart rhythms.
Potassium doesn’t occur just in bananas; other potassium-rich foods include:
— Potatoes
— Avocados
— Oranges
— Dried fruit
— Cooked spinach
If you’re taking an ACE inhibitor, one banana a day is likely fine, but ask your doctor how much potassium you can safely have in your diet.
17. Levodopa and high protein foods
People with advanced Parkinson’s disease on the medication levodopa should know about “the protein effect” when they pair the drug with too much protein in their diet. Although it’s not actually dangerous, too much protein could cause malabsorption of the medication in some people, making it less effective.
If the protein effect is a problem for you, don’t eliminate it from your diet altogether. You can space out your protein intake throughout the day so that there’s not too much of it in your system all at once, or save your protein intake for the end of the day when you’re less active.
8 Drug-Condition Interactions
Certain health conditions can affect how drugs are processed by the body, especially in older adults. Because of this, understanding the impact of health conditions and medications on seniors is essential before starting any new treatment, as some combinations may be precluded based on your medical history.
“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.
Here are eight drug-condition interactions to avoid:
— Decongestants and high blood pressure
— Ibuprofen and asthma
— Diabetes and beta blockers
— NSAIDs and kidney disease
— GLP-1s and thyroid cancer
— Aspirin and peptic ulcers
— Antihistamines and enlarged prostate
— Muscle relaxants older age
18. Decongestants and high blood pressure
Patients with high blood pressure should avoid decongestant medications that contain pseudoephedrine or phenylephrine, as these ingredients can increase blood pressure and interfere with blood pressure medications. Common OTC decongestants include products often labeled with “-D,” such as Claritin-D, Mucinex-D, Allegra-D and Zyrtec-D, as well as Sudafed.
19. Ibuprofen and asthma
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.
20. Beta blockers and diabetes
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.
21. NSAIDs and kidney disease
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.
22. GLP-1s and thyroid cancer
GLP-1 medications — 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.
23. Aspirin and peptic ulcers
Although a daily aspirin can help some people reduce their risk of heart disease and stroke, you shouldn’t take it if you have a peptic ulcer, an open sore in your stomach or small intestine.
Aspirin can also increase the risk of developing an ulcer, so you and your doctor should carefully weigh the risks of ulcer and the heart benefits for your individual health history to determine whether to start taking aspirin regularly.
If you’re currently taking aspirin and are concerned about developing an ulcer, don’t stop taking it without talking to your doctor.
24. Antihistamines and enlarged prostate
Having an enlarged prostate, or benign prostatic hyperplasia (BPH), is nearly universal in older men: More than 90% of men over 80 have the condition.
Antihistamines are often used for seasonal allergies or cold symptoms, but also can make urinating and other BPH symptoms worse.
However, not all antihistamines are created equal: The “first generation” OTC antihistamines, such as Benadryl and Chlor-Trimeton, have a greater effect on BPH symptoms than the second generation, which include brand names Zyrtec, Claritin and Allegra.
If you have allergies and BPH, discuss with your doctor what the best choice is for you.
25. Muscle relaxants and older age
Older patients should avoid taking most muscle relaxants, as they are known to be a medication that can increase the risk of falls, confusion, sedation, constipation, dry mouth and other negative side effects.
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.
How Aging Affects Sensitivity to Drugs
As we get older, our bodies undergo changes that can affect the way we metabolize medications. Processes in our bodies slow down, so medications may be absorbed more gradually, which increases the risk of interactions.
Age-related factors that affect how we react to drugs include:
— Metabolic changes. As we age, our liver and kidneys are not as efficient in breaking down and eliminating drugs, which causes them to build up in the body and lead to potentially harmful side effects.
— Body composition changes. Older adults commonly experience age-related muscle loss, known as sarcopenia, and have higher body fat. This affects how certain medications are absorbed and circulated in the body.
— Polypharmacy. More than 40% of adults ages 65 or older are on at least 5 prescription drugs, a practice known as polypharmacy. When combined with over-the-counter medications, this significances increases the risk of adverse drug-drug interactions in many older adults and can even lead to new health complications. 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.
“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.
Tips for Preventing Adverse Drug Interactions
Follow these 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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25 Dangerous Drug Interactions: What You Should Never Mix (Plus Foods & Supplements) originally appeared on usnews.com
