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Pharmacy and Medications

Are There Any Medication Interaction Problems Involved?

09/11/2008

Question:

I am on metoprolol 75mg BID, Hydrochlorathiazide 25mg daily, Claritin 10mg daily, 2 sprays of Flonase daily, 2 drops of Patanol in each eye daily, I also take Advil cold and sinus about 4 times a week, Motrin at times, Vicodin at times, and am wanting to start back on Paxil CR 12.5mg daily. Will there be any problems I may encounter with this mixture? Thank you for your time.

Answer:

After reviewing this entire medication list, a few moderate drug interactions were found. These interactions may not be noticed immediately after starting a new medication, but may be more noticeable with time.

Metoprolol is a medication that is used commonly for patients with high blood pressure. This medication may be used in combination with other medications like hydrocholorothiazide, which is a diuretic (water pill), to help control elevations in blood pressure.

When metoprolol is used in combination with paroxetine (Paxil CR), it may result in some increased risk of side effects from metoprolol including shortness of breath, decreased heart rate, and decreased blood pressure. It may be necessary to reduce the dose of metoprolol when used in combination with Paxil to reduce the incidence of these side effects.

Ibuprofen (Motrin) is a non-steroidal anti-inflammatory medication that is commonly used to treat patients with many conditions including arthritis, joint injury, or even headache. When ibuprofen is taken in combination with hydrochlorothiazide (a diuretic), hydrochlorothiazide may not be as effective at lowering blood pressure. This happens because ibuprofen increases water and salt retention within the body and may cause blood vessels to constrict (narrow), resulting in an increase in blood pressure.

When ibuprofen (Motrin) and paroxetine (Paxil) are used in combination, the risk of bleeding may be slightly increased. This bleeding happens mostly in areas like the mouth, esophagus, or stomach. You should call your family doctor immediately if you experience any signs of bleeding. If you decide to re-start Paxil therapy, you should try to avoid taking ibuprofen to minimize this risk.

Finally, when ibuprofen and metoprolol are taken together, ibuprofen may interfere with the ability of the metoprolol to reduce blood pressure. This effect has been reported with ibuprofen doses of more than 400mg per day. Advil Cold and Sinus also contains a medication called pseudoephedrine that will elevate blood pressure; therefore use of this medication should be minimized if you currently have high blood pressure that is not controlled.

While there are some drug interactions with this list of medications, many of them could be prevented or minimized by decreasing the use of over-the-counter (OTC) medications like ibuprofen and Advil Cold and Sinus. Although the interactions from these medications are not severe, they may interfere with the effectiveness of your blood pressure therapy.

I do not see a problem with restarting paroxetine, as long as you are monitored closely for changes in your blood pressure control and possible bleeding. Your doctor should be aware of these concerns and will be able to manage these drug interactions.

As always, if you have any further questions, feel free to contact your local doctor or pharmacist and discuss any issues with them.

Submitted by Monika Coletto, PharmD Candidate 2009, The University of Toledo College of Pharmacy

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Response by:

Carmen M Hadley, RPh, CSPI
Former Clinical Instructor
College of Pharmacy
The Ohio State University