On Thursday, Feb. 10 we discussed drug interactions -- how patients taking prescription medicines can avoid problems with other medications including over-the-counter cold and flu remedies; how drug interactions occur; the leading drugs involved in drug interactions; and how progress in drug development could help address the problem of drug interactions.

Our panel of experts included Stefanie C. Nigro, Pharm.D., C-TTS, CNWC, assistant clinical professor at the University of Connecticut School of Pharmacy, who practices primary/ambulatory care at the Community Health Center in New Britain; and Laura Hobbs, Pharm.D., BCPS, pharmacy clinical coordinator and director of the pharmacy residency program at Hartford Hospital; and Flora Harp, PharmD, community practice resident for CVS/pharmacy.

The chat transcript is available below

 Drug Interactions: Common Drug Interactions, How To Avoid Them(02/10/2011) 
11:37
Rinker Buck: 
Hello, and welcome to our live chat on prescrption drug interactions and how to detect and prevent them. I am Rinker Buck, a health writer for the Hartford Courant. Our panel today are experts Stefanie C. Nigro, an assistant clinical professor at the University of Connecticut School of Pharmacy; Laura Hobbs, a pharmacy clinical coordinator and director of the pharmacy residency program at Hartford Hospital; and Flora Harp, a community practice resident for CVS pharmacy in Woonsocket, Rhode Island.

Please feel free to ask your questions and tell us what is on your mind.
Thursday February 10, 2011 11:37 Rinker Buck
11:48
Rinker Buck: 
For those of you who logged on early, we will start promptly ay noon, EST, so please wait and hang on for 10 more minutes! Thanks.
Thursday February 10, 2011 11:48 Rinker Buck
11:59
Rinker Buck: 
Let me just start with a basic question, which I thought would be appropriate for Stefanie Nigro, who also practices primary/ambulatory care at the Community Health Center in New Britain. Stefanie, what are some of the most common drug interactions--between drugs, and with foods, drinks, etc.--and how are pharamcists trained to avoid them, and help patients recognize them?
Thursday February 10, 2011 11:59 Rinker Buck
12:02
[Comment From SusanSusan: ] 
How do I make time to talk to the pharmacist? It's so busy at the pharmacy and I always feel so rushed.
Thursday February 10, 2011 12:02 Susan
12:03
Stefanie Nigro, PharmD: 
That is a great question - one that is not quickly answered. Some common interactions that we see are cholesterol lowering medications with grapefruit juice, warfarin ( a blood thinner) with aspirin or other anti-inflammatory drugs like motrin or aleve, antacids (for upset stomach) and slect antibiotics. Also, medications like Sudafed can interaction with blood pressure medications
Thursday February 10, 2011 12:03 Stefanie Nigro, PharmD
12:03
Stefanie Nigro, PharmD: 
These are some common ones, but remember the list is quite extensive.
Thursday February 10, 2011 12:03 Stefanie Nigro, PharmD
12:03
Stefanie Nigro, PharmD: 
In the cimmunity setting, pharmacists have computer programs that are able to identify potential drug interactions
Thursday February 10, 2011 12:03 Stefanie Nigro, PharmD
12:04
Stefanie Nigro, PharmD: 
If patients use the same pharmacy and keep their medication lists up to date, then a pharmacist can screen for potential problems
Thursday February 10, 2011 12:04 Stefanie Nigro, PharmD
12:05
Rinker Buck: 
Okay, fine, and thankyou Stefanie, perhaps Flora can suggest how, in a busy pharmacy, we can get time to talk? That is Susan's question.
Thursday February 10, 2011 12:05 Rinker Buck
12:06
Stefanie Nigro, PharmD: 
Beyond computer programs, pharmacists are trained to identify and resolve drug interactions by looking to see if two or more medications are metabolized through the same liver enzymes. We also to the medical literature to support us with any evidence
Thursday February 10, 2011 12:06 Stefanie Nigro, PharmD
12:06
[Comment From AnnaAnna: ] 
I was taking a Z-pack. Should I not have taken Motrin at the same time?
Thursday February 10, 2011 12:06 Anna
12:06
Flora Harp, PharmD: 
Hi, this is Flora Harp, PharmD from CVS/pharmacy. Thank you all for being here today. Susan, thank you for your question. Even though pharmacies can be busy, the primary role of the pharmacist is to make sure you are educated on how to take your medications safely and effectively. Your pharmacist is always available to provide you with information on your medication upon request when you are in the store, or you can always call the pharmacist at your convenience from home.
Thursday February 10, 2011 12:06 Flora Harp, PharmD
12:07
Stefanie Nigro, PharmD: 
*We also turn to the medical literature to support us
Thursday February 10, 2011 12:07 Stefanie Nigro, PharmD
12:08
Stefanie Nigro, PharmD: 
Zpak and Motrin can be taken at the same time. Motrin should be taken with food and Zpak can be taken with or without food
Thursday February 10, 2011 12:08 Stefanie Nigro, PharmD
12:08
[Comment From sherrysherry: ] 
In July of 2010 I underwent by-pass surgery. During the procedure nerve damage occured in my left arm from the a-line. I am in constant pain. I cannot take opiate drugs because they make me too sick. Is it safe to take ibuprophen and alternate with Tylenol? I also take amlodipine besylate 5 mg and 80 mg of asprin.
Thursday February 10, 2011 12:08 sherry
12:09
Flora Harp, PharmD: 
Hi Sherry, thank you for your question. It is best to avoid taking ibuprofen if you are also on aspirin. Although you are on a low dose of aspirin, taking these two medications together can result in an increased risk of bleeding and stomach side effects. If you cannot tolerate the opiate drugs you can try Tylenol as an alternative.
Thursday February 10, 2011 12:09 Flora Harp, PharmD
12:10
Stefanie Nigro, PharmD: 
There have been some case reports suggesting the medications like ibuprofen can cause ulcers in patients after bypass surgery. I would try to avoid them to be safe. Tylenol is a better option if you do not have liver problems
Thursday February 10, 2011 12:10 Stefanie Nigro, PharmD
12:11
[Comment From jerryjerry: ] 
do ace inhibitors ineract with nph insulin?
Thursday February 10, 2011 12:11 jerry
12:12
[Comment From AnnaAnna: ] 
Thank you. I was worried.
Thursday February 10, 2011 12:12 Anna
12:12
Stefanie Nigro, PharmD: 
No ACE inhoibitors are safe with NPH. Often times patients who have diabetes are on both medications. The insulin to help keep blood sugars controled and the ACE inhibitor to control blood pressure and protect the kidneys
Thursday February 10, 2011 12:12 Stefanie Nigro, PharmD
12:12
[Comment From Rafael PinedaRafael Pineda: ] 
Hello. When working on a hospital with computerized physician order entries, how do you deal with physician overriding interaction alerts?
Thursday February 10, 2011 12:12 Rafael Pineda
12:14
[Comment From Laura Hobbs, PharmDLaura Hobbs, PharmD: ] 
Hi, I am Laura Hobbs and have joined a little late.
Thursday February 10, 2011 12:14 Laura Hobbs, PharmD
12:15
[Comment From LouisaLouisa: ] 
Are researchers trying to develop drugs that don't cause interactions?
Thursday February 10, 2011 12:15 Louisa
12:16
Stefanie Nigro, PharmD: 
The order entry question is tricky - at the clinic I work at our physicians are able to set their controls to only have the computer program alert them when the drug interaction is considered "major." As always, the pharmacist who received the order is responsible for conducting a thorough review of the appropriateness and safety of the medication. I would be curious to hear Flora and Laura's thoughts.
Thursday February 10, 2011 12:16 Stefanie Nigro, PharmD
12:18
[Comment From Laura Hobbs, PharmDLaura Hobbs, PharmD: ] 
Pharmacists have the same and even more alerts in the computerized systems. We need to evaluate the significance of the alert for the patient and then call the prescibrer and talk to him/her directly about the interaction.
Thursday February 10, 2011 12:18 Laura Hobbs, PharmD
12:18
[Comment From DianaDiana: ] 
I've gotten sinus infections regularly over the years. Are there other drugs, besides birth control, that interact with the antibiotics?
Thursday February 10, 2011 12:18 Diana
12:18
[Comment From Laura Hobbs, PharmDLaura Hobbs, PharmD: ] 
When they develop new medications, they test for drug interactions. There are many new drugs that never make it to market not because they don't work but the interactions could be too dangerous.
Thursday February 10, 2011 12:18 Laura Hobbs, PharmD
12:20
Flora Harp, PharmD: 
Hi Diana. It would have to depend on the antibiotic. The interaction between birth control and antibiotics does not decrease the efficacy of the antibiotics. Rather, the antibiotic decreases the effectiveness of the birth control pills. However, keep in mind that drug interactions are specific to individual drugs, not just a class of drugs.
Thursday February 10, 2011 12:20 Flora Harp, PharmD
12:20
[Comment From PeggyPeggy: ] 
can restoril and neurontin be taken together at night safely.
Thursday February 10, 2011 12:20 Peggy
12:21
Flora Harp, PharmD: 
Hi Peggy. Yes, you may take Restoril and Neurontin together at night safely.
Thursday February 10, 2011 12:21 Flora Harp, PharmD
12:21
[Comment From lauralaura: ] 
My M.D. prescribed Clarinex 5 mg tablets and Nasonex spray for allergies and also Flovent HFA 44 mcg for bronchitis. She also stated that I can take Mucinex D. This seems like a lot...should I be concerned about any adverse interactions?
Thursday February 10, 2011 12:21 laura
12:21
Stefanie Nigro, PharmD: 
to Diana - antacid medications and calcium and iron supplements can sometimes interact with certain antibiotics. They often prevent the drug from being absorbed properly and can decrease how well they work. I would suggest talking with the pharmacist when being prescribed any new antibiotic.
Thursday February 10, 2011 12:21 Stefanie Nigro, PharmD
12:22
[Comment From BillBill: ] 
Speaking of Tylenol, I've read that the active ingredient, acetaminophen, is more dangerous for heart patients that doctors had previously thought. What's the latest on that?
Thursday February 10, 2011 12:22 Bill
12:22
[Comment From Laura Hobbs, PharmDLaura Hobbs, PharmD: ] 
Another example of a drug that interacts with many antibiotics is warfarin, a blood thinner also called Coumadin. Some antibiotics affect how the warfarin is process and can both increase or decrease the blood thinning effects.
Thursday February 10, 2011 12:22 Laura Hobbs, PharmD
12:25
[Comment From Laura Hobbs, PharmDLaura Hobbs, PharmD: ] 
The FDA has been evaluating acetaminophen because too much can cause liver damage. A major concern is that it is combined with many other medications so consumers do not always realize they are taking medications with that ingredient. The FDA may likely limit the products that contain ingredients combined with acetaminophen.
Thursday February 10, 2011 12:25 Laura Hobbs, PharmD
12:25
Flora Harp, PharmD: 
Hi Laura. It is not unusual to take these medications together if you have the different symptoms that they treat. Clarinex is an antihistamine so it will treat itchy, watery eyes and a runny nose. Nasonex is a nasal steroid so it will help with nasal congestion by decreasing inflammation in the nose. Flovent is an inhaled steroid that is used during allergy season to decrease inflammation in the lungs and help relieve symptoms. Mucinex D helps to loosen up phlegm build up. Again, it is not unusual to take these medications in combination.
Thursday February 10, 2011 12:25 Flora Harp, PharmD
12:25
Stefanie Nigro, PharmD: 
To Laura - I can understand your concern about taking all of those medications. The meds you listed above can be safely used together. Are you taking other medications in addition? If you experience any side effects, perhaps you should consider separating the doses to help minimize any problems. Common reactions to the nasal spray is nose irritation and itchiness. For the inhaler, be sure to wash your mouth after using. For the Muciniex, drink plenty of water
Thursday February 10, 2011 12:25 Stefanie Nigro, PharmD
12:26
[Comment From Bellas MomBellas Mom: ] 
Do Baclofen and Lamotrigen process thru the liver and should a person have blood levels drawn when on these two drugs over long period of time?
Thursday February 10, 2011 12:26 Bellas Mom
12:27
[Comment From Rafael PinedaRafael Pineda: ] 
How do you deal with: a) educating about information quality, and b) patient reactions and fear.
Thursday February 10, 2011 12:27 Rafael Pineda
12:28
Rinker Buck: 
Flora, what should parents watch for when their children are on prescription drugs? Are there common interaction problems with drugs frequently prescribed to children?
Thursday February 10, 2011 12:28 Rinker Buck
12:28
Laura Hobbs, PharmD: 
Baclofen and Lamotrigine both are broken down in the liver to some extent but kidney function matters too. Levels are not usually monitored.
Thursday February 10, 2011 12:28 Laura Hobbs, PharmD
12:29
Stefanie Nigro, PharmD: 
Currently baclofen and lamotrigine do not require blood monitoring although other medications may. Both medications go through the liver but at varying degrees. Many medications go through the liver because that is how they are broken down to be eliminated by the body.
Thursday February 10, 2011 12:29 Stefanie Nigro, PharmD
12:30
[Comment From DianaDiana: ] 
Is it true that some drugs are prescribed FOR their side effects? Such as prozac as an appetite suppressant?
Thursday February 10, 2011 12:30 Diana
12:31
Laura Hobbs, PharmD: 
Consumers should always be cautious about where they get their medical information. The internet is great but inaccurate information abounds. Look for internet sites from reputable institutions.
Thursday February 10, 2011 12:31 Laura Hobbs, PharmD
12:31
[Comment From lauralaura: ] 
Thank you for your responsed re: the clarinex, nasonex, flovent HFA and mucinex D. I actually haven't taken the Mucinex D yet, b/c i was concerned about all the meds, but have taken Advil for headaches in addition to the above...and also acidophillus supplements (I had been on 4 coursed of antibiotics in Nov/Dec for resistant sinus infection (Z-pak, Cefdinir, Levaquin 750 mg and Levaquin 500 mg)...trying to minimize any effects from all of those by using the acidophillus...
Thursday February 10, 2011 12:31 laura
12:32
Stefanie Nigro, PharmD: 
To Diana - I would say sometimes yes. A good example in addition to the one you provided is Benadryl, traditionally used for allergic symptoms) for sleep. Sometimes these are considered "off-label" uses.
Thursday February 10, 2011 12:32 Stefanie Nigro, PharmD
12:32
Flora Harp, PharmD: 
When first starting a prescription drug therapy for a child, one thing to pay close attention to is the dosing and directions of the medication. Typically children's dosing is significantly lower than adults and it is important to make sure you are giving them the right amount as prescribed by their physician.
Thursday February 10, 2011 12:32 Flora Harp, PharmD
12:32
[Comment From JenniferJennifer: ] 
Are there any reliable website that you would recommend that would help identify OTC/prescription medication interactions easily? There are so many ... can't decide which I can trust.
Thursday February 10, 2011 12:32 Jennifer
12:33
Laura Hobbs, PharmD: 
A great example for using a medication for the side effects is minoxidil otherwise known as Rograine. It is used for blood pressure control but cause excess hair growth. It is also marketed topically for baldness.
Thursday February 10, 2011 12:33 Laura Hobbs, PharmD
12:34
Stefanie Nigro, PharmD: 
To jennifer - I like http://www.bemedwise.org
This does not necessarily talk about all interactions but focuses more on how to better educate yourself to prevent such interactions. They review how to read a drug label as well as provide a list of questions you should ask about your medications.
Thursday February 10, 2011 12:34 Stefanie Nigro, PharmD
12:34
[Comment From GuestGuest: ] 
Are there greater risks of interactions if patients choose to save money on a generic instead of a brand name drug?
Thursday February 10, 2011 12:34 Guest
12:35
Flora Harp, PharmD: 
There is always a possibility of drug interactions whether it is for an adult or child. Community pharmacists are always available to answer any questions about your medications and help identify any potential drug interactions.
Thursday February 10, 2011 12:35 Flora Harp, PharmD
12:36
Laura Hobbs, PharmD: 
No, interactions depend on the drug itself not whether it was marketed first as a Brand product or later as a generic.
Thursday February 10, 2011 12:36 Laura Hobbs, PharmD
12:36
[Comment From GuestGuest: ] 
Can important drug interactions hide behind other symptoms?
Thursday February 10, 2011 12:36 Guest
12:37
Flora Harp, PharmD: 
Hi Guest. Generic medications are approved by the Food and Drug Administration (FDA) to be equivalent to the brand name product. Therefore, they do not post any greater risk to causing interactions than its brand name counterpart.
Thursday February 10, 2011 12:37 Flora Harp, PharmD
12:37
Rinker Buck: 
Strong medications, particularly antihistomines and steroids, are now prescribed for people with asthma, even children. Are there risks for drug interactions here?
Thursday February 10, 2011 12:37 Rinker Buck
12:38
Stefanie Nigro, PharmD: 
To Guest - the short answer is yes. A good example of this is drugs known as beta blockers (atenolol for example) can mask the signs of hypoglycemia (low blood sugar). It important to read the medication label to help educate on what to look out for.
Thursday February 10, 2011 12:38 Stefanie Nigro, PharmD
12:39
Flora Harp, PharmD: 
Yes, drug interactions can be hidden behind other symptoms. Sometimes you may think that symptoms you are experiencing are a side effect of the medication itself but it may in fact be a drug interaction with something else you are taking. That is why the pharmacist is a great resource to help you distinguish between true side effects of a medication and a drug interaction. You should also always read the written materials that are provided with every prescription.
Thursday February 10, 2011 12:39 Flora Harp, PharmD
12:42
Stefanie Nigro, PharmD: 
To Rinker - although I don't think a direct interaction exisits, both antihistamines (like Benadryl) and steroids (like prednisone) can cause some mental status changes like confusion, mood changes, etc. These side effects may be additive in certain patients.
Thursday February 10, 2011 12:42 Stefanie Nigro, PharmD
12:42
Flora Harp, PharmD: 
Hi Jennifer. Nothing is better than talking to your doctor or pharmacist about drug interactions. However, a user-friendly site that may be helpful is www.drugs.com.
Thursday February 10, 2011 12:42 Flora Harp, PharmD
12:42
Laura Hobbs, PharmD: 
With antihistamines and steroids I would be more concerned with side effects than drug interactions per se. A patient needs to communicate with the prescriber about adverse effects. With steroids, the side effects are more severe when taken by mouth or intravenously than when inhaled. When using inhaled steroids, patients should wash out their mouth to remove the residue that can cause thrush in the mouth.
Thursday February 10, 2011 12:42 Laura Hobbs, PharmD
12:44
Rinker Buck: 
Okay, everyone, we are approaching the end here, and I would just like any guests with last-minute questions to get them in now, so our panelists have time to reply.
Thursday February 10, 2011 12:44 Rinker Buck
12:44
[Comment From GuestGuest: ] 
If people decide to take routine pain medications like Advil or Tylenol (say, after shoveling a lot of snow), what should they be looking for if they are on other prescribed medications?
Thursday February 10, 2011 12:44 Guest
12:45
[Comment From Rafael PinedaRafael Pineda: ] 
Thanks for your time and useful information.
Thursday February 10, 2011 12:45 Rafael Pineda
12:46
Stefanie Nigro, PharmD: 
To guest - Well this depends on what other prescribed medications they are on. If a patient is on other blood thinners, then motrin shoud be avoided. Also, many prescription and over the counter products for cough, cold or pain may contain Tylenol as well. Its important to avoid duplications in therapy.
Thursday February 10, 2011 12:46 Stefanie Nigro, PharmD
12:46
Flora Harp, PharmD: 
There are some medications that may interact with Advil or Tylenol. It is always good practice to read the labels on all over-the-counter medications as well as the written materials provided with your prescription medications. These sources will let you know if there could be a potential interaction. As always, you can ask your local pharmacist.
Thursday February 10, 2011 12:46 Flora Harp, PharmD
12:47
Rinker Buck: 
And, do we have any final comments from the panelists? Perhaps a question that wasn't asked, or a parting thought that you would like patients and consumers out there to have?
Thursday February 10, 2011 12:47 Rinker Buck
12:47
Laura Hobbs, PharmD: 
Ibuprofen (Advil) decreases swelling and helps pain but also increase the risk of bleeding. So I would be cautious if you are taking any other medications that affect bleeding such as aspirin, clopidigrel/Plavix, or warfarin. As the others have stated pharmacists are there to answer questions.
Thursday February 10, 2011 12:47 Laura Hobbs, PharmD
12:47
[Comment From GuestGuest: ] 
Thank you for your time and information. Very helpful discussion!
Thursday February 10, 2011 12:47 Guest
12:49
Stefanie Nigro, PharmD: 
Thank you all for a great discussion. I would recommend the following "tips" to ensure the safe and effective use of your medicines: 1. Keep an active, updated list of your medications 2. Use only 1 pharmacy for all of your medication needs 3. Read drug lables in their entirety 4. Get to you know your pharmacist 5. Ask ANY questions you have, no matter how "silly" you think they are.
Thursday February 10, 2011 12:49 Stefanie Nigro, PharmD
12:50
[Comment From AnnaAnna: ] 
What about mixing over-the-counter pain medicines with alcohol? How much can you safely drink if you've taken Advil or Motrin, for example?
Thursday February 10, 2011 12:50 Anna
12:50
Flora Harp, PharmD: 
Rinker, thank you for moderating today's chat. I would like to end the chat by saying that drug interactions can be very harmful. Having all of your prescriptions filled at one pharmacy will allow your pharmacist to have a full view of all of the medications that you are taking. This will allow them to review the complete list of medications you are on and identify any potential drug interactions.
Thursday February 10, 2011 12:50 Flora Harp, PharmD
12:52
Laura Hobbs, PharmD: 
Many OTC medications interact with alcohol. Usually the more alcohol the increased the interaction, so one cannot say there is a safe amount you can drink. Always in moderation and read the labels to see if there is an interaction for a specific OTC medication.
Thursday February 10, 2011 12:52 Laura Hobbs, PharmD
12:53
Rinker Buck: 
Well thanks, everyone, especially panelists Stefanie, Laura and Flora, who took time out from busy schedules to do this. For a replay of this chat, go to courant.com/cthealth, and everyone have a great day.
Thursday February 10, 2011 12:53 Rinker Buck
12:54
Stefanie Nigro, PharmD: 
Have a great day everyone! Thank you for your insighful questions and discussion.
Thursday February 10, 2011 12:54 Stefanie Nigro, PharmD
12:55
Flora Harp, PharmD: 
Thank you everyone! Have a great day.
Thursday February 10, 2011 12:55 Flora Harp, PharmD
12:55