Q. I have taken Zocor for several years to control my cholesterol, and it keeps the cholesterol around 200. It does nothing for my elevated triglycerides, though, and my ratio has been around 5 although it should be under 4.

I started taking fish oil concentrate for itchy dry skin. It certainly helped, but to my surprise I discovered by accident that the fish oil seems to have had a dramatic effect on my blood lipids. The triglycerides have dropped over 160 points and now are within the normal range. The cholesterol ratio is down to 4. And most startling of all, my cholesterol is now just 94. Is there a connection between fish oil and cholesterol? My doctor is considering cutting my dose of Zocor, since he says 94 may be just too low.

A. Fish oil is well known to lower cholesterol and triglycerides and raise good HDL cholesterol. It also reduces the risk of blood clots and stabilizes the electrical activity of heart cells, reducing the chance of irregular heart rhythms.

We agree with your physician that a cholesterol level of 94 could be too low. There is some research to suggest that very low cholesterol is associated with depression and bleeding strokes.

For more information on fish oil, cholesterol ratios and the hazards of low cholesterol, we are sending you our Guide to Cholesterol & Heart Health. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped, self-addressed envelope: Graedons’ People’s Pharmacy, No. C-8, P. O. Box 52027, Durham, NC 27717-2027.

Q. I have just recently read that cimetidine can cause impotence as a side effect. I was diagnosed with erectile dysfunction before I started taking this heartburn medicine. I now take Viagra as needed, and it works fine. But I wonder if the cimetidine is making my condition worse. Also, does cimetidine interact with Viagra?

A. Cimetidine (Tagamet) has been associated with erectile problems, but usually only at higher doses. More alarming, however, is the potential interaction with Viagra. Your heartburn medicine could increase blood levels of Viagra that could lead to toxicity.

Q. You have written about Prozac poop-out. I have found a way to overcome Paxil poop-out!

I take Paxil and Klonopin for depression. By itself, Paxil always pooped out in a month or so, but the combination has worked very well for me for five years.

Then that combo began to poop out too, and for about a year my mood was noticeably lower. By accident, I discovered that if I stop both pills for a few days, my mood gets Much Better. After that pause I resume my full dose till effectiveness droops again.

My psychiatrist agrees with this strategy. In fact, he long ago suggested that I could stop Paxil for a weekend to ameliorate the sexual “damping” that occurs with Paxil.

A. Thanks for sharing your novel approach. Many patients have experienced a loss of effectiveness of Prozac, Paxil, Zoloft or similar antidepressants with time. Often the solution is to switch to a different medication. Finding a combination that works for you and a way to maintain its power is less complicated than changing drugs.

Anyone else who wants to try your strategy should consult a physician since stopping Paxil suddenly could lead to symptoms of withdrawal.

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