Q. My doctor prescribed tramadol with APAP for headaches. He also wrote prescriptions for Lexapro and Effexor for depression and anxiety. He said that Effexor and Lexapro are both antidepressants, but they work on different parts of the brain.
When I went to fill the new Lexapro and refill the tramadol prescription, the pharmacist would not fill them. She said the combination could cause side effects. What would those be?
A. Your pharmacist may have saved your life. The combination of Lexapro, Effexor and tramadol (Ultram) could have raised serotonin to dangerous levels (serotonin syndrome). In such situations, people may experience symptoms such as anxiety, agitation, muscle twitches and contractions, sweating, high blood pressure, confusion, hallucinations, convulsions and even coma.
Q. Three years ago, you ran a letter from someone who said that patting cornstarch on her face with a cotton ball had helped her rosacea. I’d like to thank that person. I’ve tried many products over the years, without much success, but the cornstarch works better than anything. What a simple, cheap remedy!
A. Thanks for sharing your interesting experience. Another reader reported: “I have had rosacea–dry, flaky reddened facial skin–for years. I decided to try vinegar as a facial cleanser. I dampen a cloth with it and wipe my face off once daily. My facial skin has not felt this smooth or been this free of redness for a long time.��?
People who don’t find such home remedies helpful may be pleased to learn that the FDA recently approved a new prescription drug for this hard-to-treat skin condition. Oracea contains a special low-dose formulation of doxycyline (40 mg). Results from clinical trials indicate that Oracea has anti-inflammatory activity against the “pimples��? of rosacea and does not seem to trigger antibiotic resistance or typical side effects. Oracea should reach pharmacy shelves in July.
Q. My friend is diabetic and suffers terribly from nerve pain in his legs. What can you tell me about ways to treat this problem?
A. Diabetic nerve pain (neuropathy) can be debilitating. The burning can be unbearable and the loss of feeling in feet is dangerous.
A drug called Lyrica is approved for treating this condition. Side effects may include dizziness, drowsiness, weight gain, blurred vision, fluid retention and dry mouth. The antidepressant Cymbalta has also been shown to help ease diabetic neuropathy. Adverse reactions to watch for include nausea, dizziness, drowsiness, constipation, dry mouth and increased sweating.
Another option may be alpha-lipoic acid. This natural antioxidant, available at health food stores, has been shown to help reverse symptoms for some people.
We are sending you a one-hour CD of a radio interview we conducted with experts in diabetes care. They discussed the latest drug treatments for diabetes and neuropathy as well as diet controversies. Anyone who would like a copy of this CD may send $16 to: People’s Pharmacy (CD-526), P. O. Box 52027, Durham, NC 27717-2027 or visit our Web site, www.peoplespharmacy.com and look for radio show No. 526.

Q. Have you heard of any commercial formulation of diphenhydramine and ibuprofen? I’m hoping for something with anti-inflammatory activity.

A. Advil PM contains ibuprofen plus the antihistamine diphenhydramine. You could also buy both drugs separately as generics.

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