Unless you have been hibernating for the last few weeks, you have probably heard that Anna Nicole Smith died of an accidental overdose. According to the Broward County Medical Examiner, the legal medicines she was taking led to “combined drug intoxication.”

She apparently stopped breathing because her nervous system couldn’t handle all the chemicals floating around in her blood stream.

The autopsy report listed chloral hydrate, an old-fashioned sleep aid that is sometimes used to help a person withdraw from alcohol dependence. Also found in her blood stream were traces of methadone, a pain reliever also used to treat narcotic dependence.

She also seems to have been taking clonazepam, a sedative and anti-seizure drug that is sometimes used as a sleeping pill. Other drugs in her body included diazepam (Valium), lorazepam (Ativan) and oxazepam (Serax). These are all benzodiazepines used as anti-anxiety agents or sleeping pills. The over-the-counter allergy and sleeping pill diphenhydramine (Benadryl) was also detected.

One wonders who prescribed all these drugs to Anna Nicole Smith and what pharmacy dispensed them. Taking them all together was a prescription for death.

Chloral hydrate was developed in 1832 but it wasn’t used medicinally until 1869. That makes it one of our oldest sleeping medicines. It gained notoriety for its part in the “Mickey Finn,” also known as knockout drops. Folklore claims that bartenders in cahoots with sea captains would slip chloral hydrate into a drink. The hapless sailor would pass out and wake up on board a ship miles from shore.

Why did Anna Nicole take so much sleeping medicine? One theory involves an interaction between the antibiotic Cipro, which she was taking for an infection, and the caffeine in soft drinks that were found around her bed. Cipro magnifies the effects of caffeine. This might have made it difficult for her to get to sleep, leading her to take too many sedatives.

Although the Broward County Medical Examiner ruled it non-contributory, Cipro might have had another potentially lethal interaction with her mix of medicines. The combination of methadone with ciprofloxacin can throw the heart out of rhythm.

We may never know which interaction actually killed Anna Nicole, but it is clear that she was taking way too many medications. Therein lies a lesson for all of us.

Millions of Americans suffer adverse drug reactions each year from legitimate medicines. Many die. Deadly combinations are far more common than most people imagine.

Every time you get a new prescription, remind the doctor of all the other drugs you are taking. Include the dietary supplements, even if you don’t consider them drugs. Make sure the pharmacist double-checks the safety of any combination of drugs you are taking.

Then do your own homework as well. Our book, Dangerous Drug Interactions (St. Martin’s Press), offers guidelines and provides examples of food, drug and supplement interactions. It is available online (www.peoplespharmacy.com) or from your local library.

If you are taking a lot of different drugs, it may take time to check the safety of all the possible combinations. It’s worth taking the time. Your life could be on the line.

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