In the United States most law-abiding citizens don’t run red lights. They know that the traffic rules are there to protect everyone from accidents.
There’s also the fear factor. If a policeman catches you going through an intersection against the light, there is a hefty penalty.
Physicians are often faced with the equivalent of a red light when they write an electronic prescription. The software that they use on the computer or a hand-held PDA has been programmed to alert them to dangerous drug interactions.
Incompatible drug combinations contribute to 20 to 30 percent of adverse reactions to medications. For example, the heart rhythm regulator amiodarone can increase blood levels of the heart medicine digoxin. Without very careful monitoring this could result in serious toxicity.
Patients who take an antidepressant such as sertraline (Zoloft) or fluoxetine (Prozac) should be warned not to take a triptan-type migraine medicine such as eletriptan (Relpax), rizatriptan (Maxalt) or sumatriptan (Imitrex).
The FDA has warned physicians that such a combination could result in serotonin syndrome. Symptoms include uncontrollable twitches or muscle contractions, shivering and tremor, sweating, agitation and confusion. People can go into coma or die as a consequence of serotonin syndrome.
When doctors see an interaction alert on their screen, what do they do? Some reconsider the prescription. But a study of physician behavior at six Veterans Affairs medical centers reveals some shocking shortcomings.
During the year that was under study, physicians ignored nearly 300,000 warnings. Almost three quarters of these were for “critical drug-drug interactions” (American Journal of Managed Care, Oct. 2007).
When doctors are asked why they override drug interaction notices they frequently cite “alert fatigue.” They complain that they get too many false alarms in which the interaction does not result in any problems for the patient. As a result, they get into the habit of overriding many of the alerts they see, even those that could cause serious harm (Medical Care, Dec., 2002).
Pharmacists are supposed to detect incompatible combinations of medications. They represent a safety net for prescribers. But they too may override interaction warnings on their computers.
Even when a pharmacist decides that an interaction needs further investigation before dispensing, she may run into a roadblock at the doctor’s office. Sometimes the physician fails to return a pharmacist’s call, or even several calls. This leaves the pharmacist and the patient in a quandary.
To assist patients in their quest for drug information we have prepared a free Drug Safety Questionnaire for the pharmacist and physician to fill out.
Perhaps it’s time for prescribers and dispensers to stop overriding drug alerts. Just as drivers should not ignore yellow or red lights, physicians and pharmacists need to exercise caution when faced with potentially dangerous combinations.

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  1. Al_capone

    I am on sotalol, amiodarone & sertraline… Is it ok to take all of the three meds together? I am really scared of the drugs interactions… Can anyone with experience tell me?

  2. DHL

    I was suffering from depression, tremors, pain from metastatic bone cancer, high blood pressure, etc. I also was taking thyroid medication. For years had been taking Celexa. Was on fentanyl patch and tramadol for breakthrough pain. I was in the process of reducing the pain medications- they also had been used for recovery from 3 surgeries for a colostomy and subsequent prolapses of same. In the meantime had received metoprolol, lisinopril/HCTZ for high blood pressure, along with metformin for type II diabetes.
    I began to have high/low blood pressure swings with pressures as low as 86/38. I had nausea and vomiting, along with trouble focusing my eyes, tremor, dry eyes, dry mouth, problems sleeping, etc. PC stopped metoprolol – no relief. Then cut dose of lisinopril/HCTZ in half, no relief yet.
    Then I went for a checkup for the ostomy in which the nurse practitioner entered all my medications in the computer. She then read off the possible drug interactions (many potentiated the effects of Celexa). Several days later I looked up the effects of overdose of Celexa and BINGO! there were all my symptoms.
    Now, I am off all heart medications and still reducing pain meds which also produces Serotinin Syndrome-like symptoms. Am suffering from feeling cold and hungry. Related? Blood pressure has stabilized without orthostatic problems. Still pain (of withdrawal?) We’ll see. My gut fights decreasing pain meds by producing lots of gas, diarrhea, and mucus. To be continued.
    For once thankful for a computer program, and the fact that I have been a medical researcher, and info is on the internet. Once I recited all my symptoms together for the Pain management doctor, he said: Setotonin Syndrome.
    It also happened that for a year or more I had been doing relaxation and hypnosis treatments for pain management,which apparently were responsible for the decrease in my need for high blood pressure medications. Only pain management doctor had enough time to listen to all these different symptoms. I had to put it together mostly myself. Pay attention patients, trust your body and your perceptions and don’t give up until you get answers. I could have died 3 or 4 times unless I had persisted.

  3. SS

    MY DR. prescribed METFORMIN AND ACTOSPLUS it made me sick for few days, my head was spinning. I called the Dr. but he didn’t do anything. I asked to change the medication immediately. Now I got a warning =black box- saying both drugs should not be prescribed together.

  4. P.O.

    I was on Zoloft for depression (& ADD) a few years then stopped then back on (stress/depression again but it also lost effectiveness after a few months) and then diagnosed with diabetes. Now I’m on Strattera (ADD) and Metformin & Actos- Metformin & Actos are common combo and recent study show Actos helps prevent developing type 2 Diabetes- there’s also a drug with that combo.

  5. M.

    The issue here should not be how many alerts the doctors ignored. It should be how many of their patients had a bad reaction to the drugs. If all of their patients turned out fine than maybe we need to reevaluate the alert system.

  6. md

    I had to learn the hard way on drug interactions. I wish I could of read this before I almost died. I also had serotin syndrome. It took my dr about 24 hrs to pick up on it. I never heard of it before.
    I am allergic to SSRI’s now. I have had two seizures because of drug interactions. The last caused my brain to swell (PRES) with a grandmal seizure. My neurologist told me trazodone and wellbutrin caused this one. Now I have to take seizure meds for 2 yrs.

  7. cpmt

    MY DR. prescribed METFORMIN AND ACTOSPLUS it made me sick for few days, my head was spinning. I called the Dr. but he didn’t do anything. I asked to change the medication immediately. Now I got a warning =black box- saying both drugs should not be prescribed together.

  8. DS

    I took Prozac and then Zoloft for depression on and off for a number of years, but I would get muscle twitches whenever I would use them. I would go off the SSRI’s, but my depression continued, so my psychiatrist told me I would have to choose between the depression or having muscle twitches. I decided to continue the SSRI medication, but the muscle twitching became worse.
    I talked to my doctor, my psychiatrist,a pharmacist and my doctor’s pharmaceutical rep and they all would not commit as to any causal relationship between the muscle twitching and the SSRI. One weekend it became so bad my facial muscles would involuntarily grimace and I was jerking in my bed. Before I went to bed, I knew I had to do something about it and went online and discovered the “seratonin syndrome” that matched my symptoms exactly.
    I called my doctor the next morning and he told me to go off Zoloft immediately. Now, why didn’t even one of those four medical professionals diagnose the “seratonin syndrome” that I was getting from taking a SSRI? Going off the Zoloft cold turkey was another nightmare in itself, but I got through it, never to take an antidepressant again. Instead I have doing cognitive therapy, exercise, positive thinking, meditation, and vitamin D and fish oil, and after 25 years I am depression free!

  9. S.F. Eisner

    My experience is doctors ignore dangerous interactions. I’m dealing with (doctor induced) chronic pain. The doc who did this denies responsibility (even though it’s been in surgical journals). I’m going to a psychiatrist to help me deal with it. He prescribed Prozac.
    One of the pain doctors, who knew about the Prozac, prescribed Ultram. I had a clonic-tonic seizure which is known to happen from this combination. The only thing that’s helped the pain is narcotics. Can’t get it; docs now saying “drug-seeking”. NO! Pain-relief-seeking. Tried every alternative treatment before turning to drugs.

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