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What would be the most likely side effects/interactions, if any,
for a person taking the following medications: Effexor XR (300mg/day),
Lorazepam (.5mg/day), Levoxyl (.088mg/day), and Ortho Tri-cyclen 28
(birth control pill)?Dear Betsyj, hello and thanks for a great medical question.
To answer your question, I used a medical software program called
Epocrates Rx Pro (http://www2.epocrates.com/products/rxpro/), which is
designed to help health professionals look up information on
medications, including side effects/adverse reactions and potential
interactions between medications for patients who are on, or being
considered for, multiple medicines. This program is widely used and
highly respected, for example, it is used by pharmacists at Provena
Saint Joseph Hospital, Elgin,
IL.http://www.uspharmacist.com/oldformat.asp?url=newlook/files/phar/technology.htm
and is even mentioned on the FDA web site as a way to reduce adverse
drug reactions (though the product is not officially endorsed by the
FDA) http://www.fda.gov/cder/drug/drugReactions/default.htm
I first checked to see if there were any expected interactions between
the medicines and then looked at the adverse reactions (side effects)
for each one.
1. ASSESSING POSSIBLE INTERACTIONS
To evaluate for any possible interactions, I used the function called
"multi-check", and entered the names of the medicines you listed in
your question. No advisories to alter or monitor the combination were
given but instead I retrieved the following summary statement:
"No interactions found for drugs selected. Caution always advised with
multiple medications."
This is an excellent and fully up-to-date software program that
represents the current knowledge in modern western medicine. Thus, I
feel fairly confident in telling you that there are no likely
interactions for the medicines that you listed. The interpretation is
that as far as is known, there is no significant interaction between
any of the medications that you listed. In other words, a physician
prescribing this combination could focus on possible adverse from any
one medication on the list, but need not worry about interactions.
2. ASSESSING FOR POSSIBLE ADVERSE REACTIONS FOR EACH MEDICINE
Almost all medicines have possible side effects and the ones you
listed are no exception. I looked up each one on the Epocrates program
and have listed the results for you here. They are listed in groups by
"serious reactions" and by "common reactions." The Common Reactions
are listed in order of their relative frequency, with more common
reactions being listed first.
a) Effexor XR (venlafaxine)
SERIOUS REACTIONS: seizures, suicidality, worsening depression,
withdrawal symptoms, anaphylaxis, mania, hypertension, hyponatremia,
SIADH (syndrome of inappropriate ADH), serotonin syndrome,
extrapyramidal symptoms, abnormal bleeding, blood dyscrasias,
arrhythmias, severe skin reactions, glaucoma, pancreatitis.
COMMON REACTIONS: nausea, headache, somnolence, dry mouth, dizziness,
insomnia, constipation, nervousness, sweating, asthenia, abnormal
ejaculation, anorexia, diarrhea, blurred vision, vomiting, anxiety,
impotence, infection, hypercholesterolemia, tremor, dyspepsia,
vasodilation, abnormal dreams, yawning, paresthesias, rash,
hypertension, tachycardia, chills.
b)Lorazepam (generic)
SERIOUS REACTIONS: Cardiovascular collapse, respiratory depression,
withdrawal syndrome, gangrene (if intra-arterial), blood dyscrasias,
abuse/dendency.
COMMON REACTIONS: sedation, dizziness, weakness, ataxia, depression,
nausea, antegrade amnesia, headache, sleep disturbance, agitation,
rhythmic myoclonic jerks, urinary incontinece, diplopia, nystagmus.
c)Ortho Tri-Cyclen
SERIOUS REACTIONS: thromboembolism, retinal thrombosis,
thrombophlebitis, myocardial infarction, cerebral thrombosis, cerebral
hemorrhage, severe hypertension, hepatic adenoma, cholestatic
jaundice, gallbladder disease, depression, anaphylaxis/anaphylactoid
reaction.
COMMON REACTIONS: Nausea/vomiting, abdominal cramps, bloating,
breakthrough bleeding, altered menstrual flow, amenorrhea, breast
tenderness, breast changes, edema, headache/migraine, weight changes,
cervical secreation changes, emotional lability, vaginal candidiasis,
rash, acne, melasma, contact lens intolerance, elevated BP, glucose
intolerance.
I hope that this information is helpful to you. If you have other
specific questions about medications and possible side effects we look
forward to your posting them. Let me know if I can clarify any of this
for you.
Take care and best of luck,
RMH
Search strategy: Epocrates Rx Pro Multicheck and Adverse Reactions
available for handheld at www.epocrates.com#If you have any other info about this subject , Please add it free.# |
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