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Official Newsletter of Drug Free Workplaces February 2015 Vol. 16 No. 2 DrugFree@WorkPlace Published by The Council on Alcohol and Drugs Tel (404) 223-2486 | Fax (866) 786-9811 | www.LiveDrugFree.org Illegal drug users prefer to sell to their coworkers! www.LiveDrugFree.org Dangerous Drug Interactions combination are needed." Adverse drug interactions are one of the leading causes of death in the United States. Many celebrities have died as a result of combining illicit street drugs with prescription drugs and/or alcohol. Mixing antidepressants and methadone is another dangerous combination because of the sedative effect of both drugs. There has been a dramatic increase in deaths in recent years related to methadone use, and drug interactions have been implicated in many of these deaths. Severe adverse events including deaths have also occurred in patients who co-ingested methadone and alcohol. While most drug interactions are not life-threatening, mixing some medicines or drinking alcohol and/or ingesting street drugs with certain medications can cause serious consequences. Some drugs, when taken in combination, exhibit synergism resulting in toxicity. At the very least, mixing some medications and/or food and drink interactions with certain meds can cause them to not work properly. Mixing Percocet and Xanax, especially if abusing these prescription drugs by taking more than prescribed, is one example of a dangerous combination. Both drugs are depressants and can cause shallow breathing, respiratory arrest, and even death. Drinking alcohol while taking fast-acting Xanax is also dangerous for the same reason. Drinking alcohol with any depressant drug is risky because both affect the part of the brain that regulates heart rate and breathing. Just because alcohol and prescription drugs are legal does not mean they are safe, especially when combined. Legal does not always mean safe. While drinking alcohol and taking some prescription medications can be safe in moderation, drinking while taking other medicines can intensify the effects of both alcohol and the drug taken, resulting in serious injury or death. Alcohol and Depressant/Stimulant Use Combining painkillers, sedatives, or stimulants with booze can be a deadly combination. According to a 2010 study of 13 U.S. states, 3,883 deaths were tied to opioid pain relievers – 22 percent of which involved alcohol. And another 1,512 deaths were tied to benzodiazepine drugs, more than 21 percent of which involved alcohol. Opioid pain relievers and benzodiazepine drugs – like alcohol – are central nervous system depressants. "These findings indicate that alcohol plays a significant role in opioid pain reliever and benzodiazepine abuse,” the study authors wrote. “Interventions to reduce the abuse of alcohol and these drugs alone and in For the same reason(s) that no one should ever use cocaine and methamphetamine at the same time, prescription stimulant drugs such as Ritalin or Adderal should not be taken with alcohol. Mixing stimulant drugs with alcohol is dangerous because the combination can create a false sense of sobriety. Stimulants may convince the user that he or she can continue to drink beyond physical limitations, resulting in alcohol poisoning and death, or the alcohol could mask the effects of the drug, resulting in a stimulant drug overdose. “Speedballing” Unless a doctor prescribes both medications and carefully monitors the patient, stimulants and depressants such as opiates should not be mixed because of the opposite effects of these drugs. Stimulants speed up the heart, while opiates slow it down, creating an increased risk of overdose. It may seem that one drug would cancel out the effects of the other, but this is not the case. The body is not capable of adequately processing these counteracting drugs. Stimulants require that the body use more oxygen, but depressants reduce the breathing rate, causing a lack of oxygen at a time when it is needed most. Many overdoses have occurred from celebrities and street drug users engaging in the risky behavior of “speedballing”; mixing stimulants and opiates. Most fatal overdoses occur as a result of this type of polydrug abuse. Antidepressants Most people who take antidepressants know that they should not drink alcohol because it can lessen the effect of the medication. But there are also prescription drugs that should not be combined with antidepressants. To help us combat substance abuse, go to www.LiveDrugFree.org and click on “Donate!” DrugFree@WorkPlace | February 2015 Vol. 16 No. 2 | www.LiveDrugFree.org | Tel (404) 223-2486 Antidepressants affect serotonin levels, and when taken in combination with some pain medicines, a deadly reaction known as serotonin syndrome can occur. Serotonin impacts the heart, muscles, and breathing, and the wrong combination of meds can result in shivering, restlessness, euphoria, and diarrhea. If not treated quickly, serotonin syndrome could result in death. Food and OTC Drug Interactions It is always best to check with your doctor and pharmacist about combining medications and drinking and drug interactions, but it is also important to ask about food and drug interactions. While alcohol and prescription drugs are among the most common and dangerous, other types of interactions also can be life threating, including interactions between herbal or dietary supplements, over-the-counter (OTC) medications, and food. For example, limes and Seville oranges may block enzymes that break down statins, including dextromethorphan, the active ingredient in cough medicine. This could result in a build-up of dextromethorphan in the blood, increasing side effects. Symptoms could include severe muscle damage, sleepiness, and hallucinations. Mixing ACE inhibitors like Prinivil, Capoten, Vasotec, and Zestril that are used to lower blood pressure with bananas, oranges, green leafy vegetables, and certain salt substitutes could result in irregular heartbeat and heart palpitations. The reason is that ACE inhibitors can increase the amount of potassium in the body, and foods and products high in potassium lead to too much potassium buildup. Some over-thecounter decongestants can also decrease the effectiveness of these blood pressure medications. People with high blood pressure should not take over-thecounter nasal decongestants without checking with their doctor or pharmacist. Kale, spinach, broccoli, cabbage, Brussels sprouts, and other greens should be eaten in moderation when taking blood thinners such as Warfarin or Coumadin. These foods are rich in Vitamin K and can reduce the drugs’ anticlotting effects. Warfarin should also not be combined with aspirin as this significantly increases the risk of bleeding. The risk is even higher if taken with garlic pills or other herbal remedies that thin the blood. Staying Safe People who take medicine must avoid deadly drug combinations and take their medications responsibly. Every person reacts differently to each psychoactive drug. It is important for patients to check their reaction carefully and contact their doctor immediately if they feel something is wrong. To be safe, always follow your doctor’s advice, never abuse prescription drugs or mix medications without a doctor’s approval, and be aware of and careful with all food, alcohol, OTC medicines, and drug interactions. Know exactly what drugs you are taking and all of their side effects, and if possible get all of your drugs at the same pharmacy so that the pharmacist will have a complete record of all your medications. You should always ask your pharmacist about the side effects of a new medication and review what the medication is used for. It’s also a good idea to ask general questions regarding how to take meds (with or without food), if you need refills, when drugs expire, and what to do if you miss a dose. Always check your medication before leaving the pharmacy to make sure it is your name on the bottle and that it is the correct drug your doctor prescribed. Be sure to tell your doctor and pharmacist about any over-the-counter, herbal or home remedy medications you are taking, and don’t engage in illegal drug use or alcohol abuse, especially in combination with prescription meds. Never take medicine prescribed for someone else, and don’t increase or decrease the dosage of your medicine without your doctor’s consent. Ask your doctor for written instructions on taking any new medication, and when you leave the doctor’s office, make sure you know the name of the medication and the generic name, what it is for, how many times a day you should take it, and how you might react. Reducing the risk of adverse drug interactions is often a matter of using common sense and asking your doctor or pharmacist the right questions. To help us combat substance abuse, go to www.LiveDrugFree.org and click on “Donate!”