If we keep looking up all he time at interactions then I don't think there would be any choice available for such kind of poorly managed cases. Hence, it is always said that the presciber should always weigh the risks against the benefits and go ahead. You can classify most of his drugs in to following classes as per the condition due to poor control of dibetes
1. Type 2 diabetes.
2. Diabetic Neuropathy.
3. Diabetic Nephropathy.
4. Secondary prevention of Cardiovascular Complications or CVD risks (specialy the aspirin & cholesterol reducing drugs)
Then add Temazepam for possible insomnia and MST for further control of pain which leads to constipation hence give Senna. So if you see, it is rather a chain prescribing rather than treating the actual cause re DIABETES. This is how NHS ends spending lots on people who don't care to take control of their condition (particularly DIABETES) and continue their lifestyle as it is and end up in this situation. I am suprised why this list does not include SILDENAFIL/ TADALAFIL, as is the case with most of the diabetics these days
The patient could possibly - continue on these medicines relatively safely for a very long time - but there the prescribing could and should be improved and rationalised.
E.g. with 2 tricyclics - even if they are being used for different indications - it does not appear to me to make sense. If he really needs to continue on a tricyclic, an effective dose of 1 drug should be enough.
I agree with the other posters that simply classifying this patient as a type 2 diabetic is misleading. E.g. - at the very least her also must have established heart disease to be prescribed nitrates. Also, without knowing doses - it is difficult to pass more comments. Can you post up doses?
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