Interaction

[Buggerlugz]

Hi is there any problems taking these medicines 54 male type 2 diabetes been taking them for at least 4 yrs and will be taking them long term:
2 Co-Amilozide
3 Rosuvastatin
4 Metformin
5 Oxybutynin
6 Lansoprazole
7 Temazepam
8 Glipizide
9 Trimethoprim
10 Glyceryl Trinitrate
11 Mst
12 Dosulepin
13 Ferrous Sulphate
14 Senna
15 Gabapentin
16 Amitriptyline
17 Asprin
18 Ezetimibe
19 Tamsulosin
20 Baclofen
21 Oramorph

[Nik]

Bit detailed to get just a simple yes/no response

[Buggerlugz]

I dont think I asked for a yes/no answer

[crit care]

I dont think I asked for a yes/no answer

well you asked if there were any problems with the lsit of medicines..surely that woudl warrant a yes/no answer?

[johnep]

Has not been trained in open and closed questions. Poster asked a closed question.
johnep

[trulylovelyperson]

Good grief
Recent posts - pedantic or what?

Btw had cat called buggerlugs when I was a student so feel need to respond to this: however is Saturday night after 10pm so be advised...............

Ginormous list of drugs so bound to be interactions - consult BNF you lazy person,
On the bright side, you say has been taking this lot for some time so presumably still breathing ; hence nothing immediately fatal eh.

Seriously - if taken into hospital am willing to bet they would want to cut down number of drugs while safely monitoring process. Even a dinosaur like me can spot Temazepam over 4 years is outside licence and for a 54yr old, long overdue for review. Without GP notes on the why's and why still's, is difficult as we work in the dark. As always.
Fastest way to get up a GP's nose is to suggest somat he has already tried and failed.
Maybe after checking with patient/carer when last review was done you could make constructive suggestions .

Am I a wimp?

[crit care]

i'm guessing in a hospital, they would stop a lot of them..either that or not touch them and leave it for the GP to sort out..Drs in hospital are not going to mess around with weaning someone off temazepam whilst they are in hospital,

looking at the list i could get rid of a few of them, although it does seem as though the aptient coulod be in a bit of pain....without knwoing doses of them its tricky! but i'm guessing you could uptitrate up a few of them and lose the others

[shan]

I think you are just trying to term him only a Type 2 diabetic based only 2 drugs out of the whole list. In my opinion he has poorly controlled diabetes, may be his own lifestyle or the GPs fault, which might have led to many other complications for which all other meds are prescribed. On the other hand apart from diabetes, he may have another condition like MS or some painful condition. A typical case for aneffective MUR. Definitely NHS will say value for money spent on this MUR. Forget the interactions first find out what is wrong with him and who and why he was prescribed these meds? Chances are likely he is either just getting them on repeats without even knowing why he takes them.

[Pharmacie]

Regarding drug-drug interaction , you can use medscape Drug Interaction Checker.
Medscape: Medscape Access
I've entered the list you've mentioned.The result was in three categories:

Serious - Use Alternative
amitriptyline + dosulepin
amitriptyline and dosulepin both increase QTc interval. Serious - Use Alternative.

amitriptyline + dosulepin
amitriptyline and dosulepin both increase serotonin levels. Serious - Use Alternative.

Significant - Monitor Closely
aspirin + glipizide
aspirin increases effects of glipizide by unknown mechanism. Significant - Monitor Closely. Risk of hypoglycemia.

amiloride + aspirin
amiloride and aspirin both increase serum potassium. Significant - Monitor Closely.

amitriptyline + trimethoprim
amitriptyline and trimethoprim both increase QTc interval. Significant - Monitor Closely.

dosulepin + trimethoprim
dosulepin and trimethoprim both increase QTc interval. Significant - Monitor Closely.

amitriptyline + morphine
amitriptyline and morphine both increase serotonin levels. Significant - Monitor Closely.

dosulepin + morphine
dosulepin and morphine both increase serotonin levels. Significant - Monitor Closely.

lansoprazole + glipizide
lansoprazole will increase the level or effect of glipizide by increasing gastric pH. Applies only to oral form of both agents. Significant - Monitor Closely.

lansoprazole + ferrous sulfate
lansoprazole will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Significant - Monitor Closely.

oxybutynin + amitriptyline
oxybutynin and amitriptyline both decrease cholinergic effects/transmission. Significant - Monitor Closely.

oxybutynin + dosulepin
oxybutynin and dosulepin both decrease cholinergic effects/transmission. Significant - Monitor Closely.

amitriptyline + dosulepin
amitriptyline and dosulepin both decrease cholinergic effects/transmission. Significant - Monitor Closely.

aspirin + hydrochlorothiazide
aspirin increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Significant - Monitor Closely.

temazepam + baclofen
temazepam and baclofen both increase sedation. Significant - Monitor Closely.

temazepam + morphine
temazepam and morphine both increase sedation. Significant - Monitor Closely.

temazepam + amitriptyline
temazepam and amitriptyline both increase sedation. Significant - Monitor Closely.

temazepam + dosulepin
temazepam and dosulepin both increase sedation. Significant - Monitor Closely.

baclofen + morphine
baclofen and morphine both increase sedation. Significant - Monitor Closely.

baclofen + amitriptyline
baclofen and amitriptyline both increase sedation. Significant - Monitor Closely.

baclofen + dosulepin
baclofen and dosulepin both increase sedation. Significant - Monitor Closely.

morphine + amitriptyline
morphine and amitriptyline both increase sedation. Significant - Monitor Closely.

morphine + dosulepin
morphine and dosulepin both increase sedation. Significant - Monitor Closely.

amitriptyline + dosulepin
amitriptyline and dosulepin both increase sedation. Significant - Monitor Closely.

trimethoprim + amiloride
trimethoprim and amiloride both increase serum potassium. Significant - Monitor Closely. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

Minor
hydrochlorothiazide + aspirin
hydrochlorothiazide will increase the level or effect of aspirin by acidic (anionic) drug competition for renal tubular clearance. Minor or non-significant interaction.

hydrochlorothiazide + metformin
hydrochlorothiazide will increase the level or effect of metformin by basic (cationic) drug competition for renal tubular clearance. Minor or non-significant interaction.

hydrochlorothiazide + trimethoprim
hydrochlorothiazide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor or non-significant interaction.

metformin + trimethoprim
metformin will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Minor or non-significant interaction.

hydrochlorothiazide + glipizide
hydrochlorothiazide decreases effects of glipizide by pharmacodynamic antagonism. Minor or non-significant interaction. Thiazide dosage >50 mg/day may increase blood glucose.

hydrochlorothiazide + metformin
hydrochlorothiazide decreases effects of metformin by pharmacodynamic antagonism. Minor or non-significant interaction. Thiazide dosage >50 mg/day may increase blood glucose.

amiloride + trimethoprim
amiloride, trimethoprim. Mechanism: unspecified interaction mechanism. Minor or non-significant interaction. Hyperkalemia.

amitriptyline + glipizide
amitriptyline increases effects of glipizide by pharmacodynamic synergism. Minor or non-significant interaction.

amitriptyline + metformin
amitriptyline increases effects of metformin by pharmacodynamic synergism. Minor or non-significant interaction.

dosulepin + glipizide
dosulepin increases effects of glipizide by pharmacodynamic synergism. Minor or non-significant interaction.

dosulepin + metformin
dosulepin increases effects of metformin by pharmacodynamic synergism. Minor or non-significant interaction.

hydrochlorothiazide + trimethoprim
hydrochlorothiazide, trimethoprim. Mechanism: unspecified interaction mechanism. Minor or non-significant interaction. Risk of hyponatremia.

aspirin + glipizide
aspirin increases effects of glipizide by plasma protein binding competition. Minor or non-significant interaction. Large dose of salicylate.


I hope that this was useful.
Thanks

[Nik]

I don't think you can simplify it down to this - this patient is taking many drugs together, so you can't just look at all possible combinations of 2 drugs. As shan has said, this looks like a poorly controlled type 2 diabetic with many of the drugs being prescribed for micro and macrovascular complications. Also, if they've been taking said combo for 4 years, I think they will have become tolerant to the sedative effects of drugs like baclofen, amitriptyline and dosulepin.