------------------------------
Date: Tue, 22 Sep 1998 02:20:56 EDT
From: [log in to unmask]
Subject: overprescribing and problem drug interactions
I really don't want to scare anybody, but I do think it might be helpful =
to
share what may be the final findings from our research into my mother's
death
this past January. Whatever happened to her is apparently not very
common,
but should be considered in the mix of experience.
History in a nutshell: As some of you may recall, my mother was
(mis)diagnosed
with Parkinson's Disease a little over a year ago, after a few/several
years
of dramatic "slowing down", shuffling, and problematic falls. She had be=
en
taking low doses of Compazine for many years, maybe decades, for a chroni=
c
g.i. problem and, more recently, for the "calming effect" she read about =
on
the pharmacy's drug info flyer. After starting on Parkinson's drugs
(sinemet,
then w/amantadine, then sinemet w/permax), and finally stopping the
Compazine,
her movement disorder stabilized (maybe improved a little), but her gener=
al
wellbeing deteriorated from persistent nausea and the onset of anorexia. =
Two
days before the end, she was admitted to the hospital with pneumonia and
jaundice, and the official cause of death was given as ARDS (adult
respiratory
distress syndrome.)
An autopsy revealed that she did not have Parkinson's Disease ("had plent=
y
of
pigment") or any other discernable "neurodegenerative disease that
primarily
feature Parkinsonsim". The autopsy also revealed that her liver (which h=
ad
frequently and consistently tested normal as recently as a week before he=
r
death) had been completely been replaced by fat cells, "consistent with
metabolic abnormality and a drug induced cholestatic picture."
Here's an excerpt from email I sent my siblings about what one of the
pathologists said, after concluding that mom's liver had suffered a drug=
reaction:
She (the pathologist) has a theory, from looking at the prescription list=
I
sent her, that a drug interaction probably caused Mom's liver to react th=
e
way
it did. She said that Prozac is known to inhibit some of the enzymes in
the
liver called the cytochrome P450 system, which is important for
metabolizing a
lot of drugs. Several of the drugs Mom took over the years are supposed =
to
be
broken down by this "enzyme pathway;" she mentioned Tagamet/cimetidine,
Prilosec, Phenergan and Glyburide. The literature on these other drugs
will
say they have been associated with jaundice, under the heading of Adverse=
Reactions, Rare. Because of the timing, she is inclined to pin the blame=
on
Prilosec and perhaps Phenergan. Mom was taking those in the last weeks f=
or
nausea, and not before, whereas the Tagamet and Glyburide appear to have
been
stopped earlier. (Though now I'm thinking that the Tagamet didn't stop s=
o
suddenly -- it just became available over the counter, so the prescriptio=
ns
stopped.)
The pathologist said that there is a lot of literature discussing whether=
taking Prozac (particularly a lot, over a long period) could be one of
those
conditions that makes this adverse drug reaction more likely to occur. S=
he
also said that even among Prozac users, it is theorized that some, called=
poor
metabolizers, have a genetic predisposition to a lower level of this
enzyme.
I didn't ask the obvious follow-up questions (I'm just not good at that):=
a)
should we worry about a genetic predisposition, and 2) could Mom who burn=
ed
through calories the way she did possibly be a poor metabolizer?
She said that, unfortunately, it is not unusual for someone with all of t=
he
chronic conditions (that she didn't really have!) to be taking so many
prescription drugs, and that once a drug is started, it is rarely stopped=
=2E
She said the relatively new field of geriatric pharmacology is paying mor=
e
attention to this problem.
After I spoke with her, I researched some of the drugs she was talking
about
to see if I could find any reference to her hypothesis. (I could, but it=
was
pretty technical -it was the kind of info I just skim over because I don'=
t
understand) However, under Prozac, I found a paragraph which I excerpt
here
(from Mosby's GenRx):
Postintroduction Reports: Voluntary reports of adverse events temporally=
associated with fluoxetine HCI [Prozac] that have been received since
market
introduction, and that may have no causal relationship with the drug
include
the following: [lots of stuff], ...movement disorders developing in
patients
with risk factors including drugs associated with such events and worseni=
ng
or
preexisting movement disorders,...[more stuff].
The sentence is pretty obtuse, but it sounds like they might be referring=
to
something like Compazine. I keep wanting to ask questions of researchers=
at
the drug companies (e.g. ask for more info on the specific incidents
they're
reporting) but I keep assuming they wouldn't be very forthcoming. I wond=
er
if
any of their research is public, like reports submitted to the FDA, and h=
ow
difficult it would be to get it and sort through it.
I'm no longer on the PD list (one of my first letting go steps), so I wou=
ld
appreciate it if any feedback were mailed to me directly.
best wishes and happier new years to you all.
emily rosenthal ([log in to unmask])
------------------------------
Date: Tue, 22 Sep 1998 02:28:34 EDT
From: [log in to unmask]
Subject: overprescribing and problem drug interactions
This is a multi-part message in MIME format.
--part0_906445715_boundary
Content-ID: <[log in to unmask]>
Content-type: text/plain; charset=3DUS-ASCII
actually I didn't send this to the Parkinson's list. the mail was reject=
ed
because I am no longer a member. (nice to know the security works.) if
anybody here who is also on the main list thinks my previous posting woul=
d
be
useful to the main list, please copy and post it there. thank you.
emily
([log in to unmask])
