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Pharmacy and Medications

Dangerous Combinations

08/26/2010

Question:

I was in a car wreck, resulting in constant and permanent pain in my right leg.  I see several Dr’s. who have prescribed many different drugs. My scripts are: Vicodin ES 7.5mg every 12 hrs, Xanax 5mg as needed, Ambien 5mg one at bedtime. Neurontin 300mg 1 pill twice daily. With all these different Narcotics am I at danger for possible other health problems? Heart attack? overdose? I’m always tired, anxious, light headed.

Answer:

Vicodin ES is a brand name for a combination of hydrocodone 7.5mg and acetaminophen 750 mg, Xanax is the brand name for alprazolam, Ambien is the brand name for zolpidem, and Neurontin is the brand name for gabapentin. With the exception of your Xanax,which we discuss below, the doses of your medications are toward the low end of their range.

None of these medicines alone or in combination is likely to increase your risk of having a heart attack. However, they all cause central nervous system depression which can manifest as the tiredness and dizziness you mention. Taking them together can increase these effects. These side effects normally abate somewhat with continued use. Taking more than the dose prescribed by your doctor or drinking alcohol while taking these medicines will increase your risk of more severe central nervous system depression. Anxiety is most likely related to the accident and injury, not your medicines.

Being dizzy and lightheaded can increase your risk of falling or having an accident. Do not drive or perform other potentially hazardous tasks because these medicines can increase your risk of having another accident.

5mg of Xanax is a very high dose. Did you mean 0.5mg? The usual dose for anxiety is 0.5mg to 1mg three times a day with a maximum daily dose of 4mg. If you are really taking 5mg as needed, then you should expect to see increased side effects such as tiredness and an increased risk of falls.

Vicodin ES contains 750mg of acetaminophen. Acetaminophen, the generic name for Tylenol, is a common ingredient in many over-the-counter medicines. It is important to avoid daily doses of acetaminophen in excess of 4000 mg because taking this much on a regular basis can cause liver toxicity. Since you take two Vicodin ES tablets daily, your daily dose of acetaminophen is already at 1,500mg. Make sure your total daily dose of acetaminophen from all sources does not exceed 4000mg.

If your pain is permanent as you state, it may be appropriate for you to see a doctor at a pain clinic. Remember that the goal of pain control is to make pain manageable while minimizing side effects so that you can continue to live your life to the fullest extent possible. The side effects associated with these medicines do tend to abate with continued use. However, complete pain relief without any side effects may not be possible in every situation.

You state that you are seeing several doctors for pain control. In this situation, it's important that all your doctors and your pharmacist know about all of the drugs you are currently taking. That way they can review your medications to make sure you are on the appropriate medication regimen for your leg pain.


This response was prepared in part by Madeline Stephens, 2011 PharmD Candidate at the University of Cincinnati College of Pharmacy.

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati