Semi OT - Sleep Aids like ZZZQuil

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
JDS74
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Semi OT - Sleep Aids like ZZZQuil

Post by JDS74 » Fri Aug 29, 2014 8:52 am

Just a cautionary note on the drug interactions of the active ingredients in OTC sleep aids such as ZZZQuil, Benadryl, and others that contain the active ingredient Diphenhydramine HCL.

I was stung by a fire ant ( just one sting ) and had a regular scheduled visit with my PCP the next morning. I mentioned it and was prescribed a topical steroid and Benadryl to deal with the inflammation.

Fortunately, I checked with my iPad app, Epocrates, about interactions. Two meds I take are labeled as contraindicated because of serious interactions with Benadryl (Diphenhydramine).

If you are taking one of these sleep aids and you are also taking other meds, it is a really good idea to check for interactions between your other meds and this one. Check either on line, with Epocrates, or ask your pharmacist.

Epocrates is available for IOS devices and is free

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49er
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by 49er » Fri Aug 29, 2014 9:06 am

Thanks for the caution JDS74. I am curious, did your PCP say it was ok to take these meds knowing your history?

49er
JDS74 wrote:Just a cautionary note on the drug interactions of the active ingredients in OTC sleep aids such as ZZZQuil, Benadryl, and others that contain the active ingredient Diphenhydramine HCL.

I was stung by a fire ant ( just one sting ) and had a regular scheduled visit with my PCP the next morning. I mentioned it and was prescribed a topical steroid and Benadryl to deal with the inflammation.

Fortunately, I checked with my iPad app, Epocrates, about interactions. Two meds I take are labeled as contraindicated because of serious interactions with Benadryl (Diphenhydramine).

If you are taking one of these sleep aids and you are also taking other meds, it is a really good idea to check for interactions between your other meds and this one. Check either on line, with Epocrates, or ask your pharmacist.

Epocrates is available for IOS devices and is free

JDS74
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by JDS74 » Fri Aug 29, 2014 9:13 am

Unfortunately, my PCP, like most, didn't consider drug interactions when prescribing. Before anyone suggests changing, It has been my experience with several PCPs over my lifetime and specialists that they assume someone else will check - your pharmacist, etc.
So, I like him really well and am not changing. I just check each and every time.

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49er
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by 49er » Fri Aug 29, 2014 9:22 am

JDS74 wrote:Unfortunately, my PCP, like most, didn't consider drug interactions when prescribing. Before anyone suggests changing, It has been my experience with several PCPs over my lifetime and specialists that they assume someone else will check - your pharmacist, etc.
So, I like him really well and am not changing. I just check each and every time.
Nah, I wasn't going to suggest changing and I do understand that this is sadly the reality of modern medicine. Still annoys me though.

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BlackSpinner
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by BlackSpinner » Fri Aug 29, 2014 11:07 am

The best person to check this kind of thing with is your pharmacist. They have a degree in this stuff. Their job is to prevent any interactions, your PCP does the diagnosis and prescription.
If you take any medication regularly then if you want to take OTC meds always check it with your pharmacist - this is one of the things they get paid to do.

Make friends with your pharmacists and treat them nice, they could save your life.

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Jay Aitchsee
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by Jay Aitchsee » Fri Aug 29, 2014 11:33 am

Unfortunately, OTC sleep aids (most of which contain Diphenhydramine HCL) may result in sleepiness the following day for some people. Usually, the very thing they are trying to avoid.

Here's one reference with a quote from the abstract.
http://journals.lww.com/psychopharmacol ... ime.9.aspx
In conclusion, the next-day residual sedative effect after nighttime administration of the OTC sleep aid diphenhydramine was verified for the first time by direct PET measurement of H1RO. Taking into account the possible hangover effect of OTC antihistamine sleep aids, care needs to be taken during their administration
.

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49er
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by 49er » Fri Aug 29, 2014 12:14 pm

BlackSpinner wrote:The best person to check this kind of thing with is your pharmacist. They have a degree in this stuff. Their job is to prevent any interactions, your PCP does the diagnosis and prescription.
If you take any medication regularly then if you want to take OTC meds always check it with your pharmacist - this is one of the things they get paid to do.

Make friends with your pharmacists and treat them nice, they could save your life.
Black Spinner,

I don't disagree with you and have always had a good experience with my local pharmacist regarding asking about drug interactions.

But I am thinking of the person on multiple drugs who might not remember for various reasons to check for drug interactions and doesn't have anyone advocating for him/her. That happened to a former co-worker of mine who kept getting mysterious conditions that I am convinced were due to drug interactions that no one was checking for.

I just think if a doctor writes a prescription, he/she has an obligation to make sure it isn't contra indicated with what the patient is already taking particularly if they are on multiple meds. But I know I am living in fantasy-land with that opinion.

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Re: Semi OT - Sleep Aids like ZZZQuil

Post by BlackSpinner » Fri Aug 29, 2014 9:25 pm

49er wrote:
But I am thinking of the person on multiple drugs who might not remember for various reasons to check for drug interactions and doesn't have anyone advocating for him/her. That happened to a former co-worker of mine who kept getting mysterious conditions that I am convinced were due to drug interactions that no one was checking for.

I just think if a doctor writes a prescription, he/she has an obligation to make sure it isn't contra indicated with what the patient is already taking particularly if they are on multiple meds. But I know I am living in fantasy-land with that opinion.

49er
No that IS the pharmacists job - however they can't do it if you are buying from all different places. All of my parents dozens of different drugs are all coming from the same pharmacy so it is easy for them to verify any new drug. If you are a senior and slowly accumulated different prescriptions from different doctors then you should, every few years, consult with a geriatric specialist team to verify all the drugs not only for interactions but also for effectiveness and overlap.

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49er
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by 49er » Sat Aug 30, 2014 3:43 am

BlackSpinner wrote:
49er wrote:
But I am thinking of the person on multiple drugs who might not remember for various reasons to check for drug interactions and doesn't have anyone advocating for him/her. That happened to a former co-worker of mine who kept getting mysterious conditions that I am convinced were due to drug interactions that no one was checking for.

I just think if a doctor writes a prescription, he/she has an obligation to make sure it isn't contra indicated with what the patient is already taking particularly if they are on multiple meds. But I know I am living in fantasy-land with that opinion.

49er
No that IS the pharmacists job - however they can't do it if you are buying from all different places. All of my parents dozens of different drugs are all coming from the same pharmacy so it is easy for them to verify any new drug. If you are a senior and slowly accumulated different prescriptions from different doctors then you should, every few years, consult with a geriatric specialist team to verify all the drugs not only for interactions but also for effectiveness and overlap.
Sorry I have to disagree. By the time someone consults with a specialist in two years, it could be too late regarding drug interactions since of them can be deadly.

I just feel if a primary care physician doesn't know a patient well enough regarding drug history or any other relevant fact factors, then he/she has no business prescribing a med. But like I said, I know I am living in fantasyland.

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Re: Semi OT - Sleep Aids like ZZZQuil

Post by JDS74 » Sat Aug 30, 2014 6:27 am

Do you notice that every time you see a physician, they ask you to bring in ALL of your meds?
A trusting patient might assume that they are checking for interactions.

The best person to rely on to check for interactions in your local pharmacist even for OTC meds.
The second best person is the patient.
While I agree that the prescriber (PCP or specialist) should do it, the harsh fact is they don't.

Pressures for payment to them from Medicare and / or the insurance industry make office visits shorter and shorter. Drug checking seems to be one of those things that got lost in the process - a real loss to the patient.

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Re: Semi OT - Sleep Aids like ZZZQuil

Post by BlackSpinner » Sat Aug 30, 2014 8:47 am

49er wrote: Sorry I have to disagree. By the time someone consults with a specialist in two years, it could be too late regarding drug interactions since of them can be deadly.

I just feel if a primary care physician doesn't know a patient well enough regarding drug history or any other relevant fact factors, then he/she has no business prescribing a med. But like I said, I know I am living in fantasyland.
Doctors are trained in diagnosis and prescribing, some of them are also surgeons, now you want them to have a degree in pharmacy plus take the extra 15 minutes to check every med you are taking for interactions, in spite of the fact that a fully trained pharmacist will be providing the medications and it is their stated job to do just this? That was probably true 150 years ago but that is not how the medical system works these days.
If you take more then one medication YOU need to ask the trained specialist - the pharmacist - about any interactions when you hand them your new prescription. At my pharmacy when a new prescription is handed in they will ask why you have it, they review what is on file and discuss all the effects, how to take it and why there might be issues. When it is ready to be picked up they will ask if you want to speak to the pharmacist again to review it. EVERY SINGLE TIME. This is one of the main reasons that online pharmacies are a bad thing. This is the service you should expect from your pharmacist every time you drop off a prescription.

Most of my parents prescriptions don't come from our PCP they come from specialists. In the last couple of years they have been able to call up the medical records with more and more details so they can check tests and reports but that is very new. I do bring the list of meds along for them to look at but no specialist is going to take the time to review all the other meds for interactions - it is not their job. Our PCP gets the report and controls all renewals but she will refer to the geriatric pharmaceutical specialists to review them all when she feels the list is getting to big or complex. It is not her job to deal with that. If you find a doctor who thinks it is their job then I would run for the door.

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Re: Semi OT - Sleep Aids like ZZZQuil

Post by zoocrewphoto » Sun Aug 31, 2014 3:20 am

BlackSpinner wrote:The best person to check this kind of thing with is your pharmacist. They have a degree in this stuff. Their job is to prevent any interactions, your PCP does the diagnosis and prescription.
If you take any medication regularly then if you want to take OTC meds always check it with your pharmacist - this is one of the things they get paid to do.

Make friends with your pharmacists and treat them nice, they could save your life.

I do this any time I want to try something new like an allergy medication, cough syrup,etc. I want to make sure it isn't a problem with my medications as well as with my asthma and high blood pressure. It wasn't until I changed doctors though, that it was noticed that one of my high blood pressure medications is known for causing asthma problems. At my first appointment with the new doctor, I took a printed list of all medications - prescriptions and OTC, sorted by daily, as needed by frequent, and rare. She made several changes the first day, and I felt better within a week. Some more changes since this. Reminds me that I need to redo the list and send my ipod a current version.

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JDS74
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Re: Semi OT - Sleep Aids like ZZZQuil

Post by JDS74 » Sun Aug 31, 2014 5:30 am

BlackSpinner wrote:...At my pharmacy when a new prescription is handed in they will ask why you have it, they review what is on file and discuss all the effects, how to take it and why there might be issues. When it is ready to be picked up they will ask if you want to speak to the pharmacist again to review it. EVERY SINGLE TIME. This is one of the main reasons that online pharmacies are a bad thing. This is the service you should expect from your pharmacist every time you drop off a prescription...
You have a great pharmacy. Unfortunately, my local one doesn't do any interaction review unless asked specifically. If I ask, then they will review everything for interactions, etc. My online pharmacy does when I call in to refill. Normally, I don't ask questions but, on Tuesday when I call in my refill (the $3,500 one), I will ask for their review. I'll do the same for local refills as well.

Thanks for pointing that out.

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