When you go into any doctor’s office and fill out the mountain of paperwork, you will inevitably be asked what medications you are taking, both prescription and over-the-counter. They are not just being nosy or keeping track of what refills you may need. They are also looking for drug interactions. Drug interactions happen all the time. They can be anywhere from minor to severe. Being treated for bipolar disorder makes this process a little more complicated. Most people take more than one medication to treat their bipolar disorder, and those drugs can interact with any number of things, including something as simple as cold medicine.
There are different types of interactions.
Some drug interactions are purposeful. For example, adding caffeine to aspirin speeds up time time it takes for the aspirin to take effect. That’s what happens in most over-the-counter migraine medications. Others are incredibly dangerous and possibly lethal. For example, combining cholesterol-lowering statins with Diflucan (a common drug for yeast infections) can lead to severe muscle breakdown and kidney damage.
Sometimes it’s not even drug-to-drug interactions that are worrisome. Some drugs also have negative interactions with certain foods while some foods will negate the drug completely. For example, drugs used to treat thyroid disease can be negated by foods high in iron like spinach or soy when ingested too closely together.
Herbal supplements are not overseen by the FDA. They don’t require the same warning labels or purity tests yet can have severe side effects and interactions with other drugs. St. John’s Wort is a very popular supplement, but has serious potential side-effects. When combined with antidepressants, it can lead to serotonin syndrome, a potentially lethal condition characterized by increased heart rate, fever, nausea and seizures.
Over-the-counter medications can also interact with prescription drugs, but that’s not something you automatically consider when you have a cold and just want your nose to stop running or when you can’t believe you ate the whole thing and need a heartburn remedy. It’s still important to contact your doctor. Some types of drugs that can interact with bipolar disorder medications are:
- Cold/flu medications containing antihistamines, decongestants and expectorants
- Sleep aids
- Antacids (specifically when taking lithium)
- NSAID pain relievers like Advil, Motrin or Aleve (also specific to lithium)
Doctors check for these potential drug/food/herb interactions when you visit or call and give you advice on medication or even warning signs if your current illness leads to a manic or depressive episode. If there is an interaction warning, your doctor will make the judgement as to whether or not the medicine is safe for you to take.
Medications made specifically to treat bipolar disorder are typically flagged as interacting with one another, yet most patients need more than one drug. That’s why we need the professionals to handle our care. That’s also why it’s important not to rely on internet searches.
You should always tell every doctor and pharmacist everything that you take. Prescriptions, vitamins, headache medicine, herbal supplements and, yes, recreational drugs and alcohol.
Always be completely honest with your doctor. They are there to help you, not judge you. You are protected under the HIPAA patient confidentiality law that your records cannot be shared without your permission or a special court order. This includes bringing or substantiating charges on drug use. Recreational drug use and abuse is incredibly common in bipolar disorder (around 50%). Your doctor knows this and is prepared. Recreational drugs not only worsen bipolar disorder symptoms, but can have nasty interactions with all sorts medications. The same goes for alcohol.
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