Worst Pills
interactions, drug

Disease and Drug Family Information

  • Adverse Drug Reactions [hide all summaries]
    Although some adverse drug reactions (ADR) are not very serious, others cause the death, hospitalization, or serious injury of more than 2 million people in the United States each year, including more than 100,000 fatalities. In fact, adverse drug reactions are one of the leading causes of death in the United States. Most of the time, these dangerous events could and should have been avoided. Even the less drastic reactions, such as change in mood, loss of appetite, and nausea, may seriously diminish the quality of life.

Additional Information from Public Citizen

Each profile is a comprehensive review of the safety and effectiveness of this . If is not a Do Not Use product, information on adverse effects, drug interactions and how to use the medication are included.

Worst Pills, Best Pills Newsletter Articles

Each profile is a comprehensive review of the safety and effectiveness of this . If is not a Do Not Use product, information on adverse effects, drug interactions and how to use the medication are included.
  • Nebivolol (BYSTOLIC): Limited Use for Hypertension [hide all summaries]
    (April 2018)
    When the beta blocker nebivolol was approved by the FDA in 2007, we advised readers not to use the drug until 2015, in accordance with our seven-year rule. Find out why we now have designated nebivolol as Limited Use and whether it is the right choice for treating hypertension.
  • Meclizine: A Risky and Possibly Ineffective Drug [hide all summaries]
    (March 2018)
    Meclizine is a drug that is commonly used to treat symptoms of motion sickness. Find out why we have designated this drug as Do Not Use.
  • Do Not Use Fentanyl for Non-Cancer Pain [hide all summaries]
    (February 2018)
    Fentanyl is a dangerous synthetic opioid that has been involved in an increasing number of overdose deaths in the U.S. Learn why this drug should be used only by cancer patients with breakthrough cancer-related pain.
  • Milnacipran For Fibromyalgia: Do Not Use [hide all summaries]
    (January 2018)
    Milnacipran (SAVELLA) was approved by the Food and Drug Administration in 2009 for the treatment of fibromyalgia in adults, which remains its only approved use. In this article, we review data showing that the drug is ineffective for treating fibromyalgia and dangerous.
  • Abuse-deterrent Opioids [hide all summaries]
    (September 2017)
    To address the growing epidemic of prescription opioid drug overdoses in the U.S., many drugmakers have attempted to develop opioid pills that are supposedly resistant to being manipulated in ways that make them easier to abuse. In this article, we highlight problems with these so-called abuse-deterrent opioid formulations.
  • Food-Drug Interactions You Should Know About [hide all summaries]
    (August 2017)
    Although health care professionals often advise patients on whether the medications they are taking may interact with each other, they do not always discuss how various foods may interact with medications. Learn about some of these dangerous food-drug interactions and how to protect yourself.
  • Spironolactone: Review of a ‘Water Pill’ [hide all summaries]
    (March 2017)
    Spironolactone is a diuretic (water pill) that has been used for decades to treat certain patients with high blood pressure, heart failure, swelling (water retention) and other conditions. Find out who is most likely to benefit from using this drug and who should avoid it because of its dangerous adverse effects.
  • News Brief for November 2016 [hide all summaries]
    (November 2016)
    In this month's News Brief section, we report on action taken by the Food and Drug Administration to add important new warnings to the labeling of all opioid and benzodiazepines drugs.
  • Is XARELTO Really the 'Right Move' for Patients With Blood Clots or Risk for Stroke? [hide all summaries]
    (April 2016)
    If you watch TV, you likely have seen ads touting the advantages of the new oral antico-agulant (blood thinner) rivaroxaban (XARELTO). Learn why we have designated this drug as Do Not Use for Seven Years (until at least July 2018).
  • St. John’s Wort: No ‘Wonder Remedy’ for Depression [hide all summaries]
    (February 2016)
    St. John’s wort, an over-the-counter herbal supplement, has been around for centuries, and many patients have been using it in recent years to self-medicate for depression. In this article, we explain why St. John’s wort should not be used to treat this disease.
  • Health Canada Warns of Dangerous Drug Interaction [hide all summaries]
    (January 2016)
    Learn why Health Canada, an agency similar to the Food and Drug Administration, warned Canadian consumers not to combine repaglinide-containing diabetes medications (PRANDIN or PRANDIMET) with the anti-platelet drug clopidogrel (PLAVIX).
  • Drug Treatments for Chronic Heart Failure [hide all summaries]
    (January 2016)
    For the approximately 5 million Americans suffering from chronic heart failure, there is a wide array of lifesaving drug treatments. Find out our take on the most recent expert guidelines for treating this disease.
  • Dangerous Atypical Antipsychotics Minimally Effective for Depression [hide all summaries]
    (December 2015)
    Some powerful antipsychotic drugs originally developed to treat schizophrenia now have been approved to treat depression. Learn about the serious side effects of these drugs that make it advisable to explore other, safer options for managing depression.
  • Long-Acting Opioids: Extra Caution Needed [hide all summaries]
    (December 2015)
    In this article, we review new evidence suggesting that long-acting opioids are associated with a higher risk of unintentional life-threatening over¬doses than short-acting forms of these drugs.
  • Risks but No Benefits to Taking Newest Drugs For Type 2 Diabetes [hide all summaries]
    (August 2015)
    The airwaves are filled with ads promoting the newest class of diabetes medications, often referred to as “flozins.” In this article, we review the serious safety concerns that have prompted us to designate all flozins as Do Not Use.
  • Risk of Sudden Death With Some Hypertension Drug-Antibiotic Combinations [hide all summaries]
    (June 2015)
    Find out which commonly used antibiotic can increase your risk of sudden death if it is combined with either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), which are among the most widely prescribed drugs in the U.S.
  • Calcium Channel Blockers Plus Most Macrolide Antibiotics: A Dangerous Combination [hide all summaries]
    (April 2014)
    Learn about new evidence demonstrating the dangers of combining calcium channel blockers, a widely used class of drugs for treating high blood pressure, with the commonly used macrolide antibiotic clarithromycin and other related antibiotics. Also find out which macrolide antibiotic does not have this dangerous interaction with calcium channel blockers.
  • FDA Restricts, EMA Moves to Ban Ketoconazole Tablets [hide all summaries]
    (January 2014)
    A dangerous and easily substituted antifungal drug presents yet another example of Europeans being more protected from dangerous medicines by their regulatory authorities than Americans.
  • Do Not Use: Duloxetine (CYMBALTA) [hide all summaries]
    (June 2012)
    We review the dangers of the extremely popular drug duloxetine (CYMBALTA) and discuss why you should not use it to treat depression, anxiety or pain.
  • Fenofibric Acid (TRILIPIX) May Not Lower Heart Attack/Stroke Risk [hide all summaries]
    (February 2012)
    Over 15.2 million prescriptions were filled in 2010 for the brand-name or generic versions of two essentially identical drugs (fenofibrate [TRICOR] and fenofibric acid [TRILIPIX]) that clearly do not add any benefits to taking statin drugs alone but add to the risks.
  • Quetiapine (SEROQUEL) Drug Interactions and Heart Trouble [hide all summaries]
    (December 2011)
    Find out about 12 drugs that can interact with widely prescribed quetiapine -- 12 million prescriptions sold in 2010 -- to cause serious, sometimes fatal, heart arrhythmias.
  • Dangers of Taking Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Together [hide all summaries]
    (September 2011)
    Find out how using a combination of two drugs, one from each of these two families, can increase the risks of kidney toxicity and dangerously higher blood levels of potassium compared to use of one of these two families of drugs alone. The article lists 10 different drugs in the first class and seven in the second class. Worse yet, most of the patients in the study were prescribed the combination to treat conditions for which the combination has not proven to be beneficial.
  • Quality of Drug Prescribing [hide all summaries]
    (March 2011)
    The article reviews a study on the potentially dangerous, inappropriate prescribing of 77 drugs that pose a high risk to older adults. Of the 67 of these drugs that we had previously reviewed in Worst, Pills, Best Pills News, we had classified 60 (90 percent) of them as “Do Not Use,” and the other seven as "Limited Use."
  • No. 1 Rule for Safe Drug Use: Have ‘Brown Bag Sessions’ with Your Primary Doctor; Fill Out a Drug Worksheet [hide all summaries]
    (March 2011)
    The article details how you should review all of the medications you are using with your doctor. It also provides a drug worksheet for you to fill out with him or her. The worksheet, when shown to your doctors, may save you from being prescribed drugs that interact with each other or have other side effects that you might not have recognized as being drug-related.
  • Pitavastatin (LIVALO): 8th Cholesterol-Lowering Statin Marketed in the U.S. [hide all summaries]
    (December 2010)
    Find out why you should not use the newest entry into the crowded statin market.
  • Fatal Drug Interactions With Simvastatin (ZOCOR) [hide all summaries]
    (December 2010)
    Find out how simvastatin (ZOCOR) can interact with another widely used drug to greatly increase the chance of life-threatening muscle damage that can lead to kidney damage.
  • U.S. Troops: More Deaths Related to Prescription Drugs [hide all summaries]
    (December 2010)
    Two recent studies found that indiscriminate prescribing of drugs to U.S military troops has been associated with an increase in drug-associated suicides and drug-induced deaths, probably related to interactions between drugs.
  • The Dangers of Combining Sleeping Pills With Other Medication [hide all summaries]
    (September 2010)
    The article list 34 other medications that can harmfully interact with sleeping pills, increasing their sedative properties and causing excessive sedation. Excessive sedation at night could increase the risk of falls, should the person get up in the night for some reason. Moreover, excessive sedation causing respiratory depression could be dangerous for people with certain disorders, such as lung disease.
  • Life-Threatening Side Effects With Quinine (QUALAQUIN) [hide all summaries]
    (September 2010)
    Quinine is only approved to treat malaria but most of the use is for treating or preventing nighttime leg cramps, a purpose for which there is no evidence of effectiveness. Among 38 reports of serious side effects, including two deaths and two dozen cases of serious blood reactions, almost all occurred in people using the drug for purposes other than malaria.
  • Risk of Serious Gastrointestinal Bleeding With Newer Antidepressant Drugs [hide all summaries]
    (April 2010)
    This article discusses the greatly increased risk of bleeding with some widely-used antidepressant drugs and provides information that the FDA has not yet required be included in the patient Medication Guides for these drugs.
  • Aripiprazole (ABILIFY) Drug Interactions [hide all summaries]
    (April 2010)
    The article lists 53 drugs that can interact with the psychiatric drug ABILIFY to either increase the amount in the body, which can lead to toxicity, or decrease the amount rendering the drug less effective.
  • Digoxin Drug Interactions [hide all summaries]
    (March 2010)
    The article lists 35 different interacting drugs that can either increase blood levels of digoxin, leading to the serious problem of digitalis toxicity or decrease blood levels, causing the drug to be less effective.
  • Quetiapine (SEROQUEL) Interactions With Other Drugs [hide all summaries]
    (February 2010)
    Quetiapine (SEROQUEL) can interact with 26 different drugs, increasing its blood levels and causing dangerous side effects such as slowed breathing, dizziness and fainting. The article also lists 10 other interacting drugs that can result in lower blood levels, rendering the drug less effective.
  • Lithium Toxicity Due to Drug Interactions [hide all summaries]
    (January 2010)
    This article lists a large number of drugs, used to treat high blood pressure and other carediovascular disease, that can interact harmfully with lithium (ESKALITH; LITHOBID; LITHONATE;generic lithium carbonate), drugs used to treat bipolar (manic/depressive) disorder. This may result in a dangerous condition known as lithium toxicity because these drugs stop the body from getting rid of lithium and lithium blood levels are increased; in severe cases, this can cause seizures, coma and even death. The article also lists other symptoms of lithium toxicity.
  • Supreme Court Justice Ginsburg’s Drug Interaction Is a Reminder to Pay Attention to Meds [hide all summaries]
    (December 2009)
    In mid-October, Supreme Court Justice Ruth Bader Ginsburg was kept at a hospital overnight after she became drowsy, fell from her airplane seat and had to be taken off the plane before it departed. What common drug interaction was to blame?
  • New Gout Drug Febuxostat (ULORIC) Has Important Drug Interactions: Do Not Use Until 2016 [hide all summaries]
    (November 2009)
    The article explains why febuxostat (ULORIC) should not be used because of problems with both its safety and effectivness.
  • Antacid Drug Interactions [hide all summaries]
    (October 2009)
    Antacids can interact with a number of medications, either increasing or decreasing drug effect.
  • Oxycodone: Be Careful What You Take With It [hide all summaries]
    (September 2009)
    The article lists 24 drugs that can increase the toxicity of oxycodone if taken together with the drug and 11 other drugs that can weaken its effectiveness as a painkiller if they are simutaneously used.
  • Do Automated Screening Systems for Drug Interactions Adequately Protect You? [hide all summaries]
    (August 2009)
    Many doctors and pharmacists use computerized drug interaction screening systems to prevent the prescriptions for drugs that may have a harmful interaction with drugs already being used by the patient. This article points out several significant weaknesses of these systems and provides five common sense suggestions as to how patients can avoid dangerous drug interactions despite the weaknesses of these computerized systems.
  • Herbal Medicines for Menopausal Symptoms? Hang Onto Your Wallet and Your Health [hide all summaries]
    (August 2009)
    The article reviews published evidence of safety and effectiveness for five herbal supplements widely used for treating menopausal symptoms. There is no convincing evidence that any of the herbal supplements promoted for relief of menopausal symptoms is beneficial. In addition, as discussed in the article, many of them have serious safety problems.
  • Muscle Damage from Interactions Between Statins and Other Commonly Prescribed Drugs [hide all summaries]
    (July 2009)
    The article lists 38 prescription drugs that can harmfully interact with statin drugs. The article also advises that No matter what statin you are taking and regardless of any interacting drugs, you should notify your prescriber immediately if you develop muscle pain, weakness or a darkening of your urine. .
  • Alpha-Blockers for Prostate Enlargement: Some Important Drug Interactions [hide all summaries]
    (June 2009)
    Taking alpha-blockers in combination with drugs for erectile dysfunction and with other drugs can cause dizziness and fainting. In this article we will discuss alfuzosin (UROXATRAL), doxazosin (CARDURA), tamsulosin (FLOMAX) and terazosin (HYTRIN) and drugs with which they can have harmful interactions.
  • People on Certain Beta Blockers Should Be Wary of Epinephrine [hide all summaries]
    (May 2009)
    Patients taking a non-selective beta blocker should make sure the provider is aware of this before they receive an injection of epinephrine, as your physician or other health care provider may not be aware that a systemic dose of epinephrine may produce a dangerous spike in blood pressure. The article lists the selective beta blockers that do not cause this problem because they do not interact with epinephrine.
  • Possible Interaction Between Cranberry Products and Widely Used Blood-Thinner Warfarin (COUMADIN) [hide all summaries]
    (April 2009)
    This article adds other substances, cranberry products, to the long lists of drugs we have previously stated should not be used with the important blood thinner, warfarin (COUMADIN).
  • Watch Out for Interactions with Tamoxifen (NOLVADEX) [hide all summaries]
    (March 2009)
    Tamoxifen (NOLVADEX) is still widely and successfully used for treatment of breast cancer. However, when used along with certain other drugs, its effectiveness can be significantly reduced. The article explains how this can happen and lists 19 different drugs that can cause this serious problem if used with tamoxifen.
  • Dangerous Interaction Between Heartburn Drugs and Clopidogrel (PLAVIX) [hide all summaries]
    (March 2009)
    This article describes how and why people using both PLAVIX, a drug that prevents blood clotting, and heartburn drugs such as NEXIUM had a 27 percent increased risk of heart attacks compared with people using PLAVIX alone.
  • Nonsteroidal Anti-Inflammatory Drugs Can Make Blood Pressure Hard to Control [hide all summaries]
    (February 2009)
    Twenty different NSAIDS (nonsteroidal antiinflammatory drugs) are listed in this article that can adversely affect your blood pressure control. The article discusses the way in which this happens and what you can do about it.
  • Watch out for Interactions Between Drugs for Erectile Dysfunction and Other Medications [hide all summaries]
    (January 2009)
    The article lists 56 drugs that can interact with the three drugs for erectile dysfunction (ED): sildenafil (VIAGRA), tadalafil (CIALIS) and vardenafil (LEVITRA). Eight of the drugs are either nitrates such as nitroglycerin or a certain group of high blood pressure drugs.In combination with ED drugs, these drugs can cause a dangerous fall in blood pressure that could lead to a heart attack or stroke. Thirty-two other drugs can inhibit the enzyme that helps the body to eliminate the ED drugs, resulting in abnormally high blood levels of the drugs and a potentially harmful "overdose" even though you are actually taking the recommended amount. The other 16 drugs speed up the metabolism of the ED drugs, thereby lowering the blood levels and reducing the effectiveness of the ED drugs.
  • Colchicine Interactions with Other Drugs Can Be Life-Threatening [hide all summaries]
    (December 2008)
    This article lists 27 drugs that can have life-threatening interactions with the widely-used gout drug, colchicine, resulting in dangerously elevated levels of colchicine. Too much colchicine in the body leads to toxicity such as fever, vomiting, diarrhea, abdominal pain and muscle pains. Even worse, it can impair the bone marrow’s ability to make red and white blood cells, causing severe anemia and dangerously low numbers of white blood cells. When the number of white blood cells is reduced, your body may have difficulty fighting infections. Most people who have died from colchicine toxicity have had bone marrow toxicity or had preexisting kidney problems. Every patient on colchicine — whether on other drugs or not — should be alert for evidence of colchicine toxicity as described above.
  • Potassium Increases Due to Drug Interactions Can Be Dangerous [hide all summaries]
    (November 2008)
    One of the most common drug interactions occurs when patients take two or more drugs that can each increase blood potassium levels. The resulting condition, hyperkalemia (increased blood potassium levels), can cause nausea, fatigue, muscle weakness or tingling sensations, as well as heart abnormalities, showing up as an abnormal electrocardiogram. In some cases it can be fatal. The article lists 50 drugs which, especially when used in combination, can cause hyperkalemia.
  • Muscle Injury From Use of Simvastatin (ZOCOR) with Amiodarone (CORDARONE) [hide all summaries]
    (November 2008)
    Despite the dangers of this combination--risk of severe muscle injury, rhabdomyolysis, which can lead to kidney failure or death--many clinicians continue to prescribe them together and cases of life-threatening adverse reactions from continue to be reported to the FDA. Patients taking simvastatin at a dose greater than 20 milligrams a day in combination with amiodarone should let their physician know that this combination puts them at high risk of muscle injury. There are other statins that do not appear to interact with amiodarone that are discussed.
  • Tizanidine: Watch Out for Drugs Interacting With This Muscle Relaxant [hide all summaries]
    (October 2008)
    Tizanidine (ZANAFLEX) is a muscle relaxant for which more than 3.8 million prescriptions were filled in the U.S. last year. The article lists more than 64 drugs with which it can have dangerous interactions resulting in excess sedation, difficulty breathing or dangerously low blood pressure that can result in falling.
  • 29 Medications That May Cause Adverse Interactions with Thyroid Drugs [hide all summaries]
    (September 2008)
    Thyroid medications are among the most widely-prescribed drugs in the U.S. In this article, we review 29 different medications that can have harmful interactions with thyroid medicines such as levothyroxine (Synthroid). There are four major kinds of interaction problems that can occur: • Certain medications can decrease the absorption of levothyroxine resulting in lower levels in the blood. • Other medications can increase the rate at which the body gets rid of levothyroxine, also resulting in lower thyroid levels in the blood. • Other medications can cause changes of levothyroxine binding in blood, decreasing the body's ability to use levothyroxine. • Levothyroxine can affect the safety or effectiveness of other medications by raising or lowering the levels of these other drugs in the blood, causing them to be either infective (lower levels) or dangerous (higher levels).
  • Dangers of Mixing Alcohol with Certain Medications or Diseases [hide all summaries]
    (August 2008)
    The article discusses 273 drugs that can have harmful interactions with alcohol. Also reviewed are several ways in which these harmful interactions can occur: 1/ Medications Can Increase Alcohol Blood Levels 2/ Additive effects of medications and alcohol. One of the best- known drug-alcohol interactions is when alcohol, a depressant, is taken with other sedative medications, and excessive sedation or depression of respiration can occur 3/Alcohol can increase the blood levels of some medications leading to toxicity of these drugs. 4/ Alcohol also can reduce blood levels of some medications causing them to be less effective. Although some of the interactions between alcohol and medications mainly occur in people who drink heavily (three or more drinks on one occasion), many of these interactions may occur with much lower amounts of alcohol use, such as one to two drinks on an occasion. We strongly urge you to tell your physicians and other health care providers how much alcohol you are drinking so they can effectively assess the risks and advise you about the safe use of alcohol and medications.
  • Codeine: The Drug With Multiple Personalities [hide all summaries]
    (June 2008)
    Codeine is routinely converted to morphine in the body in order for it to be an effective painkiller. The metabolism of codeine to morphine takes place through the actions of an enzyme in the liver. The article explains how various drugs and or a person's genetic makeup can greatly influence the conversion of codeine to morphine, making its pain-relieving properties too week if not enough conversion occurs and resulting in what amounts to an overdose at the recommended dose if the conversion to morphine is too rapid. Fourteen drugs that inhibit the conversion to morphine are listed in the article.
  • Calcium Channel Blocker Drug Interactions [hide all summaries]
    (May 2008)
    This article lists more than 60 prescription drugs that can interact with calcium channel blocking drugs such as amlodipine (NORVASC),diltiazem (CARDIZEM, DILACOR XR TIAZAC)or nifedipine (PROCARDIA)to either cause toxicity or to lessen the effectiveness of the calcium channel blocking drugs. Included in the lists are a number of drugs that we list in Worst Pills, Best Pills as DO NOT USE or LIMITED USE drugs. The article also explains the different kinds of toxicity that can ensue from these interactions.
  • A Review of Modafinil (PROVIGIL) For Narcolepsy [hide all summaries]
    (May 2008)
    PROVIGIL, an amphetamine-like drug, has been illegally promoted by its manufacturer for treating many conditions for which there is no evidence that its benefits outweigh its risks. Thus, a large proportion of prescriptions for this top-200 selling drug are for off-label or unapproved uses.
  • Serotonin Syndrome Due to Drug Interactions [hide all summaries]
    (April 2008)
    The article lists more than 30 prescription drugs that can cause the serotonin syndrome.
  • Ibuprofen Can Reduce Aspirin’s Protective Effect Against Heart Attacks and Strokes [hide all summaries]
    (March 2008)
    This article explains the dangers of using ibuprofen (MOTRIN, ADVIL) because it interferes with the protective effect of low-dose aspirin to prevent blood clots and protect against heart attacks or strokes. Find out how these two widely-used therapies have a harmful interaction and what you should do.
  • Macrolide Antibiotic Drug Interactions [hide all summaries]
    (February 2008)
    The article discusses the adverse drug interactions between either of two widely-prescribed macrolide antibiotics, erythromycin (as in ERYTHROCIN) and clarithromycin (BIAXIN)and more than 40 other drugs that are listed in a table in the article. It also describes the nature of the adverse interactions that can occur.
  • SSRIs Can Have Dangerous Interactions With Other Drugs [hide all summaries]
    (January 2008)
    More than 70 million prescriptions a year are filled for these popular antidepressants, including Prozac, Paxil, Zoloft, Luvox, Celexa and Lexapro. This article gives details about more than 60 other widely prescribed prescription drugs that can have harmful interactions if used with these antidepressants. The two different kinds of interactions are also discussed.
  • Taking TOPAMAX to Treat Alcoholism Could Have Serious Consequences [hide all summaries]
    (December 2007)
    A recent drug industry-funded study was widely hailed as showing that TOPAMAX, a drug approved for seizures and migraines, worked well in treating alcoholism in heavy drinkers. However, upon closer inspection, the study does not convincingly prove the safety or effectiveness of the new suggested use of topiramate. The use of the drug produced only a modest decrease in the percentage of days of heavy drinking, compared to placebo. Topiramate can be unsafe if mixed with alcohol. Current FDA labeling for the approved uses of the drug states, “You should avoid drinking alcohol while taking [topiramate]. Alcohol with [topiramate] can make side effects such as sleepiness and dizziness worse.” In addition. the drug can cause metabolic acidosis, a condition that occurs when there is too much acid in your blood. Metabolic acidosis can cause symptoms such as tiredness, loss of appetite, irregular heartbeat and impaired consciousness.
  • Drug Interactions: Warfarin (COUMADIN) [hide all summaries]
    (December 2007)
    This article explains how to understand the International Normalized Ratio (INR), a test applied to a sample of a patient’s blood to determine how “thin” it is when you are using the blood thinner COUMADIN (warfarin). In addition, the article lists more than 50 drugs or dietary supplements that can interact harmfully with COUMADIN to cause the blood to be too thin (abnormal bleeding) or not thin enough which could result in lessening the effect of COUMADIN in stopping blood clot formation.
  • Harmful Interactions Between Smoking and Prescription Drugs [hide all summaries]
    (November 2007)
    Something never mentioned on cigarette warning labels is that smoking can affect the way a number of medications work, in some cases resulting in significant, dangerous adverse outcomes. Smokers should be aware that a number of medications may not work as well because of smoking cigarettes. The article lists 16 drugs whose levels in the blood become lower, making the drugs less effective, if the patient is also smoking.
  • Drug Interactions 101 [hide all summaries]
    (November 2007)
    This month marks the beginning of an important addition to every issue of Worst Pills, Best Pills News concerning drug interactions. The articles are being written by one of the world’s top authorities on interactions, Dr. Philip Hansten of the University of Washington. This introductory article explains how to understand different types of interactions and every month, starting now, there will be a specific article on the adverse interaction of the month.
  • A Review of Ranolazine (RANEXA) For Chronic Chest Pain [hide all summaries]
    (March 2007)
    Although the FDA medical officer in charge of reviewing ranolazine recommended that ranolazine's professional product labeling display a black box warning about potential disruption in the heart's electrical cycle, the drug does not have a black box warning.
  • FDA-Approved Drug Information Now Required For The Blood Thinner Warfarin (COUMADIN) [hide all summaries]
    (December 2006)
    The Food and Drug Administration (FDA) announced October 10 that an agency-approved Medication Guide, which provides information about drug safety, will now be required to accompany all new and refill prescriptions for the blood thinner warfarin (COUMADIN). Warfarin can interact dangerously with a number of other drugs, dietary supplements and vitamins, but these products are inexplicably not listed in the Medication Guide. The details of these serioius interactions can be found at Worstpills.org or in our book, Worst Pills, Best Pills.
  • PUBLIC HEALTH ADVISORY: Migraine Drugs, Antidepressants May Cause Life-Threatening Interactions [hide all summaries]
    (October 2006)
    If you are taking triptans, SSRIs or SNRIs and experience the symptoms of serotonin syndrome listed in this article, you should seek medical attention immediately. This is because of the possibility of life-threatening reactions such as nausea, changes in blood pressure or hallucinations that may be caused by the interaction of migraine headache drugs, called triptans, and certain antidepressants.
  • Drug Interactions: Updated Information on the Cholesterol Drug Lovastatin (MEVACOR) [hide all summaries]
    (April 2006)
    If you are taking lovastatin to lower your cholesterol and also take any of the 13 drugs discussed in this article, consult with your physician as soon as possible. Dose alterations may be necessary to avoid drug-induced muscle damage.
  • A Warning about AVINZA: Updated Black Box Warning on Extended-Release Morphine Capsules [hide all summaries]
    (March 2006)
    If you are now taking Avinza or Kadian, you should ask your doctor whether another painkiller such as immediate-release morphine might be more appropriate. If you decide to continue taking Avinza or Kadian, you should be sure never to consume alcohol or chew, crush, or dissolve the capsules.
  • Antibiotic Clarithromycin (BIAXIN) Can Have Deadly Interaction with Anti-Gout Drug Colchicine [hide all summaries]
    (October 2005)
    Using the antibiotic clarithromycin (BIAXIN, BIAXIN XL) in combination with the gout drug colchicine at the same time increases the risk of death because of colchicine toxicity, a recent study shows. In the 88 patients who received the two drugs together, nine (10.2 percent) died. Only one (3.6 percent) of the 28 patients who received the two drugs sequentially died.
  • Extensive New Warnings for the Potent Pain Drug Fentanyl Transdermal System (DURAGESIC) [hide all summaries]
    (October 2005)
    As the black box warning suggests, fentanyl skin patches should not be used in the following situations:in patients who have not previously been prescribed opioid painkillers, in the management of acute pain or in patients who require opioid pain killers only for a short period of time.
  • When Drinking Alcohol Causes “Dose-Dumping” in a Widely-used Painkiller [hide all summaries]
    (September 2005)
    The Food and Drug Administration (FDA) asked the maker of the long-acting potent narcotic, or opiate, painkiller hydromorphone (PALLADONE) to remove the drug from the market because of a potentially fatal interaction with alcohol. If you are now taking Palladone, Avinza, or Kadian you should talk to your physician immediately to discuss alternative treatment.
  • The Dark Side of Viagra: Erectile Dysfunction Drugs And Vision Problems [hide all summaries]
    (August 2005)
    You should not use sildenafil Viagra), vardenafil(Levitra), or tadalafil(Cialis) for recreational purposes because there is no medical benefit to be gained. The possible harm from these drugs, no matter how small, will always outweigh a lack of medical benefit. If you experience any visual problems while using these drugs, notify your doctor immediately.
  • The Widely Used Antibiotic Erythromycin And Fatal Heart Rhythm Disturbances [hide all summaries]
    (November 2004)
    You should not take erythromycin in combination with one of the interacting drugs listed in this article. If you are, you should contact your physician immediately. As mentioned above, erythromycin is an important antibiotic when used appropriately. Therefore, we do not recommend against its use when it is not used with one of these interacting drugs.
  • Drug Interaction Reminder: Fluoroquinolone Antibiotics and the Anticoagulant (Blood Thinner) Warfarin (COUMADIN) [hide all summaries]
    (September 2004)
    You should consider that all fluoroquinolone antibiotics have the potential to interact with warfarin and your physician should be ordering blood tests to monitor the status of your blood clotting if one of these antibiotics is needed and you are using warfarin. This is the safest thing to do.
  • New Drug Interaction Warnings For The Antidepressant Trazodone (DESYREL) [hide all summaries]
    (August 2004)
    In May 2004, the Food and Drug Administration (FDA) announced that new drug interaction warnings are now required in the professional product labeling or package insert for the antidepressant trazodone (DESYREL). Health Canada, the Canadian drug regulatory authority, announced similar warnings for the drug on July 9, 2004. This article lists those drugs that interact with trazodone.
  • Grapefruit Juice and Prescription Drugs: Some Dangerous Interactions [hide all summaries]
    (February 2004)
    The January 5th issue of the Medical Letter, a widely respected source of independent information about pharmaceuticals and dietary supplements, has a review of the increasingly researched problem of the interaction between grapefruit juice and many prescription and over-the-counter drugs. Like most interactions between chemicals in the body, this one involves the impairment, by grapefruit juice, of the body’s ability to metabolize many drugs, leading to higher than expected — and sometimes dangerous — levels of these drugs.This article lists the drugs.
  • A Review of Two More Drugs For Erectile Dysfunction: Vardenafil (LEVITRA) And Tadalifil (CIALIS) [hide all summaries]
    (January 2004)
    You should wait at least seven years from the date of release to take any new drug unless it is one of those rare “breakthrough” drugs that offers you a documented therapeutic advantage over older proven drugs.
  • DO NOT USE UNTIL 2011 Eplerenone (INSPRA) For High Blood Pressure [hide all summaries]
    (December 2003)
    This statement appears in the professional product labeling, or package insert, for eplerenone: “The principal risk of INSPRA is hyperkalemia. Hyperkalemia can cause serious, sometimes fatal, arrhythmias (heart rhythm disturbances).”
  • Do Not Use! Rosuvastatin (Crestor) - A New But More Dangerous Cholesterol Lowering 'Statin' Drug [hide all summaries]
    (October 2003)
    Rosuvastatin (CRESTOR) became the sixth cholesterol lowering "statin" drug on the U.S. There is no medical reason for you to be taking rosuvastatin when there are three safer and more effective statins, in terms of reducing cardiovascular events, on the market.
  • Over-The-Counter Omeprazole (PRILOSEC OTC) — There Are Better Choices For Heartburn [hide all summaries]
    (October 2003)
    You should try the non-pharmacologic interventions listed in the box below before trying antacids, histamine-2 blockers, or, as a last resort, proton pump inhibitors. If you classify yourself as a person with frequent heartburn, that is heartburn more than two days per week, and the interventions recommended above have failed, you should be under the care of a physician
  • The Serotonin Syndrome: A Potentially Life-Threatening Adverse Drug Reaction — Fluoxetine (PROZAC), Escitalopram (LEXAPRO), Sibutramine (MERIDIA) And Other Drugs [hide all summaries]
    (September 2003)
    Canadian drug regulatory authorities reviewed reported cases of serotonin syndrome in the July 2003 issue of the Canadian Adverse Reaction Newsletter. The serotonin syndrome is a potentially life-threatening adverse drug reaction involving an excess of serotonin, a naturally occurring nerve transmitter.
  • NEW DRUG INTERACTION WARNING! Repaglinide (PRANDIN) For Diabetes And The Cholesterol Lowering Drug Gemfibrozil (LOPID) [hide all summaries]
    (August 2003)
    The European Agency for the Evaluation of Medicinal Products (EMEA) issued a public warning on May 21, 2003 not to use the combination of repaglinide (PRANDIN), a drug for lowering blood sugar in type-2 diabetics, and the cholesterol drug gemfibrozil (LOPID). The warning was based on a recent publication in the March 2003 issue of the medical journal Diabetologia that found the use of these two drugs in combination can enhance the blood sugar lowering effects of repaglinide and can thereby result in severe blood sugar lowering (hypoglycemia).
  • Do Not Use Until December 2009 The New Antipsychotic Drug Aripiprazole (ABILIFY) [hide all summaries]
    (June 2003)
    You should follow the Health Research Group’s Seven Year Rule with aripiprazole. There is no evidence to suggest that aripiprazole is a “breakthrough” drug.
  • Stronger Warnings for the Fluoroquinolone Antibiotic Gatifloxacin (TEQUIN) [hide all summaries]
    (May 2003)
    Stronger warnings have been added to the professional product label, or “package insert,” for the fluoroquinolone antibiotic gatifloxacin (TEQUIN) about possible heart rhythm disturbances and problems with blood sugar control. This drug was approved by the Food and Drug Administration (FDA) in October 2001 and its marketing brought to nine the number of fluoroquinolone antibiotics on the market.
  • DO NOT USE! Nitrofurantoin (FURADANTIN, MACRODANTIN, MACROBID) — Adverse Effects On the Lungs [hide all summaries]
    (April 2003)
    Older adults should not use nitrofurantoin long term for the treatment of urinary tract infections. If you develop the symptoms of acute lung toxicity listed above, contact your physician immediately.
  • Do Not Use! New Safety Warning Added to the Arthritis Drug Valdecoxib (BEXTRA) [hide all summaries]
    (January 2003)
    There is an additional similarity (aside from our listing both as DO NOT USE drugs) between valdecoxib and celecoxib, both are sulfa drugs and individuals who are allergic to sulfa drugs should not use them. Although celecoxib came on the market with a warning about sulfa drug allergy, valdecoxib did not. We previously wrote “It may be a dangerous oversight on the part of the FDA not to have required the same warning for valdecoxib.” Unfortunately, because uninformed patients have been needlessly harmed, our prediction has come to pass.
  • Do Not Use Until October 2005 Escitalopram (LEXAPRO) – The Sixth Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressant [hide all summaries]
    (January 2003)
    Escitalopram (LEXAPRO) was approved by the Food and Drug Administration (FDA) in August 2002 and brings to six the number of selective serotonin reuptake inhibitor (SSRI) antidepressants now on the market in the U.S. The primary purpose for developing escitalopram appears to be nothing more than a strategy to protect sales as citalopram nears the end of its patent protection. In the long run, escitalopram will cause economic harm to individuals and the healthcare system.
  • New Safety Warnings! Dihydroergotamine (DHE 45 INJECTION, MIGRANAL NASAL SPRAY) for Migraine Headache [hide all summaries]
    (November 2002)
    On July 31, 2002, the strongest type of drug safety warning that the Food and Drug Administration (FDA) can require, a black box warning, was added to the professional product labeling, or “package insert,” for the migraine headache drug dihydroergotamine (DHE 45 INJECTION, MIGRANAL NASAL SPRAY). The new warning involved numerous drug interactions between dihydroergotamine and other drugs that can raise the blood levels of dihydroergotamine leading to a life-threatening contraction of blood vessels (vasospasm) that can block the flow of blood to the brain and other areas of the body.
  • New Safety Labeling Changes for Anticoagulant Warfarin (COUMADIN) [hide all summaries]
    (September 2002)
    Several new safety labeling changes have been required by the Food and Drug Administration (FDA) for the widely used anticoagulant drug warfarin (COUMADIN). These changes to the drug’s professional product labeling, or “package insert,” were made in May 2002. The article discusses the changes.
  • Do Not Use! Dexmethylphenidate (FOCALIN) - a Methylphenidate (RITALIN) Copy [hide all summaries]
    (August 2002)
    Dexmethylphenidate (FOCALIN), approved by the Food and Drug Administration (FDA) in November 2001 for attention-deficit/hyperactivity disorder (ADHD), joins a growing list of Do Not Use drugs, so called because they primarily result in economic harm to both individuals and the health care system. These drugs exist solely to extend a manufacturer’s brand name monopoly position in a lucrative market but offer nothing better than the drugs they replace.
  • Do Not Use! The Fluoroquinolone Antibiotic Gatifloxacin (TEQUIN) [hide all summaries]
    (July 2002)
    The approval of gatifloxacin(TEQUIN) in October 2001 brought to nine the number of fluoroquinolone antibiotics on the market, and this drug joins sparfloxacin (ZAGAM) and moxifloxacin (AVELOX) as fluoroquinolones that can cause a dangerous abnormality in the heart’s electrical conduction known as QT prolongation that can lead to fatal heart rhythm disturbances such as torsade de pointes.
  • Grapefruit Juice and Drug Interactions [hide all summaries]
    (June 2002)
    Grapefruit juice can interact with a number of therapeutically important drugs that could lead to the possibility of toxicity. These drugs are listed in the article.
  • Preventable Drug-Induced Injury: What is the Last Line of Defense? [hide all summaries]
    (December 2001)
    A study published in the October 3, 2001, Journal of the American Medical Association reveals the extent of inappropriate prescribing by physicians and the equally inappropriate dispensing by pharmacists of cisapride (PROPULSID), a dangerous nighttime heartburn drug that was removed from the market in March 2000 because of fatal heart rhythm disturbances (see the March 2000 issue of Worst Pills, Best Pills News). Before using a new prescription drug, ask your pharmacist for the drug’s professional product labeling or “package insert.” This is not the same as the automatically-dispensed, information-deficient sheet you usually get.
  • Drugs for Possible Exposure to Anthrax: What Makes Sense? [hide all summaries]
    (November 2001)
    With each new day come new reports of exposures, possible exposures and what turn out to be fake exposures to anthrax. Originally coming from Florida, reports are now emanating from other states including New York, Nevada and the District of Columbia.

Drug and Dietary Supplement Profiles

Each profile is a comprehensive review of the safety and effectiveness of this drug. If drug is not a Do Not Use product, information on adverse effects, drug interactions and how to use the medication are included.
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