People’s Pharmacy: Hemorrhoid remedy plus heart pill caused collapse

Q. Watch out for serious drug interactions with Preparation H! A few years ago, I was taking a beta blocker drug called metoprolol for a heart rhythm problem. During that time, I developed hemorrhoids and used Preparation H as directed.

I had used this product in the past with no problems. Consequently, I didn’t think to read the warning about interactions with beta-blockers. The second day, I got up in the night to use the bathroom and fainted. My face hit the countertop as I fell, and I damaged my face and teeth.

After I regained consciousness and went back to bed, I convulsed and shivered for an hour. The combination of the beta blocker and the phenylephrine in Preparation H caused a life-threatening reaction. The cautionary statement is obscure and people who have used the product without problems are unlikely to look for the warning.

A. Thank you for sharing your story. Interactions between beta-blockers like metoprolol and topical phenylephrine (a vasoconstrictor in Preparation H) can be hazardous.

That’s because phenylephrine constricts blood vessels and can raise blood pressure. Paradoxically, this might reduce blood flow to the brain and lead to fainting. Thank you for warning others about this potential interaction.

Q. A few months ago, you wrote about a new form of epinephrine for treating severe allergic reactions. It’s a nasal spray called neffy.

I am curious: How can “neffy” be approved to treat anaphylactic reactions although it has not been tested in people experiencing anaphylactic shock?

A. The Food and Drug Administration approved neffy in August to provide an alternative for people with allergies and fear of injections. Some people also have difficulty using an auto-injector correctly.

You are right that this new way of administering epinephrine was tested in healthy people, not in those suffering an anaphylactic reaction. FDA officials explained that it would be unethical to provoke a life-threatening crisis to test the effectiveness of the drug.

Regardless of the form of epinephrine used, after it is administered, the patient should call 911. Reactions can come back quickly and may require a second dose as well as emergency medical treatment.

Q. For years, I took various statin meds such as atorvastatin. I suffered many side effects such as muscle pain and mental fog.

Now my doctor has recommended that I stop taking the statin. Instead, he wants me to take Repatha. What are the side effects of that drug? Am I jumping from the frying pan into the fire?

A. Many readers have complained about statin side effects like those you mentioned. Two nonstatin cholesterol-lowering drugs are PCSK9 inhibitors. They include evolucumab (Repatha) and alirocumab (Praluent). They are injected once or twice a month.

Side effects of Repatha may include runny nose, sore throat, flu-like symptoms, sinusitis, cough, headache, dizziness, back pain, muscle pain or injection site reactions. The most serious side effect is a serious allergic reaction. Muscle pain and spasms can also occur with Praluent.

To learn more about statins and these newer medications, you may find our “eGuide to Cholesterol Control and Heart Health” useful. This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com. You will discover many nondrug approaches along with other medicines that can help reduce cardiovascular risks.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”