Cough medicine plus antidepressant is a dangerous mix
Q. Thank you for saving my life! If I had not read your article about an interaction between antidepressants like fluoxetine and cough medicine, I am positive I wouldn’t be here today.
A. The interaction between SSRI-type antidepressants like fluoxetine (Prozac) and the cough suppressant dextromethorphan could be potentially life-threatening. Doctors call this serotonin syndrome. Symptoms may include agitation, nausea, confusion, rapid heart rate, muscle spasms, overactive reflexes and hallucinations.
Although over-the-counter cough medicine often contains dextromethorphan (DM), it is not the only source of this compound. An antidepressant called Auvelity contains both dextromethorphan and bupropion.
In one case, a man taking fluoxetine was still depressed, so his doctor added a prescription for Auvelity. Within three days, the patient reported “flushing, chills, confusion, urinary retention, dysuria, agitation, paranoia, anxiety, and auditory/visual hallucinations of humming and persons in his home” (Journal of Clinical Psychiatry, April 3, 2024). A work-up at the hospital diagnosed serotonin syndrome and dextromethorphan toxicity.
Many other case reports involve antidepressants and cough medicine or the pain reliever tramadol. Not only can serotonin syndrome alter mental status, but it can also affect the cardiovascular system, including the heart (Journal of Cardiology Cases, Aug. 19, 2012). We are glad you were alerted in time.
Q. I controlled my blood pressure for years on a low dose of metoprolol. After recovering from COVID-19, though, my blood pressure went up.
At first, my doctor increased the dose of metoprolol, but my heart rate slowed down too much. Next was a blood pressure pill with HCTZ and triamterene. That was ineffective, so lisinopril was added. The result was uncontrollable coughing. I stopped it and was given irbesartan, but that resulted in fluid retention and headaches. Then amlodipine was prescribed but it caused vertigo and hives. Help!
A. Your doctor has tried most of the types of blood pressure medication on the market. Perhaps it’s time to consider some nondrug options including the DASH diet (dietary approaches to stop hypertension). Make sure your levels of calcium, magnesium and potassium are normal. Other approaches might include juices like pomegranate, beet or Concord grape. Sauna baths, deep breathing exercises and meditation may also help. You should be monitoring your blood pressure at home on a regular basis.
The Food and Drug Administration recently approved a new type of antihypertensive medication called Tryvio (aprocitentan). You can learn more about the pros and cons of this drug, other medicines and nondrug approaches in our “eGuide to Blood Pressure Solutions.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.
Q. I have read your article on magnesium and sleep. What you don’t mention is what kind of magnesium is best. There are so many different types!
A. A study published in Frontiers in Endocrinology found that magnesium gluconate, by itself or in combination with potassium, helped people sleep better (Oct. 29, 2024). Magnesium L-threonate has also been shown to improve sleep (Sleep Medicine X, Aug. 17, 2024). Magnesium L-threonate might be preferred, as it is less likely to result in diarrhea. People with poor kidney function should avoid magnesium supplements.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”