People’s Pharmacy: Cocktails trigger dangerous heart rhythm

Q. A family member had recurring episodes of atrial fibrillation that were about to lead to potentially dangerous drugs to suppress the dysrhythmia. After she completely discontinued her alcohol intake (one vodka martini and two glasses of wine each night), her AF has not returned. Are you aware of any data to support this correlation?

A. Alcohol consumption is a well-established risk factor for atrial fibrillation (AF). This heart rhythm disturbance occurs when the upper chambers of the heart (atria) contract rapidly in a disorganized fashion. Symptoms may include palpitations, dizziness, fatigue, chest pain, shortness of breath or swollen ankles. Not everyone with AF experiences clear symptoms, though.

As a result of this arrhythmia, blood can pool and form clots within the heart. If a clot travels to the brain, it can cause a stroke. That’s why AF is frequently treated with anticoagulant medication to prevent blood clots.

Of course, avoiding AF by skipping alcohol is a good strategy. A number of medications can also increase the risk for this kind of heart rhythm disturbance. They include NSAIDs like ibuprofen or naproxen, cortisone-type drugs and antidepressants.

We did hear from one reader who suspects quinine: “I found that quinine is a trigger for me – in my case gin and tonic. I now have a pacemaker (for other reasons) and have not had AF in two years.” Whether quinine in tonic or alcohol in gin was the culprit would be hard to determine.

Q. You have written about pharmacy errors, but you did not emphasize that this is a potentially life-threatening issue. There are two resources that could help.

First, many patient leaflets have the physical description of the pills. I check each refill against the leaflets to verify the name of the drug, the color, size, shape and the identifying codes. Second, several websites give detailed physical descriptions or photos of pills.

I worked in health insurance. My pharmacist friends never take any medication without checking it. When my parents were hospitalized, I asked about everything that came in the room.

Since scripts usually go straight to the pharmacy via computer, a lot of people might not pay attention to what is being prescribed until they pick it up. Patients and their families need to be proactive to avoid mistakes in the pharmacy.

A. Thank you for the reminder that everyone should be aware of what medicine they are prescribed and that they should always check it before leaving the pharmacy counter.

One reader recently reported: “I have Crohn’s disease and take 0.6 milliliters opium tincture for diarrhea. I recently renewed my prescription, and when I got home, my daughter read the label out loud.

“When she said 6 milliliters, I grabbed the bottle and called the pharmacy. They were horrified. They apologized over and over, refunded my cost, gave me a proper label and thanked me for catching their mistake. We both knew that taking 6 milliliters of opium tincture could put a person in a coma.”

This underscores the importance of checking each detail of every prescription. We have written more extensively about pharmacy errors in our book “Top Screwups.” You can find it in the book section of the store at PeoplesPharmacy.com. This book provides practical tips on how to avoid pharmacy and medical mistakes.

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: PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”