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Drug-Drug Interactions, Drug-Food Interactions, and Drug Side Effects In The World Of Chronic Pain

Whether you are a chronic pain patient, or anyone else for that matter, here is some food for thought.

Every medication known to us has the potential to present us with at least three types of problems--

1) Medications can interact with other medications in a person's system.
2) Medication can interact with foods that people eat.
3) All medications have side effects.

Let me elaborate a bit:

Medications can interact with other medications in a person's system.

Many drugs have the potential to interact with other drugs; it's probably a lot more common than one might believe.  A common reason for this type of problem occurs when both drugs in question are metabolized in the liver, commonly through the cytochrome P-450 system.  In this scenario, both drugs are competing for the same enzyme, and usually one drug will predominate.  This results in a change of effectiveness and/or drug toxicity for one or all of the drugs involved.  The opioid drugs are an example of a class of drugs that are metabolized this way.

There are other mechanisms for drug-drug interactions besides this one...a second example would be
the scenario where two drugs compete for the same binding site on the proteins in the bloodstream. If Drug A has a stronger ability to bind to said site, more of Drug B will end up in circulation...and that could result in higher levels of Drug B, possibly even toxicity.  Other mechanisms also exist, but I think that these two examples will give you the idea.

Medication can interact with foods that people eat.

In a similar way to drug-drug interactions, drugs can interact with food. The most common culprit I can think of is grapefruit/grapefruit juice.  For some reason ingestion of these foods causes abnormal metabolism of a number of medications...and it can be fatal.  The cholesterol lowering "statin" drugs are one such group of drugs that come under this heading.

Another example of a drug food interaction is the interaction between warfarin, an anticoagulant, and vitamin K rich foods such as green leafy vegetables.  This is because vitamin K is actually the warfarin antidote.  Most patients are giving counseling in this regard when warfarin/Coumadin therapy is initiated.

All medications have side effects.

In addition to drug interactions, there is always the possibility of a side effect from a given drug. Drowsiness and GI upset are very common side effects.  But some drugs actually present with a side effect of pain!  Here's an example:  a class of diabetes drugs known as DPP-4 inhibitors has been found to cause severe joint pain. This class of drugs includes a number of names you may know: Januvia, Onglyza, and Tradjenta, to name a few.

Why am I telling you this?  Because whenever you're  considering use of new medication you should know as much about it as possible.  The more drugs a person takes, the higher the risk of a drug-drug interaction, a drug-food interaction, or a side effect.

It's good to know what you're getting yourself into before you start.  Drugs can do a lot to improve the quality of life...but one needs to proceed with caution.  I always like to think that that lifestyle changes should be the first approach; medication should be used when other options are not realistically possible.

Sources:;;; wikimedia


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