WebMD Ask the Pharmacist

Heart Health: Ask the Pharmacist

Pharmacist Maria Marzella Sulli, PharmD, answers questions about heart health issues.

Question:

Can Crestor (or another statin) and/or warfarin raise the blood sugar levels overnight?

Answer:

No. It is unlikely that your cholesterol medication or warfarin would raise blood sugar levels. If you suddenly notice a change in your blood sugar levels, you should contact your health care professional. I wouldn't worry too much if it happens only one time. But if it becomes consistent, talk to your healthcare professional.

Question:

What foods should be avoided when taking Coumadin (warfarin)?

Answer:

There really aren't any foods you need to avoid while taking Coumadin. Since Coumadin works on vitamin K, foods that are high in vitamin K can affect your INR (the test to measure how well your Coumadin is working). Foods like kale, spinach, collard greens, and Brussels sprouts all have high amounts of vitamin K. While you shouldn't binge on them one day and avoid them the next, if you have one or two servings a week consistently, you should not notice a difference.

Question:

I have been taking atenolol for some time, and I've found that my hair is thinning. I take flecainide, hydrochlorothiazide, prednisone, and warfarin. Please let me know if any of these medications are contributing to my thinning hair.

Answer:

Thinning hair can be caused by many factors, and should really be evaluated by a physician. Age and hormones are the most likely culprits. Prednisone can cause hair loss, since it affects hormone levels in the body. But you should talk to your healthcare professional, who can properly examine you and perform any necessary tests to help solve the mystery of your thinning hair.

Question:

I've been taking Benicar HCT for some time. When I saw a urologist about urinary incontinence, she put me on doxazosin. When she did this she requested that the heart doctor take the HCT out of my Benicar. Can you tell me what this was for and what the difference is in the two?

Answer:

She most likely suggested stopping the HCT part of the Benicar since the HCT refers to hydrochlorothiazide, a diuretic that helps lower blood pressure by acting as a water pill. The effects of a water pill can bring on or worsen urinary incontinence, since it makes you have to urinate more often.

Question:

Can atenolol stunt a child's growth?

Answer:

I am not aware of any evidence that beta-blockers like atenolol can stunt a child's growth. If you have concerns about your child's medications, you should talk to his or her healthcare professional.

Question:

What are the side effects of taking verapamil SR 240?

Answer:

The most common side effects of verapamil are headache, constipation, heartburn, and dizziness. More severe side effects include swelling of the hands and feet, slow heartbeat, and difficulty breathing. If the side effects are bothersome, or if you experience any severe side effects, you should contact your healthcare professional.

Question:

Can metoprolol tartrate raise triglyceride levels? How about raising LDL or lowering HDL?

Answer:

Metoprolol can slightly raise triglycerides and decrease the HDL cholesterol. If you are worried about this, or have questions about whether the metoprolol may be raising your cholesterol, you should talk to your healthcare professional. Most often, the benefits of taking the metoprolol outweigh the risks of the changes in cholesterol. But you should consult your doctor before making any decisions about your prescriptions.

Question:

Should I be concerned about taking these four medications all together: Avapro, amlodipine, Coreg, and clonidine?

Answer:

I would assume you are using all of these medications to lower blood pressure. It is quite common for someone to require several blood pressure medications to reach their blood pressure goal. I would need more information as to what specifically you are concerned about to help you further. I do not recognize any dangers in taking those four medications.

Question:

Are there any drug interactions between Vicodin -- or any other narcotic pain relievers -- and heart failure medications?

Answer:

To answer your question, I would need to know which medications you take for heart failure, and how severe your heart failure is. Vicodin and other narcotic pain relievers can cause breathing difficulties if you take too much. People with congestive heart failure, who often already have breathing difficulties, may be more prone to that side effect.

In reference to your question about specific drug interactions, I would need a list of your medications to answer that question. I suggest you talk to your pharmacist, who has a list of all your current medications, and can discuss the potential for drug interactions with you.

Question:

Is there a generic form of Plavix? If not, what is clopidigrel?

Answer:

The generic name of Plavix is clopidigrel. But at this time, clopidogrel is not available in the U.S. as a generic product. Plavix is the only version of clopidogrel available in the U.S.

Question:

I take metformin, enalapril, simvastatin, HCTZ, and omega-3 fish oil. Can I take St. John's wort safely with these medications?

Answer:

St. John's wort is an herbal supplement that has many drug interactions. In your case, it can make your simvastatin less effective, which can result in elevated cholesterol levels. It also can affect blood glucose.

I would suggest you avoid St. John's wort. If you are having symptoms of depression (a common use for St. John's wort) you should talk to your healthcare professional, who can help.

Question:

Is it OK to take metoprolol, Topamax, Diamox, and Excedrin all at the same time?

Answer:

While there are no dangerous drug interactions in the medications you listed, there is an increased risk of developing kidney stones when taking Topamax and Diamox. If you are concerned about drug interactions, you should talk to your pharmacist. And always be sure to have your prescriptions filled at only one pharmacy, so that all your prescriptions can be properly screened for interactions.

Question:

I have recently been prescribed metoprolol, simvastatin (generic for Zocor), and pantoprazole (generic for Protonix). I have also been put on the fish oil vitamin. I take these first thing in the morning and at bedtime. Would it be OK for me to resume taking the fat blocker, Alli?

Answer:

Yes. It would be OK. There are no dangerous drug interactions between Alli and the medications you listed. The one suggestion I would give you is to separate your Alli doses from the fish oil by at least 2 hours, to ensure you get the full benefits of the fish oil supplement.

Question:

I had an angioplasty done 2 weeks ago and now I am on blood thinners. I am 59 years-old and take Viagra. Is it OK to continue taking the Viagra, or any other drug for erectile dysfunction?

Answer:

If you have heart problems and recently underwent a procedure, I would recommend first that you check with your cardiologist to make sure it's safe for you to engage in sexual activity. If your doctor thinks it is safe, you can take Viagra while taking blood thinners. You would need to avoid Viagra if you were taking any medication in the nitrate class, like nitroglycerin or isosorbide dinitrate, which are taken for chest pain and angina.

Question:

My husband and I have been prescribed several medications for heart problems. But they are so expensive that we can't purchase them. Is there a good place to get them cheaper online -- and legitimately?

Answer:

While there are many ways to save money on expensive medications, buying them online from a foreign pharmacy is not one that I would suggest. While you can safely buy medications online, you can only do so from a trusted, verified site. Websites that carry the VIPPS seal, which stands for verified Internet pharmacy practice site, are reputable, safe sites that sell medications online.

Also, many pharmacies have discount cards available and generic medication programs that can help patients save money. Talk to your doctor or pharmacist to ensure you are taking the least expensive versions of all your medications, and switch to generics wherever possible. While shopping around for the cheapest price may seem like a good idea, it is strongly advised that you have all your medications filled at one pharmacy, so your pharmacist can properly screen for potential drug interactions.

Question:

Is it OK for a cardiac patient to take over-the-counter cough medicine?

Answer:

There really is not enough information in this question for me to answer it. It depends on what "cardiac patient" means and what type of cough they want to treat.

Question:

Can you take amlodipine and Exforge together?

Answer:

No, and you shouldn't need to. Exforge is a combination medication that contains amlodipine and valsartan. Taking it with plain amlodipine could give you too much amlodipine, which could be dangerous. Talk with your doctor to clarify what blood pressure medications you are supposed to be taking to avoid any dangerous medication error.

Question:

I had a heart attack 2 months ago. I was prescribed the heart medication Coreg. I have been taking Premarin for 10 years. Are these two medications safe to take together?

Answer:

There are no dangerous drug interactions between Premarin and Coreg -- the two medications can be safely taken together.

Question:

Is it safe to take the heart medicine, Toprol-XL with the high blood pressure medication, lisinopril? Are there any adverse drug interactions for Toprol-XL?

Answer:

All medications carry some risk of side effects. Side effects of Toprol-XL include dizziness, drowsiness, dry mouth, nausea, constipation, and depression. Signs of serious side effects are shortness of breath or wheezing, changes in your heartbeat, and swelling of the feet and hands. It is safe to take Toprol-XL with lisinopril. There are no dangerous drug interactions.

Question:

Are propranolol ER and propranolol HCL ER the same drug?

Answer:

They are the same drug. They both contain the active ingredient propranolol in an extended-release capsule.

Question:

What is Coreg CR taken for?

Answer:

Coreg CR is indicated to treat high blood pressure and congestive heart failure.

Question:

Is there a big difference between fish oil and flaxseed oil supplements?

Answer:

There is a difference in the types of omega-3 and omega-6 fatty acids they provide. Flaxseeds provide alpha-linoleic acid (ALA), which our bodies convert in small amounts to EPA and DHA, which are the omega-3s found in fish oil. But flaxseed oil has not been shown to reduce triglycerides like fish oil has.

Question:

My husband takes a statin prescribed by his cardiologist. A recent visit to the cardiologist revealed that his cholesterol levels are rising while on the medication. The doctor asked him if he drank tea. He does on a daily basis, sometimes 2-3 glasses of brewed iced tea a day. The doctor said that drinking tea will interfere with the efficiency of his statin to control cholesterol. How does that happen?

Answer:

To answer your question, I would first need to know which statin your husband took for his cholesterol. However, you state that his cholesterol was rising, which would mean that his statin was being less effective.

There is some evidence to support a possible interaction between green tea and statins. But the evidence shows that the tea can increase levels of the statin, which would put him more at risk for side effects. So basically, it would make the statin work more, not less. I suggest you talk to your husband's doctor again to ensure there was no miscommunication.

Question:

I am a 63 year-old male. I currently take a low dose of atenolol and am considering taking Viagra. Is there any interaction between these two medications that I should be aware of?

Answer:

No. There are no dangerous interactions between atenolol and Viagra. However, you should discuss your erectile dysfunction with your doctor as it may be a sign of other conditions.

Question:

My cardiologist told me to measure my sodium intake. How do I measure it?

Answer:

Excellent question! The only way to monitor your sodium intake is to keep track of how much sodium you eat by reading food labels. Food labels will tell you how much sodium (in mg) a serving of that product contains. And you can use that information to calculate your overall sodium intake for the day.

Most of the salt in our diets comes from eating too many prepared or processed foods, like canned or frozen foods. Try to choose fresh, homemade foods wherever possible. Beware of restaurant foods that are often laden with sodium. There are good sources of information on sodium intake I would recommend. Check out the American Heart Association's web site at www.americanheart.org for more information.

Question:

What kind of problems can occur when taking the following prescriptions together: gabapentin 300MG, Topamax 25MG, Zocor 40MG, and verapamil 120MG?

Answer:

The only potential for interaction on your list of medications is that taking verapamil with Zocor can increase the levels of Zocor and make a patient more likely to experience side effects from the Zocor, like muscle pain. If you are worried about drug interactions, it is important that you only use one pharmacy to fill all of your prescriptions, so that the pharmacist can properly screen for interactions. And talk to your pharmacist. They can provide you all the information you need to take your medications safely.

Question:

Is it safe for my 76-year-old father to be taking carvedilol 12.5 mg, furosemide 40 mg, ramipril 5 mg, warfarin 5 mg, lovastatin 40 mg, pravastatin sodium 20 mg, along with a variety of vitamins?

Answer:

Your father should not be taking lovastatin and pravastatin. They are in the same class of medications and he should not need both of them. Taking both can put him at risk for adverse effects, like muscle pain and myopathy. All of his other medications look fine. But you should have him sit down and review all of his medications with his doctor and pharmacist to be sure he is using them appropriately.

If you are worried about drug interactions, it is important that you only use one pharmacy to fill all of your prescriptions, so that the pharmacist can properly screen for interactions. And talk to your pharmacist. They can provide you all the information you need to use your medications safely.

Question:

I take Zetia for my cholesterol. I've read that it doesn't work as well as Lipitor. Will my doctor switch my prescription?

Answer:

Zetia and Lipitor are different types of medications that work differently to lower cholesterol. But only you and your doctor can decide which one is the best for you. If you are concerned about the medication you are taking, talk to your doctor about your concerns and he or she may decide to switch your medication.

Question:

Is it safe to take propranolol 60mg per day and drink a 6oz glass of red wine each day, as well?

Answer:

Propranolol can cause some drowsiness in some people. And combining it with alcohol can make that worse. But it is not dangerous. The key to consuming alcohol safely is moderation. So be sure to limit yourself to 1–2 glasses of wine per day.

Thank you for joining us for WebMD Ask the Pharmacist. Be sure to come back on Dec. 7 at 1 p.m. ET, when we'll be discussing men's health issues. Sign up if you'd like an e-mail reminder the day before our next premiere event.