WebMD Ask the Pharmacist

Caring for Elderly Parents: Ask the Pharmacist

Pharmacist Macary Marciniak, PharmD, BCPS, answers your questions about prescription and over-the-counter drugs for seniors.

Question:

What company makes Pylera? My mom cannot afford to pay for it and insurance won't cover it.

Answer:

Pylera is a brand-name medication that is manufactured by a company named Aptalis. Pylera is used to treat ulcers that are infected with Helicobacter pylori. The ingredients in Pylera are bismuth, metronidazole, and tetracycline. This one medication contains three combined medications, allowing someone to take fewer tablets. However, each of the three separate medications can be purchased at a reduced cost. I would talk to your mom’s health care provider and tell him/her that the cost is too much. Ask for a prescription for the three separate ingredients. It's important that your mom take the correct doses of all three medications, so the infection can be treated properly.

Question:

My dad has diverticulitis and is currently taking antibiotics for it. He has been on several different antibiotics over the past 4 weeks. Can drinking fruit juice affect the effectiveness of antibiotics?

Answer:

Interactions between medications and fruit juice is a hot topic. There is some evidence that the absorption of certain medications can be reduced by some fruit juices. Ciprofloxacin is one antibiotic that may be affected by drinking either apple juice, orange juice, or grapefruit juice. If your father is concerned about the potential for an interaction, he should avoid taking his antibiotics and drinking any fruit juices within 4 hours of each other. This should be enough time to prevent an interaction. Your dad can also check with his local pharmacist to see if the specific antibiotic he is using may have interactions with any kind of fruit juice.

Question:

My mom is 88 years old and has Alzheimer’s disease. She uses an Exelon patch and takes Namenda. Lately she has had an alcohol-like smell on her breath. Could this be a result of her medications?

Answer:

Breath that smells like alcohol is not a common side effect of Exelon or Namenda. If you don’t believe the smell to be related to the actual consumption of alcohol, consult with your mother's health care provider so that she can be evaluated.

Question:

My dad is taking Coumadin. Is it safe for him to drink alcohol?

Answer:

People taking Coumadin may drink alcohol. But it's possible that drinking alcohol may increase your dad's risk for bruising or bleeding. If you're going to drink, drinking in moderation is best. One or two drinks a day is the most he should have. Thanks for your question!

Question:

My dad has diabetes and takes insulin injections four times a day. He has a cold now. Can he safely take NyQuil, or any other cold medicines?

Answer:

NyQuil in its liquid form is a nonprescription cough and cold medicine. It can be used safely for short-term treatment of a cold in people with diabetes. However, NyQuil syrup is not sugar-free, so it could raise your dad's blood sugar. NyQuil LiquiCaps would be better for him, as they wouldn’t affect his blood sugar. Before he tries the LiquiCaps, it would be best for your dad to explain his symptoms to his local pharmacist. It is possible that NyQuil might not be the best medication to treat his symptoms. When treating colds, we try to match the symptoms to the active ingredients in the product. His pharmacist can help him determine if there may be a more appropriate product to treat his symptoms.

Question:

My mom has diabetes and seasonal allergies. Her doctor has given her the OK to take Claritin, but she's still a little concerned if she can really take it or not. Can my mom take Claritin with diabetes and CHF?

Answer:

Claritin is safe for someone with diabetes and CHF to use. It is an effective medication that causes very few concerns when taken with other medications or medical conditions.

Question:

My father-in-law was just given Lyrica. He is also taking gabapentin, which is used to treat nerve pain due to diabetes. Is it safe for him to take both?

Answer:

Both Lyrica and gabapentin are used to treat pain, and they can be used together. But both medications can cause some dizziness or drowsiness. So taking them together can increase those effects. It's important for your father-in-law to recognize if he experiences any side effects from using these medications together. He should also avoid driving until he finds out how taking both medications makes him feel.

Question:

My mom has diabetes and she fell tonight. She’s sore and was wondering what she can take for pain. She takes Humalog 75/25.

Answer:

Acetaminophen (Tylenol) would be a safe option to try for aches and pains in someone with diabetes. Ibuprofen (Advil or Motrin) can also be an option. However, it can be a problem if the patient does not have good kidney function, as kidney disease is a long-term complication of diabetes. Not knowing your mother’s kidney function, I would suggest starting with acetaminophen.

Question:

My mom was prescribed ciprofloxacin, and the label says not to take it with antacids. She's currently taking famotidine. Are there any potential risks and/or complications associated with combining these two medicines?

Answer:

There are no risks and or possible complications from taking both famotidine and ciprofloxacin. Thanks for checking! It is always important to look for potential interactions with prescription medications before starting a nonprescription medication.

Question:

My dad, age 84, is taking Aricept for Alzheimer’s. I read an article about melatonin and its benefits. Can I give this supplement to my dad?

Answer:

There are no interactions between Aricept and melatonin. Melatonin is a dietary supplement that is used for insomnia or as a sleep aid. Have your dad try immediate-release melatonin if he is having difficulty falling asleep. Use extended-release melatonin if your dad is having trouble staying asleep. It should only be used short-term. If your dad doesn’t see benefit after a few weeks, then it probably won’t be helpful.

Question:

My mom has emphysema. She is ill at this time and her doctor put her on something called a Z- Pack. Can you tell me what a Z-Pack is used for?

Answer:

A Z-pack is an antibiotic called azithromycin. Azithromycin’s brand name is Zithromax, hence the "Z". The Z-pack packages the full course of the medication -- 2 tablets on day 1 and 1 tablet daily for each of the next 4 days. Your mom has a respiratory tract infection that this antibiotic will help treat.

Question:

My grandmother just turned 65 and has had arthritis for years. I wanted to suggest that she take cod fish oil supplements. Are they effective at helping relieve arthritis pains?

Answer:

There is not a lot of strong data supporting the use of fish oil supplements for arthritis. While it may be safe for your grandmother to take, it may not be very effective in helping to relieve her pain.

Question:

My dad just had a prostate biopsy. He was given Cipro 500 mg to take for three days prior to the procedure and for three days after. He would like to resume taking ibuprofen and his vitamins. Is it safe for him to do so after taking his last dose of Cipro 24 hours ago?

Answer:

Cipro, or ciprofloxacin, is an antibiotic and its absorption can be decreased by taking products that contain calcium, iron, or zinc. Calcium, iron, and zinc are common minerals found in vitamins. Pharmacists recommend taking the ciprofloxacin either 2 hours before or 6 hours after taking any calcium, iron, or zinc supplements. Now that 24 hours has passed, your father can resume his vitamins and ibuprofen.

Question:

My mom has stage 4 lung cancer and takes a Tarceva pill every day. She is thinking about starting a regimen of natural vitamins "without fillers". How do we know that this would be safe for her? Are there any vitamins that she shouldn't take with lung cancer?

Answer:

Tarceva is a very potent and important medication for your mom’s condition. It is very important that she check with her oncologist and pharmacist before starting any new medications in order to ensure that there are no interactions.

Many companies that sell natural products also include dietary supplements and herbs in their vitamins. A number of dietary supplements and herbs are not recommended for someone with cancer, taking Tarceva. There could be very serious drug interactions that might reduce the effectiveness of the Tarceva. Before your mom starts using these products, take some print information about the products to her pharmacist so he/she can confirm that there are no interactions.

Question:

My dad takes Coumadin for his heart. He has a toothache and has been putting Orajel on the tooth. Orajel contains benzocaine. Can the Orajel interact negatively with his Coumadin?

Answer:

It is completely safe to use both Coumadin and Orajel. There are no interactions.

Question:

My mother is 84 years old. She has been taking cephalexin 500mg, 1 capsule four times a day for about three days. If she cannot take it as prescribed, can it hurt to let her take them 2½ hours apart? She is only awake for 8 hours a day.

Answer:

I would talk to your mother’s health care provider to see if there is another antibiotic that can be prescribed. Cephalexin is typically dosed every 6 hours (4 times a day). While it is absorbed pretty quickly, it may not be the best to take these pills so soon in succession. Another antibiotic -- one with a more convenient dosing schedule -- may work just as well for her infection.

Question:

My dad has cancer and he doesn't sleep much. He uses the Fentanyl 25mcg pain patch. He also takes a sleep aid of Ambien 5mg. Is it safe for him to take these together?

Answer:

Fentanyl patch and Ambien can be used safely together. On their own, each medication could make him a little dizzy, drowsy, or sleepy. So taking both medications together can intensify those effects. This might not be a problem for him, though, considering his current difficulty sleeping. Thanks for your question.

Question:

My mother has osteoporosis and is taking Actonel once a month. She missed taking her pill yesterday. Can she take her pill today instead?

Answer:

Yes. Your mother can take her pill today. She should go back to her regular day next month. It can sometimes be hard to remember to take a medication only once a month. But it is important to make up for that missed dose as soon as possible.

Question:

My dad has an enlarged prostate. He also has a cold. All the OTC cold medicines we have say not to take if you have an enlarged prostate. What medications are out there that he can take?

Answer:

Cold medicines that contain antihistamines (such as diphenhydramine or doxylamine) and decongestants (such as pseudoephedrine or phenylephrine) are not recommended for a person with an enlarged prostate. They can worsen the symptoms of having an enlarged prostate. I would recommend talking with your father's pharmacist about his symptoms.

Doctors and pharmacists try to match a person's symptoms with the active ingredient(s) that are best suited to treat them. So the products you have at home may not be the best choice for your dad’s cold. There may be more effective options that don't include an antihistamine or decongestant.

Question:

My father received a Roxicet prescription for pain. The pharmacist I called said it is a generic form of Percocet. Is this true?

Answer:

Yes. This is true. Oxycodone and acetaminophen are the active ingredients. Percocet is a brand name product and Roxicet is a branded generic product.

Question:

My elderly mother has a hard time swallowing pills. Can I cut her calcium tablets in half? Also, she was recently prescribed Evista for bone health. Can this pill also be cut in half?

Answer:

Calcium tablets and Evista pills may be cut in half to make them easier to swallow. When your mother finishes the calcium she has on hand, you may want to consider purchasing a form that is available in smaller tablets, or a chewable form.

Question:

My mother started taking Boniva a few days ago. Since then she's had some shooting pains down her leg. Could this be related to taking the Boniva?

Answer:

Boniva is a prescription medication used to treat osteoporosis. Shooting pains are not a common side effect. Less frequently, Boniva may cause muscle pain or pain in the extremities. I suggest she continue taking the Boniva and see if the problem persists. The shooting pains could be completely unrelated to the medication. If you have continued problems, talk with your mother’s health care provider to see if he/she can prescribe an alternative product, so you can see if the pain stops without the Boniva.

Question:

My father is taking Aricept for Alzheimer’s disease. This drug is very expensive. Is there a generic form of this drug?

Answer:

Yes. Aricept is available as a generic medication. I encourage you to talk with your father's health care provider about making this change. Your father might also benefit from a getting a medication review from his pharmacist. The pharmacist can go through all the medications that your father is taking to see if there are cost-savings alternatives.

Question:

My 70-year-old mother has dry eye syndrome and has just started suffering from spring allergies. What allergy medication would you recommend that could ease her sinus congestion and headaches, but not irritate her eyes even more?

Answer:

The most effective medications for allergies are antihistamines. But antihistamines can be drying, so they could make dry eyes worse. If your mother finds this to be true for her, another option is nasal saline spray, which would help if her symptoms are only in her nose.

For sinus congestion and headaches, relieving her allergy symptoms may help. But it's possible that a decongestant might also be needed to relieve sinus pressure. If relieving the sinus pressure doesn't help with her headaches, an over-the-counter pain reliever, such as acetaminophen or ibuprofen, might also be helpful.

Question:

My mom has been taking 2mg of Coumadin, after open-heart surgery a few years ago. Is the flu shot safe for her, even with her blood-thinning issues? She's 73 by the way, and in overall good health.

Answer:

Great question! It is very important that your mom get her flu shot this year! It is safe for people taking Coumadin to get their flu shots. It is possible that she may have a little bit of bleeding or bruising. However, that is a very slight risk. And the much bigger risk is that she catch the flu and get seriously sick or hospitalized. People who are older and have heart disease are more likely to get really sick if they get the flu. So I definitely encourage her to get her flu shot!

Question:

My grandfather is on a blood-thinning medication, and last week he was instructed to raise his dosage. Then, this week, he was told to stop taking it the medication all together. What could be the side effects of just stopping cold turkey?

Answer:

It sounds like the blood-thinning medication your grandfather is taking is warfarin (Coumadin). Warfarin is a medication that needs to be monitored closely with blood tests. Depending on the results of the blood tests, the dose of warfarin is often changed. Sometimes this means an increase in the dosage, sometimes a reduction, and sometimes the medication may even be completely withheld for a day or two.

It's important to know whether your grandfather's health care provider is recommending that he stop taking his medication all together, or if he/she wants him to just stop for just a dose or two. Too much warfarin can lead to bruising or bleeding. So stopping warfarin altogether might be necessary for people who have an increased risk for bleeding. But stopping the warfarin could also place someone at increased risk for blood clots, heart attack, or stroke. So I suggest you communicate with your grandfather’s health care provider to confirm the actual instructions and talk with him/her some more about why all the changes in his dosage are taking place.

Question:

My mother had a stroke and was prescribed digoxin. What is digoxin for? Her daily dosage is very low.

Answer:

Digoxin is a medication for your mother’s heart. It helps to improve her heart contractions. Your mother will need to have her potassium levels, kidney functioning, and the levels of the digoxin in her body routinely monitored while taking this medication.

Question:

My father takes finasteride to reduce the size of his prostate. I just realized that his nurse has been giving him a discontinued and expired form of oxybutynin to relax his bladder. Are these medicines contraindicated for use together?

Answer:

In general, finasteride and oxybutynin are OK to take together. However, it is obviously not good for your father to be taking a medication which has been discontinued and/or has expired.

It's very important for everyone to have their own personal medication record, which is a list of all the medications -- prescription, nonprescription, herbal products, dietary supplements, etc. -- that he/she is taking. This list should be updated as frequently as changes to your medications are made. You should have your medication list with you for all your health care providers and share the list with all those who take care of you.

It's also important to regularly check your medication supply and ensure that the medications you're using are current and in-date.

Question:

My mother is taking ciprofloxacin HCL. Can she eat eggs?

Answer:

Ciprofloxacin is an antibiotic that can be used to treat a number of different infections. It is not a problem for your mother to eat eggs while she is taking ciprofloxacin. However, it is important to separate taking calcium, antacids, or products containing iron or zinc from her ciprofloxacin dosage. It's best to take ciprofloxacin either 2 hours before or 6 hours after taking any products containing iron or zinc.

Question:

My 81-year-old father has been given gabapentin 100mg, to be taken three times a day for his leg pain. Is this dosage too high?

Answer:

Gabapentin is a medication that is used quite often for leg pain. A hundred milligrams, three times daily is a starting dose for the medication. Generally, in older adults, it may be necessary to use lower doses. But doses can also be much higher, up to 3,600 mg daily for many people. So, in this case, the dose is definitely not too much. But when starting a new medication, it's important that you understand the reasons for your personal dosage.

Question:

I want to stop taking 10mg of Prozac after 2 months. How do I stop safely?

Answer:

Thanks for your question. It is always important to talk with your health care provider and your pharmacist before stopping any prescription medication. Prozac is a medication that should be slowly discontinued, rather than stopped abruptly. Your health care provider will give you a specific taper. For example, your doctor might instruct you to take the Prozac every other day for a week or two, and see how you do. Then, you may be able to stop altogether, or you may start taking the Prozac just once or twice a week before stopping it completely. Good luck!

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