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Drug Interactions / Side Effects board

Sorry this is so long. I felt by giving a lot of information I'd get a better response, I also had a hard time deciding which board to post this to, so if it's in the wrong spot mods, I'm really sorry.

I go to my PHP tomorrow and want some advice on what questions I should ask.

I have Adult ADHD, and have been taking Metadate CD for this since 2003. It has really made a big difference in my life to be able to focus and stay on task. Prior to being on medication I had turned into a shop-a-holic and spent around $30k on various stuff. Not only did that almost cost me my 16 year marriage, but it almost cost me my life as I was in a horrible depression over all the money I’d spent and thought that if I died no one would have to deal with me causing problems anymore. Thank goodness, I found a psychiatrist, got on some anti-depressants along with the ADHD medicine and turned my life around. I was on Wellbutrin for about 8 months and have not had thoughts about hurting myself in a long time. I don’t ever want to feel like that again.

In 2005 my PHP put me on Verapamil to treat mild hypertension and migraine headaches. Since being on the Verapamil I have had a couple of mild migraine’s and one that wasn’t very fun but prior to that I would get 4 or 5 a year that would last for 3 or 4 days even with midrin or a trip to the ER for a stronger shot. My blood pressure was around 140/90 now it’s around 117-125/70-85. So that was an improvement.

In early spring on 2006 I had a panic attack. I got in bed and was about to go to sleep when I started to have hot flashes and was certain that if I went to sleep I would not wake up again. It was terrifying! I woke my husband up and made him take me to the ER. They ran a bunch of tests including an EKG and did not find anything wrong with me. Gave me some tranquilizer injection, (took 2 of whatever it was to calm me down) and sent me home with a prescription for Xanax, which I filled but never used.

In October of last year I got word that my biological father was dying of prostate cancer. My mind started racing about all the things that needed to be done to care for him. He had never been a father figure to me; I had been raised by his parents. I, in turn, took care of them for the last 10 years of their lives through Grandmother’s stroke and Grandfather’s Parkinson’s disease. It took me about 2 years to put my life back together after my Grandfather died and I wasn’t about to go through all of that again for a man who never even acted like he cared that I existed. So I talked with my physiatrist about taking something for the anxiety. We chose sertraline and I have been taking it for about a year now. I did have another episode with hot flashes not long after I started the sertraline, but I have been fine since then.

Now last month I had surgery on 9/26 to reconstruct the arch in my right foot. I have had flat feet my whole life and had tried every non surgical treatment for Posterior tibial tendon dysfunction with no long term success. In the surgery I had they replaced the posterior tibial tendon with a graft from another tendon in my foot, lengthened my Achilles’ tendon, cut my heal bone and moved it back into alignment with the rest of my foot, and reset the bone in my big toe. Post operative pain management was done with a nerve block and Oxycodone w apap. My initial prescription was for 60 tablets, and it took me 3 ½ weeks to use them. I have taken Hydrocodone before and it usually keeps my pain away but also makes me so I can’t sleep. The first couple of nights I was home I could not sleep and was feeling nervous which I thought could be related to the Oxycodone I ended up taking a Xanax two different nights to get some sleep and then I was ok after that. I broke out on my face and into my hair during this time with awful pimples I get them anyway but haven’t had them this bad for years. I look like I have a case of the measles when I’m not wearing makeup and it seems I can’t stop picking at the scabs.

I went for my 1st post op visit on 10/8 the x-rays looked great, they took the staples out put me in a fracture boot and said I was doing good. I had been home from work on sick leave since the surgery and was happy to go back to work. (bed rest sucks)! On 10/10 when I was getting into bed for the night I got over balanced and had the option to put all of my weight on my surgical leg (not supposed to do that) or fall, so I fell grabbing hold of the bed to ease my way down. Called my hubby over with a chair, got back up and in bed no problem.
On 10/11 my daughter picked me up to bring me home and when I got in the car I got a cramp in my left hip like a charlie horse. It had gone away by the time we got home so I was thinking it was from sitting up all day. I came in the house and got in bed put some ice on my surgery foot and took it easy for the rest of the night, except to get up to go to the bathroom.
By the time I got up the second time in the night to go my left calf was hurting I hadn’t had a Charlie horse in the calf it was in the hip but the calf felt like it does when I have a Charlie horse or two in it. I started wondering if I’d done something to my leg when I fell. I woke my poor husband up and made him take me to the ER. An ultrasound confirmed my fear that I had/have a blood clot in my left calf.

I had 12 tubes of blood taken, was put on Coumadin, given an Arixtra Shot and sent home. I went back to the ER for follow up on my PT/INR and daily Arixtra Shot until last Thursday when the ER care specialist decided to teach me how to give the shot to myself. I went back to the Hospital yesterday for the latest lab and I’m still not therapeutic on the Coumadin, so two more shot’s came home with me and I go back tomorrow for more labs. When they started this on 10/12 the thought was that I’d be therapeutic within 3 or 4 days and could stop the shots, but I took my 10th shot this morning. The blood tests they did to check for abnormalities in my blood were all negative so the clot is either from the surgery in the first place, or from the fall.

I started looking around last night at drug interactions trying to decide if something else I’m taking could be the reason why. Turns out that it looks like everything known to man has the potential to interact with Coumadin but I did find that the sertraline specifically does say it can cause a delay in the PT/INR results. It also looks like the Sertraline can interact with the Metadate CD, and the Verapamil can interact with the Metadate CD. I've been on the Sertraline with the Metadate CD and Verapamil for long enough that I'm not too concerned about that part the only time I have ever had a problem is if I forget to take my meds I get a bad headache the next day.

My leg feels good for the most part now. I am still pretty much on bed rest and have really had my fill of that. My emotions are fine during the day but when evening comes around I get nervous/anxious about the blood clot and my mind runs away with me. I’ve had some discomfort in my left leg but it’s not awful it just scares me. Then I get all worked up and can't sleep, then I worry that getting worried about it will make it worse...so it's a never ending cycle. I hadn’t taken an Oxycodone for a few days but have taken it the last two nights again just to calm down and go to sleep.

I am hoping for some suggestions on what kind of questions I should ask my Dr. tomorrow?

I don’t like the feeling of being scared at night and it keeps me from sleeping. My face is still broken out and I find that I’m still picking at them, which now that I’m taking the blood thinners, is really not a good thing to be doing. I don’t want to start on yet another medication, but I don’t want to be taking the Oxycodone for the wrong reasons either since I understand it’s pretty easy to get dependent on it. Should I ask about the Sertraline - Coumadin possible interaction?

It's really been an ordeal for me. I put off having the foot surger for along time because I didn't want to have to be on crutches and dependent on everyone to take care of me. The surgery foot feels fine, and it looks pretty good all things considered when I take the boot off to get in the shower. I go back to the surgeon on 11/5 and find out where I go from here. PT or longer in the cast. I just want to get better and move on with my life.

Thank you for your suggestions.