Medically Reviewed by Joshua Conrad, PharmD
When a medication works right, it boosts your health or helps you feel better. But a drug can bring on problems if it doesn't mix well with something else you put into your body, like another medication, a certain food, or alcohol.
When that happens, it's called a drug interaction. It could make your medication stop working, become less effective, or too strong. It could also trigger side effects.
The more you learn about drug interactions, the better you'll be able to avoid them. Here's what you need to know.
The main types are:
Drug-drug interaction. This is when a medication reacts with one or more other drugs. For example, taking a cough medicine (antitussive) and a drug to help you sleep (sedative) could cause the two medications to affect each other.
Drug-food/drink interaction. This is when something you eat or drink affects a drug. For instance, it can be dangerous to drink alcohol while you're on certain medications. Some vitamins and dietary supplements interact with medicines, too.
Drug-condition interaction. This is when you have a health problem that makes it risky for you to take certain meds. For example, if you have a condition like high blood pressure, taking a decongestant for a cold could drive up your blood pressure even more.
There are many types of drugs you shouldn't take together, but in general, don't take combinations like these:
Two or more drugs that share an active ingredient. You could have side effects or an overdose. Active ingredients are the chemicals in medications that treat your condition or symptoms. Always check for them on the drug label.
Blood-thinning drugs with NSAIDs. Your odds for a dangerous bleed could go up. NSAIDs (nonsteroidal anti-inflammatory drugs) are pain relievers like ibuprofen or naproxen. If you're on a blood thinner, ask your doctor to suggest a different type of over-the-counter pain medication and dose that's safer for you.
Pills with antihistamines. Taking these together can cause you to react more slowly, which would make it dangerous for you to drive or work with heavy machines.
Some other drug-drug combinations that can be dangerous are:
Certain foods and drinks don't mix well with some medications. A few of these are:Alcohol. Booze can bring on dangerous side effects with many medications, including some drugs for:
Before you start a new medication, ask your doctor or pharmacist if it could interact with alcohol. Check the drug label for alcohol warnings, too.Grapefruit or grapefruit juice. Too much of either can affect some drugs like:
Grapefruit juice doesn't mix badly with every type of drug in these classes of medications. Check your drug's label or information pamphlet for any warnings about it. Also, ask your doctor or pharmacist if it's safe to have grapefruit or its juice in any amount with your specific drug. If they tell you to stop eating or drinking it, ask if any other fruits or juices might have similar effects on your medicine.Foods with vitamin K, like leafy greens. These can interact with the blood thinner warfarin. You don't have to stop eating them, but it's important to be consistent and not overdo it. Ask your doctor how much food with vitamin K you can have, then eat the same amount around the same times each week.High-potassium foods and drinks, like bananas, salt substitutes, and orange juice. These can affect blood pressure drugs called ACE inhibitors. Your doctor will track your potassium levels, and they may tell you to cut back on foods with it.St. John's wort. This herbal dietary supplement can affect many medications for heart disease, HIV, depression, and other conditions. It can also affect birth control pills and the cancer drugs irinotecan and imatinib.Always get your doctor's or pharmacist's OK before you try a new supplement. It's also possible for a medication you take to interact with a health condition you have. Some common drug-condition interactions happen between:
It's important to take your medication as directed by your doctor or pharmacist. If two meds interact, spacing them apart during the day may not stop them from interacting and could lead to new or worse problems. To avoid an interaction, your doctor may need to change your dose or prescribe a different medication.
The symptoms of a drug interaction can vary a lot, depending on the drugs you’re taking and how they’re interacting. Sometimes you might not even know right away that an interaction is happening.If you do notice an interaction, it will usually feel like one of these is happening:
In general, call your doctor if you're having side effects that worry you or if your medicine doesn't seem to be working, especially after you’ve recently started or changed doses of a drug.
There are several ways that drugs can interact with one another. Here are some examples of the most common ways.When two drugs can cause the same side effect and are used at the same time, they might cause more of that side effect. For example, if two drugs can each make you sleepy, taking them together can make you more or dangerously sleepy.When the unwanted effects of one drug are the opposite of the desired effects of another drug, you might end up with less of the desired effects. For example, taking one medication that raises blood pressure as an unwanted effect may decrease the benefits of taking another medication to lower your blood pressure.Most drugs that you swallow enter your blood through your intestines. Sometimes a drug or supplement can block or trap another drug in the intestine before it can be absorbed. For example, supplements like calcium and iron can prevent absorption of thyroid meds.Your body has enzymes, such as the cytochrome p450 (CYP) and others, that process many types of medications. This is called metabolism. It also has a way to get rid of drugs, usually though your urine. Other drugs may speed up, slow down, or even completely block these functions. When this happens, the amount of drug in your body may increase (similar to taking too much) or decrease (similar to taking too little). Either way, this could cause serious problems.
Work closely with your doctor. Make sure they know all the medicines, vitamins, and supplements you're taking. That's extra important if you have more than one doctor who prescribes medicines for you. You could show them a list of the meds you're taking, or bring the medication packages to your appointment.Before you take a new drug, ask your doctor or pharmacist questions like:
Pharmacists are experts on medicine safety, and they can work with your doctors to help you avoid drug interactions. For example, if you have two doctors and they separately prescribe drugs that interact, your pharmacist can warn them -- and you -- before you have a problem.Read labels carefully. Over-the-counter drug labels include information about possible drug interactions and the medication's active ingredients. Prescription medications usually come with a sheet that explains what the drug is and how to take it safely.But most drug labels and patient handouts don't list every possible drug interaction. Talk to your pharmacist to get the full picture. They can also answer any questions about medical terms or jargon on the drug packages.
Benzodiazepines belong to the prescription sedative class of drugs. Although benzodiazepines have a calming effect, they are highly addictive, and a person who abuses them faces a host of symptoms. Some of the physical, psychological, and behavioral symptoms of benzodiazepine abuse include:
Due to the natural process of building a tolerance, over time, a person will require a higher volume of benzodiazepines to reach the familiar high. When the abuse stops or the familiar dose is significantly cut down, withdrawal symptoms will emerge. Benzodiazepine withdrawal can be particularly dangerous and even life-threatening. Undergoing medical detox under the direct care of a doctor is generally advised.
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The drug class known as benzodiazepines is made up of prescription tranquilizers, also called sedatives or anxiolytics. They are prescribed for a host of conditions, such as anxiety disorder or panic disorder. Benzodiazepines can be prescribed for the following medical conditions:1
The following is a list of benzodiazepines, by branded name:1,2
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Today, the mental health community uses the term hypnotic, sedative, or anxiolytic use disorder to describe benzodiazepine abuse or addiction. This term comes from a main mental health book for clinicians, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.3 In order to be diagnosed with a sedative use disorder, at least two of a possible 11 symptoms must manifest within the same 12- month period. The National Association of Addiction Professionals explains each symptom, five of which are paraphrased here:4
The sedative effect of these drugs, as well as their addiction-forming chemical properties, makes them ripe for abuse. Since these are prescription drugs, it is critical to note that some individuals may initially have a legitimate medical reason to use them, but over time, they develop a use disorder. If a patient who has a prescription for a benzodiazepine follows their doctor’s orders, a use disorder will not likely set in. But if a use disorder does arise, there are different ways people go about getting the volume they need (discussed below). Legitimate doctors will not overprescribe these medications.
Individuals who are concerned that someone they know or love is abusing benzodiazepines should keep in mind that although these drugs are legally manufactured and prescribed by doctors, they are acutely addictive and available for sale on the street.
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If you believe that you or a loved one may be overdosing on benzodiazepines or any other drugs, call 911 immediately.
A review of the physical and psychological symptoms associated with benzodiazepine use illuminates the many dangers inherent in abusing this type of prescription drug. Benzodiazepine toxicity may cause the following symptoms:5
If a person chronically abuses benzodiazepines, the following symptoms may emerge:
As discussed, the development of tolerance to benzodiazepines is a medical condition, known as physical dependence. Tolerance is the process by which the brain becomes increasingly accustomed to the drug and, for this reason, requires more of it in order for the person to get the familiar high. When the brain does not get its familiar dose, because the person is abstaining or reducing the familiar amount, withdrawal is triggered. Withdrawal from benzodiazepines is considered to be particularly dangerous, and in some instances, it can be fatal. For instance, seizures are a symptom of withdrawal.
A person who is concerned with a loved one’s benzodiazepine abuse may not be able to pinpoint whether the signs they are seeing are symptoms that are emerging as a result of drug use or because of withdrawal. People who want to help may feel unsure and not know whether what they are seeing is a dangerous symptom or a common one. Ideally, the person who used the benzodiazepine would disclose important facts, such as the amount recently taken. If any serious symptoms emerge such as signs of benzodiazepine overdose the best practice is to seek immediate help, which can include going to a local emergency room or contacting a doctor.
Signs & Symptoms of Drug Abuse
Tolerance tends to develop when someone chronically takes benzos for long periods of time.4 Most people who are prescribed benzodiazepines for anxiety prefer these medications for the treatment of their condition because they can take them on an as-needed basis.4 Most patients can use benzos judiciously.4 But when someone uses benzos for a long period time, uses benzos in excess (or uses more benzos than they prescribed), this can lead to the development of benzodiazepine dependence and tolerance.4
Every person’s body chemistry is different, and the time it takes for someone to develop a tolerance for benzos will vary from person to person. The amount of benzos someone uses and other factors can also influence how quickly they develop a tolerance to benzos.
The development of a sedative use disorder may creep up on a person, but when it exists, it is likely going to be observable. Substance abuse has a way of shifting a person into exhibiting uncharacteristic traits. In short, the person stops being in service of the life they used to lead, and now spends an increasing amount of time in service to the drug abuse. People who develop a substance use disorder may exhibit some or all of the following (partial) list of behavioral symptoms of substance abuse:3
Behaviors around drug abuse relate to different facets of drug use, including how the person administers the drug. Typically, benzodiazepines are swallowed. According to feedback from individuals who tried to crush, cook, and inject benzodiazepines, they do not appear to be injectable drugs. There may be very little paraphernalia associated with benzodiazepine abuse.
Since benzodiazepines are prescription drugs, some individuals who have a sedative use disorder will get a high volume of this drug by “doctor shopping.” Getting a few prescriptions from different doctors can occur, and individuals will have to fill these prescriptions at different pharmacies. Prescription bottles and their labels will reveal if an individual has different prescriptions from different doctors, filled by different pharmacies within the same timeframe.
Benzodiazepines can also be obtained from people who are not drug dealers – friends, a friend of a friend, coworkers, or family members may share or sell their pills. Benzodiazepines can also be purchased on the street. Purchase at the street level carries specific dangers. For instance, when drug sellers do not have benzodiazepines available, they may offer other dangerous drugs to the person, which can lead to polydrug abuse. Also, whenever a substance is purchased on the street, users never truly know what they are buying, as substances are not tested or verified.
As mentioned earlier, benzodiazepine abuse alone does not typically result in death (though withdrawal can be life-threatening). However, it appears that many people take benzodiazepines with alcohol, and this combination can be deadly. Addiction professionals agree that the best practice for individuals seeking to stop using benzodiazepines is to be weaned off these drugs during a medically supervised detox process.
Addiction can’t always be prevented, but there are certain measures you may be able to take to remain aware of how you use benzos.
Although at first blush benzodiazepines may not seem like a dangerous drug, they are. These drugs are highly addictive, but with the right help, recovery is possible.
Volume 9, Issue 5, September 1968, Pages 536-543
Author links open overlay panelM.D. John Paul Brady (Professor of Psychiatry)Show moreAdd to MendeleyShareCitehttps://doi.org/10
Volume 9, Issue 5, September 1968, Pages 536-543
Much of the psychological theory underlying behavior therapy and dynamic therapy are not contradictory or mutually exclusive but are different levels of conceptualization of the same phenomena. There seems to be much overlap in the way patients are actually treated within the frameworks of these two approaches. It is argued that for some patients an effective therapeutic regimen may be one that includes both a behavioral and a dynamic course of treatment. The feasibility of such a combined approach is illustrated by a case report of a woman whose severe frigidity was first treated by Brevitalaided systematic desensitization. This brought about an increase in her sexual responsiveness and improvement in her general adjustment. Following this, problems in relationships with her husband and others were the focus of short-term dynamic psychotherapy. This was followed by further improvement in her sexual functioning as well as improvement in other aspects of her adjustment.