Dizzy Or Not; Here I Come

My good friend from way back sent me a note the other day:

"Hey Steve, one thing you may want to consider discussing on your page is on the overuse of meclizine for an incorrect diagnosis of vertigo. Many elderly people (my dad) have undiagnosed orthostatic hypotension that take drugs like Cardura for hypertension or Prostate. Unfortunately, Meclizine increases the levels of Cardura making the "vertigo" worse causing the patient to take max dose of Meclizine.... what a mess it was. Also, because Meclizine was prescribed by ER doc and is over the counter, it missed ALL safety catches."

My friend is exactly right.  If a patient is taking the sustained release form of doxazosin (Cardura XLTM), the side effects of the meclizine will slow the transit time through the gastro intestinal tract and allow for an increased absorption of the medication.  This increased absorption will definitely increase the level of the medication and decrease blood pressure even more, causing more dizziness!

Meclizine is an over the counter medication that blocks certain receptors in your brain that are associated with vertigo and motion sickness.  This medication usually works quite well for short term treatment of someone with motion sickness (nausea from being on a boat) or vertigo (perhaps some dizziness from an inner ear infection).  The problem with this medication is that it has a whole host of side effects such as drowsiness, dizziness, dry mouth, blurry vision, constipation etc…

Unfortunately, the scenario that my friend presents is all too common.  An elderly person may be feeling faint or dizzy after hours.  Their doctor’s office is closed so they present to the emergency room.  Of course, the concern is that there may be some blood clot issue such as a stroke or heart attack causing the dizziness or uncomfortable feeling.  Many tests are done to rule out life threatening concerns. 

The patient is then discharged from the emergency room with an order to go pick up some over-the-counter meclizine and take as directed.  If the problem does not get better, follow up with your primary care doctor.  In this situation, the big picture is looked at; however, the little picture is missed.  Is there something that the patient is already taking that may be causing this to happen?

I talk a lot about medication responsibility, communication, questions, community pharmacy and yes…more communication.  It is so important that everyone write a list of all the medications they are taking and put it in their wallet.  Every time you go to your doctor, pharmacy, or any other health care provider, take out the list and show it to them.  Make certain that everyone knows exactly what you are taking and why.

Now the important part that only you or your care giver can do; be sure to ask your health care provider if any of the medications you are currently taking will interact with what you are going to receive today.  Quite often your health care provider will be happy to look at your list; however, it is possible that they will not take the time to officially verify any critical interactions between what they are giving you today and what medications you may already be taking.

(not mail order.....)

Please people, filling your prescription should not be the same as how you order your e-books or sweaters on line.  Please take the time to develop a relationship with a community pharmacist and fill your prescriptions at a community pharmacy.  Shop around and find a community pharmacist that you feel comfortable with and trust.  When you receive a new medication, prescription or over-the-counter, ask to speak with your pharmacist.  Discuss all of the important information and make sure your understand what to expect from the medication.  Add the medication to your list and have your pharmacist check it to make sure all looks appropriate.

Finally, if you are ever feeling dizzy, call your community pharmacist and ask them if any of your medications tend to cause some dizziness.

You may also be interested in reading:
Pharmacy Counseling
Medication Responsibility
Community Pharmacy


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