Cough medicine creates dangerous interaction


Q: I have had Serotonin Syndrome in the past even though I have used a Drug Interaction Checker. Unfortunately, it was difficult to use. As a result, I had a frightening experience.

Being a suspicious person, I went to an online interaction checker and typed in “Prozac”. When he told me he couldn’t find any drug interactions, I typed in “fluoxetine”. Again, nothing.

So I, a Prozac patient, went ahead and took my cough suppressant. Soon after, I was exhausted, agitated, shaking and saying things that didn’t make sense. Fortunately, it calmed down after a few hours.

Suspecting an interaction, I returned to this interaction checker and typed in “fluoxetine dextromethorphan”. Presto! I saw that this combination could have sent me to the hospital. Why is it not better known?

A: Many antidepressants, including fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), can interact with cold medicines containing the cough suppressant dextromethorphan (DM) or the antihistamine chlorpheniramine (British Journal of Clinical Pharmacology, December 2010). This potential interaction is not widely recognized.

The resulting serotonin syndrome can be life threatening. Symptoms may include confusion, agitation, diarrhea, nausea or vomiting, rapid heart rate, muscle spasms, fever, overactive reflexes, hallucinations, and rapid changes in blood pressure.

Investigators found that almost 8% of patients in an intensive care unit met criteria for serotonin syndrome, although none of them were diagnosed (Journal of Critical Care, June 2021). Most of these patients had taken at least two serotonergic drugs, including ondansetron (Zofran), tramadol (Ultram), dextromethorphan or chlorpheniramine.

Q: My Medicare Advantage Plan always tries to get my medications mailed to me because it’s cheaper. Instead, however, I get my prescriptions filled locally, where I know my pharmacist.

Once a doctor prescribed me a new medicine. As I was in a hurry, I stopped at the nearest pharmacy. However, when they quoted the price, I said, “Oh no! “

I drove a few blocks further and went to my usual pharmacist. When he looked at the prescription, he told me my insurance would not cover him. However, they would cover an alternative, and he named it. Then he advised me to call the doctor to see if it would work as a substitute.

I did, and she prescribed it. I still use this drug, which works well. This is the reason why I refuse to buy my medications by mail. The slight extra cost is worth it.

A: Having a vigilant pharmacist who monitors potential drug interactions as well as what your insurance will and will not cover is invaluable. Finding an affordable alternative medicine can sometimes be difficult.

If there is no substitute, there are a few options. Consumer Reports mentions that Costco has good prices at its drugstores, which you can use without becoming a member. They also suggest looking at for the right price for the drug. The coupons there can sometimes save you a bit of money.

To learn more about these and other cost reduction strategies, you may be interested in our eGuide for saving money on drugs. This online resource can be found under the Health eGuides tab at

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