Is Child At Risk Of Drug Interaction?

Q. My grandson has behavior problems and has been on Prozac since age four. Because he is still disruptive in class, the doctor recently added Adderall. His concentration is somewhat improved but he is still disruptive. Is the combination of Prozac and Adderall safe for a seven-year-old?
A. The FDA has recently asked makers of serotonin-type antidepressants like Prozac to add new warnings. The agency cautions prescribers that some children may experience anxiety, agitation, panic attacks, irritability, hostility, impulsivity and restlessness.
When Adderall (mixed amphetamines) is added to Prozac, the risk of “serotonin syndrome” is increased. This reaction can include anxiety, agitation, muscle twitches, nausea, confusion and convulsions. Scientists don’t know much about how drugs like amphetamine and Prozac interact in young children. Your grandson’s doctor should evaluate whether these two drugs are safe in combination.
Q. I am a family physician. Back when we were prescribing hormone replacement therapy (HRT) regularly, I used to offer women the option of plant-based estrogens instead of synthetic hormones. Since we learned the results of the Women’s Health Initiative (WHI), though, I’ve viewed all estrogens as carrying similar risk until proven otherwise.
There are practitioners who are saying that bio-identical hormones are safer. They encourage women to use them as an alternative for menopausal symptoms. Is there any research that shows that the risks are lower for plant-based HRT than for synthetic?
A. There is no comparable study of plant-based estrogens, and there is not likely to be one. The Women’s Health Initiative was a very large, expensive study, funded by the National Institutes of Health. Women were randomly assigned to receive Prempro or placebo. The results showed that postmenopausal hormones increased the risk of breast cancer, heart attack and stroke.
Women’s health expert, Susan Love, MD, responded to a question like yours: “I think that it is very unlikely that bio-identical hormones, as they’re called, will be any safer than Prempro.”
We have summarized information on estrogen and natural treatments for menopause in our Guide to Estrogen: Benefits, Risks and Interactions. Anyone who would like a copy, please send $2 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. W-49, P. O. Box 52027, Durham, NC 27717-2027.
Q. I have never seen you recommend calcium carbonate for heartburn. Why? You keep suggesting sodium bicarbonate, even though it introduces too much sodium into the body. Calcium carbonate, on the other hand, provides much needed calcium. What is your problem?
A. We agree that calcium carbonate (Caltrate, Titralac, Tums, etc) is an excellent inexpensive antacid that can quickly ease heartburn and supply extra calcium. We’ve recommended it for decades.
Q. I have an enlarged prostate. Virtually all the over-the-counter sleep aids say I should not take them. Is it OK for me to take the prescription sleep aid Ambien?
A. Nonprescription sleep aids can make urination difficult. Urinary retention is a very rare side effect with Ambien. Check with your doctor to see if it would be safe for you.