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"I'll be careful!" - (3/12/2019)

By Dr. Ron Gasbarro

“I’ll be careful!”

Harry, 53, came into the pharmacy with a prescription for an antihistamine. Knowing that Harry likes to stop at the corner tavern for a beer or two, the pharmacist warned him about taking his medication with alcohol. “Oh, I’ll be okay. I’ve been having a couple of beers every afternoon for 30 years.” “Yes, but, the combined effects of the drug and the alcohol could make you drowsy and interfere with your driving,” replied the pharmacist. “I’ll be careful,” Harry reassured the pharmacist. Two days later, Harry’s SUV ran off the road and narrowly missed a phone pole. Luckily, he was not hurt badly. And never spilled a drop.

According to a report by the Centers for Disease Control and Prevention (CDC), driving while drowsy is widespread and dangerous. Each year, Americans are involved in approximately 72,000 collisions; 44,000 of these accidents result in an injury. Furthermore, over 8,000 people die in drowsy-related wrecks annually. The CDC report cites the use of medications as one of the top 5 reasons for drowsy or fatigued driving that result in these accidents. 

Drowsiness, or feeling abnormally sleepy, is a common side effect of many medications, according to the US Food and Drug Administration (FDA). Drowsiness can affect one’s ability to drive, operate machinery, or accomplish other tasks that require alertness. It affects some people more than others. The following types of medications can cause drowsiness: Narcotics, used to relieve pain (e.g., codeine, morphine); antianxiety medications (e.g., diazepam [Valium®], lorazepam [Ativan®], alprazolam [Xanax®]); antidepressants (e.g., duloxetine [Cymbalta®], fluoxetine [Prozac®], venlafaxine [Effexor®]; antihistamines, often found in cold and allergy products (e.g., diphenhydramine [Benadryl®], hydrocodone-chlorpheniramine [TussiCaps ®, Tussionex®]. The newer antihistamines (e.g., desloratadine [Clarinex®], fexofenadine [Allegra®] are much less likely to cause drowsiness.

Frank, 38, works in a machine shop. He recently started taking a narcotic for his chronic back pain. The doctor put him on a high dose since nothing else seemed to ease his discomfort. The pharmacist warned him about the drug. “I’ll be careful,” Frank said. Yet, the medication made him sleepy enough to have a serious accident at work. Now they call him “Three-finger Frankie.”

Common over-the-counter medicines can cause drowsiness including antihistamines – used to treat symptoms like runny nose and sneezing – as well as anti-diarrheals (Imodium®) and anti-emetics – medicines that treat nausea, vomiting, and dizziness related to motion sickness (Dramamine®, Bonine®),  according to the FDA. Cough medicines can cause drowsiness as well, especially those that contain dextromethorphan (Robitussin® DM, Mucinex® DM or any with DM after the name). Even medications one would never expect to cause fatigue and/or sleepiness can result in these side effects. For example, antibiotics such as amoxicillin (Augmentin®), ciprofloxacin (Cipro®), and azithromycin (Zithromax®) do cause tiredness. Because one takes an antibiotic from 5 to 14 days or more, drowsiness can be cumulative and the prescriber should be called immediately to change the medication, if possible. 

Amy, 25, started taking an antibiotic for a urinary tract infection (UTI). The pharmacist advised her to watch for sleepiness. “I’ll be careful,” she said. Three days later at dinner and after two glasses of white wine, her husband found her face down in her Baked Pears Alicia. Don’t be like Harry, Frank, and Amy. If you are not sure a medication causes drowsiness, always ask the pharmacist. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com

 


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