Q. I have been taking tramadol, amitriptyline and sertraline for more than three years. I was having a hard time with my depression and told my doctor it was getting worse.
She increased the dose of sertraline from 100 mg to 150 mg. Five days later, I had a seizure. Nobody could understand why.
My electrolytes were abnormal, so I went back to see the doctor a few weeks later and asked if the increased dosage could have been the cause.
She dismissed that idea, but since then I have seen two other doctors, who both expressed concern about this combination of drugs. One of them said it could be a lethal cocktail, and the combination could well have caused my seizure. I feel as if I’ve been misled by someone I trusted. I’d be grateful for your opinion.
A. The pain reliever tramadol and the SSRI-type antidepressant sertraline could interact to trigger serotonin syndrome. Excessive levels of the neurochemical serotonin can lead to agitation, confusion, muscle twitches, tremor, sweating and seizures (Pharmacy Times, July 15, 2009). Adding amitriptyline makes this combination even more hazardous. Electrolytes also can be disrupted.
Q. My doctor says that I need to take vitamin D-3 with fat, such as whole milk or avocado, so that the body can properly absorb the vitamin. Apparently, vitamin D is best absorbed with a moderate amount of fat compared with no fat or lots of fat.
A. Vitamin D is a fat-soluble vitamin. Nutritionists have long advised people to take such nutrients with a meal that contains fat, to enhance absorption.
Vitamin D is a bit more complicated, though. Factors that might influence absorption include the form of the vitamin (D-2 compared with D-3) as well as the type of meal and the amount of fat in the meal. A review of the research found, however, that none of these matters very much (Critical Reviews in Food Science and Nutrition, Vol. 15, No. 9, 2015). One study that tested the amount of fat in the meal compared absorption of vitamin D taken with a high-fat meal, a low-fat meal or no meal (Journal of Bone and Mineral Research, August 2013). Absorption was highest when the supplement was taken with a low-fat meal.
To learn more about this crucial nutrient, you may wish to read our “Guide to Vitamin D Deficiency.” Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. D-23, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q. I’m writing to thank you for recommending NasalCrom for allergies. I had never heard of it before, despite having allergies for over 40 years. Last season was especially bad for me, with severe laryngitis that started at the end of March. I wasn’t able to speak in my normal voice until I started using NasalCrom. This is going to be a staple in my house from now on!
A. Cromolyn (NasalCrom) stabilizes mast cells in the upper respiratory tract. These cells release histamine and other irritating chemicals in response to allergens. We’re glad you had such a good response to this nasal spray.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”