Category: Medications not working

Supplements that can mess up your meds

Supplements and Medications Interactions

At your last checkup, your doctor told you to take calcium 500 – 600 mg twice a day because your bone density tests indicate that you have osteopenia. Osteopenia is a decrease in bone mineral density below normal reference values, but not low enough to meet a diagnosis of osteoporosis.

Ok, no big deal. You pick some up and begin taking them. Wait, there could be a big deal. Do you take medication for your thyroid, such as levothyroxine? Are you taking doxycycline or ciprofloxacin for an infection? If yes, you cannot take the calcium supplements with the thyroid medication or the antibiotic. They need to be separated by two hours. There are other medications that are made less effective by calcium. 

March 22, 2023

Calcium effects – Medication interactions

Calcium binds up the medications (those that are affected by it) and makes them less available for absorption and may decrease the effectiveness of your medications. Some of your medications may increase the absorption of calcium causing too much calcium in your body. Kidney problems or serious side effects of calcium may occur.

You may have tolerated problems in your earlier years, but now you are 60 or older and things are changing. Your kidneys don’t filter as well. Your liver may not be able to metabolize things as well as it once did, causing an increase in side effect problems or adverse drug events.

Be more aware of supplements and drug interactions

I want you to be more aware of what can impact your medications. Some things cause too little of your medication to be absorbed. Some things cause too much of your medication to be absorbed. If you are taking supplements, find out what you can and cannot take with your current meds. Find out the best time to take your supplements.

Iron, Potassium, Vitamin K

Over-the-counter Iron supplements, potassium supplements, or vitamin K supplements can cause problems too. St. John’s wort is another supplement that may cause problems. A lot of folks are on medications that are used to treat high blood pressure medications, heart medications, antidepressant medications, and blood thinners such as warfarin, or antiviral medications.

It matters!

You need to know what can and can’t be taken together. You need to know when to take what. You need to know that the fat-soluble vitamins A,D,E,K can build up in your body. Some of you have been told that you “pee out what your body doesn’t absorb” which is not entirely true. Did you know that your body can only absorb 500 – 600 mg of calcium at a time?

PPI’s and Medication interactions

Even gastric acidity affects some medications. Are you taking a proton pump inhibitor (PPI) such as Prilosec® (omeprazole), Nexium® (esomeprazole), Prevacid® (lansoprazole), etc.? If you have to take an iron supplement and you take a PPI, your iron is probably not being absorbed as the gastric acid is “less acidy.”

Certain foods can also interfere with medication absorption. Examples include Grapefruit, Kale, Dairy, Yogurt, Alcohol, and Tyramine-rich foods.

Common things that we don’t think about that affect medications:

  1. ·       Nicotine use
  2. ·       Alcohol
  3. ·       Caffeine
  4. ·       Our diet
  5. ·       Changes in medical conditions
  6. ·       Changes in illness (usually a decline)
  7. ·       Infections

Aging and what the body does to drugs

With aging comes changing pharmacokinetics. Pharmacokinetics is what the body does to drugs. These changes include Absorption, Distribution across body compartments, Metabolism, and Excretion. The metabolism and excretion of many drugs decrease, which means your dosage probably needs to decrease as well. Absorption is not usually a clinically significant problem unless other factors come into play. As we age body fat usually increases and total body water decreases. This can affect the distribution of drugs that are lipophilic (dissolves in lipids or fats). Hepatic (liver) metabolism through the cytochrome P-450 system, decreases with age. Renal (kidney) elimination. This one actually begins to decline at about age 40.

As you can see, there are a lot of factors that can impact your medication’s ability to do its job. Your pharmacist can help you with these issues. 


Wednesday Wonderings … How can I know if my medications are working?

November 3, 2021

Are my prescription medications helping me or hurting me?

Have you ever wondered if the medications that you are taking or someone that you love is taking are helping you, hurting you or even working at all? Have you ever wondered if you are having an unexpected reaction or side effect to your meds?

What is pharmacogenomics?

Pharmacogenomics is the study of how genes affect a person’s response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that will be tailored to a person’s genetic makeup.

This definition is from the U.S. National Library of Medicine

Basically, your genes affect how and if certain medications are metabolized in your body. And why is that important? Because you need a medication to be therapeutic (to do its job well). Some drugs, called prodrugs, are inactive when administered (taken) and then they are metabolized into the active form to provide benefits. What happens if you cannot metabolize that medication into its active form? It will be like taking water. It won’t do anything because your body cannot change it into its active form. What if you take a medication and your body rapidly metabolizes it too quickly? You will not get the benefits of an Effective therapeutic dose. You are burning through it too quickly. What happens if you metabolize the medication very slowly? It can build up inside your body and cause more and more problems along with more intense side effects. Most medications are metabolized in the liver and excreted through the kidneys.

Metabolism, liver, kidneys, liver enzymes, excretion rates, inactive and active metabolites, metabolism rates, phases of metabolism, blood flow, changes in liver volume, etc. all of these things come in to play. What I want you to know is that you can find out how you metabolize certain medications and you and your doctor can decide what medications are best for you and your particular needs. You can also find out if you need more or less of a certain medication. Do the test once and use the information the rest of your life.

What are some of the benefits to having this test?

Helps your doctor find the medications that may work best for you

Helps you to know which medications to avoid

Helps you to know which medications dosage may need to be increased or decreased

Severe drug reactions can be reduced or eliminated

Stops the trial-and-error method that usually takes months to see if it helps or not

May help decrease opioid dependency

May increase pain relief

Bothersome side effects may be decreased or avoided

Do it once and use the information the rest of your life

Who can truly benefit from this test?

If you have been diagnosed with:


Anxiety disorders

Obsessive-compulsive disorder







Lipid disorders (high cholesterol)

Alzheimer’s disease

Parkinson’s disease

Multiple Sclerosis

Breast cancer


Cardiovascular disease



Autoimmune disorders

Check-out the Medications that are impacted by your genes.

To see the medications list, go to

Click on the Products tab

Go about midway down the page and click on the blue bar that has the RightMed® Medication List

**Remember, some physicians prescribe medications for off-label use, which means they are using it for something other than what the medication is approved to treat. **

My own experience with pain medications has led me to encourage others to take this test. I had arthroscopic shoulder surgery in the early 1990’s. They sent me home with Percocet® (Oxycodone and acetaminophen) and Phenergan® (promethazine). I get home, ice and take my medications. I am out like a light in about 45 minutes. Now, I had never had any type of pain medications before and I don’t remember having any anti-nausea medications as an adult. After two hours, I am apparently whining in my sleep. I am awakened and I am hurting, but I am so sleepy. The promethazine is kicking my ass and I cannot wake up. The pain is fairly intense. Over the next 24 hours I am taking my pain medications as directed and only taking half of the promethazine. I do believe that the only thing that was helping me was being knocked out by the promethazine. I called my doctor and told him that the Percocet® was not working. He told me that was the strongest that they have. I know that’s a lie, I am a pharmacist. I understand that doctors are concerned about drug seekers, but hell, I just had surgery the previous day. He called in Tylenol#3 (acetaminophen and codeine). I took that and guess what? It did not work either. I knew that I was screwed and would have to deal with this on my own. I iced, I breathed deeply and I took a half a tab of promethazine every 8 hours and Ibuprofen 800mg every four hours. I am thinking that I never ever want another surgery in my lifetime! After about 5 days, I could stand it. Then came physical therapy. You do what you have to do. I cannot imagine what I would have gone through if I had anything other than an arthroscopic surgery.

As a pharmacist I knew that not every medication worked for every person. We all knew that; we just did not know why. We knew it had to be something inside our body make-up, but what? We knew that when Ultram® (tramadol) came out that it worked for some people and it did not work for others. I believed people when they told me that certain medications were not working for them, and I would have them ask their doctor to try X, Y, or Z. Just because something is “supposed” to work does not mean that it does work for all people.

Funny how when we don’t really have the answers, that we tend Not to believe it could be happening. We doubt the person and not the medication. Well, no more! Now we know that some medications are impacted by our genes. I now know that I cannot metabolize Percocet®. My body cannot metabolize Tylenol#3® nor can it metabolize tramadol. They are pro-drugs which means they need to be converted into the active form inside the body in order to work. So, I was taking sugar pills for my body. I have a genetic “defect” for CYP-2D6. But, by God, I now know what will work for me and the dosage that I will need. I have the tests to prove it for all the skeptical physician’s worried about drug seekers. My primary care physician has a copy of it in my records and now I tell them to call him for the results, if they want.

So, if you are going to have a planned surgery and you don’t know what pain meds work for you, it might be worth it to have this test. I know that it is expensive and it is going up after the first of the year (in 2022).  Only you can decide what is of value to you. It was valuable information for me and I can use it the rest of my life. No more waiting and hoping. No more wondering for months on end. No more wasting money and time. 

Have you been diagnosed with depression? Have you been started on a medication? What did your doctor and pharmacist tell you? Hopefully, they told you to take it at the same time each day, do not miss doses and give it 3 months. You do. It doesn’t seem to have helped very much, maybe a little. You return to your doctor and he or she takes you off of that medication and you begin again with another medication for 3 months. Nope, this one is not helping and you are now dealing with sexual arousal dysfunction. You return a third time, maybe or you stop going back and just suffer. You are 6 months down the road with no real results to speak of. Six months of your life that you will never get back. You tell me, what is that worth to you and your family?

Are you a chronic pain patient that want the best quality of life possible? Let’s find the medications that will work for you and not wipe you out. Let’s find the right combination to help you to get back to living. I know that you will not be pain free, but you have every right to expect it to be manageable.

Everyone deserves the best quality of life possible for them.

Do it now, before the price goes up in January 2022.

Most HSA’s and Flexible Spending plans allow coverage for this in-home test.


The 5 different types of metabolizer status are described below.

    • A person who is a “Poor Metabolizer” for a medicine will process that medicine very slowly. The medicine might not work if it is processed slowly, or it could put them at risk for side-effects.

    • A person who is an “Intermediate Metabolizer” for a medicine will process that drug slowly, but not as slowly as a poor metabolizer. This means that the normal amount (or dosage) of certain medicines may not work for them, or may cause side-effects.

    • “Normal Metabolizer” for a medicine usually benefits from the normal amount (or dosage) of the medicine. This means the metabolizer status does not put them at increased risk for side-effects.

  • A person who is a “Rapid Metabolizer” or “Ultrarapid Metabolizer” for a medicine can process the medicine very quickly. A medicine might not work if it is processed very quickly, or it could put the person at risk for side-effects.

Are my prescription meds helping me, hurting me or doing nothing at all?

If you need steady state medications (dosages that last 24 hours around the clock), to effectively control your condition and you take it half the time or miss doses, guess what? You have caused your own treatment failure. Everything has been going well and then …Bam! You feel like crap and you don’t know why. What has happened? Is your medication helping you, hurting you or just plain not working for you anymore? How many of you have wondered if your medication is hurting you or if it is really helping you? Quite a few, I am sure. You are right to consider those possibilities, because it happens more than you think.

Can your body become used to the medication?

Your body becomes tolerant to the medication and you no longer get the same benefits or results. You may have added another medication that is interfering with the medication. You can be sure that something has changed. But what? That takes some digging. It happens quite a lot in folks that are taking medications for depression, anxiety, diabetes, Parkinson’s disease, chronic pain, fibromyalgia, asthma or COPD.  What is happening? Why is it happening?

Do your regimen correctly

Well, one thing that happens is that folks with chronic health conditions get sloppy when using their regular medications. They do not take it as they are supposed to. Sometimes, it is defiance and sometimes they forget. Did you know that there is a proper way to use mouth and nasal inhalers to get the benefits of the medication? You cannot just squirt all willy-nilly.

Is it the right medication for your needs?

Another thing that happens is the medication is not the right medication for you. You either metabolize it too quickly, too slowly or not at all. This happens a lot with antidepressants, pain medications and antiseizure medications. If you have had a treatment failure with any of these types of medications, I would suggest getting a genetics test. Full discloser – I do offer those tests for $595.00. All I need is an order from your physician, physician’s assistant or nurse practitioner stating a treatment failure or multiple tries with their NPI number and I can order you a test. Contact me if you want more information. 865-684-8771 or Your body may have become tolerant to the medication and you need a change.

What you eat and drink may alter the absorption

A new medication has been introduced that is causing the current medication to have problems. It may even be a food that is causing metabolism problems. A new health condition may be the culprit. Even your own lifestyle decisions may be impacting the medication. Lifestyle factors include your diet, alcohol intake, recreational drug use, physical activity or the lack of physical activity. Even medication overload can be the culprit. Medication overload includes too many medications and too much of a dose. Your chronic health condition has progressed and gotten worse.

Is it the appropriate medication for your needs?

Another thing to consider is – Are you on the appropriate medication to begin with? Do you have an appropriate diagnosis? Remember, it is the practice of medicine and there are not absolutes. We do see mistakes in diagnosing. It is not always the doctor’s fault. Some things act and look like other conditions and diseases. So, it is very important to rule out what can be ruled out as a cause.