ArcaMax

DEAR DR. ROACH: I am an 84-year-old male in fairly good health for my age. I take 8-10 pills a day, including two over-the-counter medications. I take four or five in the morning and four or five in the evening. My question is, how effective are these medications if they are all being taken together and mixed in my stomach? Won't there be some kind of chemical reaction resulting in less effectiveness?

The medicines that I am presently taken are atorvastatin, amlodipine, baby aspirin (81 mg), irbesartan, finasteride, hydralazine, clonidine and Myrbetriq. -- R.W.

ANSWER: These medicines are commonly used together, but since it's impossible to keep all possible drug interactions in just one head, doctors and pharmacists use drug interaction calculators to look for possible interactions. But these take expertise to interpret.

For example, when I ran your list through my calculator, it identified six potential interactions. However, only one of them was considered to be of potential significance (between metformin and aspirin), and this is only when the dose of aspirin is 40 times the dose you are taking.

The rest of the potential interactions are considered minor, such as small changes in the effectiveness of the blood pressure medicines. But since you are on four blood pressure medicines, your doctor should already be carefully monitoring your blood pressure.

In order for your doctor and pharmacist to be able to optimally help you, it's critical that at least one of your doctors (such as your primary care doctor) knows all of your medicines, and it's best to get them all at the same pharmacy.

DEAR DR. ROACH: I have been tentatively diagnosed with normal pressure hydrocephalus (NPH). I am 96, and they are hesitant to put in a shunt. They will try a spinal tap. Is there any hope that this will have lasting effects? -- M.G.

ANSWER: Most cases of NPH have no obvious cause. The diagnosis is made when the symptoms are consistent and the MRI scan shows increased amounts of fluid in the brain. The diagnosis isn't always easy to make, and the main issue is often failing to think of the diagnosis.

The classic triad of symptoms are memory and thinking changes (resembling early dementia), changes in gait, and urinary incontinence. However, not everyone has urinary incontinence, especially early on in the disease. In addition, the brain changes may be misdiagnosed as depression. The gait changes are the most consistent and often what makes the clinician think of the disease. The gait can appear similar to Parkinson's disease, but people with NPH have a wider-based gait, which is slow with small steps.

When the diagnosis is considered, a lumbar puncture ("spinal tap") may be performed to see if removing the excess fluid will improve symptoms. Only if the removal of fluid improves symptoms (usually the gait is measured before and after) would they consider a shunt, which is a permanent tube to let excess spinal fluid drain into the abdomen. The benefit of the diagnostic fluid removal is only for the short-term, while the shunt provides long-term relief.

Without knowing more about the symptoms that led your doctors to consider NPH, I can't guess how likely it is that the removal of the spinal fluid and subsequent shunt will help you, but there absolutely is hope that it might help, especially with the gait disturbance.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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