A 77 year old male is receiving the following medications:
- aspirin
- omeprazole
- metronidazole
- thiamine
- ibuprofen
- tramadol
- lamotrigine
So, based on this limited information, what would I investigate? Without diagnosis listed, there are a few things that I’m going to investigate based on previous experience. What does thiamine possibly warn us about metronidazole? The first thing is the metronidazole and thiamine combination. Thiamine is a classic supplement used in patients with a history of alcohol abuse, so I would want to make sure this patient is not actively drinking on the metronidazole.
I would want to know what the lamotrigine is being used for. If for seizures, we certainly have to reassess the use of tramadol in this patient and identify if a better option would be appropriate.
Ibuprofen use with omeprazole is something I see very often. Whether the ibuprofen or the omeprazole was started first may or may not matter, but assessing for anemia, GI symptoms, etc. would be significantly important. The aspirin on top of the ibuprofen could also increase the anemia/GI risk. Acetaminophen is generally a safer alternative, but liver issues should be assessed before a suggestion is appropriate. Again the thiamine may be indicative of alcohol history.
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Interesting brain juggler there Eric; good exercise.
I will agree with your assessments. Now, the ppi could be used to decrease the pH level there in the stomach. The aspirin could be for some heart condition; ibuprofen could be for any number of inflammatory conditions including inflammatory bowel disease (eg UC). The thiamine while in general would be indicated in it’s deficiency, I’ve seen in the past thrown in the mix for any number conditions from aging to improving appetite WKS common in alcoholics.
Thanks for providing us with the detailed analysis of few common medicines used by Ibuprofen and Thiamine, along with its positive and negative effects. Indeed, your post will help B. Pharma and D. Pharma students of our Shri Ram Group Jabalpur not only during their regular courses, but also in practical applications in future.
No problem! thanks for the kind words – Best, Eric
Very interesting piece…u really got experience on ur side. Critical clinical thinking…!
Good one!