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Q. I just recovered from a near-fatal drug interaction. I am a healthy, 38-year old woman with bipolar disorder for which I have been taking Nardil for 13 years. My psychiatrist recently prescribed Anafranil to alleviate symptoms of obsessive-compulsive disorder.

I immediately became ill. I had difficulty breathing, a fever of 105, muscle rigidity, delirium and a heart rate of 200. I woke up days later on a ventilator in the ICU. I was in critical condition.

Thank goodness my husband, who is a physician, was home when I took the pills. He got me immediate medical attention that saved my life.

I have since learned that this combination can be lethal. I cannot comprehend the stupidity of the doctor prescribing these medicines together. Please warn your readers to check before taking any medications together, even those prescribed by the same doctor.

A. You were fortunate to survive this dangerous drug interaction. As you point out, this combination is extremely hazardous.

Most patients trust their physicians and pharmacists to protect them from such complications. Your experience underscores the importance of doing your own homework.

Thyroid hormone and calcium

Q. My wife is on Synthroid for an underactive thyroid and Premarin and Provera for menopause. She also takes 1,500 mg of calcium to prevent osteoporosis.

She swallows all her pills at breakfast time, but I recall reading that calcium might interfere with Synthroid absorption. Would that explain her tiredness, weight gain, hair loss and puffiness around the eyes?

A. Your wife should take calcium or any other minerals (such as iron or a multiple vitamin) at least two hours after the Synthroid to allow time for the thyroid hormone to be absorbed.

If this change does not alleviate her symptoms (typical of underactive thyroid), have her check with her physician. Her Synthroid dose might need adjustment. She should remind the doctor and the laboratory that she is taking Premarin, since the estrogen it contains can elevate T3 and T4 thyroid tests without actually increasing thyroid function.

Help for smokers

Q. Zyban is now being prescribed as an aid in stopping smoking. Just how effective is it?

The literature on Zyban as an aid to stop smoking doesn't mention any test results. My husband is planning to try it, but frankly, I have some reservations.

A. Clinical studies show that Zyban (bupropion) can help people stop smoking: Forty-four percent to 50 percent of smokers on Zyban quit over the course of two months, compared with about 20 percent of those taking a placebo. After a year, more than 20 percent of those who had taken Zyban were still nonsmokers.

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