The People's Pharmacy

Q: I was recently diagnosed with an irregular heart rhythm called atrial fibrillation. The doctor prescribed Coumadin and Toprol XL. I would like to know whether my vitamins and other supplements would interact with these drugs. In addition to a B complex and multivitamin, I take vitamin E, vitamin C, selenium, garlic, Coenzyme Q10 and fish oil.

A: The blood thinner Coumadin (warfarin) can interact with dozens of drugs, foods and dietary supplements. For example, Coenzyme Q10 is also known as ubiquinone and is related to vitamin K. It might reduce the effectiveness of Coumadin and lead to a blood clot.

Vitamin E, garlic and fish oil have modest anticoagulant activity. That means they might increase the risk of bleeding when combined with Coumadin.

Q: What is a safe daily dose of Advil? What harmful side effects does it have, if any?

A: Ibuprofen (Advil, Motrin IB, etc.) is a nonsteroidal anti-inflammatory drug. Like other medications in this class, it can be irritating to the digestive tract. Such drugs also might cause dizziness, rash, ringing in the ears, fluid retention and higher blood pressure.

The recommended dose for over-the-counter use is one caplet every four to six hours up to a maximum of six pills (1,200 mg) in 24 hours. This dose should not be taken for more than 10 days without medical supervision. Physicians might prescribe ibuprofen in doses up to 3,200 mg in a day, but this large amount requires careful medical supervision.

Q: I take aspirin for my heart. I bruise easily and get dark splotches on my hands and arms. Is there any connection?

A: Some people are very susceptible to this potential side effect. Please discuss this issue with your doctor to see whether you should take a lower dose of aspirin.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 888 Seventh Ave., New York, NY 10019, or e-mail them at pharmacy@mindspring.com or via their Web site: www.peoplespharmacy.org