First aid kit: Attention, interactions!

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MunichThe medication protection against malaria is selected, the tablets against the traveler's diarrhea are still in the luggage from the last vacation. But if you have to take active ingredients against chronic diseases at the same time, you should be careful. Because dangerous interactions can occur.

Tropical specialist Dr. Shumel Stienlauf and his colleagues from the Travel Medical Center in Tel Hashomer, Israel, analyzed data from 16,000 travelers who had contacted the Travel Medical Center over a three-year period. The chronically ill among them took a total of more than 370 different drugs on a long-term basis, the most common of which were drugs for cardiovascular diseases, cholesterol-lowering drugs, thyroid hormones and anticoagulants. Of the female globetrotters, 14 percent took the pill. In order to find possible interactions between long-term medications and travel medicine, the authors used the Micromedex® drug database.

Risk for every second person

In fact, Stienlauf's research group found many possible interactions: Almost half of the chronically ill travelers took active ingredients that can develop moderate to severe interactions with travel medicines.

HIV Patients: Beware of Malaria Protection

In Germany, anyone who flies to a malaria area is usually given Malarone for prophylaxis. However, caution is advised for people with HIV infection. Medicines that are supposed to block the reproduction of the HI virus may no longer work properly with Malarone. The anti-malarial drug mefloquine, which is no longer prescribed in Germany, was associated with the most dangerous interactions. Several cardiovascular drugs can interact with it, the possible consequence: life-threatening cardiac arrhythmias. The anti-malarial drug doxycycline may make the pill less effective.

Cardiac arrhythmias instead of diarrhea

Antibiotics for traveler's diarrhea are particularly common if the patient swallows other drugs at the same time. Interactions would have been possible for every third subject in the study. Doctors usually prescribe azithromycin or fluoroquinolones against “Montezuma's revenge”. And in combination with other drugs, these can cause the striated muscle fibers of the skeletal muscles to dissolve. In addition to this dangerous so-called rhabdomyolysis, cardiac arrhythmias are also possible.

If there is a suspicion of possible interactions, it is better to pack medication with the active ingredient rifaximin, because no complications are known with this antibiotic.

Altitude sickness drug dangerous for diabetics

If you aim high, you may take the active ingredient acetazolamide as a preventive measure. Type 2 diabetics who are taking metformin at the same time should be careful - the result can be acidification of the blood (lactic acidosis). Three percent of the study participants were affected. The drug can also affect blood sugar control in diabetics. Type 1 diabetics should avoid acetazolamide anyway. There is a suspicion that it increases the risk of what is known as ketoacidosis - the accumulation of acetone and other acidic substances in the blood.

If you have your first-aid kit put together by a doctor or you are treated for common illnesses at your travel destination, you should therefore always discuss medication that you take permanently and inform your doctor about chronic illnesses. (away)

Source: Stienlauf S. et al .: Potential drug interactions in travelers with chronic illnesses: A large retrospective cohort study, Stienlauf S, et al: Travel Med Infect Dis (online) May 5, 2014, http: //dx.doi. org / 10.1016 / j.tmaid.2014.04.008

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