Ask the pharmacist...

I have recently started taking quetiapine x l 400mg tablet at night for psychotic depression but about an hour after I have taken it I get a pounding headache, get really dizzy and feel as though my blood is boiling. Is this a common side effect?

Quetiapine causes something called ‘postural hypotension’. This means that the blood pressure may be lower than normal on sitting or standing. This lowered blood pressure often leads to dizziness and sometimes headache.  Most people develop a tolerance to this side effect after a few weeks. For those that do not, the best idea is often to take the nightly dose just before going to sleep. Other options include splitting the dose (morning and night) or reducing the dose (to, say, 300mg). Options should be discussed with your prescriber.

Does alcohol have an effect on antipsychotic medication. Does it make it less effective if you drink a lot of beer?

In general, alcohol should not be taken (except in strict moderation) by people taking antipsychotics. The main reason for this is that the sedative effects of alcohol can combine with the sedative effects of antipsychotics. This may lead to severe drowsiness and to accidents.

If alcohol is taken within recommended limits, it is unlikely that the effectiveness of antipsychotics will be reduced. When taken in excess (more than 3-4 units a day or 6 units at one time), alcohol probably reduces the effectiveness of antipsychotics, leading to a greater risk of relapse.

I have been taking venlafaxine 37.5mg for 3 years now, and if I forget to take just one I don't sleep. Last weekend I forgot to take it and then on the evening had a few drinks, went to bed slept well and in the morning got up to let the dogs out. When I was in the kitchen, I heard a distinct voice saying: “got a bad head have we?”, and no-one else was down stairs. I told my doctor and she just smiled and gave me my monthly prescription. Does that mean there's nothing to worry about? Or could the drug be causing me to hear voices?

Missing a dose of venlafaxine or other similar drugs can cause symptoms such as dizziness, insomnia and anxiety. Only very, very rarely are symptoms such as delusions or hallucinations experienced. In any case, such symptoms are only usually seen with older MAOI-type antidepressants.

Hearing voices is something experienced by up to 1 in 10 people at some time in their lives. It is usually nothing to worry about.

What research has been carried out about the anaesthetic drug lignocaine and its possible role in causing the symptoms of bipolar disorder and psychosis? Could it be that having an epidural that contains lignocaine could cause puerperal psychosis?

The product literature for lignocaine (lidocaine) does not list psychosis as an adverse effect. There are, however, a few cases reported in the medical literature of short-lived psychosis occuring during or after intravenous lignocaine. I am not aware of any reported cases in people receiving epidural lignocaine.

I am writing this on behalf of my husband who is in hospital. He is 72-years-old. He went in hospital before Xmas to have a pill changed and they have taken him off all medication. They have put him on a small dose of medication, but he is not well at all and has started to head butt people. I warned them about this, he was supposed to be watched 24/7, but still managed to head butt another person. His medication was: amitriptylene 175mg, lorazepam, 6mg, merrille, 100mg, zopiclone, 15mg, lithium, 800mg.

Is it right to take him off all these drugs at the same time?

All medicines that are taken long-term should generally be reduced slowly before stopping. Stopping lithium suddenly may cause rebound hypomania or depression and an increase in the rate of cycling (mood swings). Stopping lorazepam suddenly will cause anxiety and possibly panic, amongst other symptoms. Stopping amitriptyline suddenly is likely to cause insomnia, anxiety and diarrhoea. Stopping zopiclone suddenly is likely to cause insomnia and possibly anxiety.

I am currently in receipt of 750mg Depakote 2 X daily. I am showing ‘elevated levels’ (a figure of 4.8 was mentioned) on liver function tests. My faeces are pale, I have an itchy anus, as well as feeling a need to rest in the day. I am concerned that indefinite treatment with Depakote will cause irreversible damage to my liver.

I am on section 3, 117 indefinite leave, so I cannot choose to alter my medical regime even though I fear it is harming me physically. How can I get an objective second opinion on the risk to my liver?

Valproate (Depakote) only very rarely causes serious liver damage in adults. There are many tests for liver function and it is not clear to which your result pertains. It is quite ‘normal’ to have apparently abnormal liver test results when taking drugs that are metabolised by the liver. High levels in one or two tests do not usually indicate any important toxic effect on the liver. You should request repeat liver function tests and an explanation of their meaning, but be reassured that liver damage is very unlikely.