Ask the Doc: Q & A with Edward Kasarskis, MD, PhD

Edward Kasarskis, M.D., Ph.D. is Director of the multidisciplinary ALS Center at the University of Kentucky Neuroscience Center in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY. 

Dr. Kasarskis

Q: I’m taking a lot of medications, some for ALS and others for different conditions, and wonder if there could be drug interactions or side effects from them? What can I do to be sure I need everything I’m taking?

A: First, I know this may sound like a very low-tech way to initially approach your problem, but I recommend you bring all your medications, in their containers in a big plastic bag to the ALS clinic or to your neurologist. It’s actually handier than a simple list because the pills can be examined and reviewed in person. By going over the drugs together, we can usually identify any potential interaction problems and may even discover a few medications that are no longer necessary. A typed list is still welcome so you can do both.

You can also discover potential drug interactions using several high-tech tools available through your smart phone, iPad, or computer. For example, epocrates.com can take information about your pills and help you identify them. It can also give you potential drug interactions and side effects so you can be on the lookout. The tool also reminds you of safety monitoring required with certain drugs. (Rilutek©, for example, requires a blood test for liver function every month for the first three months when you begin to take the drug). There are also free tools for pill identification and drug interaction on drugs.com and AARP.

When reviewing your “sack of pills,” your physician or your pharmacist can check to see if you have too many pills that may negatively affect a particular organ or cause you risk. Perhaps you take two or more drugs that can affect the liver for example, or that could sedate you and decrease your respiratory ability, especially when you’re sleeping.

Sometimes people wonder if a particular symptom is due to any of the drugs they’re taking or is caused by ALS itself. By reviewing your drug list, your physician or pharmacist can help you determine which it might be.

If you take your medications via a PEG tube to your stomach, you can ask your pharmacist if you can safely take all your drugs at once. In other words, might there be any negative interaction if they’re all part of the same tube feeding? You can also ask your pharmacist if any of your medications might be available in a liquid form. That would cut down on the time it takes for you to crush the pills for the tube feeding.

It is likely that someday we’ll have a drug “cocktail” available that will help control ALS with a combination of medications. Certainly, anything that can make managing your drug portfolio easier and more foolproof should be welcomed by all!   

If you would like to submit questions for a future Q & A, please send your questions to theexchange@alsa-national.org. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally.