Edema After Antacid Use: A Patient's Dilemma - Gastroenterology and Hepatology

Q: Edema After Antacid Use: A Patient's Dilemma

Hello： There are many causes of edema, including diseases of the heart, liver, and kidneys, as well as circulatory issues. <br>Medications can also be a contributing factor. <br>Besides using Ranitidine or Pantoprazole, are there any other medications being used? If these medicat

Consultation: Unexplained edema after taking antacids?

Hello Dr.
Chen,
1.
Around mid-May, my mother sought medical attention for stomach pain (no endoscopy was performed), and the doctor prescribed medication (I don't remember the name).
After taking the medication for a few days, she experienced swelling in both her upper and lower limbs, which improved after discontinuing the medication.

2.
On June 13, she visited another hospital.
Since she had already eaten, an endoscopy could not be performed, so the doctor prescribed Ranitidine 150mg and scheduled an endoscopy for the next day.
After taking the stomach medication, she again experienced swelling in both her upper and lower limbs.

3.
On June 14, the endoscopy confirmed the presence of a gastric ulcer, and the doctor prescribed Pantoprazole 40mg for seven days.
After taking it, the swelling in her upper limbs decreased, but the swelling in her lower limbs remained severe (especially around the calves and ankles; when pressed with a finger, the tissue would indent and not immediately rebound).
I informed the doctor of this situation, and the doctor ordered blood tests, urine tests, and X-rays.
After the examinations, the doctor indicated that the test results showed no significant issues.

4.
The following week, on June 21, she returned for a follow-up regarding the gastric ulcer report, which indicated the presence of Helicobacter pylori.
The doctor prescribed Amoxicillin 500mg capsules (two capsules twice daily), Clarithromycin 500mg tablets (one tablet twice daily), and Pantoprazole 40mg tablets (one tablet twice daily) for one week.
The swelling in her lower limbs remained severe.

5.
The following week, on June 28, she returned to pick up a one-month supply of Pantoprazole 40mg.
As of today, July 12, the swelling in her lower limbs is still severe.
This week, she consulted a cardiologist, who arranged for X-rays and an electrocardiogram, and the doctor reported no issues.
I would like to ask the doctor if it would be advisable to temporarily discontinue the medication for a few days (to test if the swelling is a side effect of Pantoprazole).
Would this affect the treatment of the gastric ulcer? Thank you.
(Since the hospital where she received the medication is in Taipei and she currently resides in central Taiwan, returning for follow-up is inconvenient, so we are considering stopping the medication to see if it is a side effect.
If it is, we would return to the original hospital to change the medication.)

Niming, 20~29 year old female. Ask Date: 2014/07/12

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello: There are many causes of edema, including diseases of the heart, liver, and kidneys, as well as circulatory issues.
Medications can also be a contributing factor.
Besides using Ranitidine or Pantoprazole, are there any other medications being used? If these medications are indeed the cause, it may be worth considering different classes of ulcer medications.
Wishing you safety and health.
Sincerely, Dr.
Chi-Feng Chen, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2014/07/12

More Info

When considering the potential side effects and interactions of medications like Methylphenidate (Ritalin) and Escitalopram (Epram), it is essential to understand both the pharmacological properties of these drugs and the individual patient's health status.
1. Potential Side Effects: Both Methylphenidate and Escitalopram can cause a range of side effects. Methylphenidate, a stimulant used primarily for ADHD, can lead to increased heart rate, anxiety, insomnia, and tremors. Escitalopram, an SSRI used for depression and anxiety, may cause side effects such as nausea, fatigue, sexual dysfunction, and, in rare cases, bleeding issues. The combination of these two medications can heighten the risk of serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin in the brain. Symptoms of serotonin syndrome include confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and gastrointestinal distress.
2. Unusual Bleeding: The occurrence of non-menstrual bleeding while taking Escitalopram is concerning. While it is classified as a rare side effect, SSRIs can affect platelet function, potentially leading to increased bleeding risk. If this bleeding is persistent or worsening, it is crucial to consult with a healthcare provider to determine whether the medication should be adjusted or changed. The bleeding is unlikely to cause permanent reproductive harm, but it should be monitored closely.

3. Drug Interaction and Symptoms: The concern about Methylphenidate and SSRIs like Escitalopram is valid. While some studies suggest that the combination can be effective for patients with ADHD and comorbid depression, close monitoring for adverse effects is necessary. Distinguishing whether symptoms like tremors, dizziness, and anxiety are due to the initiation of Escitalopram or the interaction between the two medications can be challenging. Keeping a symptom diary can help identify patterns and provide valuable information to healthcare providers.

4. Dietary Considerations: When taking Methylphenidate or Escitalopram, it is advisable to avoid alcohol, as it can exacerbate side effects such as dizziness and sedation. Additionally, certain foods may interact with medications, although specific interactions with these two drugs are not well-documented. However, maintaining a balanced diet rich in fruits, vegetables, and whole grains can support overall health and potentially mitigate some side effects.

In summary, while the combination of Methylphenidate and Escitalopram can be beneficial for managing ADHD and depression, it is essential to monitor for side effects and interactions closely. If unusual symptoms arise, such as bleeding or significant side effects, it is crucial to consult with a healthcare provider to evaluate the need for medication adjustments. Always communicate openly with your healthcare team about any concerns or changes in symptoms to ensure safe and effective treatment.

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