Take caution when treating carpal tunnel with vitamin B-6

thought to be among the safest drugs in the pharmacy. Over the past decade or so we have learned about some unexpected adverse reactions associated with long-term use. They include magnesium and vitamin B-12 deficiency along with bacterial overgrowth in the small intestine. Other possible complications include weakened bones, fractures, chronic kidney disease and heart attacks (Heart Lung & Circulation, online, Nov. 20, 2017). The potential link between PPI use and stomach cancer is more controversial. A meta-analysis suggests there is an association (Clinical Gastroenterology and Hepatology, December 2016). A recent study has confirmed this connection (Gut, January 2018). Ask your doctor how frequently you should schedule endoscopies to check for suspicious growths.

A: You’ve identified a big problem for people on the anticoagulant warfarin (Coumadin, Jantoven). More than 2 grams of acetaminophen (Tylenol) per week could increase the possibility of a dangerously high INR lab reading (Journal of Pharmacy Practice, October 2013). The INR, or International Normalized Ratio, is a measure of anticoagulant activity. One day’s worth of acetaminophen for arthritis would exceed the recommended 2 gram limit. NSAIDs like aspirin, ibuprofen or naproxen also are risky. They raise the risk of bleeding. Your doctor may be able to prescribe a different anticoagulant. Some of the newer (and pricier) ones don’t seem to interact with acetaminophen.