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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for sunburn while on Cardizem and Synthroid

Answered by
Dr.
Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3675 Questions

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Posted on Tue, 18 Apr 2017 in Medicines and Side Effects
Question: My mother takes 240mg cardizem in a.m. And 10 mg of norvasc at bedtime. Also 50 mg synthroid in a.m. She was recently treated for a bladder infection with sulfameth/tmp 800/160mg. She took 10 doses and swelled and turned red like a sunburn. She stopped it immediately. The next morning after stopping the antibiotic, her skin started peeling. For the past 4 days she wakes every morning with her skin peeling like a severe sunburn. We have been using eurcernin intensive repair liberally. She has no fever, although she has felt sweaty and clammy. Her skin continues to look red and raw and her left forarm is swollen. Yesterday and today ive noticed her palms of her hand look bluish and her fingers and around her mouth look pale. Her blood pressure has been 130's over 66-75. Her heart rate 70. (She has a pacemaker). Her oxygen level at one time dropped to 90 but last few checks have been 97-98. Her cholestrol is all within normal parameters. Her CRP is 40.64! The supplements she takes is 1 g garlic oil, 2 g salmon oil, vitamin d & calcium bone builder, 400 iu vitamin e, 81 mg aspirin. I have given her 1000mg vitamin c today. Any advise on how to help my mother would be appreciated.
doctor
Answered by Dr. Panagiotis Zografakis 3 hours later
Brief Answer:
she'd better visit the ER for urgent assessment

Detailed Answer:
Hello,

although I couldn't possibly be sure about that - without examining her and going into little details of her history - her case sounds like a side effect of the antibiotic (TMP-SMX) which is called Stevens-Johnson's syndrome. Mouth lesions are common in this syndrome. The skin may become denuded (like a serious sunburn) and the CRP levels rise. You haven't clarified the units in CRP measurement (is it per litter or per deci-litter?). If it's mg/L then it's not very high. If it's mg/dL then it's sky-high and has to be investigated urgently!

In such cases infection control and withdrawal of potentially implicated agents has to be done. The first thing to do is to get a diagnosis!

So in conclusion, I believe that your mother needs urgent medical assessment to exclude the possibility (or confirm) of a serious disorder like Stevens-Johnson's syndrome and receive appropriate treatment.

I hope it helps!
Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 2 hours later
Her Crp is in mg/ L
doctor
Answered by Dr. Panagiotis Zografakis 12 minutes later
Brief Answer:
it's not normal but it's not too high

Detailed Answer:
I see. 40mg/L is not normal (usually less than 5-6mg/L is considered negative - check the normal range of the lab) but it's not very high either. A low value like this does not raise suspicion for serious bacterial infection unless corticosteroids are given (which may lower CRP despite ongoing infection).

I still believe that you have to visit a doctor as soon as possible to assess the skin lesions.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 6 minutes later
Thank you so much!
doctor
Answered by Dr. Panagiotis Zografakis 4 minutes later
Brief Answer:
You're welcome!

Detailed Answer:
You're welcome! Best wishes for a speedy recovery!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 19 minutes later
I am curious to know, would the two calcium channel blockers have anything to do with her skin peeling. Would she need both?
doctor
Answered by Dr. Panagiotis Zografakis 12 minutes later
Brief Answer:
probably not

Detailed Answer:
I doubt that the CCBs have anything to do with it. I assumed that she's using them for longer than the antibiotic, right? Such drugs are very commonly used for long periods of time and patients do not usually have similar problems.
Combining two CCBs is a little unusual but they belong to different classes of CCB (dihydropyridines and non-dihydropyridines). Diltiazem reduces the blood pressure and heart rate. Amlodipine reduces the blood pressure but may increase the heart rate.

Whether she needs both is a question for her cardiologist to answer. I can't possibly know why the cardiologist prescribed them...

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 7 minutes later
She had allergic reaction to ace inhibotors and beta blocker reduced her sodium level. Shes 86 years old. I too questioned the dupilcation but then again I am a daughter,not a doctor. Thank you so much for your time!
doctor
Answered by Dr. Panagiotis Zografakis 29 minutes later
Brief Answer:
the ace inhibitor allergy does not affect the other drugs

Detailed Answer:
I see... that's an explanation although an angiotensin receptor blocker could have been tried too. Anyway, the best regimen for any patient is what works best! If her current regimen has everything under control there is no reason to think about it.

The allergic reaction to the ACEi does not predict anything for the rest of the drugs.

You're very welcome!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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