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What Causes Hallucination While On Fluconazole, Metoprolol And Levothyroxine?

Posted on Tue, 27 Jun 2017

Question: My mother has liver cancer and just recently broke her shoulder while on Morphine and Tramadol. She is currently on a long list of medicine and we are giving her morphine or tramadol every four hours at times she is alert while other times she hallucinates and is spaced and unable to communicate or answer basic questions. She is taking Fluconazole for an infection once daily. Tramadol at every 8 hrs. Morphine every 8 hrs but not at the same time only alternating each one. Pantoprzole once daily for stomach. Ondansetron/Zofran twice daily. Metoprolol once daily for blood pressure. polyethylene twice daily for constipation. Levothyroxine once daily for thyroid and Fibricor once daily for cholesterol. We are suspecting that one drug might be interacting with another but we aren't sure which one. We suspect is might be something that she is taking once daily interacting with one of the pain medications as in the morning she is more aware and alert and knows whats going on while later in the day she becomes incoherent at times. Can you tell me if any of the medicines might be causing this trouble when being taking along with any of the other medications

Answered by Dr. Dr. Matt Wachsman (31 minutes later)

Brief Answer:
A few possibilities.

Detailed Answer:
People with liver cancer usually die rather peacefully from liver failure and the liver takes out toxins. These have ammonia as a marker for them and there are simple ways to lower the toxins if that is the problem.

And, the medicines need to be adjusted for liver functions. Yeah, it's the pantoprozole. Lowering the dose by half often helps. Fluconazole also markedly elevates its level.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Matt Wachsman (4 hours later)

thank you, just to clarify, Is it the toxin or toxins that have ammonia.thank you, just to clarify, is it the toxin or toxins that have ammonia and have would we confirm that is the problem. I understand that we should try reducing the pantoprozole by half and that her medicine need adjusted for liver function. the fluconazole is almost finished just a couple days left. Would it be a better idea to only use morphine for now at least until the fluconazole is finished or just from now on and finally what if any are other ways to reduce the toxins if that is the problem

Answered by Dr. Dr. Matt Wachsman (17 minutes later)

Brief Answer:
Several questions several points.

Detailed Answer:
The liver gets rid of a lot of drugs and hormones and other biproducts both given and made by the body. We cannot test for most of them. We use one particular chemical to monitor build up of all of them just to see if there is or isn't a problem (this is ammonia). We used to think ammonia was directly the toxin causing the problems but it probably is NOT. But it is easy and cheap to measure.

Then, some drugs gum up liver metaoblism such that even normal people can have drug itneractions iwth the FLUCONAZOLE. Other drugs can't et out and accumulate if you give FLUCONAZOLE. and Pantopazole is likely to be one of those. And it can cause confusion.
So, stopping it might be one option.

Narcotics are not very influenced by liver problems. So, it might not matter to any of this with any of the narcotics. Tramadol has a lower safety margin than most.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Matt Wachsman (12 hours later)

thanks so much

Answered by Dr. Dr. Matt Wachsman (35 minutes later)

Brief Answer:
You are quite welcome

Detailed Answer:
feel free to contact us again for more issues!

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar