DEAR DR. ROACH: I have always wondered if it matters if you swallow a bunch of pills in one swallow or if it would be better to space them out. I take a bunch, like Eliquis, dicyclomine, gabapentin, etc. — B.A.
ANSWER: With most pills, it’s OK to take them as a bunch together, if you can tolerate doing so (I’ve known people who have a tough time taking multiple pills at the same time due to gagging). There are a few combinations of pills that shouldn’t be taken together, such as tetracyclines and calcium, but these should be labelled clearly on your bottle. A few medicines, like alendronate (Fosamax), can’t be taken with any other medicines. Some medicines, including all the ones you mentioned, can cause sedation, which can be worse if taken together.
As always, your pharmacist is your best friend for questions about medication interactions.
DEAR DR ROACH: Despite having family history of high cholesterol (including early death due to heart failure), I was told at 53 that my 10-year risk is not alarming. I do not smoke nor drink.
I recently had some tests done and was told that my Lipoprotein (a) is above normal. I am wondering if that may explain my concern of why, despite keeping a very careful diet over two decades (and a fairly good Mediterranean diet before, as well) and an ideal BMI, my figures are not getting better. (I still have a high LDL, low HDL and high triglycerides.)
After I recovered from COVID, I seemed to have a high pulse and was advised that my stress ECG is positive. I find aerobic exercise very challenging, but keep active when I can. I tend to be anemic and feel tired very often due to heavy periods, but I take iron supplements.
What should I do concerning my cholesterol in my blood? I am concerned that my high figures may indicate a silent serious illness. — M.H.
ANSWER: The 10-year risk is a good place to start in deciding whether elevated cholesterol needs to be treated; however, the 10-year risk does not consider some risk factors, including the high Lp(a), which is an independent risk factor on top of your high LDL and low HDL. The Lp(a) doesn’t affect the other cholesterol numbers.
Diet and exercise do tend to help cholesterol numbers, and definitely help reduce heart disease risk, but it is possible to have cholesterol results that are not ideal despite a very good lifestyle.
A positive stress test is a concerning finding and is usually followed up by a definitive test for blockages in the artery, such as an angiogram. The results of that will absolutely guide your cardiologist as far as further treatment, including whether you need treatment for your cholesterol numbers.
Although statin drugs do not reduce Lp(a), they do reduce the risk of heart disease in people with elevated levels of Lp(a). I follow the advice of experts who recommend a lower threshold for medication treatment in people with high Lp(a) levels, especially in people with a family history of heart blockages or heart attacks.
