Can these medications combined cause death?

Question

Hi

I am doing some research on medication fatalities.

If a person took one each of Xanax, Restoril, valium,oxycodone and hydrocodone and an otc sleep aid over the course of 2-3 hours would it kill them? If their lab sheet showed that none of the meds were at toxic levels but they died then which med could have caused the death?

Answer 1

I know that mixing Xanax and oxycodone and over-the-counter sleep aids can be potentially fatal. This list of drugs is very similar to the list that Heath Ledger took before he died (prehaps the same). Mixing these drugs may cause respiratory failure even if each are taken at normal therapuetic doses. There are serious questions here such as, "Why would a doctor prescribe Xanax when the patient is already on Valium and oxycodone and other potentially reactive drugs?" Unfortunately this does happen. Doctors don't always know everything their patients are taking or what the possible effects might be if someone takes certain drugs together (with or without prescription). Xanax does the same things as Valium and many sleep aids, so why would all of those drugs be used by one patient? I would think the patient should even know better. These drugs depress the body (especially the lungs); taking multiple ones of these will increase this effect. If the system (the body and its metabolism) is slowed down enough, death instead of sleep will occur. If alcohol is consumed, the effect can be magnified many times. It isn't always as simple as addition (2+2=4). Drug cocktails often have negative effects which can be worse than overdose on any of the components or the sum of the components. The medical community should do more to protect people from this.

Also you need to consider that toxic levels can vary. What is not toxic for most people can be for a few. For example, the prescribed dose of Xanax to elderly people is often half of what is prescribed to young adults. It often depends on metabolism. Many drugs (such as Xanax) buildup quickly in elderly people, so doctors need to be even more careful about reactions with other drugs. Some drugs may effect people of different sizes or races differently too. For some drugs it is hard to tell what the toxic level is.

Answer 2

oxycodone and hydrocodone are both opiates with the side effect of respiratory depression even at low doses.

Xanax, Restoril and valium are benzodiazepines which cause drowsiness and would compound the problem.

The combination of these meds - even one of each - are likely to cause the patient to stop breathing while sleeping and subsequently die.

there is no reason to take one of each at the same time.

Answer 3

There is no yes-or-know answer to the fatality of the combination. Doubtless there are people who take a combination like that every day. It would certainly be fatal for a few, and the "blame" couldn't be pinned to a single drug. They're all respiratory depressants. It's kind of like asking if 2+2=4, which 2 makes it so.

Answer 4

The problem with mixing medications is there there are no hard data on the effects of 3 or more medications. The list you gave, though can be divided into two groups:

Benzodiazepines: Xanax, Restoril, Valium

These are sedating, hypnotic (sleep) drugs that work to depress your central nervous system by acting on your GABA receptors.

Opiods analgesics: oxy-/hydrocodone

These are narcotics that work on your endorphine receptors to control pain. They are also can be sedating and depress you nervous system.

It's impossible to make a good guess without knowing more of the patient history (i.e. height, weight, history of use of these drugs, etc.) but it is *possible* for an inexperienced person to die, most likely from respiratory depression. In other words, they would fall asleep and stop breathing.

However, I would consider this unlikely with just "one" of each pill. And it would be the added effects of all the pills together, no one pill should cause death, especially if the person had been taking them regularly in the past.

Note:  If alcohol is consumed, then the risk rises dramatically!

Additional info:

There may be a few differences between you and this other patient.

Firstly, it sounds like you were taking your medications over a period of time, and so, the numbers and types of you medications were consistent with someone who may have been under great pain and/or were opiod "tolerant". If this patient was "naive", the same medication that just helped you 'get by' would have been too strong for him.

Also, many people respond differently to different medications. This is related to your metabolism and has a basis in genetics. If this was his first time taking one or more of the drugs you listed, there's no way to know if they were more than his metabolism could handle.

Finally, if the patient was *not* new to these medications, and took them regularly, then a change in his lifestyle (drinking, food consumption, recent change in prescription) may be to blame. There's really no way to be sure without an autopsy and a thorough investigation of his medical records.

Answer 5

There shouldn't be any interactions between these that are inherently fatal, but there would be a good chance that someone who took all of these would stop breathing. It wouldn't be any specific medication that killed them.

There are lots of reasons why it could have affected them differently for example other drugs/alcohol present in their system. You can also build up a tolerance to those meds. for example my sister started out by taking a xanax 2xs a day and the occasional vicodine. The last time I spoke with her (years after she started the meds for anxiety and pain) she was taking around 8 xanax a day and several different opiate pain meds. I once took both a vicodine and a percocate at the same time because I was is so much pain (adenitis) and I almost stopped breathing.

I also have asthma, things like asthma, pneumonia, and emphazima can increase the risk to several of those drugs because you already have trouble with breathing. We had an elderly neighbor who had bronchitis, she went to the ER they sent her home with vicodine and she stopped breathing and died. The only other possibility I can think of is a possible allergic reaction. And these wouldn't have to be all new meds for that to happen, every time you are exposed to a medication the likelihood of you having a reaction exists.