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Spokane, Washington  Est. May 19, 1883
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Avoid poppy-seed muffins before drug test

Joe Graedon and Teresa Graedon King Features Syndicate

Q. I go to the pain center at our local hospital, and a few times a year we are given a urine test. Last week my urine test came out positive for morphine, and since I don’t take morphine, I was wondering what could cause this result. I have a lemon poppy-seed muffin and a cup of coffee for breakfast, a cheese sandwich for lunch with fruit and a normal dinner. I value my relationship with the pain center. I don’t take illegal drugs!

A. Your poppy-seed muffin is the most likely culprit. Sensitive drug tests can pick up traces of opium in the poppy seeds even though you can’t get high on a muffin or bagel. This can lead to a false-positive test for morphine or codeine for up to two days. To avoid problems on another test, you will need to change your breakfast pattern or explain your diet to the person in charge.

Q. My husband takes 5 mg of Lipitor per day, but our pharmacy sends him 45 10-mg tabs for a 90-day refill, and he has to cut them in half. The tablets cut unevenly and with difficulty even with the special tablet-cutter he bought. Is 10 mg the lowest dose?

A. The lowest dose of Lipitor is 10 mg. Insurance companies and HMOs have discovered that they can save money by asking patients to split some pills in half. That’s because the price is frequently about the same regardless of the dose, which tells you everything you need to know about the cost of the raw ingredients.

Some pill-splitters are easier to use than others. Ask your pharmacist if he or she has a recommendation.

Q. I take Viagra or Levitra to have sex occasionally. I like grapefruit and usually buy a case when they come into season.

There is a warning about eating grapefruit or drinking grapefruit juice while on either of those medications. How long before or after using Viagra or Levitra is it safe to have grapefruit or grapefruit juice? I’d appreciate any information you have.

A. Your pharmacist may have cautioned you against grapefruit, but when we checked we found no warning in the official information for these medications.

We asked the Food and Drug Administration and were informed that “there is nothing in the labeling about the interaction with grapefruit. It does appear in the Cialis, but not the Viagra, labeling.” The maker of Levitra also has no such warning, and a spokesman dismissed our concerns when we brought your question to his attention.

Grapefruit affects dozens of drugs, and it is clear that the FDA does not have a standardized approach to such interactions. Toxicity can be increased because grapefruit boosts blood levels of the drugs. The effect can last for up to two days.

For more information on this topic, we are sending you our Guide to Grapefruit Interactions, with a list of medications that are susceptible and some that might be safer alternatives. Anyone who would like a copy, please send $2 in check or money order with a long (No. 10), stamped (60 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. J-91, P.O. Box 52027, Durham, NC 27717-2027.

Q. I read in your column that there is a program for low-income families to receive prescription drugs through their doctor at no cost. How can I find out about this program?

A. The best way is through the Web site www.helpingpatients.org. It lists pharmaceutical-industry and state-assistance programs.

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