1/2 Rocket PM BG 108 -NS-QUESTIONS

morning all
sorry if i don't visit condos today
thank you for the well wishes

last night i gave Rocket a reduced dose of Tramadol...literally half the gelcap that was Rx to him....it has been quite the eventful night...and i'm more than empty....if there is such a word....

here is yesterday viewtopic.php?f=9&t=33362&start=100

he peed twice in his bed....before the drug fully kicked in i managed to get him from under the bed and i fed him some FF with gravy in it...i figure he might as well get something in his system before he stops eating on me and the gravy he did lick and left the chunks....

about 1 hr later (12:30 midnight)....i gave some more gravy....he didn't want baby food or reg food or any of the other foods already in the fridge even heated up....he slept for about 45 mins....then got up and headed straight to drink water....then i found him laying in the bathroom all tired....so picked him up and took him to bed....

his shaking has gotten a lot milder....actually when he slept there was no shaking....this morning so far has been eventful....even after giving him subq fluids he still goes to drink water and seems nauseaus...even after his zofran...he is sitting on his bed in the bedroom....i have changed his blankets and he did poo and pee in the litter box about half hr ago....he ate well at 5 am....and then at 9 am....mind you i had to add gravy to his reg food

so i knew i was not gonna give him the insulin as i am not up to speed with wanting to deal with him going hypo on me....i remember Keri and Mowgli having a bad experience with that...

so now what would have been his +4.5 of after amps he is 126.......

i'm soooooo upset....trembling is mild now...he is due to have his next tramadol at 11:30 am....1 1/2 hr away....he is just staring out the window...didn't seem to have slept much....

i really do not know what to do.....

do i just forget about the tramadol? do i continue?

i think i am ready for a nervous breakdown...have only slept probably 2 hrs and not straight thru again....

i wish i knew what to do.....i'm at a loss....

he is all wrapped up in his clean blankets on his heated bed...but not sleeping....him peeing twice on the bed i assume it's due to the tramadol....i can hear his tummy bubbling up....and yesterday night he was burping....

i don't know anymore

 

Re: 1/2 Rocket AM BG 104 -NS

just sending you our support...rocket...we're thinking of you and claudia and sending all our healing your way...

 

Re: 1/2 Rocket AM BG 104 -NS

Hi Claudia,

What a good bean you are! You are doing a great job, keep it up. The less trembling has to be a good sign. :razz:

 

Re: 1/2 Rocket AM BG 104 -NS

(((((((Claudia & Rocket)))))))
I don't know what advice to give you, having no experience with the medications you are using, but I had the thought that perhaps Rocket might be having an allergic reaction to one or more of the drugs (or the combination of drugs). It's good that the trembling is milder. Can you attribute that to any changes in his medications or doses of medicines? Several years ago I had an extreme, (anaphalaxis) reaction to Amoxicillin and wound up in the ER. One of my symptoms was trembling.

I do so hope that you and Rocket will have a better day today and that you both will get some sleep. You are in our thoughts and our prayers.

Ella & Rusty

 

Re: 1/2 Rocket AM BG 104 -NS--question

he's been on the same meds now for over a yr..some over 2 yrs
only new med is the tramadol last night
i've got him on my lap in bed he is sleeping eyes not fully closed but no trembling

will give next tramadol (perhaps reduce the reduced dose) in 45 mins

thoughts?

 

Re: 1/2 Rocket AM BG 104 -NS

Claudia.. Lots of support for you and prayers, healing/feel better vines for Rocket..

Hang in there, you'll be able to see your regular vet soon.

Hope you can eat/sleep a little today... :YMHUG:

 

Re: 1/2 Rocket AM BG 104 -NS

(((claudia))) you have to be exhausted.
all i can offer is support and positive thoughts. the questions you're asking are beyond my experience. all i can think of is posting specific medical questions on the Health forum, sending a PM to Jess & Earl (vet tech) asking her to look in on your threads, and talking to a vet.
hope rocket has a better day and you can get some rest...

 

Re: 1/2 Rocket AM BG 104 -NS

i can't think straight anymore.....sorry for not posting there for help.....i feel my head will explode...next tramadol at 11:30 MT

 

Re: 1/2 Rocket AM BG 104 -NS--question

Oh dear Claudia....I wish some of us could be there just to sit with you. I think we've all been there with a desperately ill baby and not known what to do...I know
we have. You are the best mamabean....if your love alone could cure whatever ails Rocket, he would be 150% better immediately and never be ill again. Some of his
symptoms sound so much like advanced CKD but his numbers don't show it. I know they say treat the cat, not the numbers but you can't even begin to know what to
give him if his numbers haven't changed. I am hoping you can just keep him comfy and stable today and get some rest and take him to your regular vet first thing tomorrow. Sending healing vines, snowflakes, and all our thoughts and prayers to you.

 

Re: 1/2 Rocket AM BG 104 -NS--question

claudia, there's nothing wrong with asking for medical advice here. cross-posting on health will just get the attention of a broader audience... some experienced eyes who may not visit the support groups on a regular basis.
are you able to lay down for a little bit after you give rocket his meds?

 

Re: 1/2 Rocket AM BG 104 -NS--question

((((Claudia)))) I think its a good sign that he's eating and that the shaking is less. Since Tramadol is an opiate (I think), that may be why he isn't sleeping and peed in his bed. I pm'd Jess & Earl and I hope she is around and can post here. Please try to get some sleep. You need to keep your strength up in order to help Rocket. :YMHUG:

 

Re: 1/2 Rocket AM BG 104 -NS--question

you poor thing you must be at your wits end. Can't offer any advice but a cyber hug and my prayers.

 

Re: 1/2 Rocket AM BG 104 -NS--question

depending on what sort of NEW reaction he has to the tramadol i may not be able to sleep....all depends on that....
i'm feeding him now...waiting for 11:30 to come around to give the tramadol...giving same dose as last night....see how that goes....
i have not even emailed his reg vet...have not translated his lab reports either...i'm way too tired to do it...no energy either...coffee is not working...
the trembling has improved...and he is now eating his reg food no gravy in it....no assist feed either....
i'm locked in the room with him....DH and parents will have to keep each other entertained! i have blocked the bed so he can't go under it....he was even snoring a lil while ago even though his eyes were not fully closed....his eyes are dilated too....

 

Re: 1/2 Rocket AM BG 104 -NS--question

TRamadol can lower BGs.i know this from my experience as well as surfing i found an article that also supprts this. it is in think tank if yu want to read it. the main thing with the tram is you want to definately keep an eye on his numbers.as well as have HC in case yu need it. Tram is an opiate agonist., it can make a cat drowsy.I dont know if your vet is aware of there is an interaction between zofran and the tram as far as when they are taken they can negate the effects of each other.. you might want to call a pharmacy and pass this by a pharmicist. my dose was 12.5 mg but i had to half that dose as the 12.5 was too much. It can also affect appetite by decreasing it. i stopped using tram for these reasons. i was using it for pain.but due to the side effects and not seeing much difference there i stopped it. yu were wise to not shoot.just be more diligent on your testing if he has to be on the tramadol and make sure he has Hc if need be.subqs as well can affect numbers to be lower.

 

Re: 1/2 Rocket AM BG 104 -NS--question

Claudia, I don't have experience with Rocket's issues either, so I'm no help with advice. It's encouraging that he's eating his regular food on his own, and that the trembling is reduced. I hope he continues to improve.

I echo everyone else's concern about you getting some rest. Can you get DH to check on Rocket while you take a nap?

 

Re: 1/2 Rocket AM BG 104 -NS--question

DH is of the opinion that the less testing the better...if Rocket wants to be left alone so be it...if Rocket doesnt wanna eat then he is not hungry....MEN! that's all i have to say.... MEN!

 

Re: 1/2 Rocket AM BG 104 -NS--question

Yes, men can be big pia's sometimes, especially when it comes to our fur babies. Guess they missed those maternal instincts, huh.
I'm sorry you are having such a hard time of it. I really have no advise to offer except to try to relax and get some rest. You really aren't goig to be of anyhelp to Rocket being stressed out.
Sending some white lights and positive vines to Rocket and some peaceful, restful vines to you. (((Claudia & Rocket)))

 

Re: 1/2 Rocket AM BG 104 -NS--question

bump

 

Re: 1/2 Rocket AM BG 104 -NS--question

Claudia.. we are all thinking of you & can hear the stressful situation more & more, until you get some rest - it is going to continue to get worse. Is there anything we can do? (email the regular vet? etc. for you?) I would think there would be someone there who could help you since your parents are there too, even if it is only to keep an eye on him & make sure he has food available. They may not give the quality of care that you would give, but sometimes you have to let go & take care of you for a few hours :YMHUG:

 

Re: 1/2 Rocket AM BG 104 -NS--question

claudia, i'm sure dh and parents care about you very much. please ask for their help. they can keep an eye on rocket for an hour or two. it sounds very much like you need to lay down before you fall down.

girlcat is expressing the same concern others have expressed about the possible interaction between zofran and tramadol. she suggested calling a pharmacist for more information. i agree with her. perhaps dh can do this while you take a nap...

 

Re: 1/2 Rocket AM BG 104 -NS--question

no interaction between tramadol and phenobarbital and zofran....pharmacist said to keep in mind she is giving me info on humans not cats...she was RUDE too

everyone is out...have place to myself...

will see if i can take a nap with Rocket but doubt it...he is in the bathroom just sitting there....

 

Re: 1/2 Rocket AM BG 104 -NS--question

I hope you can find a way to get some rest today, Claudia...both for yours and Rockets sake.
Please do keep in mind that Rocket is on some big time medications, all combined. At this point, I wonder if even a vet would be able to distinquish the difference between if its due to drug interactions or something else going on. I went through similar things with Latte...was it the medications or was she really unwell. Hopefully once you get to your regular vet, they will be able to help make that distinction by doing another exam and labs.

Here are some links about the interactions:
http://www.drugs.com/interactions-check.php?drug_list=1846-0,2221-0,1752-1120
Interactions between zofran, pheno, and tramadol from drugs.com (Moderate interaction)

http://www.drugs.com/zofran.html
Please note, a possible side effect from zofran/ondansetron is listed to be shivering. I understand he has been on it for a while. Latte's specialist was never keen on my long term use of it because such little was known if its long term affects. I still used it because it helped and it was worth the potential risk in our case.

http://www.drsfostersmith.com/Rx_Info_Sheets/rx_tramadol.pdf
This is the client information sheet for tramadol (geared toward pets)

For future reference, when you are rested and feeling better. Info on pain management and options to discuss with your vet:
http://www.vasg.org/chronic_pain_management.htm

I hope Jess can stop by and help you out.
Is there anything else WE can help you with? Please dont hesitate to ask. And do ask your family for some support. The worst they will say is no.
Will continue to send positive vibes to both you and Rocket. (((((((((claudia))))))))) ((((((((((rocket))))))))

ETA: The links regarding interactions ARE for humans.

 

Re: 1/2 Rocket AM BG 104 -NS--question

Can you bring him to bed with you, or lie down next to him? When Donny would throw me low numbers in the wee hours, I would just curl up on the floor next to him wherever he was sleeping until the next pokey time.

I will light a candle for you both tonight at church.

MJ&Donovan

 

Re: 1/2 Rocket AM BG 104 -NS--question

Claudia:

In addition to the pharmacist being rude, she's not knowledgeable. The link that Carolyn provided as well as other links I've found suggests that if ondansatron and Tramadol are co-administered, there is not as potent of a pain management effect from the Tramadol. There are no truly adverse side effects it's just that the analgesic effect is reduced.

 

Re: 1/2 Rocket AM BG 104 -NS--question

((((((((((((Claudia & Rocket, too)))))))))))) I have been following, but staying out of the way. Sending white light and healing vines. The one thing i know is that you do need to get some rest so that you can think. Please take care of yourself! Will he stay on the bed with you so you can nap?

You just started the Tramadol last night? and he is now eating and shaking less? From what Sienne says that sounds like it should not cause more ill effects and it seems to have helped at least a little.

 

Re: 1/2 Rocket AM BG 104 -NS--question

sending more healing vines and white light for Rocket ((((((Claudia))) hang in there we are here for you :YMHUG: :YMHUG: cat_pet_icon

 

Re: 1/2 Rocket AM BG 104 -NS--question

i managed to get him to bed with me and i slept about 1 1/2 hr off and on....he seemed ok not shaking...resting....but did not close his eyes much unless i closed them for him

what could have been his +9.5 108 test
not wanting to eat so i offered reg food with some gravy in it
he is laying in the litter box

will try to read those links Carolyn...thank you

been trying to get thru the vet clinic to see if they're open tomorrow but get vm saying if ER to go to the nearest ER....their website doesn't have their hours for the holidays....will call them at 7:30 am tomorrow....hopefully they will be open

i wonder if i should stop the tramadol for tonight.....i don't kow what to do....

 

Re: 1/2 Rocket AM BG 104 -NS--question

Claudia...I can't answer your question about stopping the tramadol. I used it a few times on Gracie with her bladder spasms and didn't like the side effects on HER...which are not the same as what you are seeing with Rocket. I am glad you got some rest but you must have more. Sending more healing vines, light, and snowflakes.

 

Re: 1/2 Rocket AM BG 104 -NS--question

if i'm ever really late giving the zofran he doesn't want to eat and sits near the waterbowl.....so i know he needs it....half hr after pilling him the zofran and after he sleeps it off...he is ready to eat and seems fine....

 

Re: 1/2 Rocket AM BG 104 -NS--question

(((Claudia and Rocket)))

Sending healing vines for Rocket and calming vines to you. I hope you got to get some sleep Claudia and I hope Rocket is doing better. You must be a wreck.

My thoughts and prayers are with you.

jan and sara

 

Re: 1/2 Rocket PM BG 108 -NS-Will stop Tramadol

well i can not stop the phenobarbital....so tonight he won't get the tramadol...what would have been his pmps of 108 even though he ate baby food 20 mins prior....

i guess insulin can be started tomorrow for amps...right? or do i hold off on that too?

hoping vet is open tomorrow....answering service doesn't know....
so i will call first thing....

i hope things go better tonight....he gets the pheno in 15 mins....as per the zofran....i will see if he needs it at 9 pm....

i'm still pretty tired....so if he doesn't get the tramadol i hope the one he got at 11:30 am will slowly wear off....

 

Re: 1/2 Rocket PM BG 108 -NS-Will stop Tramadol

bump

 

Re: 1/2 Rocket PM BG 108 -NS-Will stop Tramadol

Claudia:

Help me to understand how you're thinking about the meds. From what I understand, the only interaction that is noteworthy is the tendency of Tramadol to lower BG. You can hold off on insulin or shoot a lower dose if this is a concern.

The interaction between the ondansatron and Tramadol would make the Tramadol a little less effective in its ability to help manage pain.

If Rocket is feeling better and based on what the ER vet suggested with respect to pain management, it seems like the Tramadol was helping today.

I don't want to tell you what to do. Rocket's situation is complex and you are there, we're not. I just want to make sure I'm understanding how you're thinking.

 

Re: 1/2 Rocket PM BG 108 -NS-Will stop Tramadol

Hi Claudia

This thread is long and complicated and I'm sorry if I am repeating anything that others have said.

First I noticed that you changed the heading to stopping tramadol. Is this because it caused him bad side effects, or is it because there were a lot of scary posts about potential side effects/side effects that other people noticed? I think the primary rule outs for his trembling are brain disease or pain, so if you thought it was helping, please do not let the posts in this thread dissuade you from continuing a drug that appears to be making him feel better. As far as the Zofran + tramadol combo, it is very commonly used in dogs with cancer. Cats, as we know, are not small dogs, but as there are no reports on dogs needing significantly higher doses of tramadol when on Zofran, this goes in the 'keep an eye out b/c theoretically possible' category. And for some reason I thought it could go both ways, add to efficacy or take away from it. Dunno why that idea is in my head but I'll investigate later Point is, would not let your cat's ondansetron alone keep you from tryng tramadol for pain.

I mention brain disease mostly because of his age and his previous seizures. Brain problems can cause nearly any symptom, so I have to mention this for an elderly cat with a history of seizures, I have no other particular reason to consider it here.

Where is the bloodwork from the ER visit? Do you have CPK and liver values? What are his latest renal values? Thyroid? I didn't see this in a scan of the thread.

Hypertension is also a potential cause of trembling and this is more possible given his renal disease, but I am not so impressed with the oscillometric blood pressure devices for cats (the type you use at home) that I'd hang my hat on it. When you see your vet s/he can (hopefully) get a Doppler reading. An amlodipine (blood pressure reducing medication) trial isn't unreasonable, if simple pain management doesn't help.

Also, just to cover the bases, there are no potential toxins that he could have gotten into? No plants, new cleaners, new carpets, furniture, utensils, drugs (legal or illegal), etc? You needn't answer that last bit on-thread, you can PM me or speak to your vet or the vet poison control line. This is more likely for a dog of course but it's important not to forget the most simple things.

I hope you and Rocket are both feeling much better. Please post back any specific questions ok?

 

Re: 1/2 Rocket PM BG 108 -NS-insulin ?

Jess,
thank you for taking the time to reply

Rocket officially has not been DX with seizures...i put that on his profile/signature cause he has been taking the pheno since Jul 2008....he has never had seizures...it all started with his head twitching/body shaking/trembling pretty much 24/7....no MRI or SCAN was taken....taking him to see a brain dr meant travelling to another province/city and it was not a guarantee they would find anything....for financial reasons and with no possible diagnosis...the vet and IM vet (both of them) decided to put him on the pheno....

since i've never been convinced he has seizures....to my begging his vet...we have had 3 failed attempts to wean him off of the pheno....last attempt was made Mar 2010 only to get to make it to half the 2nd week of weanning....as you know it needs to be done gradually....he is on the lowest dose possible for a cat his size (current weight is 7.17 kgs...back then he was 7.45 kgs).....dose is 7.5 mgs bid....and yes pheno levels have been taken and though the levels are low that dose seems to work with him per the vet....

what worries me giving the tramadol it's not so much the zofran interaction but rather the pheno interaction...i can stop giving either tramadol and/or zofran (until he sees the vet) but i can not stop the pheno...so the concern lies with the pheno and not so much the zofran

the trembling has stopped since i gave him the tramadol...mind you i gave him half the dose Rx by the ER vet....and even with that...he is spaced out....not eating well....circles his litter box and no pee....last pee was this morning....lies by the waterbowl....when i think he is relaxed sleeping i see his eyes fully open....

do they sleep with their eyes open? no third eyelid seen...this is new behaviour....so since i see him more awake than asleep i would say he has not slept well eiher....so the poor thing must be tired...so being spaced out is not helping the sleeping

those are concerns....and though the trembling has subsided....i don't know if this drug will do harm to his liver....i give him Denosyl as supplement but since reading up SAMe is not to be given with Tramadol....and Denosyl is similar in supplement then i have stopped giving him that too...

the lab report on the CBC was posted on yesterday's thread....sorry i have not been able to translate (and i keep mentioning) the lab report....i'm in Canada so my #s are diff than in the USA....been running on empty myself....so have not updated his lab report tab....

i have basically taken away all supplements even the Aluminum hydroxide....until he sees his vet...as the ER vet basically only wanted to either give buprenex in injection form every 6-8 hrs or me give tramadol....buying time until he sees his vet...which i still don't know if they're open tomorrow....keep calling only to be directed to an answering service and they can't give me that info....

as per anything new in the household....the answer is NO...only my parents visiting....they leave on tuesday night and have been here 3 weeks....that in itself should not have been stressful for him as they were here in the Summer when DH was in the hospital and my mother was the one feeding/pilling Rocket while i was at the hospital with DH....i'm extremely careful with what i use on the hardwood (no carpet here)....so the answer is NOTHING NEW....

the only meds he has received are his pheno, zantac, zofran, LRS, and the Tramadol....he needs his Calcitriol tomorrow afternoon (i can not withhold this med from him and he gets it every 3.5 days).....and since i gave him the tramadol last night and this morning...i did not give insulin....

i do know his issues are complex.....and taking his bp at the vet...the readings are always really high...but they ALWAYS dismiss the readings...hence why i bought a machine to do it at home and sort of keep an eye on him.....even at the ER vet yesterday NO TEMP was taken....so if they have all the equipment and the knowledge....why don't they use it?

sorry...i'm tired...and frustrated....

eta: thyroid results won't be ready until tuesday they said...as they use a different lab and was not open over the weekend....

this is what it is as IS #s

CRE 241 (27-186 umol)
PHOS 1.70 (1.09-2.74 mmol)
BUN 25 (4-11 range mmol)

 

Re: 1/2 Rocket PM BG 108 -NS-insulin ?

Jess does know her stuff-I hope with all my heart that Rocket will be better tomorrow--Holding you both close to my heart!

 

Re: 1/2 Rocket PM BG 108 -NS-insulin ?

is it normal for Rocket now to be peeing on my bed or his bed? is this a side effect of the Tramadol? should i be concerned with this or just treat it as a side effect?

he just peed on my bed....while supposedly sleeping....

 

bump

 

Re: 1/2 Rocket PM BG 108 -NS-insulin ?

Hi Claudia

Well the twitching could certainly have been focal seizures, but hard to tell. Is this trembling the same as the trembling 2 years ago? It's possible that the pheno is just sedating him out of the trembling, up to this point, but if he was having tics that is less likely.

Did you wean him to the lowest possible dose because he was having side effects at higher doses?

The risk is for increased sedation, which it sounds like is occurring. Some cats don't tolerate pheno well because it can cause profound sedation (and general lack of interest in everything).

No cats don't sleep with their eyes open; if he is not unconscious, that means he is completely zoinked. The tramadol plus the pheno are over-sedating him, most likely. Now it's unclear if the tramadol has stopped the trembling because it is covering his pain, or if he is just too sedated. If he was on a higher dose of pheno without issues, and you think this trembling resembles the before-trembling, you could ask your vet about notching his pheno up.

Cats tolerate pheno better, liver-wise, than dogs do so I wouldn't worry about a few skipped days of Denosyl. Did you get liver values from the ER? Were they normal?

Do you mean his regular vet or the internist? Is the other one in tomorrow? Can't the answering service page one of them during the day tomorrow?

(And why can't an answering service state hours of operation? They know when they themselves are working, don't they? Ridiculous.)

Is his BG normal? Or he needs insulin but you didn't give it for fear of lowering his BG?

How high is really high? I have taken the BP of some pretty angry cats and none of them were consistently over 200mmHg. I think Rocket may need pain control, and since the tramadol is too sedating in combo with pheno then you'll have to try Buprenex. (The injectable form can be given buccally, FYI.) If the trembling continues, discuss a trial of amlodipine with your vet. This is the best anti-hypertensive medication in cats -- for a truly hypertensive cat, nothing else will help in the same way.

 

he circled the litter box a while and then finally he peed there too....

not even with all the other meds he is on has he ever peed on himself or my bed or odd places....this is sooooo disturbing

he gets quite the appetite about half hr after the pheno....which in a way i haven't have the need to give cypro

 

lowest dose of pheno cause bad reaction to start and then he settled with that dose...
twitching trembling shaking was like parkinsons like 2 yrs ago...this time the trembling is more inside less noticeable unless one touches him
normally he gets the pheno...sleeps it off for half hr then gets up to eat...then goes back to bed for another half hr then is out and about around us being sociable...so this over sedation is new
normal liver values within range....
the answering service is routed to another ER clinic who doesn't know when the cat clinic will be open...they don't have that info per them....they said if i don't get a hold of his reg vet first thing tomorrow to take him back to the ER i took him or take him to them.....that is the kind of answering service they have
i'm pretty upset....at that

he seems nervous and frightened...i think i will stop the tramadol and wait for it to wear off

so with that said....do i give insulin again tomorrow....values are on SS what would have been his pmps was 108

bp readings have been high 100s close to mid 200s but they always dismiss it....and not always taken either...not even his temp

he is known to be the CRANKIEST CAT they treat there and i'm the only owner who asks for copies of lab reports..

the peeing is conserning

 

Sending good wishes to you and Rocket, Claudia. Remember to get some sleep yourself

 

Hopefully, Jess will be able to answer you about the peeing. As an ECID example, one of my kitties did pee himself. It was due to his being overly sedated. He was sound asleep on my bed and peed.

 

Yes the over-sedation could make him pee on himself, as Sienna said.

 

Re: 1/2 Rocket AM BG 104 -NS--question

tramadol has the ability to dramatically and unpredictably lower bgs in cats that take it.as well as drowsiness and being off appetite. i know this from experience as well as others who have had the exact same thing happen with their cats.

in addition doctors as well as vets often do not know of drug interactions when they write for drugs. if at all possible have all your meds filled in one place and ask every time you have a new med filled if there is any drug interactions with said drugs. also should anyone at any time be treated rudely by a pharmacist get their name and reprt them to corporate. most likely alot of times one is not talking to a pharmacist.regardless of who it is report them. pharmacy computer systems are set up to check for drug interactions even if its a mild one,computers will pick it up. thats why one should try to fill their meds in 1 place.or if thats not happening then inform the pharmacist (not the tech ,not the clerk) about what other meds the patient is taking.