Q: I recently had to have additional surgery after a total knee replacement. Nothing the hospital gave me for pain helped at all.
My neighbor told me that after her surgery, she had the same experience. Her doctor told her that certain individuals on antidepressants have an issue with opioids not helping with pain. The research was done at Stanford in 2019.
I'm only taking Tylenol, and I am still in a lot of pain. Why don't surgeons know that antidepressants make opioids ineffective?
A: We are so sorry to learn you are in pain after follow-up knee surgery. We are, however, grateful that you told us about this research (PLoS One, Feb. 6, 2019). More surgeons should be aware of this interaction.
Although opioid-type medications have come under a lot of scrutiny in recent years, they are still the first-line treatment for postoperative pain. At last count, 44 million Americans take antidepressant medications such as bupropion, duloxetine, fluoxetine, and paroxetine. These antidepressants block the action of an enzyme called CYP2D6. This natural compound is essential for activating pain relievers such as hydrocodone, codeine and tramadol (Expert Opinion in Drug Safety, Feb. 22, 2023).
That explains why people taking such antidepressants might not get adequate pain relief from opioid-type analgesics. In addition, they seem more susceptible to post-op delirium and may need longer hospitalization.
Certain opioids do not appear to require activation to work. Consequently, surgeons may want to consider whether a drug such as methadone, oxycodone or morphine might be better for pain relief in patients taking an antidepressant that could interfere with CYP2D6.
Q: Heart disease runs in my family. As a result, my doctor started me on atorvastatin. Shortly thereafter, I developed joint pain, high blood sugar and elevated creatinine. I also developed muscle pain and fatigue that interfered with my daily walks.
When blood tests showed that I was on the verge of becoming diabetic, I asked for a test that you have discussed, Lp(a).
My level was 248 nmol/L, while normal is 75. I have read that statins can increase Lp(a) levels, but that niacin and aspirin might be helpful for someone like me. Thoughts?
A: We spoke recently with one of the country's leading experts on lipoprotein a, Dr. Sam Tsimikas. Elevated levels of Lp(a) often run in families and might explain your family history of heart disease.
Rather than controlling Lp(a), statins may raise the level.
Since this compound increases the risk for blood clots and clogged arteries, doctors sometimes prescribe aspirin for patients like you (JACC: Advances, Dec. 6, 2023). You should ask your doctor if that would be appropriate. Niacin may also be helpful.
Q: I have read that some acne products contain benzene, which is a carcinogen. What's the latest information on this problem?
A: The Food and Drug Administration announced voluntary recalls of certain acne products on March 11, 2025. The agency reassured consumers that "more than 90% of tested products had undetectable or extremely low levels of benzene." According to the agency, companies withdrawing products include La Roche-Posay, Walgreens, Proactiv and SLMD.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com.