Your sleep-related problems come, in my judgment, from taking albuterol in two forms: by itself, as the metabolite of Xopenex, and in combination with ipratropium in the Combivent. I think Combivent, used as needed, is a good rescue (quick-relief) inhaler for COPD patients.

If your doctor agrees that adjusting the medications is advisable, my recommendation would be to start the Spiriva and then taper the Symbicort, Pulmicort and Xopenex by cutting the doses 50 percent for the first week, another 50 percent for the second week, and then discontinuing them. From then on, I would use the Spiriva each morning and the Combivent at bedtime if needed.

As for the Zocor, if you don't already have cardiovascular disease at your age you aren't going to get it, and the risks posed by this drug are much greater than any likely benefits. It's almost certainly the cause of your muscle pain and weakness. Stopping it will not only make the muscle problems go away but also obviate the need for the Lyrica. I'd recommend talking with your doctor about discontinuing the Zocor and then, after 30 days, cutting the dose of the Lyrica in half for a week and then discontinuing it, too.

Following this plan should improve your condition, save you some money and give you a better quality of life.

Ask the Pharmacist is written by Armon B. Neel Jr., PharmD, CGP, in collaboration with journalist Bill Hogan. They are coauthors of Are Your Prescriptions Killing You?, which was published last year by Atria Books.

Information contained in the Ask the Pharmacist column by Dr. Armon B. Neel Jr. is intended to help individuals and their families become more informed about medication usage and interactions, and be better health care consumers. Any advice or information provided should not be followed in lieu of a personal consultation with a trained medical professional.

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