By Jennifer Maloney

Newsday

(MCT)

NEW YORK _ A doctor never would have prescribed in combination the dangerous cocktail of narcotics and depressants that killed Heath Ledger because they were so similar, doctors and pharmacists said Wednesday.

The six prescription drugs, the types of which the New York City medical examiner made public Wednesday, likely slowed the actor’s breathing, causing his blood oxygen level to drop and organs to shut down, doctors said.

Two of the medicines were powerful narcotic painkillers: oxycodone, used in OxyContin, Percodan and Percocet; and hydrocodone, used in a number of painkillers, including Vicodin.

Three were sedatives with similar chemical makeups that treat anxiety or insomnia. The generic names are diazepam, temazepam, and alprazolam; they are sold as Valium, Xanax and Restoril. The final drug was doxylamine, an antihistamine found in over-the-counter cold medicines and the sleep aid Unisom.

Together, these drugs magnify each other. “One and one doesn’t give you two, it gives you five,” said Dr. Mark Hoornstra, director of emergency medicine at St. Francis Hospital in Roslyn, N.Y.

The medical examiner said Ledger died from “acute intoxication,” which means he had not been abusing these drugs because he had not built up a tolerance to them, said Dr. Maria Fernanda Gomez, a medical psychiatrist at Montefiore Medical Center. “Younger people metabolize these drugs very quickly,” Gomez said. “You take one pill, you don’t feel the side effects, then you take another one.”

A patient would have to go to multiple doctors and pharmacies to get prescriptions for these drugs, medical professionals said. Doctors warned that patients should tell physicians about all their medications. “Many, many patients have multiple doctors, and they may tell one doctor they can’t sleep and they may tell another doctor they can’t sleep,” Hoornstra said.

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(Newsday correspondent Rocco Parascandola contributed to this report.)

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© 2008, Newsday.

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