The Pillboard, written by Rick
Hogle, owner of the Fairfax Pharmacy, will continue to be a regular monthly
feature of the Fairfax News. Each month the
Pillboard information will be posted to this page, with the topics
indexed in the table below. The table also shows which month's issue of the
Fairfax News contains which topics. A year's worth of topics are
archived here.
MANY WOMEN WOULD LIKE TO GET THE BENEFIT OF ESTROGEN without the risks and side effects. Topical estrogen is available in several dosage forms including gels, patches and sprays, and may be an acceptable alternative. Topical estrogens will reduce the incidence of hot flashes. They are less likely to cause nausea and produce more even blood levels. Because topical meds do not pass though the liver first, they don't increase triglycerides and are less likely to cause blood clots.
COLD AND FLU SEASON MEANS MANY PEOPLE ARE LOOKING FOR SYMPTOM RELIEF FROM SUPPLEMENTS. Saline irrigation with a neti pot or saline nasal spray may reduce sore throat, congestion and cough. Zinc lozenges, if used at onset of symptoms, and Echinacea can modestly help decrease the duration and severity of colds. Zinc can cause a metallic taste and Echinacea should not be taken by people allergic to ragweed. Vitamin C is often taken in high does during colds. It has a questionable benefit and high doses may cause diarrhea. Vitamin D, American ginseng, and lactobacillus probiotics appear to reduce the incidence and severity of upper respiratory infections. Individuals on blood thinners should use caution with ginseng as it may affect INRs. Elderberry might shorten flu symptoms by a few days.
SOME PATIENTS TRYING TO STOP THEIR PROTON PUMP INHIBITOR (PPI) may find that symptoms come raging back. Products like Prilosec, Nexium and Prevacid, even when taken for a couple of months, then stopped abruptly, may lead to heartburn and dyspepsia. This may even happen when the symptoms weren't there to begin with. Tapering the PPI over a 4 to 6 week period and using an H2 Blocker like Pepcid or Tagamet and liquid antacids on the off days may help relieve rebound symptoms and allow stopping of the PPI.
THERE ARE QUESTIONS ARISING ABOUT HOW LONG WOMEN SHOULD TAKE MEDS FOR OSTEOPOROSIS. Drugs like Actonel and Fosamax can stay in the bones for years and effects can last when the therapy stops. Studies show that taking Fosamax longer than 5 years and Actonel longer than 3 years is not associated with preventing many more fractures. Long term use might increase the risk of femur fractures that are not associated with trauma and might also reduce bone turnover, delaying healing of micro-cracks that sometimes occur with normal activity. Patients at high risk due to very low bone density, corticosteroids or previous fractures should have long term therapy. For patients stopping these drugs, bone density should be checked every 2 years and therapy restarted if it falls by 4% to 5%.
February 2009
INFANTS AND CHILDREN NEED TO GET MORE VITAMIN D in their diet according to recent recommendations from the American Academy of Pediatrics.
The new daily-recommended amount is 400 IU of vitamin D, double the previous amount. Dietary sources of vitamin D include milk and infant formula however a baby or child needs to drink a least a quart a day of milk or formula to get 400 IU. Breastfed babies fare no better. Supplements such as Tri-Vi-Sol or Poly-Vi-Sol are recommended. Take care not to exceed the daily max of 1000 IU/day for infants under 12 months or 2000 IU/day for older children and adults.
PARENTS SHOULD NOT USE DOSING CUPS OR HOUSEHOLD TEASPOONS to give medication to children or for themselves for that matter. A calibrated syringe or dosing spoon is the best method to measure children's medication. A teaspoonful is supposed to be 5mls however a household teaspoonful can vary from 2 1/2 to 7 1/2 mls. A dosing cup can be off even more depending on how the liquid level is read on the side of the cup. Inaccurate dosing obviously can lead to over or under dosing of medication. If a calibrated dosing device is provided with the product by the manufacturer than that should be used when dosing that product.
SEVERAL MEDICATIONS SHOULD NOT BE STOPPED ABRUPTLY and should be tapered off when discontinuing. Stopping beta blockers (atenolol, metoprolol, etc) and clonidine quickly can lead to rebound hypertension. SSRI and SNRI antidepressants (Paxil, Zoloft, Effexor) ought to also be tapered off since abruptly stopping can cause flu-like symptoms, anxiety and tremor. Benzodiazepines, especially short acting ones like alprazolam or lorazepam, should also be tapered off after chronic use. Other meds frequently needing dose tapering include oral corticosteroids, antiepileptics, tramadol, opiates, tricyclic antidepressants, baclofen and antipsychotics. Always talk to your health care provider before stopping any prescribed medication abruptly.
THE BEST TIME TO TAKE LEVOTHYROXINE IS FIRST THING IN THE MORNING ON AN EMPTY STOMACH. Fiber, iron, calcium and other substances, perhaps even coffee, might reduce absorption. Avoid eating for 30 minutes and taking supplements or antacids containing calcium, iron, magnesium or aluminum for at least 4 hours. Also avoid the prescription drugs sucralfate, orlistat and cholestyramine in the 4 hour time frame. The most important thing is to take the levothyroxine so if the wait is a problem then be consistent every day so that the dose absorbed is the same.
THE CENTERS FOR DISEASE CONTROL is considering recommending pneumococcal vaccine for all smokers over 18. Cigarette smoking is the leading risk factor for invasive pneumonia among health young adults. Just one cigarette a day doubles the risk. Quitting smoking is the best way to avoid the chance of developing the illness as risk decreases by 15% per year after quitting.
March 2010
MIGRAINE SUFFERERS USING SUMATRIPTAN (IMITREX) INJECTIONS now have another option that avoids the needle. Sumavel DosePro uses a burst of high pressure nitrogen gas to push the drug into the body. It works as quickly and as well as the needle but it is not pain-free. The DosePro causes more redness, swelling, bleeding and bruising than the needle. It is more expensive than the injection and patients wanting a fast action may want to try the needle injection or nasal spray first.
NETI POTS AND SALINE NASAL IRRIGATION ARE POPULAR METHODS FOR RELIEVING CONGESTION caused by allergies, colds and sinusitis. Recently it has been suggested that regular use may lead to an increase risk of sinus infection. There is no evidence that this is true, however some common sense practices are recommended. Rinsing should be limited to no more than once or twice daily. Clean the neti pot after each use and DO NOT share it with friends. Overuse can lead to irritation and drying out of the sinuses. Users that experience frequent sinus infections probably should discontinue use for a short period.
THERE APPEARS TO BE A SLIGHT REDUCTION IN BREAST CANCERS OCCURING IN WOMEN ON BONE STRENGTHENERS such as Fosamax, Boniva and Actonel. The studies do not prove that taking these drugs reduces risk. Women with low bone density probably have lower estrogen levels which results in lower breast cancer risks. The reduction in incidence might be a side benefit due to a possible toxic effect on cancer cells caused by the drug.
THERE IS INCREASING EVIDENCE THAT HIGH DOSE FOLIC ACID MAY INCREASE CANCER RISK. A few years back high dose B vitamins and folic acid were given to heart patients to reduce homocysteine levels. High levels are commonly associated with heart disease. The supplements reduced the homocysteine levels but did not improve outcomes and those patients have about a 3 in 1000 increase risk of prostate cancer and multiple colon polyps. For most people 400 mcg/day of folic acid is enough. Pregnant women and women of childbearing age should get up to 800mcg/day.
MOST KIDS PROBABLY DO NOT GET ENOUGH VITAMIN D. It is estimated that two out of three kids have below optimal levels of vitamin D. A cup of fortified milk contains only 100 IU of D…a kid would have to drink a quart of milk a day to get 400 IU. This is the recommended intake for children from birth through adolescence. Breast milk usually does not contain enough vitamin D. Supplements are a good idea in any age group. Actually up to 1000 IU per day for kids and 2000 IU for adults. Previous recommended doses were to prevent rickets but we now know that vitamin D has other benefits including improving immunity and cardiovascular health.
April 2009
LITHIUM OROTATE IS A DIETARY SUPPLEMENT promoted as "natural" or "organic" lithium. Available without a prescription, it is found in a product called Serenity as well as others and is promoted to treat stress, depression, mood swings and anxiety. There is about 5mg of lithium per 120mg tablet vs 60mg for each prescription tablet of 300mg of lithium carbonate. Patients needing lithium treatment should take the prescription strength under the guidance of a physician since there is no evidence the lithium orotate is effective and too much can be harmful. Lithium toxicity includes muscle weakness, diarrhea, vomiting, tremors and unsteadiness.
PATIENTS PREPARING FOR SURGERY SHOULD BE SURE TO LET THEIR SURGEON KNOW OF ALL THE NATURAL SUPPLEMENTS THEY MAY BE TAKING. Ginko can cause bleeding during and after surgery. Other supplements may do the same including garlic, ginger, vitamin E, saw palmetto, policosanol, willow bark as well as others. Sedation can be enhanced by valerian, kava and l-tryptophan. Ephedra, guarana, bitter orange increase blood pressure. St. John's wort can lead to vascular collapse during anesthesia. Most supplements should be stopped two weeks prior to surgery and not restarted until the surgeon believes the risk of bleeding has passed.
PATIENT TAKING BISPHOSPHONATES TO STRENGTHEN BONES should take care to follow good dental hygiene guidelines to avoid extractions or implants. Dentists are seeing some problems in these patients when an extraction or dental injury exposes the bone. Fosamax, Actonel and Boniva may reduce bone turnover that is critical for healing. Patients should be started on Peridex or Periogard (chlorhexedrine) rinse prior to extractions and continue until healed.
PARENTS ARE TURNING TO MENTHOL AND CAMPHOR RUBS as an alternative to oral meds that were used in the past to treat cold symptoms. This is not the best approach. They do not reliably treat congestion or cough and are toxic when not used correctly. There are about 10,000 reports to poison centers for camphor exposure each year. Usually a child ingests the product when it is left out or drinks the product used in vaporizers. They should only be used in children over 2 and never applied on broken skin or covered with a bandage. Applying under the nostrils is not advisable since it can actually increase mucus production and lead to more chance of ingestion. Better choices to treat congestion include saline nasal sprays, humidifiers and increasing fluid intake.
May 2009
MYTHS CONTINUE TO CAUSE FEARS IN PARENTS ABOUT PEDIATRIC VACCINES. Multiple vaccines do not overload the immune system. While there are more vaccines now, the number of antigens is miniscule when compared to exposure in the environment. Kids still need immunization even if other kids are getting them. “Herd immunity” decreases as fewer kids are immunized. The illnesses prevented ARE serious. Before measles vaccine-3 million contacted it, 48,000 were hospitalized and 500 died annually. Chickenpox causes one death in 200,000 infected infants; one death in 100,000 older kids and 1 in 500 are hospitalized. Vaccines are tested in more kids for longer periods than most drugs. Mercury poisoning is not a risk since today's vaccines do not contain thiomersol. The aluminum in baby formula is 10 times more than in their shots during the first six months.
NASAL DECONGESTANT SPRAYS SUCH AS AFRIN ARE THE CONGESTED PATIENTS BEST FRIEND for about 3 to 10 days. Then they try to stop them and the rebound congestion begins. The rebound can be worse than the original problem. Sometimes an effective way to use and discontinue nasal sprays is to apply only in one nostril at a time. Occasionally a prescribed nasal steroid spray started one week prior to stopping the decongestant and continuing for two to six weeks can also get patients over the hump. Oral steroids or pseudoephedrine may also be effective in getting “off” the decongestant nasal spray.
MANY PATIENTS TAKING PLAVIX OR ASPIRIN MAY BE PRESCRIBED A PROTON PUMP INHIBITOR especially if they are prone to ulcers or are taking NSAIDS for arthritis. This may present a problem if the right PPI is not chosen. Omeprazole (Prilosec) interferes with the conversion of Plavix to its active form. This could increase the risk of clotting. A better choice is pantoprazole (Protonix) which appears to be the least likely PPI to interact with the Plavix.
A RECENT STUDY HAS RAISED CONCERNS THAT SOME STATINS MAY INCREASE THE RISK OF DEVELOPING DIABETES. Other studies have shown a worsening in sugar control when patients are on different statins-drugs used to lower cholesterol. At this point researchers have to sort the findings out but the proven benefits of lower cholesterol exceed the unproven risk of developing diabetes.
FOR HEART FAILURE, FISH OILS ARE MORE EFFECTIVE THAN STATINS. The omega-3s in fish oils might have an antiarrhythmic effect and reduce inflammation. Statins don't seem to help heart failure. They do prevent coronary artery narrowing that may lead to heart attacks and stroke but do not reduce the complications of heart failure.
Patients with heart failure AND high cholesterol, diabetes or coronary heart disease should still take statins. Heart failure patients should take about 1 gram per day of omega-3s either by prescription or over the counter supplements containing the similar amounts of DHA and EPA.
June 2009
SAVING MONEY AND STILL TAKING YOUR PRESCRIPTIONS can be a challenge during a tough economy. Some patients skip doses or don't fill prescriptions for medications they should be taking. There are effective ways to save and still take the meds you need. Exercising and eating a healthy diet are the first line in treating many chronic illnesses and they don't cost anything but your effort. Just because you see an ad for a medication on TV doesn't mean it's any better than ones that have been on the market for years. Many brand name medications used to treat the same condition work well in different patients so ask your doctor if a different brand name that costs less would work for you. Of course generic medications are versions of brand names that have been used for years and are going to save you money. Pill splitting is a viable option especially when higher doses are available for the same price as the lower dose. Ask your pharmacist if this is available and appropriate for any of your meds and purchase an inexpensive pill cutter to reduce your cost.
SOLUBLE FIBER IN THE DIET OFTEN IMPROVES SYMPTOMS OF IRRITABLE BOWEL SYNDROME (IBS). Citrucel, Metamucil and Fibercon as well as rice, potatoes, applesauce and oatmeal are soluble fibers that form a gel in the GI tract helping food move along more smoothly. Raw fruit and vegetables as well as wheat bran are insoluble and can make symptoms worse. Antidepressants can improve mood and relieve abdominal pain. Antispasmodics and peppermint oil aid some patients. Imodium will help diarrhea but not discomfort and bloating. Miralax and milk of magnesia should be tried first for constipation. Probiotics help some patients especially ones with bifidobacteria such as Align or Activia. Lactobacillus acidophilus does not help symptoms.
A WRIGLEY SCIENCE INSTITUTE STUDY found that chewing gum might reduce appetite. People chewing sugarless gum ate fewer snacks between meals and consumed 40 calories less than people who didn't chew gum….and it keeps your jaw muscles in shape! Another study found that laughter is sometimes the best medicine. Diabetics who laugh daily can significantly increase good cholesterol and decrease their risk of heart attack. Get out those old “I Love Lucy” and “The Three Stooges” tapes.
VITAMIN D IS GETTING A LOT OF ATTENTION due to the fact that most people don't get enough in their diet or from sun exposure. As we age our bodies lose the ability to use sunlight to make vitamin D. Current intake recommendations are at levels that prevent rickets. Higher intake levels can reduce muscle and bone pain, prevent falls and bone breaks as well as reduce the risk of some cancers and heart disease. Experts now recommend 1000 units per day for kids and 1000 to 2000 units per day for adults. D2 (ergocalciferol) is the vitamin D made by plants, D3 (cholecalciferol) is the one our bodies makes and is probably more potent and a better choice.
July 2009
H1N1 “SWINE FLU” WILL MAKE THIS UPCOMING FLU SEASON A LITTLE MORE COMPLICATED. Seasonal flu vaccine is already being made so it may take at least two and maybe three injections for full coverage. The H1N1 vaccine may not be ready for fall as the cultures of virus needed to make it are not growing fast enough in the lab. H1N1 may require two shots since most people have not been exposed and have no immunity-the first shot is a priming dose and the second shot several weeks later would be necessary to boost antibody titers. H1N1 is sensitive to both Tamiflu and Relenza so patients with severe symptoms or at high risk for complications can be treated and Tamiflu can be given to infants under one year of age. As always the best medicine is prevention with hand washing, covering mouth for coughs and sneezes and staying home if you are ill with symptoms.
PATIENTS TAKING WARFARIN are often warned to be aware of their dietary intake of green leafy vegetables due to the vitamin K content interfering with the effectiveness of the warfarin. Some clinicians are having patients with unstable INR's, the measurement regimen used to regulate warfarin dosing, take a small daily vitamin K supplement. It may seem against conventional wisdom but having a consistent daily intake of vitamin K appears to make it easier to maintain a steady warfarin dose.
TOPICAL CAFFEINE APPLIED TO THE SKIN OF MICE suppressed the development of skin cancer by up to 72%. Researchers believe the caffeine protects against non-melanoma skin cancer and may reverse sun damage. I guess it won't be long before we have coffee based sunscreen and moisturizers.
GINSENG IS ALREADY BEING USED TO IMPROVE MENTAL AND PHYSICAL PERFORMANCE as well as treat hepatitis C, erectile dysfunction, menopause symptoms and control blood pressure. You can now add reducing inflammation. A recent study indicates that ginseng may reduce inflammation.
SODIUM IN THE DIET OF A PATIENT WITH HIGH BLOOD PRESSURE can have a dramatic effect on controlling their illness. The normal limit for salt intake is one teaspoon daily, about 2300 mgs. Hypertensive patients should not exceed 1500mgs daily or about 2/3 of a teaspoon. Just because you don't use the salt shaker doesn't mean your not getting too much salt. Campbell's chicken noodle soup has about 2000mgs in a can, while some restaurant meals may contain over 5000mgs. Reducing salt intake to 1500mgs per day may lower blood pressure as much as hydrochlorothiazide or an ACE inhibitor and too much salt will make diuretics less effective. Effervescent antacids like Alka-Seltzer Original contain 500mg per tablet.
August 2009
PREGNANT OR NURSING MOTHERS ARE OFTEN CONCERNED ABOUT what antibiotics are safe to take. Cephalosporins and penicillins as well as erythromycin and azithromycin are generally safe to use. Metronidazole can be used in the second and third trimester if there is no good alternative. Clindamycin can be used as an alternative to metronidazole Nitrofurantoin may be used except close to delivery due to a small risk of causing anemia in newborns. Septra and Bactrim and their generic equivalents should be avoided as they have been associated with birth defects and liver problems in the infant. Quinolones like Cipro and Levaquin and tetracyclines should be avoided during pregnancy. Tetracyclines can be used during nursing since only low levels occur in breast milk.
PATIENTS WITH PEANUT ALLERGIES should avoid using Combivent inhalers. These inhalers contain soy proteins which may trigger an allergic reaction in patients allergic to peanuts. There is a new inhaler coming that will not contain soy proteins and Atrovent HFA, which contains one part of the combo in Combivent, does not have soy protein.
MANY PATIENTS WITH ASTHMA ARE PRESCRIBED drugs used to treat acid reflux even if they don't have reflux symptoms. There is conflicting evidence from current studies as to whether this is effective. Nexium given to poorly controlled asthmatics without acid reflux symptoms did not improve asthma symptoms. If patients have a persistent cough or nighttime asthma symptoms it may be worth a trial on a PPI such as Nexium, however if no improvement occurs in about 8 weeks then the PPI probably is not going to help.
THERE ARE GROWING CONCERNS REGARDING THE AMOUNT OF ACETAMINOPHEN (Tylenol) that people are ingesting. So much so that regulators are considering lowering the maximum daily intake and reducing the mg of drug per tablet. Many people do not understand the pervasiveness of acetaminophen in OTC drugs. They take a prescription pain med, an OTC cold and flu med and a night time sleep aid, all of which may contain enough acetaminophen to put them over the recommended dose leading to toxicity and liver failure. Just 6000mg per day for 2 days can cause liver failure in some people. The current recommendation is no more that 650mg per dose and 4000mg per day however that will probably soon drop to no more than 3250mg per day. Heavy drinkers actually should stay well below 3250mg per day. Read the labels on every OTC medication and make sure you don't exceed the maximum daily intake.
September 2009
THE ADS SUGGEST THAT IF YOU LOVE YOUR AGING PARENTS you should get them on an Alzheimer's drugs at the first sign of dementia. The problem is these drugs offer modest benefits and in rare instances can cause slow heart rate and fainting. This can increase the risk of falls, fractures and the need for pacemaker insertion. Some patients benefit greatly from these medications but the risks should be known by the caregiver as well as the reasonable expectation of benefits. If side effects occur or no noticeable benefit is seen within 3 months the medication should perhaps be discontinued.
TAKING FLAXSEED INSTEAD OF FISH OIL is popular to increase intake of omega-3 fatty acids. The problem is that they contain different fatty acids. Flaxseed has ALA fatty acid and fish oil has EPA and DHA. Our bodies convert a small amount of ALA to EPA and DHA- but not much. Flaxseed does not lower triglycerides and has not been proven to reduce risk cardiovascular disease. Ground flaxseed will reduce LDL modestly and does provide fiber as well as phytoestrogens. Soybean and canola oil and walnuts are good sources of ALA but almonds and others are not.
MANY DRUG COMPANIES BRING OUT NEW PRODUCTS when the patent on their blockbuster drugs are expiring. Often the new product is a metabolite of the original or a mirror image molecule. This allows them to extend the shelf life of the original product. Keep in mind that most of these new versions are not any better than the original tried and true product and often cost much more because they are only available as the brand name. There are a few rare exceptions. When you see an advertisement on TV you should be skeptical and discuss the benefits of a change to the new product with your doctor or pharmacist.
PATIENTS SHOULD STOP USING ZICAM NASAL PRODUCTS as they have been known to cause loss of smell. Marketed as a homeopathic remedy for colds they actually contain a measurable amount of zinc which when used in the nose may cause loss of smell. Other Zicam products are not affected.
A RECENT EUROPEAN STUDY SUGGESTING A HIGHER RISK OF CANCER in patients using Lantus insulin alone is concerning some patients. This was an observational study and other studies show no such link. Patients that use only Lantus tend to be older and more obese which also increases the risk for cancer. Patients that are concerned may want to switch to human insulin. So far there is no evidence of an increase risk associated with the use of Humalog or Novolog insulins.
October 2009
PATIENTS TAKING METFORMIN TO TREAT THEIR DIABETES should consider taking an oral supplement of vitamin B12. There appears to be a possible link between lower B12 levels caused by metformin and peripheral neuropathy. Because peripheral neuropathy is often associated with diabetes even in patients not on metformin, blood levels should be checked in patients on metformin who develop neuropathy or have a worsening of their condition. An oral supplement of 1000mcg of B12 generally will treat a B12 deficiency. Calcium may increase B12 absorption so adequate calcium intake is also recommended.
RINGWORM INFECTIONS ARE EASILY TREATED WITH OTC TOPICAL ANTIFUNGALS. Lamisil AT and Lotrimin Ultra are the most effective products and work within 1 to 2 weeks. Clotrimazole and miconazole are also available but require 2 to 4 weeks to work. Creams and lotions are more effective than powders and sprays. Application should cover areas 1 to 2 inches beyond the rash and continue for 1 to 2 weeks after the skin has healed. Tea tree oil, Vicks VapoRub and vinegar show no evidence of effectiveness against topical fungal infections.
A SINGLE DOSE EMERGENCY CONTRACEPTIVE IS NOW AVAILABLE. Plan B One-Step is the same as Plan B however it contains only one tablet taken as a single dose. There is also a generic version of the original Plan B, Next Choice that contains the original regimen of two doses, each taken 12 hours apart.
IF YOUR INHALER COMES IN A FOIL CONTAINER, after you remove the foil to use, the expiration date on the box no longer applies. The foil protects the drug from moisture. Advair Diskus are only good for one month; Serevent is good for six weeks and Symbicort for 90 days. Ventolin HFA 60-count is potent for 12 months but the 200 dose package is only good for 6 months. Proair HFA and Proventil HFA are not packaged in foil and generally are good for 2 years after manufacturing date.
THE NEEDLE ON EPIPEN MAY NOT BE LONG ENOUGH to provide the epinephrine quickly in an allergic reaction especially in an overweight individual. Epinephrine may be given subcutaneously or IM for anaphylaxis but IM is preferred because absorption is quicker. Injecting sub-q can delay absorption from 10 to 30 minutes. Be sure to press down firmly for 10 seconds with the injector on the outer thigh when administering an emergency dose of epinephrine using an Epipen.
November 2009
MANY NEW PRODUCTS PROMOTING IMPROVED GI FUNCTION AND IMMUNITY contain probiotics. These products are supposed to provide “good” bacteria in the diet in an attempt to crowd out the “bad” bacteria that may be causing bloating, upset stomach or diarrhea. Patients suffering from irritable bowel syndrome may benefit from Align for abdominal pain and bloating or VSL #3 for bloating with diarrhea predominant IBS. VSL#3 may also maintain remission in ulcerative colitis. Diarrhea associated with antibiotics may respond to Culturelle, DanActive or Florastor. These should be taken about 2 hrs after the antibiotic, all through therapy and for one week after completion. Activa and Yakult may help soften stool but they have not been proven to prevent constipation.
PATIENTS OFTEN WONDER IF THEY SHOULD REPEAT A DOSE OF MEDICATION IF THEY VOMIT AFTER TAKING. It depends on a couple of factors.
If it occurs within 15 minutes of taking or if the intact dosage is present in the vomit then redosing is advisable. If more than an hour has passed then redosing is not necessary since the drug is probably beyond the stomach. The 15 to 60 minute period is where a judgment call is necessary. Medications with low margin for errors, such as HIV or birth control pills should probably be retaken. Antibiotics with a single daily dose especially for an acute infection should be repeated. Long acting opioids such as methadone or Oxycontin should not be retaken. Digoxin, warfarin and other drugs with narrow dosing ranges should also not be repeated unless a possibility of low blood levels exists.
WOMEN MAY BE CONCERNED ABOUT THE SAFETY OF YAZ OR YASMIN oral contraceptives due to the amount of advertising by legal firms looking for clients that want to sue the manufacturers. This is due to the fact that according to the FDA the companies were not forthcoming in their consumer ads about risks associated with their products. Most of the risks are the same as other birth control pills. There is a slightly elevated risk of high potassium levels and thrombosis but the difference is very small. In any case the risk is less than the thrombosis risk associated with pregnancy. Going with the lowest estrogen dose possible, preferably fewer than 35 mcgs, minimizes clotting risk. Yaz and Yazmin are a good choice for women with polycystic ovary syndrome, premenstrual dysphoric disorder, acne or excess hair growth.
IN THE NEXT THREE YEARS MANY BLOCKBUSTER BRAND DRUGS WILL BE GOING GENERIC. By the end to this year Prevacid, Pulmicort Respules and Valtrex will have generics. Aricept, Arimidex, Cozaar, Flomax and Effexor XR are due out in generic versions in 2010 and Lipitor, Plavix, Diovan, Levaquin, Lexapro, Seroquel and Singulair will be generic by the end of 2012. Prevacid in the 15mg strength will soon be available OTC as Prevacid 24HR. Initially the “authorized generic” may not cost a lot less than the brand but eventually other companies come out with their products and the prices start to drop.
December 2009
CLARITIN EYE AND ZYRTEC ITCHY EYE DROPS don't contain the same ingredients as the oral medications. They both contain ketotifen, which is ALSO available over the counter in Zaditor, Alaway and as a generic ketotifen eye drops. Ketotifen is an excellent antihistamine and mast cell stabilizer for use in allergic conjunctivitis. Other OTC allergy eye drops may contain decongestants that may cause rebound congestion. Be aware that many insurance companies no longer cover prescription antihistamine eye drops with the availability of OTC ketotifen.
PATIENTS UNDERGOING STOMACH BYPASS SURGERY OR GASTRIC BANDING must be mindful of medication adjustments afterward. It may be necessary to use liquid, non-oral or crushable medication for weeks or months. Sugar-free liquids are advisable since too much sugar can cause diarrhea and cramps. Time release and enteric coated medications should be avoided. Oral meds larger than an M&M should be split if possible. NSAIDS, corticosteroids and other GI irritants should be avoided or at least combined with a med like Prilosec. Blood glucose and hypertension may improve enough to reduce or eliminate dosages so monitoring blood pressure and blood glucose is recommended. Some critical dose meds such as anticonvulsants and immusuppressants may require dose adjustments. Vitamin and mineral supplements are a good idea. Calcium citrate supplements are better absorbed than calcium carbonate.
GIVING ACETAMINOPHEN TO CHILDREN PRIOR TO IMMUNIZATION may reduce immunity. The idea is to reduce that amount of pain, fever and fussiness that occurs after the shot. Studies suggest that acetaminophen slightly reduces the body's immune response to common childhood vaccines such as tetanus, diphtheria, whooping cough, Hib and pneumonia. Wait until after the vaccination to give a child acetaminophen if pain or fever occurs.
PREGNANT WOMEN OFTEN USE GINGER TO RELIEVE NAUSEA AND MORNING SICKNESS. Finnish authorities are now warning pregnant women not to consume ginger supplements since ginger contains chemicals that damage cells in test tubes. There is no evidence that there is the same effect when taken internally. So far no problems have occurred in pregnant women taking up to 1 gram per day of ginger supplements. Pregnant women may want to try vitamin B6 in doses of 12.5 to 25mgs three or four times daily for mild nausea. Adding doxylamine 12.5mg to each B6 dose may also be helpful.
I'D LIKE TO TAKE THIS OPPORTUNITY, ON BEHALF OF MYSELF AND OUR STAFF, TO THANK YOU FOR YOUR PATRONAGE AND WISH ALL OUR CUSTOMERS AND FRIENDS A PEACEFUL, HAPPY AND HEALTHY HOLIDAY SEASON! RICK
