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 2010
TAKING ASPIRIN IS HELPFUL AT PREVENTING SECOND HEART ATTACKS in patients that have already had one. Experts are now rethinking its use in preventing heart disease and first heart attacks. Aspirin prevents about 1 in 1000 initial heart attacks per year but it also causes that same number of serious bleeds. For individuals with major risk factors such as hypertension or high cholesterol who aren't at risk for bleeding aspirin may be appropriate in men over 45 and women over 55 as primary prevention. The American Diabetes Association recommends aspirin for diabetic men over 50 and women over 60 if they have risk factors such as family history of heart disease, hypertension, smoking or high cholesterol. Patients taking aspirin that don't necessarily need it should speak to their doctor before stopping.
WITH BOTH PRILOSEC AND PREVACID AVAILABLE OVER THE COUNTER, the manufacturers are gearing up their marketing engines. Prilosec OTC claims better control, Prevacid 24 HR says it's better because it's the same as the prescription product. The products are pretty much the same and should be chosen based on price or preference. Zegerid OTC will also be on the market soon and contains Prilosec and sodium bicarbonate. Due to the sodium content it should not be used by patients on sodium restricted diets. Patients on Plavix must be careful since it may interact with PPIs and some H2 blockers like Tagamet.
THERE MAY BE CONFUSION IN WOMEN TRYING TO TREAT UNCOMPLICATED VAGINAL YEAST INFECTIONS with over the counter products. Monistat contains miconazole for yeast infections, Monistat Uristat contains phenazopyridine for UTI symptoms and Monistat Itch Relief Cream contains hydrocortisone. “One day” products don't work any faster than 3 or 7 day products and symptoms can last for the same length of time regardless of which product is used. Product choice should be based on preference since all vaginal antifungals are effective. Homeopathics and probiotics are not proven to prevent or treat vaginal yeast infections.
THE USE OF COLON AND LIVER CLEANSERS IS PRESENTING QUESTIONS AND POTENTIAL PROBLEMS. Claims are made that they can boost immunity, enhance weight loss, increase energy and eliminate toxins. Liver cleansers contain milk thistle as well as other supplements and are sometime used after binge drinking. While milk thistle doesn't appear harmful, there is only limited evidence of improvement of liver disease. Colon cleansers usually contain laxatives and herbs. Overuse may lead to electrolyte imbalance. Some contain licorice which can raise blood pressure. The body is capable of getting rid of waste and toxins. Constipation can be treated with fluids, fiber and exercise and if needed a laxative.
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 2010
PATIENTS USING DUONEB NEBULIZER SOLUTION OR ITS GENERIC VERSION (albuterol/ipratropium) may want to ask their physician to write separate prescriptions for both medications and then mixing them themselves. It is quite likely to save them some money. They should ask for the regular strength ipratropium nebules and the more concentrated albuterol solution in the dropper bottles. Mixing 0.5mls of albuterol 0.5% solution with a 2.5 ml nebule of ipratropium will result in the commercial mixture. This should be nebulized over a 15 minute period.
EVEN THOUGH CHANTIX, THE SMOKING CESSATION DRUG, MAY INCREASE BLOOD PRESSURE AND HEART RATE, more doctors are using it in patients with cardiovascular disease since the risks associated with continued smoking are worse than the risks associated with the Chantix. Chantix can't be taken by pilots, air traffic controllers, and bus and truck drivers due to an association with mood and behavior changes. The success rate for quitting smoking in patients on Chantix is significantly better than other cessation products.
INSTILLING EYE DROPS INCORRECTLY CAN LEAD TO SIGNIFICANT BLOOD LEVELS AND PROBLEMS WITH CERTAIN MEDICATIONS AND CHRONIC ILLNESSES. Timolol is a beta blocker eye drop that is frequently used to treat glaucoma. If too much of the drop goes down the tear duct and is absorbed it could lead to an asthma attack in an asthmatic patient. Timolol also slows heart rate and could present a problem in the patient with poorly controlled heart failure. The key is to limit drug absorption by using the “DOT” technique or don't open the eyes technique.
After placing the drop in the eye, they should remain closed for 5 minutes if possible using gentile pressure on the inside of the eye socket next to the nose. This will reduce the amount of drug entering the tear duct.
RECENTLY CONCLUDED CLINICAL STUDIES HAVE RESULTED IN A DOWNGRADING OF THE EFFECTIVENESS OF SAW PALMETTO in relieving the symptoms of enlarged prostate. These studies are much more scientifically rigorous than previous studies and have led to a “possibly effective” rating. Men wanting to try saw palmetto should not expect too much and stick with the herbal for 1 to 2 months as it may take that length of time to develop a benefit. If symptoms are still present then a prescription medication may be the answer.
NOW THAT OTHER GENERIC MANUFACTURERS OF FLOMAX (tamsulosin) have come on the market the price for the generic has come down. Patients on doxazosin or terazosin may want to consider asking their physician about changing to tamsulosin. The two former drugs are still the least expensive but they also have more risk of dizziness and low blood pressure than tamsulosin and may be better tolerated.
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 2010
BRAND NAME NITROSTAT WILL SOON BECOME the only sublingual nitroglycerin available. The FDA has pulled the approvals on the generic versions until they go back through the approval process. This is not a recall and generic versions are still ok to use and pharmacies are allowed to dispense existing inventory. Patients using sublingual nitroglycerin should call 911 if they don't get relief within 5 minutes after ONE tablet. They can repeat the dose every 5 minutes up to a total of 3 doses or as directed by a physician. If emergency medical services are delayed, they may be instructed to take more doses while waiting. The current products on the market, including the generics, are manufactured to remain usable until the expiration date so long as they are kept in their original glass container, stored at room temperature and tightly capped.
PATIENTS WITH MEDICARE PART D COVERAGE that fall in the donut hole this year have or should soon receive a $250 rebate under the health care reform passed this year. The donut hole is a period of coverage during which the patient is responsible for the total cost of medication as well as part D premiums. It presents a hardship to many seniors and will be phased out by 2020.
THERE IS A DIFFERENCE BETWEEN AN ALLERGIC REACTION TO A DRUG and its side effects. A true allergy is generally characterized by swelling in the face and tongue, breathing difficulty, severe skin reactions, etc. Nausea, diarrhea, headache, etc are side effects. How long ago the reaction happened can also be pertinent since approximately 70% of people lose their allergy to penicillin after 10 years. The longer ago it happened the less likely it will happen again. Pseudo allergies often occur with opioid pain meds. They often lead to hives and itching. Usually a lower dose or a different opioid will help. People allergic to sulfas can take sulfur, sulfites and sulfates since sulfas represent a specific chemical structure not the element sulfur. Penicillin allergic patients have a 1 in 100 chance of also being allergic to cephalosporins. When the drug is absolutely necessary and the allergic is in question then drug allergy testing may be required.
PATIENTS NEEDING TO CARRY EPIPEN (INJECTABLE EPINEPHRINE) for severe allergic reactions should probably carry two doses. Many people get a prescription for two pens to keep in different locations however up to 20% of patients need a second dose to treat the reaction. Most experts agree that patients should carry two doses at a time. Patients that had a previous severe reaction and those over age 10 are very likely to need the second dose. This is especially important if they are traveling in a remote area. The second dose should be taken if breathing difficulty still exists 5 to 10 minutes after the first dose.
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
