Jul
16
Acetaminophen
July 16, 2009 | Leave a Comment
Generic Name
Acetaminophen (uh-SEE-tuh-MIN-uh-fen) RE
Brand Names
Acephen Mapap-
Aceta Mapap Children’s
Acetaminophen Uniserts Mapap Extra Strength
Apacet Mapap Infant Drops
Aspirin Free Anacin Maximum Maranox
Strength Neopap
Aspirin Free Pain Relief Oraphen-PD
Dynafed, Children’s JR Panadol*
Dynafed EX Redutemp
Dynafed Extra Strength Silapap
Feverall Silapap Children’s
Feverall, Infants Silapap Infants
Genapap” Tapanol
Genebs Tempra*
Liquiprin Tylenol*
*Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug
Antipyretic and analgesic.
Prescribed For
Relief of pain and fever for people who cannot or do not want to take aspirin or a nonsteroidal anti-inflammatory drug (NSAID). Acetaminophen may be given to children about to receive a
DTP vaccination to reduce the fever and pain that commonly follow the vaccination.
General Information
Acetaminophen is generally used to relieve pain and fever associated with the common cold, flu, viral infections, or other disorders where pain or fever may occur. It is also used to relieve pain in people who are allergic to aspirin, or those who cannot take aspirin because of potential interactions with other drugs such as oral anticoagulants. It can be used to relieve pain from a variety of sources, including arthritis, headache, muscle ache, menstrual cramping, and tooth and periodontic pain, although it does not reduce inflammation.
Cautions and Warnings
Do not take acetaminophen if you are allergic or sensitive to any of its ingredients. Do not take acetaminophen for more than 10 days in a row (5 days for children) unless directed by your doctor. Do not take more than is prescribed or recommended on the package.
Use this drug with extreme caution if you have kidney or liver disease or viral infections of the liver. Large amounts of alcohol increase the liver toxicity of large doses or overdoses of acetaminophen. Avoid alcohol if you regularly take acetaminophen. Some people are more sensitive to this effect than others.
Possible Side Effects
This drug is relatively free from side effects when taken in recommended doses. For this reason it has become extremely popular, especially among those who cannot take aspirin. V Rare: large doses or long-term use may cause liver dam-
age, rash, itching, fever, lowered blood sugar, stimulation,
yellowing of the skin or whites of the eyes, and/or a change
in the composition of your blood. Contact your doctor if
you experience any side effect not listed above.
Drug Interactions
o Large doses of barbiturate drugs, carbamazepine, phenytoin and similar drugs, izoniazid, rifampin, and sulfinpyrazone may increase the chances of liver toxicity if taken with acetaminophen.
• Alcoholic beverages increase the chances for liver toxicity
and possible liver failure associated with acetaminophen.
Food Interactions
None known.
Usual Dose
Adult and Child (age 12 and over): 325-650 mg 4-6 times a day,
or 1000 mg 3-4 times a day. Avoid taking more than 4 g (twelve
325-mg tablets) a day for long periods of time. Child (age 11): 480 mg 4-5 times a day. Child (age 9-10): 400 mg 4-5 times a day. Child (age 6-8): 320 mg 4-5 times a day. Child (age 4-5): 240 mg 4-5 times a day. Child (age 3): 160 mg 4-5 times a day. Child (age 1-2): 120 mg 4-5 times a day.
Child (age 4-11 months): 80 mg 4-5 times a day. Child (under age 4 months): 40 mg 4-5 times a day.
Overdosage
Acetaminophen is a commonly used ingredient in many over-the-counter (OTC) medications. Always check the list of ingredients when using more than one OTC medication to ensure that the combined dosage is within guidelines and to avoid accidental overdose.
Acute acetaminophen overdose may cause nausea, vomiting, sweating, appetite loss, drowsiness, confusion, abdominal tenderness, low blood pressure, abnormal heart rhythms, yellowing of the skin and whites of the eyes, and liver and kidney failure. Liver damage has occurred with 12 extra-strength tablets or 18 regular-strength tablets, but most people need larger doses-20 extra-strength or 30 regular-strength tablets—to damage their livers. Regular use of large doses for long periods-30004000 mg a day for a year—can also cause liver damage, especially if alcohol is involved. In case of overdose, induce vomiting as soon as possible with ipecac syrup—available at any pharmacy —and take the victim to a hospital emergency room. ALWAYS bring the acetaminophen bottle or container.
Special Information
Unless abused, acetaminophen is a beneficial, effective, and relatively nontoxic drug. Follow package directions and call your doctor if acetaminophen does not relieve pain in 10 days for adults or 5 days for children. Call your doctor if fever gets worse or persists longer than 3 days.
Alcoholic beverages will worsen the liver damage that acetaminophen can cause. People who take this drug on a regular basis should limit their alcohol intake.
If you forget to take a dose, take it as soon as you remember. If it is within an hour of your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Acetaminophen ‘is considered safe during pregnancy when taken in usual doses. Taking continuous high doses of the drug may cause birth defects or interfere with fetal development. Three cases of congenital hip dislocation appear to have been associated with acetaminophen. Check with your doctor before taking this drug if you are or might be pregnant.
Small amounts of acetaminophen may pass into breast milk, but the drug is considered harmless to nursing infants.
Seniors: Seniors may take acetaminophen as directed by a doctor.
Jul
16
Acamprosate
July 16, 2009 | Leave a Comment
Acamprosate (ah-CAM-pro-sate)
Brand Name Cameral
Type of Drug
Synthetic neurochemical similar to the amino acid homotaurine.
Prescribed For Alcoholism.
General Information
Acamprosate is used to help alcoholic patients stay alcohol-free after they have stopped drinking. Unlike other drugs used to help people stay away from alcohol, it does not cause people to have a physical reaction to alcohol. Acamprosate restores the balance between two chemical systems in the brain, glutamate and GAGA, that are known to become unbalanced in alcoholics, but its exact action is not known. It may reduce alcohol craving. Acamprosate should be part of a program that includes counseling and support, and it should be started as soon as possible after alcohol withdrawal and continued even if the patient starts drinking again. This medication has not been proven to help patients if they are still drinking when they start treatment. Acamprosate has not been studied in patients who abuse other substances together with alcohol. Tolerance or addiction has not developed with acamprosate. It passes out of the body through the kidneys.
Cautions and Warnings
Do not take acamprosate if you are allergic or sensitive to any of its ingredients or if you have severe kidney disease. People with moderate kidney disease require a lower dosage of acamprosate.
Acamprosate does not eliminate or ease alcohol withdrawal symptoms.
People taking acamprosate may become depressed or have suicidal thoughts.
Acamprosate can affect your judgment, thinking, or coordination. Do not drive or operate dangerous machinery if you are taking this medicine.
Possible Side Effects
Almost 2 of every 3 people who take this medicine will experience a drug side effect.
♦ Most common: diarrhea.
✓ Common: headache, weakness, anxiety, depression, and sleep problems.
✓ Less common: pain, accidental injuries, nausea, stomach gas, dizziness, dry mouth, tingling in the hands or feet, itching, sweating, chest pain, loss of appetite, weight gain or loss, impotence, abnormal vision, rash, vomiting, and constipation.
♦ Rare: heart or kidney failure, psoriasis, hypothyroidism, rheumatoid arthritis, and urinary tract infections. Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Mixing acamprosate with naltrexone can increase the levels of both drugs in the blood, but no dose adjustments are needed.
Food Interactions
Acamprosate may be taken without regard to food or meals.
Usual Dose
Adult: two 333-mg tablets 3 times a day. Child: not recommended.
Overdosage
The only symptom associated with acamprosate overdose has been diarrhea. Overdose victims should be taken to a hospital emergency room for observation and treatment. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you are breast-feeding, pregnant, or thinking about becoming pregnant while taking this medicine.
Take care while driving a car or performing complex tasks.
If you forget to take a dose, take it as soon as possible. If you do not remember until it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Call your doctor if you forget to take 2 or more doses in a row. Do not take a double dose.
Acamprosate must be part of an ongoing treatment program. Do not stop taking it on your own, even if you start drinking again.
Special Populations
Pregnancy/Breast-feeding: Acamprosate can damage animal fetuses in doses that are approximately equal to those taken by people on this medicine. Women of childbearing age should use an effective contraceptive while taking this drug. The potential benefits of acamprosate must be weighed against its risks if your doctor considers it a crucial treatment during your pregnancy.
Acamprosate passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Dosage reduction may be needed in seniors because of a general decline in kidney function due to age.
Jul
16
CONSTIPATION. COMPLETE INFORMATION.
July 16, 2009 | Leave a Comment
CONSTIPATION
• Get enough fluid and fiber
• Eat prunes, apples, or apricots
• Sprinkle ground flaxseed on cereal *****
• Chew sugarless gum ****
• Use psyllium powder ****
•Try docusate for less straining **
• Use milk of magnesia for quick relief (occasional use)
• Ask your doctor about a prescription for Mira Lax **
Many people feel that regularity is the key to good health. Is this true or is it a myth? Grandmothers around the world have promoted daily bowel movements for generations, but there is no evidence that a trip to the bathroom each morning is necessary. People vary in the frequency that suits them best. Some do well on a schedule of no more than three times a week. Others feel good on a schedule as frequent as a few times a day.
Constipation is defined as unsatisfactory defecation, 155 but doctors and patients don’t always agree on what is most important. Physicians may prefer objective measures like the number of days between bowel movements. But people may be as concerned about consistency as frequency. They complain about the effort of passing hard “golf balls” or “bricks.”
Sometimes physicians dismiss constipation as a minor complaint. While it is not usually life threatening, constipation can be serious. Almost 100,000 people are hospitalized each year for constipation-related problems. Many more suffer considerable distress and reduced quality of life as a result of this common condition.
Fluids and fiber are the cornerstones of constipation prevention. Those who are constipated are often urged to drink more water. Adequate fluid (at least 6 glasses of water a day) is essential, but unless someone is actually dehydrated, drinking extra water does not solve the problem of hard stools. To-SOME DRUGS THAT MAY LEAD TO CONSTIPATION
• Abilify (aripiprazole)
• Actonel (risedronate)
• Anaprox (naproxen)
• Arimidex (anastrozole)
• Asacol (mesalamine)
• Casodex (bicalutamide)
• Cataflam (diclofenac)
• Catapres (clonidine)
• Cenestin (synthetic conjugated estrogens)
• Clinoril (sulindac)
• Clorpres (clonidine and chlorthalidone)
• Clozaril (clozapine)
• Cognex (tacrine)
• C6rdarone (amiodarone)
• Covers-HS (verapamil)
• Creon (pancreatin)
• Cymbalta (duloxetine)
• Detrol (tolterodine)
• Ditropan XL (oxybutyn n)
• Duragesic (fentanyl►
• EC-Naprosyn (naproxen)
• Effexor (venlafaxine)
• Ferrara (letrozole)
• Geodon (ziprasidone)
• Gleevec (imatinib)
• Imdur (isosorbide
mononitrate)
• Kadian (morphine sulfate)
• Kytril (granisetron)
• Lexapro (escitalopram)
• Lotronex (alosetron)
• Lyrics (pregabalin)
• Meridia (sibutramine)
• Mirapex (pramipexole)
• Myfortic (mycophenolic acid)
• Nalfon (fenoprofen)
• Naprosyn (naproxen)
• Orap (pimozide)
• OxyContin (oxycodone)
• Pacerone (amiodarone)
• Pancrease MT (pancrelipase)
• Paxil (paroxetine)
• Permax (pergolide)
• Rapamune (sirolimus)
• Relafen (nabumetone)
• Remeron (mirtazapine)
• Requip (ropinirole)
• Retrovir (zidovudine)
• Risperdal (risperidone)
• Rythmol (propafenone)
• Thalomid (thalidomide)
• Topamax (topiramate)
• Vicodin (hydrocodone and acetaminophen)
• Zofran (ondansetron)
• Zoloft (sertraline)
• Zyprexa (olanzapine)
gether with fiber, though, the fluids may help. The first step, of course, is to make sure that the diet contains at least 25 grams of fiber a day. That may take some doing, but it can be accomplished with 5 to 10 servings of vegetables and fruits a day, along with whole grains rather than refined bread, pasta, crackers, and the like. For some people, though, even that may not be enough to conquer constipation completely.
If constipation arises suddenly or if it starts to interfere with everyday activities, it makes sense to check in with your doctor. There are some conditions, such as an underactive thyroid gland or Parkinson’s disease, that can lead to constipation. In those cases the underlying disease needs to be treated.
Warning signs that should trigger a doctor’s visit include blood in the stool or bleeding from the rectum; dark, tarry stool; weight loss of 10 pounds or more; a family history of colon cancer; or a positive Hemoccult test, a way of identifying invisible blood in the Stoo1.156 Be sure to tell the doctor about any of these issues, so the proper workup can be done.
People taking medications or even supplements should also check with their doctor to see whether one of these might be responsible. A surprising number of prescription drugs can trigger constipation as a side effect. Because of the impact that constipation can have on their sense of well-being, patients sometimes become upset if doctors don’t warn them that a prescribed medication may interfere with bowel function. Narcotics are among the most notorious offenders, but there are many others. Sometimes, switching to a different medicine can ease the problem. The physician should always be involved in such a decision, because some of these drugs may be essential treatment for a serious condition such as cancer or AIDS.
Dietary Approaches
For uncomplicated constipation, focus on increasing the high-fiber foods in the diet. Sometimes, people buy a loaf of softand-squishy “wheat” bread and figure that’s all they need to do to get extra fiber. Wrong! Unfortunately, the “wheat” label may just be a marketing ploy. Consumers need to read the ingredient list to see if the first ingredient is whole-wheat flour. That’s a good start.
Even better is to actually consume the whole grains in pi-FOODS THAT ARE HIGH IN FIBER
• Apples 0 Lima beans
• Barley 0 Oat bran
• Beans 0 Oats (steel-cut)
• Blackberries 0 Pears
• Bran a Popcorn
• Bran cereal 0 Prunes
• Broccoli 0 Raisins
• Bulgur wheat 0 Split peas
• Chickpeas 0 Uncle Sam Cereal
• Fiber One cereal 6 Wheat berries
• Figs • Winter squash
• Lentils
lafs or porridges, which is one reason we are so fond of steel-cut oats. (Also, they taste wonderful.) One of our favorite high-fiber breakfasts is steel-cut oats with extras: blackberries or pieces of apple, together with walnuts or almonds, topped with a sprinkling of freshly ground flaxseed. To boost the protein content of this breakfast, we stir in some egg white while the oats are cooking.
0 0 0
O. My wife is bedridden with emphysema and osteoporosis. Her fractured vertebrae are due to the steroids she takes for emphysema.
The doctor suggested calcium to strengthen her brittle bones. Then she had a problem with bowel movements because of not getting any exercise.
This caused her great distress until she tried eating a quarter of an apple every evening. The apple has made her regular again.
A. Thanks so much for reminding us all of the importance of fiber in the diet. This may help explain the wis-dom behind Grandmother’s recommendation of an apple a day.
O 0 *
Prunes
Why are the marketers changing the name of prunes to “dried plums”? While it is an accurate designation, it’s not particularly catchy. Instead, it is an attempt to get away from the image of self-treatment for constipation that “prune” or “prune juice” conjures up.
O 0 0
Q. A year ago I had a serious problem with constipation (over 2 weeks!). I tried everything I could, including Metamucil, Ex-Lax, milk of magnesia, and a Fleet enema with no results. A visit to the doctor resulted in a prescription but still no relief.
Then I remembered. Prunes are laxatives. I bought some prune juice with pulp and drank 4 ounces a day with plenty of water. Within a few days I was back to normal.
For a few months I drank some every other morning to keep me regular. Now I only need it once a week. Prune juice with pulp is my salvation.
A. Prunes are a time-honored home remedy for constipation. Researchers have confirmed what grandmothers always knew: Prunes stimulate the digestive tract.
In 1951 scientists discovered an ingredient in prunes that is closely related to the chemical laxative oxyphenisatin. This product was taken off the market when it was linked to liver damage.
Experts for the Harvard Health Letter suggest, “it is unlikely that moderate consumption [of prune juice] would cause any problems, but prune use, like everything else, should be prudent.”
Prunes are said to be loaded with antioxidant phytonutrients, so they are a healthy choice if consumed in moderation. They are not the only dried fruit that can be helpful in an attempt to overcome constipation. Dried figs and even apricots provide a little variety. They may not have any specifically laxative components, but they certainly are good sources of fiber, and some people find them quite helpful.
Dried apricots (two a day) and plenty of water can relieve constipation. It helps me and has helped my friends.
Flaxseed
Another source of fiber is not nearly as well known as prunes. Flaxseed has long been used as a source of soluble fiber. It is one of the ingredients in an old-fashioned cold cereal, Uncle Sam Cereal. Once marketed as a “natural laxative,” it is now being touted as a low-glycemic-index or low-carb food. The primary ingredients are wheat berries and flaxseed. Both should help to keep things moving in the right direction.
Constipation has been my problem for more years than I want to count Psyllium seed barely works.
My solution is flaxseeds ground in my coffee grinder I keep it in small batches in the refrigerator and take’/ teaspoon with a glass of juice or water daily. Sometimes I sprinkle it on my cereal or put it in a fruit smoothie. I like the nutty taste and it has been like. a miracle forme.
***** Flaxseed
Ground flaxseed is a good source of soluble. fiber. Not only is it helpful against constipation, it can aid in lowering cholesterol and may help reduce the hot flashes of menopause. Flaxseed is an excellent plant source of omega-3 fatty acids.
Downside: Keeps well until ground, then is susceptible to going rancid. Keep ground flaxseed in the refrigerator for no more than 10 days to 2 weeks.
Cost: Approximately $4 to $5 per month (around 130 a dose)
Besides combating constipation, flaxseed is an excellent source of omega-3 fatty acids and has the added advantage of lowering cholesterol at least modestly. The seeds keep well, but once they are ground (a blender or a coffee grinder works well), they go rancid quickly. Ground flaxseed meal should be kept in the refrigerator or even in the freezer. Someone with a tendency to constipation might well want to get in the habit of incorporating ground flaxseed into meals.
Another way to get the benefits of flax is to make a solution. Simmer 2 tablespoons of flaxseed in 3 quarts of water for 15 minutes. Cool the liquid and strain it. It should be kept in the refrigerator. Add 2 ounces a day to fruit juice.
Sugarless Gum
It might be surprising to learn that something as simple and inexpensive as sugarless gum could counter constipation quite effectively. By the way, the converse is also true. People sometimes have problems with chronic diarrhea because of their gum-chewing habits. Sugarless candy has the same impact.
* 0 0
Q. I read with interest and sympathy a letter about problems with constipation. I wanted to share something that has helped me.
After hearing some people complain that sugar-free jelly beans gave them diarrhea if eaten in quantity, I
sl%priess Gum
Pick a flavor that you like and experiment.to find the right dose. The “sugar alcohols” used to sweeten sugarless gummaltitol, sorbitol, mannitol, and xylitol—are not absorbed from the digestive tract. They act as “osmotic laxatives.” Chewing sugarless gum does not contribute to tooth decay. A gum containing xylitol might even help fight ear infections.
Side effect: Diarrhea
Downside: Many sugarless gums contain aspartame, which some people prefer to avoid.
Cost: Approximately 70 to 150 a dose
decided to see if they would help my frequent constipation. I have found that if I eat 30 sugar-free jelly beans with a glass of water half an hour before bedtime, I stay regular. I hope this idea might help others with the same problem.
A. Thanks for the tip. Many people find that the sweeteners in sugar-free candy can cause diarrhea. How clever of you to turn that side effect to your advantage! Each person will have to experiment to find the right “dose.”
0 * *
Over-the-Counter Remedies
Laxatives are among the most popular products in the pharmacy. Hundreds of millions of dollars are spent each year on these over-the-counter remedies. But overuse of such products can be a serious problem.
Q. My 19-year-old daughter and her girlfriend have been taking laxatives for weight control for several months. They also take over-the-counter diet pills.
My main concern is about the abuse of laxatives. Would you please print the harmful effects laxatives can cause? She won’t listen to me!
A. Chronic laxative abuse can undermine the body’s ability to eliminate waste on its own. We have heard from many elderly people who started using laxatives in their youth and became dependent upon them.
We are more concerned, however, about the potential interactions these young women might experience. Strong laxatives can deplete the body of potassium.
Laxatives are not an effective tool for lasting weight loss. Dietary counseling and exercise may be more helpful in the long run.
We generally suggest that people avoid stimulant chemicals like aloe, cascara sagrada, senna, and castor oil. These can be irritating to the digestive tract. Some of these compounds can interfere with proper nutrition, and chronic use might make a person more susceptible to weakened bones.
Bulk-Forming Laxatives
The first step in treating constipation is to increase your intake of fiber. Since dietary fiber may not be enough, there are several possible sources of fiber sold as “bulking agents” in the pharmacy. Psyllium is a naturally derived fiber from blond ispaghula seed (Plantago ovata). It can usually be bought quite inexpensively. There are also some alternative types of fiber.
Adequate fluid intake is crucial when taking fiber. Swallowing fiber such as psyllium without enough water could lead to choking as a result of the product clumping and swelling in the esophagus. Other digestive tract blockage is also possible if fluid intake is inadequate. 157
If psyllium is not satisfactory, other possible fiber sources are available. Polycarbophil (Equalactin, FiberCon, Fiber-Lax, Konsyl Fiber) may be the next step.
Sold under a number of brand names, including Metamucil, Fiberall, Konsyl, Perdiem Fiber Therapy, Reguloid, and Serutan. Store brands, available in most drugstore chains, are more economical. Psyllium (I tablespoon in 8 ounces of water three times a day) is approved both for constipation and for lowering. cholesterol. It may take a few days to observe the effects. Psyllium is considered safe for daily use. Sugar-free brands may be more economical, but most contain aspartame, which some people would rather avoid.
‘Side effects: Flatulence, bloating, or diarrhea; severe allergic reactions
Downside: May interfere with the absorption of other drugs taken at the same time. Many people object to the gloppy or gritty texture of dissolved psyllium fiber.
Cost: Approximately 8t. to 300 per dose
dude methylcellulose (Citrucel) and powdered cellulose (UniFiber). There’s no good evidence to suggest that any one of these is superior to the others overall, but people do have their favorites.
No bulk-forming laxative should be taken if the person is nauseated, vomiting, running a fever, or suffering abdominal pain. Such symptoms deserve prompt medical attention.
I’ve had such frustration with constipation over the years. I’ve tried a lot of remedies, but the ones that worked were too harsh. Then a friend told me about UniFiber. It is a very fine powder, and I combine it with canned peaches or homemade oat bran muffins. It really regulates my system with no diarrhea or cramping.
Stool Softeners
When the main problem is that the stool is hard, the best remedy may be a stool softener. These are also recommended for people who have had abdominal or colorectal surgery or an episiotomy during labor and delivery and must avoid straining.
Old-fashioned mineral oil is the best-known product in this category. It should be used for only a short time, though. Mineral oil is petroleum-based and is not absorbed into the body. But it can interfere with the absorption of important fat-soluble nutrients, such as vitamin A, vitamin D, vitamin E, and vitamin K. Over weeks or months, this could be detrimental to health.
The doctors’ choice in stool softeners is usually docusate sodium or docusate calcium. Although the evidence of their effectiveness is not strong, 118 they are widely used. They might work better in a postsurgical situation than they do for chronic constipation.
Dacusate Sodium
Available as Colace and Ex-Lax Stool Softener, and generically under various store brand names. Acts as a wetting agent to help stool absorb more water and thus become softer. Expect this product to take up to 3 or 4 days to work.
Side effects: Rash, throat irritation, nausea Cost: Approximately 250 to 500 per dose
This usually works fairly rapidly, within several hours. Each dose should be taken with 8 ounces of water. It is intended for occasional use only.
Side effects: Diarrhea, nausea, weakness
Downside: This laxative contains magnesium, so it should not be used by people with kidney disease. It may disrupt the balance of minerals and fluid in the body.
Cost: Approximately 600 to 750 per dose
Osmotic Laxatives
Compounds that attract water into the digestive tract add moisture to the stool. This softens it and may even help hurry it along. Such agents are called osmotic laxatives. We’ve already discussed sugarless gum, which works in this manner. It also exemplifies the downside of these laxatives: Getting the balance just right can be difficult. It’s not rare for a person to experience diarrhea as a side effect if the dose is too high. Some old familiar remedies fall into this category. Both Epsom salts and milk of magnesia are osmotic laxatives.
Prescription Laxatives
Chronic constipation can be extremely frustrating. If lifestyle changes and over-the-counter approaches are unsuccessful, people turn to their doctors hoping for a miracle. In this situation, miracles are few and far between. Physicians do have a few drugs they can prescribe that may be helpful. One is a type of osmotic laxative called lactulose (Chronulac, Duphalac, Kristalose) that has been around quite a long time. This is a type of sugar that is not absorbed well, so it pulls water into the intestines. It may take a day or 2 to produce results, and it can result in cramping, gas, or diarrhea.
There is another option as well. A prescription laxative containing polyethylene glycol, an ingredient quite similar to those used for cleansing the colon prior to a colonoscopy, can be used for desperate cases. MiraLax is not supposed to be used for more than 2 weeks at a time, however. MiraLax is an osmotic laxative.
The doctors’ big gun in prescription products is Zelnorm
Contains polyethylene glycol, or PEG. It comes as a powder to be dissolved in juice, water, coffee, or tea. Expect results in 2 to 4 days. Do not use for more than 2 weeks.
Side effects: Diarrhea, abdominal cramping, nausea, gas Downside: Prolonged or excessive use may upset the balance of fluids * and minerals in the body or result in laxative dependence.
Cost: Approximately $1.40 to $2 per dose; one dose per day
(tegaserod). It was developed for people who have irritable bowel syndrome with h constipation as the predominant symp- tom. It has also been approved for chronic constipation in adults under the age of 65. Your doctor will be able to evaluate if this last resort is appropriate for you. There have been instances of serious, dehydrating diarrhea that required hospitalization. Another dangerous side effect that worries us is ischemic colitis, a condition in which blood supply to part of the intestine shuts down. It has not been established whether Zelnorm was responsible for this frightening complication. Nevertheless, this drug is probably appropriate only when everything else has failed.
10 Tips for Combating Constipation
1. Pay attention to your diet. Getting plenty of fiber and fluid is essential. In addition, though, some foods tend to be constipating. Cheese has a reputation in this regard, but coconut, which can help ease diarrhea, may be constipating if too much is eaten. Other people have warned of the effects of pomegranate, mango, or peanut butter. The tannins in tea may also contribute to constipation.
2. Sip warm water with a tablespoon of blackstrap molasses. This sweetener contains a number of minerals. Some people find it a tasty way to cope with constipation. Another old-fashioned home remedy for constipation is drinking lemon juice in a cup of hot water first thing in the morning. Afterward, rinse your mouth with plain water, to protect your teeth.
3. Simmer 2 tablespoons of flaxseed in 3 quarts of water for 15 minutes. Cool, strain, and add 2 ounces of the liquid to orange juice every day. An alternative is to use freshly ground flaxseed on cereal or other foods.
4. Chew sugar-free gum. Experiment to find the appropriate dose. Or, if you prefer, eat sugar-free candy. Either may ease constipation; don’t overdo it.
5. Take psyllium powder in 8 ounces of water. For when you’re traveling, Metamucil makes psyllium cookies that are easier to carry, but they’re also more expensive and higher in calories.
6. Stay away from traditional laxative herbs such as aloe, cascara sagrada, and senna. They are harsh and overstimulate the digestive tract. Very occasional use may be acceptable, but overuse can lead to dependence. Instead, try dong quaff, ginger, or milk thistle.
7. Load up on vitamin C. Some people find that about 2,000 milligrams a day is enough to trigger diarrhea. Finding the dose that works for you and backing off just slightly is one approach that may work. Do not try this if you have ever had kidney stones, because excess vitamin C raises oxalate excretion and might increase the risk of a recurrence.159
8. Stir a couple teaspoons of Swedish bitters into a cup of water. Hot water or herb tea may work best. It also comes in capsules that are convenient when traveling.
9. Experiment with a bulk-forming laxative. Some people find that UniFiber or Citrucel works better for them than psyllium.
10. Make sure you get enough magnesium, especially if you are taking calcium supplements. Calcium carbonate can be constipating, but magnesium can help offset this tendency. We generally advise people that a dose above 300 milligrams of magnesium per day may cause diarrhea. The maximum short-term dose of magnesium advised on the label of Phillips’ Milk of Magnesia is 2,000 milligrams for adults. Do not take magnesium or milk of magnesia if you have kidney disease.
Conclusions
Constipation accompanied by pain, nausea, vomiting, or fever should not be ignored. It deserves medical attention. Even without such symptoms, persistent constipation should also be brought to a physician’s attention. Uncomplicated constipation may respond to home treatment.
• Begin with diet. Make sure you get six to eight 8-ounce glasses of water or other fluids daily. Concentrate on increasing fiber, and make sure you get 25 to 35 grams daily.
• Ask your doctor to check whether a medical condition or medication may be causing your constipation.
• Eat fruit. Apples, dried apricots, and (in moderation) dried plums, aka prunes, are a wonderful way to establish regularity when needed.
• Sprinkle ground flaxseed on your food, or take a solution of simmered flaxseed in juice.
• Chew sugarless gum or enjoy sugar-free candy for its laxative effect.
• Take psyllium as directed, with an 8-ounce glass of water.
• Docusate may soften stools and ease straining.
• Milk of magnesia may give relatively quick relief, but should not be overused. It’s off-limits for anyone with kidney trouble.
• Drugs such as MiraLax are intended for short-term use of less than 2 weeks.