Aug
13
Fenofibrate - Finasteride - Fioricet - Fiorinal - Fiorinal with Codeine
August 13, 2009 | Leave a Comment
Generic Name
Fenofibrate (fen-oe-Flli-brace) IM
Brand Names
Antara TriCor
Lipoten Triglide Lofibra
Type of Drug
Anti-hyperlipidemic (blood-fat reducer).
Prescribed For
High blood cholesterol and/or triglycerides; also prescribed for syndrome X, a condition which increases the risk of type 2 diabetes.
General Information
Fenofibrate works by interfering with the body’s ability to make triglyceride and by increasing its breakdown by enzymes in the body. It also reduces levels of uric acid, total cholesterol, low-density lipoprotein (LDL) cholesterol—the “bad” cholesterol—and other blood lipids. High-density lipoprotein (HDL) cholesterol—the “good” cholesterol—levels are increased. This drug should only be used in people with very high triglyceride levels who are at risk for pancreatitis (inflammation of the pancreas) and have not responded to other treatments, including statin drugs. Generic fenofibrate is not equivalent to the TriCor brand because of a new product formulation and should not be substituted for the brand unless your doctor approves of the switch.
Cautions and Warnings
Do not take fenofibrate if you are allergic or sensitive to any of its ingredients.
People taking fenofibrate and other triglyceride-lowering drugs are mate WOV to die from causes unrelated to triglyceride levels. Fenofibrate reduces the risk of a heart attack or other cardiac event in people with high triglyceride levels and low levels of HDL cholesterol, especially among people with diabetes. The evidence for this benefit is not as strong as it is for the statin drugs.
People taking fenofibrate and gemfibrozil may develop pancreatitis (inflammation of the pancreas).
People with liver or severe kidney disease should avoid fenofibrate. People with less severe kidney disease require reduced
dosage.
People taking fenofibrate are more likely to develop gallstones.
Fenofibrate can destroy muscle cells, leading to kidney failure, especially when combined with a statin cholesterol-lowering drug see “Drug Interactions”).
Possible Side Effects
• Most common: abnormal liver function, abdominal pain, and respiratory disorders.
♦ Common: rash, headache, upset stomach, pain, weakness, tiredness, and flu-like symptoms.
♦ Less common: joint pain, abnormal heart rhythms, reduced sex drive, dizziness, increased appetite, sleeplessness, tingling in the hands or feet, nausea, vomiting, diarrhea, abdominal pain, constipation, stomach noise or gas, frequent urination, vaginal irritation, runny nose, cough, sinus irritation, eye irritation, blurred vision, conjunctivitis (pinkeye). earache, and tiny particles inside the eye (”floaters”).
♦ Rare: allergic reactions including severe rash, itching, liver inflammation or enlargement, gallstones, gallbladder disease, muscle aches, and increased sensitivity to the sun. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Combining fenofibrate and a statin cholesterol-lowering drug (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) can lead to severe muscle pain, muscle cell destruction, and kidney failure. If you have extremely high blood-fat levels, the potential benefits of this combination may outweigh the risks. In people taking this combination, the health of muscles and kidneys must be monitored regularly via blood tests.
• Fenofibrate increases the effects of anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
• Combining fenofibrate and cyclosporine can increase the risk of kidney toxicity. This combination should only be used if it is absolutely necessary and the lowest possible dosage is
taken.
• If you are taking cholestyramine or colestipol (both are used
to reduce blood-fat levels) as well as fenofibrate, take the
fenofibrate at least 1 hour before or 4-6 hours after these
drugs.
Food Interactions
All forms of fenofibrate, except TriCor, should be taken with food to get the best effect. TriCor may be taken without regard to food or meals.
Usual Dose
These products may not be substituted for each other because of important dosage differences.
Antara
Adult: 43-130 mg a day with food.
Senior: Begin with 43 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
Lofibra
Adult: 67-200 mg a day with food.
Senior: Begin with 67 mg a day. This beginning dosage also applies to people with kidney disease.
Child: not recommended.
Lipofen
Adult: 50-150 mg a day with food.
Senior: Begin with 50 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
TriCor
Adult: 48-145 mg a day.
Senior: Begin with 48 mg a day. This dosage also applies to
people with kidney disease. Child; mk recommended.
Triglide
Adult: 50-160 mg a day.
Senior: Begin with 50 mg a day. This dosage also applies to
people with kidney disease. Child: not recommended.
Overdosage
Little is known about the effects of fenofibrate overdose. Victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
People should take fenofibrate only after a triglyceride- lowering diet and other medications have failed. While taking fenofibrate, follow the diet recommended by your doctor.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: Fenofibrate causes fetal injury and death in animal studies. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
This drug should not be taken by nursing mothers because of its potential to affect the nursing infant.
Seniors: Seniors are more likely to experience side effects and should never start with more than the lowest recommended dosage.
Generic Name
Finasteride (fin-ASS-ter-ide) 19
Brand Names
Proscar Propecia
The information in this profile also applies to the following drug:
Generic Ingredient: Dutasteride Avodart
Type of Drug
Alpha-reductase inhibitor and androgen hormone inhibitor.
Prescribed for
Benign prostatic hyperplasia (BPH) and male-pattern baldness. May also play a role in preventing prostrate cancer.
General Information
Finasteride works by interfering with the action of the enzyme alphareductase, which converts testosterone into 5-dihydrotestosterone (DHT). By suppressing DHT levels, finasteride reduces the size of the prostate in most men who take the drug for BPH. You may need to take finasteride for 6-12 months before its effects can be
assessed.
Urine flow improves in about 60% of men taking finasteride for BPH and symptoms improve in about 30%. In one study, men experienced a significant regression in prostate size after 3 months, and the reduction was maintained through the 12-month study period: these men experienced a significant improvement in urine flow that could be maintained up to 36 months.
Studies of finasteride for hair loss on the top and back-middle of the scalp show new hair growth in 65-80% of men taking the drug continuously for 2 years. The drug must be taken for 3 months or more before it begins to have an effect and must be taken continuously to maintain hair growth. Once you stop taking this drug, any new hair you have grown is likely to fall out in the next 12 months. Between 14-17% of men taking the drug continued to lose hair throughout the study period.
Finasteride has been studied as therapy following radical prostatectomy surgery and in the prevention of first-stage prostate cancer, acne in women, and unusual hairiness.
Cautions and Warnings
Do not take finasteride if you are allergic or sensitive to any of its ingredients.
This drug should not be used in women or children. Pregnant women must not handle the tablets and capsules because of the risk to the fetus.
People who do not respond to finasteride may have a condition that causes BPH-like symptoms, such as prostate cancer, bladder or nerve disorders, or physical obstruction of the urinary tubes. Finasteride cannot be used to treat these conditions.
Because it is broken down in the liver, finasteride must be used with caution by people with liver disease.
Finasteride may mask symptoms of prostate cancer by causing a reduction in the level of prostate-specific antigen (PSA), an increasingly acknowledged indicator of prostate cancer.
Possible Side Effects
Side effects are generally mild and often subside with continued use of the drug.
Drug Interactions
• Finasteride may reduce the effectiveness of theophylline and aminophylline, although dosage adjustments usually are not required.
• Finasteride affects the PSA blood test used for prostate cancer screening. Be sure your doctor knows you are taking this drug if you have a PSA test done or are being tested for prostate cancer.
• Dustasteride blood levels may increase when mixed with ritonavir, ketoconazole, cimetidine, and ciprofloxacin, all of which are inhibitors of a liver enzyme called CYP3A4. Blood levels of dutasteride also increase with verapamil and diltiazem.
Food Interactions
You may take finasteride with food if it upsets your stomach.
Usual Dose
Outasteride
Adult: 0.5 mg (1 capsule) once a day. Child: not recommended.
Finasteride
Adult: BPH-5 mg once a day. Male-pattern baldness-1 mg once a day.
Child: not recommended.
Women should not take finasteride. Overdosage
S%’& Ptecls are unlikely. Doses of dutasteride as high as 400 mg a day have been taken with no adverse side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Possible Side Effects (continued)
v Common: impotence, loss of sex semen, breast tenderness an
• and drug sensitivity reaction
• rash.
x drive, decreased amount nd enlargement, testicular ions including lip swelling Special Information
Women who are or might be pregnant should not handle crushed finasteride tablets because small amounts of the drug may be absorbed into the blood, possibly affecting the fetus.
If your sexual partner is or might be pregnant and you start taking finasteride, you must wear a condom during sex to avoid directly exposing her to finasteride in the semen.
Semen volume may decrease while on finasteride. Impotence or reduced sex drive is also a risk.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss a dose for 2 or more days.
Special Populations
Pregnancy/Breast-feeding: This drug is not intended for women. Finasteride will harm the fetus if taken during pregnancy. It is not known if finasteride passes into breast milk.
Seniors: Seniors with liver disease should use this drug with caution.
Brand Name
Fioricet
Generic Ingredients
Acetaminophen + Butalbital + Caffeine 91
Other Brand Names
Americet Femcet
Dolgic LQ Margesic
Dolgic Plus Medigesic
Esgic Repan
Esgic-Plus Triad
Type 101 Drug
Barbiturate and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fioricet is one of many combination products containing a barbiturate—butalbital—and an analgesic—acetaminophen. Products of this kind also often contain a sedative or a narcotic. Other analgesic combinations, such as Rorinal, substitute aspirin for
acetaminophen.
Cautions and Warnings
Do not take Fioricet if you are allergic or sensitive to any of its ingredients.
Use this drug with caution if you have kidney or liver disease or a history of porphyria.
Chronic (long-term) use of Fioricet may lead to drug dependence or addiction. It is not recommended for multiple or recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an inability to concentrate. Alcohol increases the CNS depression caused by this drug.
The safety and effectiveness of these medications have not been established in children under age 12.
For additional information see “Cautions and Warnings” in Acetaminophen (page 7).
Possible Side Effects
♦ Most common: lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, upset stomach and a feeling of intoxication.
V Less common: weakness, headache, agitation, tremor, uncoordinated muscle movement, disorientation, dry mouth, constipation, facial flushing, changes in heart rate, palpitations, feeling faint, urinary difficulties, rash, and itching.
For additional information see “Possible Side Effects” in Acet-
aminophen (page 7).
Drug Interactions
• Combining Fioricet with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
These medications may reduce the effectiveness of corticosteroids, contraceptives containing estrogen, beta blockers (e.g. propranolol), doxycycline, felodipine, griseofulvin, nifedipine, phenylbutazone, quinine, theophylline, warfarin, and tricyclic antidepressants.
For additional information see “Drug Interactions” in Acetaminophen (page 7).
Food Interactions
Fioricet is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not exceed 6 doses a day.
Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, facial flushing, sweating, and thirst. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fioricet may cause drowsiness. Be careful when driving or performing any task that requires concentration.
You should avoid alcohol while taking this medication.
Do not take Fioricet for longer or in amounts greater than prescribed.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping Fioricet may lead to withdrawal symptoms.
Call your doctor if your headache or pain persists or gets worse, or if you develop side effects that are bothersome or persistent.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one and continue
W<tkh IV61 schedule. Do not take a double dose.
For additional information see “Special Information” in Acetaminophen (page 7).
Special Populations
Pregnancy/Breast-feeding: Fioricet should not be taken during pregnancy. It is associated with birth defects, prolonged labor and delayed delivery, and breathing problems in newborns. Regular use of Fioricet during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fioricet passes into breast milk. Breast-feeding while using Fioricet may cause babies to become tired, short of breath, or have a slow heartbeat. Nursing mothers who must take this drug should use infant formula.
Seniors: Fioricet may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal
Generic Ingredients
Aspirin + Butalbital + Caffeine &9
Other Brand Names
Butalgen Fiorimor
Farbital Fortabs
Fiorigen Lanorinal
Type of Drug
Barbiturate and analgesic (pain reliever) combination. Prescribed For
Symptom relief of tension headache.
General Information
Pain relief products often combine an analgesic with a sedative. The analgesic ingredient in Fiorinal is aspirin; other brand-name products, such as Esgic and Fioricet, contain acetaminophen. The sedative ingredient in pain-relief combinations may be a barbiturate, narcotic, or other sedative. Fiorinal contains the barbiturate butalbital. Fiorinal also contains caffeine, which is ofte” \Ased in analgesic combinations that km,-M beadache because it enhances kkNt %m-relieving effect of aspirin.
Cautions and Warnings
Do not take Fiorinal if you are allergic or sensitive to any of its ingredients.
Do not give Fiorinal to children or teenagers with chickenpox or flu-like symptoms due to the aspirin content and danger of
Reye’s syndrome.
Use Fiorinal with extreme caution if you suffer from peptic ulcer,
problems with blood clotting or other bleeding disorders, or are
about to have surgery.
This drug should be used with caution if you have kidney or
liver disease, diabetes, or a history of porphyria.
Long-term use of this drug may cause drug dependence and addiction. It is not recommended for the treatment of multiple recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an
inability to concentrate. Alcohol increases the CNS depression caused by butalbital.
The safety and efficacy of Fiorinal use in children under age 12 has not been established.
For additional information see “Cautions and Warnings” in Aspirin (page 110).
Possible Side Effects
✓ Most common: lightheadedness, dizziness, and sedation.
♦ Less common: nausea, vomiting, flatulence, and rash. For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Combining Fiorinal with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
• Fiorinal may enhance the effects of oral anticoagulants (blood thinners), oral antidiabetes drugs, insulin, and mmsteroidal anti-inflammatory drugs ~VASAYDs).
• F10final may decrease the effectiveness of medications taken for gout, including probenicid and sulfinpyrazone.
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal is best taken on an empty stomach but may be taken with
food if it upsets your stomach.
usual Dose
1-2 tablets or capsules every 4 hours or as needed. Do not exceed
6 doses a day. Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin, lowered heart rate or blood pressure, nausea, vomiting, stomach pain, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose are rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, and bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fiorinal may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking Fiorinal.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take Fiorinal for longer or in amounts greater than prescribed.
Call your doctor if your headache pain persists or gets worse, or if you develop any bothersome or persistent side effect.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
PregriancylBreast-feeding. Fiorinal should not be taken during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. Fiorinal increases the risk of birth defects and may cause breathing or bleeding prob-lems in newborns. Regular use of Fiorinal during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal passes into breast milk. Breast-feeding while using Fiorinal may cause tiredness, shortness of breath, or slowed heartbeat in the baby. Nursing mothers who must take Fiorinal should use infant formula.
Seniors: Fiorinal may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal with Codeine
Generic Ingredients
Aspirin + Butalbital + Caffeine + Codeine Phosphate 19
Type of Drug
Barbiturate, narcotic, and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fiorinal with Codeine is one of many combination products containing a barbiturate, an analgesic, and a narcotic. In Fiorinal with Codeine, butalbital is the barbiturate, aspirin is the analgesic, and codeine is the narcotic. These products often also contain a sedative, and acetaminophen may be substituted for aspirin.
Cautions and Warnings
Do not take Fiorinal with Codeine if you are allergic or sensitive to any of its ingredients. Even recommended doses of aspirin can cause severe allergic reaction in those with an aspirin allergy.
Do not take this medication if you suffer from peptic ulcer, bleeding disorders, or a history of porphyria.
Use this medication with cautiOi) 11 you have kidney or liver
disease of diabetes.
Fiorinal with Codeine may cause postural low blood pressure (symptoms include dizziness or fainting when rising from a sitting or lying position).
Long-term use of this drug may cause drug dependence or addiction.
It is not recommended for treatment of multiple, recurrent head-
aches.
Fiorinal with Codeine is a respiratory depressant and affects the
central nervous system (CNS), producing sleepiness, tiredness, or inability to concentrate. Alcohol increases the depression caused
by codeine and butalbital.
Do not give Fiorinal with Codeine to children or teenagers with
chickenpox or flu-like symptoms. The aspirin content presents the
danger of Reye’s syndrome.
For additional information see “Cautions and Warnings” in As-
pirin (page 110).
Possible Side Effects
✓ Most common: dizziness, sleepiness, nausea, and vomiting.
♦ Less common: dry mouth, difficulty swallowing, heartburn, rapid heart rate, leg pain and muscle fatigue, urinary problems, rash, fever, earache, stuffy nose, and ringing in the ears. Narcotic analgesics may aggravate convulsions in those who have had them.
For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Interaction with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, or other drugs that produce sedation may cause tiredness, drowsiness, and trouble concentrating.
• Taking Fiorinal with Codeine with a monoamine oxidase inhibitor antidepressant may cause increased central nervous system effects.
• This medication may reduce the effectiveness of medications for the treatment of gout including probenicid and sulfapyrazone.
• Fiorinal with Codeine may enhance the effects of blood thin- ners, oral antidiabetes drugs, insulin, and anti-inflammatory drugs (NSAIDs).
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal with Codeine is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not ex-
ceed 6 doses a day.
Overdosage
Usual overdose symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose include rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, or bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking this drug.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take this drug for longer or in amounts greater than prescribed.
Call your doctor if you experience breathing difficulties, or persistent nausea, vomiting, or constipation.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
Pregnancy/Breast-teeding-. Fiorinal with Codeine should not be used during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. This drug increases the risk of birth defects and may cause breathing or bleeding problems in newborns. Regular use of Fiorinal with Codeine during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal with Codeine passes into breast milk. Breast-feeding while using this drug may cause tiredness, shortness of breath, or a slow heartbeat in the baby. Nursing mothers who must take this drug should use infant formula.
Seniors: This drug may have a greater depressant effect on seniors. Other effects that may be more prominent are stimulation, disorientation, lightheadedness, and dizziness or fainting when rising suddenly from a sitting or lying position.
Aug
13
Econazole - Efalizumab - Eflornithine - Enalapril - Enfuvirtide - Entacapone
August 13, 2009 | Leave a Comment
Generic Name
Econazole (ee-KON-uh-zole) 92
Brand Name Spectazole
Type of Drug Antifungal.
Prescribed For
Fungal infections of the skin, including athlete’s foot. jock itch, and ringworm.
General Information
Econazole nitrate can kill fungal organisms that may have penetrated to deep layers of the skin. Very small amounts of econazole are absorbed into the bloodstream.
Cautions and Warnings
Do not use econazole if you are allergic or sensitive to any of its ingredients.
Do not apply econazole cream in or near your eyes.
Long-term application of this product to large areas of skin may cause liver damage.
Possible Side Effects
♦ Most common: burning, itching, stinging, and redness in the areas to which the cream has been applied.
Drug Interactions None known.
Usual Dose
Adult: Apply enough of the cream to cover affected areas with a thin layer 1-2 times a day.
Overdosage
Accidental ingestion may cause nausea, upset stomach, drowsiness, and liver inflammation or damage. Call your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Clean the affected areas before applying econazole cream, unless otherwise directed by your doctor. Dry the infected area thoroughly and wear loose-fitting clothes to keep the area cool and dry.
Call your doctor if the treated area burns, stings, or becomes red.
This product can be expected to relieve symptoms within 1 or 2 days after you begin using it. Follow your doctor’s directions for the complete 2-4-week course of treatment to gain maximum benefit. Stopping the drug too soon can lead to a relapse.
If you forget a dose of econazole, apply it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not apply a double dose.
Special Populations
Pregnancy/Breast-feeding: When given by mouth to pregnant animals in high doses, econazole was toxic to the fetus. It should be strictly avoided during the first 3 months of pregnancy. During the last 6 months of pregnancy, it should be used only if absolutely necessary.
Econazole may pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors may take this drug without special restriction.
Efalizumab (ef-ah-LIZ-u-mab)
Brand Name Raptiva
Type of Drug
Immune system suppressant.
Prescribed For
Chronic to severe plaque psoriasis.
General Information
Efalizumab is a manmade antibody that works by binding to specific areas of certain white blood cells called leukocytes. This prevents the leukocytes from interacting with other cells and interrupts inflammation that is involved in the development of patches of psoriatic skin. The molecule that efaluzimab interacts with is found on many other key cells found in the immune system, and this is the source of many of the drug’s more serious side effects.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients.
People taking efalizumab are at a greater risk of infection because it suppresses the immune system. Contact your doctor if you develop any kind of infection, including a common cold. Serious infections may require hospitalization.
The chances of malignancy may be increased by efalizumab because it suppresses the immune system. People with any type of cancer should not use this drug.
Efalizumab may lead to bleeding because it can cause a drastic reduction in blood-platelet counts. People with a history of low blood-platelet counts should be extremely cautious about using efalizumab.
Psoriasis can get worse or recur during or after efalizumab treatment in a small number of people. Call your doctor immediately if your condition worsens while you are taking efalizumab.
Possible Side Effects
Headache, fever, nausea, and vomiting are common alter taking the very first dose of elaki7umab. A “conditioning” dose of about 0.3 mg per lb. of body weight is often given to minimize these reactions.
V Most common: headache, infections, chills, nausea, and pain.
V Common: muscle aches, flu-like symptoms, itching, and fever.
Possible Side Effects (continued)
✓ Less common: back pain, arthritis, lung inflammation, and
acne.
♦ Rare: psoriasis, arthritis, joint pain, malignancy, low blood-platelet count, and drug allergy or sensitivity. Other 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
• Efalizumab is an immune system suppressant and should not be combined with other immune suppressant drugs because of the increased risk of infection and malignancy.
• Combining vaccines (live and acellular) with efalizumab may exaggerate the body’s response to the vaccine and increase the risk of developing the disease against which the vaccination is being administered. People taking etalizurnab should not receive vaccines.
Food Interactions None known.
Usual Dose
Adult: 0.3 mg per lb. of body weight to start. Then about 0.5 mg per lb. of body weight once a week on the same day. The maximum dose is 200 mg by subcutaneous injection. Mix your dose immediately before it is to be injected and throw away any unused medicine.
Child: not recommended.
Overdosage
Doses up to 4 times the recommended dose have been taken for 10 weeks without additional side effects. However, overdose victims should be taken to a hospital emergency room for observation. ALWAYS bring the prescription bottle or container.
Special information
See your doctor regularly while you are taking efaluzima6. Regular blood tests are required to make sure your blood platelets are not unusually low.
Tell your doctor if you gain or lose weight, since doses of efaluzimab are based on how much you weigh.Tell your doctor about all medicines you are taking including other medicines for psoriasis, non-prescription drugs, vitamins,
and herbal supplements.
Store unused medicine in the refrigerator. Throw away medicine that has been mixed but not used.
Call your doctor immediately if you develop bleeding gums, black-and-blue marks, any kind of infection, begin to bruise easily, or if you are told by another doctor that you have any kind of cancer.
This drug is given by injection under the skin. For more information on how to properly administer this drug, see page 1242.
Special Populations
Pregnancy/Breast-feeding: It is not known how efaluzimab will affect a growing fetus. Animal studies using doses equal to 30 times the human dose showed no adverse effects. While animal studies of efaluzimab reveal no damage to the fetus, this drug should be used only during pregnancy after carefully weighing its potential benefits against its risks.
It is not known if efaluzimab passes into breast milk, although it might affect the nursing infant’s developing immune system. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors should be cautious about using efaluzimab because of the increased risk of infection.
Generic Name
Eflornithine (eh-FLOOR-nih-thene)
Brand Name
Vaniga,
Type of Drug
Hair growth retardant.
Prescribed For
Removal of unwanted facial hair by women.
General Information
This drug has only been studied for its ability to prevent hair growth on the face and chin and should not be used on other body areas. It works by interfering with enzymes in the skin necessary for hair growth, slowing the rate at which hair will grow. Improvement may be seen as soon as 4-8 weeks after you start using eflornithine, but the condition will return within 8 weeks after you stop using it.
Cautions and Warnings
Do not use eflornithine if you are allergic or sensitive to any of its ingredients.
For external use only; do not ingest.
Possible Side Effects
Eflornithine side effects are similar to those of a placebo (sugar pill).
✓ Most common: acne, bumps, or small pustules on the skin. V -Common: stinging.
✓ Less common: headache, dizziness, burning, itching, redness, tingling, irritation, rash, hair loss, upset stomach, and appetite loss.
✓ Rare: fainting, ingrown hairs, inflamed hair follicles, facial swelling, nausea, bleeding, contact dermatitis, inflammation of one or both lips, herpes breakout, numbness, and dilated blood vessels and pores on the nose and cheeks. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult and Child Me 11 anti over): Apply a thin layer of cream to ai ected areas and rub in thoroughly 2 times a day at least 8 hours apart. Do not wash your face until at least 4 hours after you have applied eflornithine cream. Wait at least 5 minutes after hair removal to apply eflornithine.
Child (under age 12): not recommended.
Overdosage Little is about the effects of eflornithine overdose or acci-
Li known
dental ingestion. Call your local poison control center for more information. ALWAYS bring the prescription container.
Special Information
If you forget to apply a dose of eflornithine, apply it as soon as you remember. Bear in mind that at least 8 hours must elapse between doses and you cannot wash the area for another 4 hours after application. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.
This product slows hair growth. It is not a depilatory. You will have to continue shaving, tweezing, or using another hair removal technique.
Wait several minutes after application of eflornithine before applying cosmetics or sunscreen.
Use only on your face and neck.
Call your doctor if your skin becomes irritated or if you develop other side effects. If skin irritation continues, you may have to stop using eflornithine.
Special Populations
Pregnancy/Breast-feeding: Eflornithine cream may cause birth defects. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if this drug passes into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors may use eflornithine without special restriction.
Generic Name
Enalapril (uh-NAL-uh-pril)
Brand Name
Vasotec
Combination Product
Ggner;c Ingredients: Enalapril + Hydrochlorothiazide RE Vaseretic
Type of Drug
Angiotensi n -converting enzyme (ACE) inhibitor.
Prescribed For
Hypertension (high blood pressure), heart failure, diabetic kidney disease, and heart attack treatment when the function of the left ventricle has been affected. Also prescribed for kidney failure, kidney hypertension, managing people with a high risk of heart disease, chronic kidney disease, and preventing a second stroke.
General Information
Enalapril maleate and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving symptoms of heart failure. Enalapril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation. Enalapril begins working about 1 hour after you take it and continues to work for 24 hours.
Cautions and Warnings
Do not take enalapril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients taking enalapril or those undergoing venom immunization.
Swelling of the face, extremities, or throat has been known to occur with enalapril, which can be dangerous (see “Special Information”).
Enalapril occasionally causes very low blood pressure.
Enalapril may affect your kidney function, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of treatment. Dosage adjustment of enalapril is necessary if you have reduced kidney function.
Enalapril can affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
Enalapril may cause serious Injury or death to the fetus if taken duriRcA pregnancy. Pregnant women should not take enalapril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
♦ Most common-. dizziness, fatigue, headache, and chronic cough. The cough usually goes away a few days after you stop taking the medication.
♦ Less common: chest tightness or pain, dizziness when rising from a sitting or lying position, fainting, abdominal pain, nausea, vomiting, diarrhea, bronchitis, urinary tract infection, breathing difficulties, weakness, and rash.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
For additional information about enalapril + felodipine, see Felodipine, page 471.
Drug Interactions
• The blood-pressure-lowering effect of enalapril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid drop in blood pressure should be used with caution if you are taking enalapril.
• Enalapril may increase the effects of lithium; this combination should be used with caution.
• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the blood-pressure-lowering effects of enalapril and other ACE inhibitors. The combination may cause reductions in kidney function.
• Enalapril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
• Antacids and enalapril should be taken at least 2 hours apart.
• Capsaicin may trigger or aggravate the cough associated with enalapril therapy.
• Indomethacin may reduce the blood-pressure-lowering effects of enalapril.
• Phenothiazine sedatives and antiemetics may increase the ef - feZIS of enalapril.
• Rifampin may reduce the effects of enalapril.
• The combination of allopurinol and enalapril increases the chance of side effects. Avoid this combination.
• Enalapril affects blood levels of digoxin. More digoxin in the blood increases the chance of digoxin-related side effects, while less digoxin in the blood can compromise its effectiveness.
• Severe sensitivity reactions can occur in those taking allo-
purinol.
For additional information about enalapril + felodipine, see Felodipine, page 471.
Food Interactions
You may take enalapril with food if it upsets your stomach.
Usual Dose
Enalapril
Adult: 5-40 mg a day in 1 or 2 doses. People with poor kidney function need less medication.
Enalapril + Felodipine
Adult: 1-2 tablets a day.
Overdosage
The principal effect of enalapril overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Enalapril can cause swelling of the face, lips, hands, or feet. This swelling can also affect the larynx (throat) or tongue and interfere with breathing. If this happens, go to a hospital emergency room at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, persistent rash, or loss of taste perception.
Some people who start taking enalapril after they are already on a diuretic (an agent that increases urination) experience a rapid drop in blood pressure after their first doses or when their dosage is increased. To prevent this from happening, your doctor may tell you to stop taking your diuretic 2 or 3 days before starting enalapril or to increase your salt intake during that time. The diuretic may then be restarted gradually.
You may gO dizzy if you rise to your feet too quickly from a sitting or lying position when taking enalapril.
Avoid strenuous exercise or very hot weather because heavy
sweating or dehydration can cause a rapid drop in blood pressure.
While taking enalapril, avoid over-the-counter diet pills, decon-
gestants, and other stimulants that can raise blood pressure. Also,
do not take potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you take enalapril once a day and forget to take a dose, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take enalapril twice a day and miss a dose, take it right away. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might become pregnant should not take ACE inhibitors. Sexually active women of childbearing age who must take enalapril must use an effective contraceptive method to prevent pregnancy. If you become pregnant, stop taking the medication and call your doctor immediately.
Small amounts of enalapril pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug due to age-related losses in kidney or liver function.
Generic Name
Enfuvirtide (en-M-ir-tide)
fusing to healthy CD4 cells, a key part of the human immune system. This helps fight HIV by having fewer HIV-infected cells as well as a healthier immune system to fight off the HIV virus. Enfuvirtide is always prescribed in combination with other antiviral medicines. It is possible for the HIV virus to become resistant to enfuvirtide, but this drug can work against types of the virus that have become resistant to other anti-HIV therapies.
Cautions and Warnings
Do not take enfuvirtide if you are allergic or sensitive to any of its ingredients. Symptoms of drug allergy can include generalized itching, rash, severe chills, and low blood pressure. In rare cases, enfuvirtide triggers severe hypersensitivity. Patients experiencing symptoms (a combination of rash, fever, nausea, and/or respiratory distress) should stop using enfuvirtide and seek medical attention immediately.
People taking enfuvirtide may be more likely to develop bacterial pneumonia. See your doctor regularly and report any difficulty breathing or unusual respiratory reactions.
Enfuvirtide may raise blood sugar levels, worsen diabetes, or trigger latent diabetes. People with diabetes who take this drug may need to have the dosage of their anti-diabetes medication adjusted.
Possible Side Effects
✓ Most common: allergic skin reaction at the site of injection (symptoms include itching, rash, and swelling of tissue under the skin), diarrhea, nausea, fatigue, and sleeplessness.
✓ Common: tingling in the hands or feet, depression, anxiety, cough, sinusitis, herpes infection, weight loss, appetite loss, weakness, itching, and muscle ache.
✓ Less common: taste changes, small skin tumors, flu infection, constipation, abdominal pain, pancreas inflammation, conjunctivitis and lymph gland inflammation.
‘T Rare: Rare side effects can affect the blood, immune system, kidneys, urinary tract, and central nervous system. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
Enfuvirtide is not broken down in the liver and does not affect liver enzyme systems, so it is not likely to be involved in common drug
interactions.
Food Interactions
None known. Usual Dose
Adult and Child (age 17 and over): 90 mg injected under the skin into the upper arm, thigh, or abdomen twice a day.
Child (age 6-16): 0.91 mg per lb. of body weight twice a day, up to 90 mg per injection. Be sure to increase enfuvirtide dosage as your child’s weight increases.
Child (under age 6): not recommended.
Overdosage
Little is known about the effects of enfuvirtide overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Enfuvirtide is not a cure for HIV It will not prevent you from transmitting the HIV virus to another person; you must still practice safe sex. People taking this drug may still develop opportunistic infections and other complications associated with HIV infection.
This drug is given by injection under the skin. For information on how to properly administer this drug, see page 1242.
Do not use a vial of enfuvirtide if the final solution has particles floating in it. It should be completely clear, colorless, and have no bubbles in the vial.
You may keep solutions of enfuvirtide in the refrigerator and use them for up to 24 hours after they have been mixed. After that, they must be thrown away.
Tell your doctor if you are pregnant, become pregnant, os plan to become pregnant.
Do not stop taking this, or any other anti-HIV medicine, without first consulting your doctor.
Special Populations
Pregnancy/Breast-feeding: While animal studies of enfuvirtide reveal no damage to the fetus, this drug should only be used during pregnancy after carefully weighing its potential benefits against its risks. A national registry has been established to gather information on pregnant women who take this drug.
It is not known if enfuvirtide passes into breast milk. Nursing mothers with HIV should always use infant formula, regardless of whether they take this drug, to avoid transmitting the virus to their child.
Seniors: The effects of enfuvirtide in seniors is unknown.
Generic Name
Entacapone (in-TACK-a-pohn)
Brand Name Comtan
Type of Drug Antiparkinsonian.
Prescribed For
Parkinson’s disease patients for whom levodopa + carbidopa loses its effectiveness between doses.
General Information
Entacapone is always used in combination with levodopa + carbidopa. Some patients experience signs and symptoms of an end-of-dose “wearing-off” effect with these drugs. Entacapone enhances the effect of levodopa + carbidopa by reversing the action of an enzyme known as catechol-O-methyltransferase (COMT), which is primarily responsible for breaking down levodopa in the body.
Cautions and Warnings
Do not take entacapone If yOU are allergic or sensitive to any of At *Ingredients.
Do not take entacapone with phenelzine or tranyleypromine, as a very serious reaction may occur.
People with liver disease should use entacapone with caution as they may accumulate twice as much of this drug in their blood as people with normal liver function.
Entacapone has been rarely associated with the formation of fibrous tissues in unusual places such as the urinary tract and lungs. It has also caused fluid in the lungs.
Entacapone may cause kidney toxicity.
Entacapone may increase the risk of dizziness or fainting when rising from a sitting or lying down position.
Hallucinations have been reported with other Parkinson’s disease drugs.
Possible Side Effects
♦ Most common: difficulty performing voluntary muscle functions, excessive muscle activity, nausea, urine discoloration, and diarrhea.
♦ Common: reduced muscle activity, dizziness, fatigue, constipation, and abdominal pain.
✓ Less common: low blood pressure and fainting when rising from a sitting or lying position, hallucinations, anxiety, agitation, gastritis or other stomach disorders, dry mouth, vomiting, increased sweating, back pain, taste changes, shortness of breath, easy bruising, weakness, and bacterial infection.
♦ Rare: muscle damage or death, high fever, and confusion. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Do not mix entacapone with the monoamine oxidase inhibitor (MAGI) antidepressants phenelzine or tranylcypromine. Entacapone may be taken with the MAGI selegiline.
• Other drugs broken down by COMT will also be affected by entacapone. Isoproterenol, epinephrine, ephedrine, norepinephrine, isoetharine, and others will interact with entacapone, even when taken by inhalation. The result may be increased heart rate, wybylh m ias, and excessive changes in Uwd pressure.
• Cholestyramine, probenecid, erythromycin, rifampin, ampicillin, and chloramphenicol may interfere with the elimination of entacapone from the body.
• Entacapone may enhance the effects of sedatives and other nervous system depressants.
Food Interactions
This drug may be taken with or without food.
Usual Dose
Adult: 200 mg with each levodopa + carbidopa dose, up to
1600 mg a day.
Child: not recommended.
Overdosage
Theoretically, a massive entacapone overdose could prove lethal by completely inhibiting COMT throughout the body. There have been no reports of significant entacapone overdose. Doses up to 800 mg have been taken and side effects were mainly abdominal pain and loose stools. Other effects that might be expected include difficulty breathing, loss of muscle coordination, reduced level of activity, and convulsions. Overdose victims should be taken to a hospital emergency room as soon as possible. ALWAYS bring the prescription bottle or container.
Special Information
Always take your entacapone dose together with your levodopa + carbidopa dose. If you forget a dose, take it as soon as you remember. If it is within 2 hours of your next dose, skip the dose you forgot and continue with your regular schedule.
This drug can cause dizziness, nausea, sweating, or fainting when rising quickly from a sitting or lying position, especially at the beginning of treatment.
Increased body movements and twitching, twisting, or uncontrolled tongue, lip, face, arm, or leg movement may occur. If this happens, your doctor may need to adjust your dose of levodopa + carbidopa.
Exercise caution when performing tasks, such as driving, that require coordination and concentration until your body has become accustomed to the effects of entacapone.
Gradually reducing the dose of entacapone decreases some drug side effects.
Rapid withdrawal can cause high fever, sweating, unstable blood pressure, stupor, and muscular rigidity. Patients who stop using entacapone should be monitored.
Entacapone can cause your urine to turn a brownish-orange color. This change is harmless.
Special Populations
Pregnancy/Breast-feeding: Entacapone causes birth defects, miscarriage and abortion in pregnant animals. When this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
Entacapone passes into the breast milk of animals but no information on humans is available. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may take this drug without special precaution.
Jul
16
COUGH
Get a prescription for codeine cough syrup ****
Smear Vicks VapoRub on the soles of the feet ****
Add thyme to chicken broth ***
Enjoy a bit of dark chocolate ** Sip a glass of Concord grape juice
Trying to ease a cough ough can be a frustrating exper*ence. If it arrived with a cold or another upper respiratory tract infection, it’s likely to go away eventually, but those 2 or 3 weeks of suffering until it does can be miserable. Way back before the end of the last century, Americans could buy cough medicines that worked. Codeine-containing antitussive syrups were widely available without prescription. Physicians also recommended terpin hydrate, an expectorant, from the late 1800s until the early 1990s. In theory, an expectorant simply loosens up the stuff in the lungs and makes it easier to cough up. But many people found that terpin hydrate offered more benefit.
0 0 *
41. For years I used terpin hydrate as an expectorant when I had a cough. It worked. .
It was sold over the counter and one small bottle would last me the entire cold season.
Over-the-counter cough remedies on the market today are no better than water. They just do NOT work.
Is terpin hydrate still available? I’ve never found another cough syrup that works so well, but I can’t find it in my local drugstores.
A. Terpin hydrate was a popular cough medicine from the late 1800s until the early 1990s. Then the FDA banned it on the grounds that it had not been proven effective.
As an expectorant, terpin hydrate was supposed to loosen mucus and relieve coughs. It was derived from natural sources such as oil of turpentine or compounds found in oregano, thyme, and eucalyptus.
Terpin hydrate is no longer available in the United States. Instead, you may want to try a different old-fashioned remedy. Vicks VapoRub contains similar ingredients: oil of turpentine, thymol, and eucalyptol. Don’t take it internally. Just rub it on the chest or the soles of the feet to ease a cough.
Another approach is thyme tea. Use 1/2 teaspoon of dried thyme leaves from the kitchen spice shelf per cup of tea. Some people like to add lemon and honey. Others prefer chicken bouillon for flavor.
0 * *
Terpin hydrate was removed from the market because the FDA did not receive enough data to support its use when they were reviewing over-the-counter (OTC) drugs for effectiveness. (A high-ranking FDA official admitted to us off the record that he had used it and found it helpful. But the agency needed real data, not testimonials.) Perhaps the fact that it had been around for so long and no one company had a strong vested interest in it meant that no one wanted to invest in research on tenpin hydrate. Or maybe it really doesn’t work quite as well as people believed. But in any event, after it was banned, Americans needed to look for other cough remedies.
Codeine Cough Medicine
Codeine at prescription doses is generally considered an effective cough suppressant, but even the lower-dose OTC forms are becoming much harder to find. If you have a cough, your doctor might write you a prescription. It is legal in some states for people to buy low-dose codeine cough syrups if they sign for them. Presumably, that step offers extra security against abuse. But even where OTC codeine is legal, many chain drugstores won’t sell it without a prescription. They simply don’t want to be bothered. If you live in a state where codeine may be sold without a prescription, check with an independent pharmacy. Otherwise, ask your physician about a prescription. Codeine can be constipating, and long-term use can lead to dependence. But for a short-term annoying hack, this is a very helpful medication.
Dextromethorphan
By far the most readily available cough medicine is dextromethorphan. It is the primary ingredient in most OTC cough
*** C
Codeine not only is a good cough medicine, it also is extremely good for relieving pain. When combined with aspirin or acetaminophen, it practically sets the standard for pain relief. Codeine can also be useful in alleviating diarrhea, though it isn’t necessarily the first choice for that problem.
Side effects: Constipation, drowsiness, upset stomach Downside: Can cause dependence. May require a prescription.
Cost: Approximately $6 to $10 for a bottle
syrups, including Robitussin DM (the DM stands for dextromethorphan) and many other popular brands. Dextromethorphan has been almost the only choice for nonprescription cough relief for years. It is considered fairly safe because (unlike codeine) it is not classified as a narcotic.
The effectiveness of dextromethorphan has been questioned, however. The American College of Chest Physicians issued guidelines in 2006 on the diagnosis and management of cough that discourage the use of dextromethorphan or any other OTC cough medicine. According to Richard Irwin, MD, the head of the committee that developed the guidelines, “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough.” That’s a pretty discouraging view, since very few coughs actually warrant a doctor’s attention. If the cough has lasted for more than a couple of weeks, or if you are otherwise sick, then you should by all means see your doctor. But a regular cough from a cold probably won’t benefit from anything your doctor can do.
Home Remedies
There’s no good evidence for most of the home remedies that we are going to suggest. No one has done studies to see if thyme tea or horehound drops will really help. On the other hand, these approaches are inexpensive, so you can try them and judge for yourself if they work.
Vicks VapoRub
Vicks VapoRub shouldn’t really be classified as a home remedy. It is, after all, a perfectly respectable OTC product that has been a popular way to treat colds for more than a hundred years. According to the history, North Carolina pharmacist Lunsford Richardson set out to formulate a vaporizing cold’ salve for his own family. His children had come down with bad chest colds and the standard treatments of the day were messy and unsatisfactory.
The result of his effort was Vicks VapoRub. With its distinctive blue jar and unforgettable aroma, Vicks became known around the world as a remedy for congestion and other cold symptoms. It still contains the original formula: menthol, camphor, eucalyptus oil, cedarleaf oil, nutmeg oil, thymol, and turpentine oil in a petrolatum base. Parents everywhere rub Vicks VapoRub on their children’s chests to ease their coughs.
Many of the herbal oils in this old-fashioned salve seem to help ease a cough. Menthol is found in many cough drops, and thymol has a reputation for fighting cough. VapoRub is even approved by the FDA for relieving congestion and cough.
You could apply it to the throat and chest, as the instruc-
tions suggest, but go ahead and try it on the soles of the feet for a nighttime cough.
Downside: Not for internal use. Keep away from broken skin. Do not apply inside nostrils. No studies confirm that applying Vicks to the soles of the feet will work to calm cough. Cost’ Approximately $6 to $10 for a jar, which will last quite a while
My son continues to have problems with ear infections, although he had tubes put in them at 8 months old. He is now 30 months old and has an ear infection with nasal and chest congestion.
I was looking for home remedies for coughs when I found your Web site. I read the idea of putting Vicks VapoRub on the soles of the feet Within 10 minutes be was asleep without a cough.
We heard from a nurse who had learned from someone in her church that Vicks could be smeared on the soles of the feet to ease a nighttime cough. As she admitted, this sounded a little crazy, but she was desperate enough to try it on her 4-year-old daughter. When she did, they both finally were able to sleep through the night. We don’t know why Vicks on the soles of the feet would work any better than Vicks on the chest. Perhaps it doesn’t. But we do know that we have heard from hundreds of people who have tried this trick and had success. We have used it ourselves and been pleased. Be sure to put on socks to protect the bed sheets.
Thyme
Coughs frequently are a consequence of colds, and chicken soup is a time-honored cold remedy. Beyond its long history of use for this purpose (the Jewish philosopher Maimonides is said to have recommended it), there is even research to demonstrate its value or relieving congestion from colds.160 So it is little wonder that chicken soup flavored with thyme can be helpful.
My husband recently had a spell of heavy, nonproductive coughing and couldn’t reach his doctor. Robitussin DM didn’t do a thing. He went 2 nights with very little sleep and was miserable.
I made him some chicken soup for supper, and after he ate a bowl of it he stopped coughing. During the night he started up again. With more chicken soup, the coughing stopped immediately and he finished the night sleeping well.
I recalled what I’d put into the soup, and zeroed in on two herbs from my garden—three fresh sage leaves and some dried thyme. On the Internet I found that sage can calm a cough and thyme has been widely used as cough medicine.
I made him 2 cups of thyme tea before he went to bed the next evening and he slept the whole night through. I think our experience shows that thyme is a good remedy to keep around until the doctor calls back.
Chicken soup with thyme is one way to get the essence of thyme. Another is to make a cup of thyme tea. Ordinary thyme leaves from the kitchen spice cupboard will work just fine-1/2 teaspoon to a cup of hot water, steeped for about 5 minutes.
One reader reported getting a cough remedy over the counter when traveling in Germany. She found it very useful, much better than Robitussin DM, and wondered what it was. The medicine, called Makatussin, came as drops to be put on a sugar cube or in tea and contained Thymianfluidextrakt and Sternanisol. These are extract of thyme and star anise oil.
,-k,** Thyme
Thyme contains compounds such as thymol and carvacrol. This herb is listed in the PDR for Herbal Medicines as indicated for cough. and bronchitis. One to 2 grams of dried thyme leaves (1/2 to 1 teaspoon) are used to make a cup of tea. The recommended daily dosage is 10 grams spaced over the course of the day.
Side effects: None known Cost: Inexpensive
The German government has approved both herbs for colds and coughs, confirming what our readers have found for themselves.
Other Herbs
A number of other herbs have traditionally been used for uncomplicated coughs. Licorice is classic for sore throat and cough. It can raise blood pressure, so we don’t recommend it for people with hypertension, but for short-term use, it could be helpful. Menthol seems to have been approved by the FDA, since it is found in most OTC cough drops (as well as Vicks VapoRub). Linden flower tea is a European favorite for cough, but may be difficult to find in this country. Elderberry flowers can also be collected and dried for use in tea as a “homegrown” cough remedy. You’d have a hard time finding elderberry flowers in a store, although there are some elderberry products that use the berries themselves, rather than the flowers.
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Q. With my high blood pressure, it’s hard to find cold or cough medicine that is safe. My sister recommended black elderberry extract and zinc. It did the trick.
A. Elderberry-flower tea is a traditional remedy for colds and coughs. Many herbalists believe elderberry is more effective than echinacea.
Studies of zinc used against colds have produced mixed results, some positive but others negative. Neither remedy should increase blood pressure, though.
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Ginger tea is one of our favorite cold remedies, and it also may help to ease a cough. One animal study found that a component of ginger called shogaol worked at least as well as dextromethorphan against cough. That may mean simply that shogaol is just as good as placebo, now that the effectiveness of dextromethorphan is in question. Nevertheless, ginger tea is tasty and not very expensive.
Another old-fashioned approach to calming a cough is horehound. Candies flavored with this herb are still available in some stores and catalogs (such as the Vermont Country Store) that pride themselves on carrying old-time products. There’s no good research for any of these herbal products, but also no indication that they would cause any serious reactions, either.
Some people find that sucking on a piece of hard candy works quite well to ease a daytime cough, whether or not the candy has any active ingredients such as licorice or menthol in it. One scientist has suggested that part of the reason most cough syrup is sweet is not only to mask the nasty flavor of dextromethorphan, but also to recruit the brain’s own opioids, endorphins, in calming the cough. 161 Since opioids are very effective against cough, this is an appealing hypothesis.
Chocolate
Another possible remedy fora simple cough may surprise you. Chocolate lovers though we are, we never suspected that theobromine, one of the essential components of chocolate and cocoa, would have any benefit against cough. But that is exactly what British researchers found in experiments with guinea pigs.” They gave the guinea pigs citric acid to make them cough, then gave them theobromine purified from cocoa. The theobromine overcame the induced cough. An experiment in humans confirmed that theobromine is also effective against coughs in people.
The question is, how much chocolate does it take, and in what form? Unfortunately, we do not have an answer to that extremely practical issue. The researchers used theobromine alone, which is not available to the rest of us. But all of us have access to chocolate. You could do some experiments of your own to find the most palatable and effective cough-suppressing chocolate. ,
Here’s what pediatrician Alan Greene, MD, says about using chocolate against cough:
How much chocolate would this be? Chocolate preparations vary widely, depending on their cocoa content but dark chocolate often has up to about 450 milligrams of theobromine per ounce. Milk chocolate has far, far less. Two ounces of dark chocolate was about the amount of theobromine used for the adults in the ** Chocolate
Theobromine has been tested and shown to be effective in suppressing a cough. We don’t know of any way to get theobromine except to eat some chocolate, preferably dark chocolate. Savor it, and remember that it has other health benefits if consumed in moderation.
Side effects: Allergy is possible.
Downside: Dose unknown. Excess chocolate consumption -may lead to weight gain.
Cost: Highly variable, no prescription dispensing fees
study. Half that maybe plenty for kids (but of course there is still a lotto learn about this marvelous food). Will that much chocolate keep them awake? Even though theobromine is structurally related to caffeine, studies have shown it doesn’t interfere with sleep at those amounts. I used some fine dark chocolate for my own family during our latest viral cough illness, and our coughs disappeared nicely. What a pleasant way to get through a cold!
One other odd cough remedy may be worth a try. This one has not been tested in guinea pigs, but some people find that drinking Concord grape juice helps to ward off colds and ease coughs. There is research demonstrating that Concord grape juice has measurable anti-inflammatory activity.163 But we don’t know what component of grape juice, if any, might be contributing to its cough-calming effect.
Q. My wife used to get sore throats every winter. They’d hang on for weeks and develop into aloud, hacking cough. Until she recovered, neither of us would get much sleep.
Then I remembered that my sister had a similar problem with her four growing boys. In desperation, she tried a remedy she read about. drinking -red” grape juice regularly.
My wife and I started drinking a glass of Concord grape juice every day fall through spring, and the prob-lem vanished. Since then, we’ve almost never had a bad cough.
We drink half a glass of grape juice and add a half glass of water. Do you know why this works?
A. Purple grape juice has a surprising number of potential health benefits. Research has shown that it can reduce bad cholesterol, lower blood pressure, and help keep blood vessels flexible. There are even some data to suggest that certain ingredients in grapes may support the immune system. Whether this effect would help ward off sore throats and coughs we do not know.
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Treating Cough in Children
It is hard on parents to listen to a child coughing away. It may even be hard on the youngster. Sometimes coughs keep them awake at night. And because children are so susceptible to colds and other respiratory tract viruses, they seem to get a lot of coughs. But parents should refrain from rushing to the drugstore for cough remedies. A study published in Pediatrics found that the two main ingredients in OTC cough medicine, dextromethorphan and diphenhydramine, were no better at easing children’s coughs than a placebo syrup was. 164
According to the lead author, Ian Paul, MD, assistant professor of pediatrics at Penn State Hershey Medical Center, “One of the conclusions you could come to from the results of our study is that these medicines don’t work [for kids]. And in fact this is what evidence-based reviews of the medical literature have found before, that the existing evidence doesn’t support the use of these medicines for acute cough due to a cold .,,161 In addition, these medicines are not without risk. According to Dr. Paul, the children who received the standard ingredient in most cough medicines, dextromethorphan (DM), had a harder time falling asleep. That’s the last thing an anxious parent wants for a sick kid.
What to do? For a nighttime cough, we are partial to Vicks on the soles of the feet. Grape juice is certainly popular with most youngsters and would be worth a try. And dur-* Grape Juice
Concord grape juice has anti-inflammatory properties, but we don’t know of any studies that confirm it has cough suppressant activity.
Side effects: None known
Cost: About $4 to $5 for a 64-ounce bottle
ing the day, a lunch of chicken soup with thyme in it would not be amiss. We don’t know for sure that any of these remedies will work for kids, though. We have received many testimonials on vanquishing kids’ coughs with Vicks, however, so we suspect it is likely to help.
Conclusions
These suggestions are not intended for a cough that has lasted longer than a few weeks, or one that is accompanied by fever, pain, or other symptoms of serious illness. They are aimed primarily at the annoying but not dangerous cough that often crops up at the tail end of a cold or the “flu” and hangs in there even though the patient is feeling much better otherwise.
When it comes to coughs and colds, be very cautious about medicating children. Although there are lots of products on the market aimed at kids, very few have been tested on children. And often, when they are tested on children, they don’t seem to work very well. For youngsters, less is definitely better.
• Codeine-containing cough syrup is one of the most effective remedies for cough. It may be difficult to purchase without a prescription. But if your cough is troubling you, ask your doctor to write one. Don’t overuse it, because it can be constipating.
• Vicks VapoRub, with its familiar aroma of menthol, camphor, and eucalyptus, is worth trying. If you don’t want to put it on your chest, try it on the soles of your feet (under your socks) for a cough-free night.
• Chicken soup with thyme is a comfort food that could help control a cough.
• Several herbal teas may be helpful. Try ginger, mint (menthol), elderflower, or linden flower tea. Sweetening the tea slightly with honey may help the brain’s own opioids kick in to help with that cough.
• Suck on hard candy flavored with licorice or horehound.
• The theobromine found in chocolate is active against cough. Perhaps the best way to get it is to melt a square or two of dark chocolate in your mouth.
• Concord grape juice has its enthusiasts, and very little risk.
Jul
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Drugs for Cough Treatment
July 1, 2009 | Leave a Comment
Cough
Cough is an explosive exptiation of air from the lungs, and is a protectiv-e–! mechanism to expel excessive exudate or foreign bodies from the respiratory tract,
but other irritant factors may also stimulate the cough reflex. Productive cough
should not be suppressed without good cause, such as when the patient finds
cough exhausting or prevents sleep, but suppression may then have the
undesirable effect of causing retention of sputum. On the other hand, suppression
of the dry, useless or unproductive cough may have corresponding advantages.
Many soothing and demulcent preparations represented by simple linctus have
been used for the symptomatic relief of cough, and another traditional remedy is
steam inhalation, assisted by the addition of Friar’s balsam and menthol.
Expectorant products such as ammonia and ipecacuanha mixture are also used,-,—,–.
even though pharmacological proof of their efficacy may be lacking. Cough
suppressants, represented by codeine, have a central depressant action on the
cough centre, but effective doses may have the disadvantage of causin
Extended use should be avoided because of the possible risk of
habituation. The treatment of severe cough in terminal lung cancer is with more potent cough suppressants such as diamorphine or methadone.
Approved names Brand names
codeine linctus Galcodine
pholcodine linctus
Table 9 Cough suppressants.
Galenophol, Pavocol D, Pholcomed