RSS

Aug

13

Estazolam - Estrogens - Eszopiclone - Exemestane - Exenatide

August 13, 2009 | Leave a Comment

Generic Name
Estazolam (es-TAZ-oe-lam) V
Type of Drug Benzodiazepine sedative.
Prescribed For
Insomnia and sleep disturbances.
General Information
Estazolam is a member of the group of drugs known as benzodiazepines. They work by a direct effect on the brain. Benzodiazepines make it easier to go to sleep and decrease the number of times you wake up during the night. Estazolam is considered an intermediate-acting sedative and generally remains in your body long enough to give you a good night’s sleep with minimal “hangover.”
Cautions and Warnings
Do not take estazolam if you are allergic or sensitive to any of its ingredients. Severe allergic reactions may occur. People with respiratory disease taking estazolam may experience sleep apnea (intermittent cessation of breathing during sleep). People who already have, or suspect they have, sleep apnea should not take estazolam.
People with kidney or liver disease should be carefully monitored while taking estazolam. Take the lowest possible dose to help you sleep.
Clinical depression may be increased by estazolam, which can depress the nervous system. Intentional overdose is more common among depressed people who take sleeping pills than among those who do not.
All benzodiazepines can be addictive if taken for long periods of time and can cause drug withdrawal symptoms if discontinued suddenly. It should be used With caution in people with a history 0 YATUg dependence. Withdrawal symptoms include tremors, Muscle cramps, insomnia, agitation, diarrhea, vomiting, sweating, and convulsions.
People with a history of seizures should not abruptly stop taking estazolam.
Possible Side Effects
♦    Common: drowsiness, headache, dizziness, talkativeness,
nervousness, apprehension, poor muscle coordination, light-
headedness, daytime tiredness, muscle weakness, slow-
ness of movement, hangover, and euphoria (feeling “high”).
♦    Less common: nausea, vomiting, rapid heartbeat, confusion, temporary memory loss, upset stomach, stomach cramps and pain, depression, blurred or double vision and other visual disturbances, constipation, changes in sense of taste, appetite changes, stuffy nose, nosebleeds, common cold symptoms, asthma, sore throat, cough, breathing difficulties, diarrhea, dry mouth, allergic reaction, fainting, abnormal heart rhythm, itching, acne, dry skin, sensitivity to bright light or to the sun, rash, nightmares or strange dreams, sleeplessness, tingling in the hands or feet, ringing or buzzing in the ears, ear or eye pain, menstrual cramps, frequent urination and other urinary difficulties, blood in the urine, discharge from the penis or vagina, lower back and joint pain, muscle spasms and pain, fever, swollen breasts, and weight changes.
✓    Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    As with all benzodiazepines, the effects of estazolam are enhanced if it is taken with an alcoholic beverage, antihistamine, sedative, barbiturate, anticonvulsant medication, antidepressant, or monoamine oxidase inhibitor antidepressant.
•    Carbamazepine and phenytoin may reduce blood levels and the effectiveness of estazolam by stimulating liver enzymes responsible for its breakdown.
•    Ketoconazole, itraca(\ailzAe, netazodone, fluvoxamine, diltiamm,’isoniazid, some macrolide antibiotics, contraceptive drugs, cimetidine, and disulfiram may increase the effect of estazolam by interfering with the drug’s breakdown in the liver. Probenecid also increases estazolam’s effects by interfering with it passing through the kidneys into urine.
•    Cigarette smoking, rifampin, and theophylline may reduce the effect of estazolam.
•    Levodopa + carbidopa’s effectiveness may be decreased by estazolam.
•    Estazolam may increase the amount of zidovudine (an HIV drug—also known as AZT), phenytoin, or digoxin in your bloodstream, increasing the chances of side effects.
•    The combination of clozapine and benzodiazepines has led to respiratory collapse in a few people. Estazolam should be stopped at least 1 week before starting clozapine treatment.
Food Interactions
Estazolam may be taken with food if it upsets your stomach.
Usual Dose
Adult (age 18 and over): 1-2 mg at bedtime.
Senior: 1 mg at bedtime. Small or frail patients should start on 0.5 mg. Dosage should be increased cautiously.
Child (under age 18): not recommended.
Overdosage
The most common overdose symptoms are confusion, sleepiness, depression, loss of muscle coordination, and slurred speech. Coma and death may also occur. People who take an estazolam overdose must be made to vomit with ipecac syrup—available at any pharmacy—to remove any remaining drug from the stomach: Call your doctor or a poison control center before doing this. The victim must be taken to a hospital emergency room for treatment if 30 minutes have passed since the overdose was taken or if symptoms have begun to develop. ALWAYS bring the prescription bottle or container.
Special Information
Never take more estazolam than your doctor has prescribed. Avoid alcoholic beverages and other nervous system depressants while taking estazolam.
Exercise caution while performing tasks that require concentration and such as driving: estazolam may make you tired, dizzy, or lightheaded. People taking estazolam or any other sleeping medicine may experience unusual and complex reactions while asleep, such as driving, making phone calls, and cooking with no memory of the event.
If you take estazolam daily for 3 or more weeks, you may experience some withdrawal symptoms when you stop taking the
drug, especially temporary sleep disturbance. In rare cases, patients discontinuing estazolam have suffered seizures or delirium. Patients with a history of seizures should taper when stopping use
of this drug.
If you forget to take a dose of estazolam and remember within about 1 hour of your regular time, take it right away. If you do not remember until later, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Estazolam absolutely should not be used by pregnant women or by women who may become pregnant.
Estazolam passes into breast milk. The drug should not be taken by nursing mothers.
Seniors: Seniors are more susceptible to the effects of estazolam. Type of Drug

Estrogens (ES-troe-jens)
Brand Names
Generic Ingredient: Conjugated Estrogens Premarin    Premarin Cream
Generic Ingredient: Conjugated Estrogens (Synthetic) Cenestin    Enjuvia
Generic Ingredients: Conjugated Estrogens + Medroxyprogesterone
Premphase    Prempro
Generic Ingredient: Esterified Estrogens Menest
Generic Ingredients: Esterified Estrogens + Methyttestosterone Estratest
Generic Ingredient: Estradio(& Alora,
Climara Divigel Elestrin Estrace Estraderm
Estring Estrogel
Evamist Transdermal Spray Femring
Femtrace Gynodiol
Innofem Menostar Vagifem
Vivelle Vivelle-Dot
Generic ingredients: Estradiol + Drospirenone Angeliq
Generic Ingredients: Estradiol + Levonorgestrel Climara Pro    Nuvaring
Generic Ingredients: Estradiol + Norgestimate 99 Pretest
Generic Ingredient: Estropipate
Ogen Cream    Ortho-Est
Generic Ingredients: Ethinyl Estradiol + Norethindrone Activella Combipatch    FemHRT 1/5
Prescribed For
Moderate to severe menopausal symptoms such as hot flashes, night sweats and sleep problems, vaginal dryness and irritation (creams and gels); also prescribed for ovarian failure, osteoporosis prevention, male breast cancer, advanced prostate cancer, abnormal bleeding of the uterus, female castration, Turner’s syndrome, and birth control.
General Information
Six estrogens have been identified in women but only 3 are present in large amounts: estradiol, estrone, and estriol. Estradiol is the most potent and most important. Other estrogens are produced by chemical conversions in the body. Estradiol, for example, is transformed into estrone, which in turn becomes estriol. Estrogens all have the same actions and side effects; only potency varies. More potent types require smaller dosages to produce the same effect.
Millions of women have taken hormone replacement therapy (HRT) to manage menopausal symp<oms, but studies show that HRT doeq WMpYove quality of life for most. Women who experience severe menopause symptoms must weigh the benefits of prolonged hormone replacement therapy against its risks.
Estrogens are largely responsible for the growth and maintenance of the female reproductive system and sex characteristics. They affect the release of hormones from the pituitary gland (con-troller of hormone production and regulator of basic bodily functions). These hormones control the functioning of capillaries (smallest blood vessels), may cause fluid retention, affect protein breakdown in the body, prevent ovulation and breast engorgement after childbirth, and influence the shaping and maintenance of the skeleton through an effect on calcium.
Estrogen products differ in their hormone content and dosage. Some may affect one part of the body more than another. Generally, though, estrogens are interchangeable as long as dosage differences are taken into account.
Cautions and Warnings
Do not take estrogens if you are allergic or sensitive to any of their ingredients.
Products containing an estrogen and a progestin should not be used for the prevention or treatment of bladder-control problems, heart disease, or mental decline (dementia).
Women with an intact uterus who choose hormone replacement therapy for menopausal symptoms should take the lowest effective dose for the shortest possible time to minimize the risks associated with these medicines. The results of a very large study called the Women’s Health Initiative (WHI) first published in 2002 and updated with new reports, have drastically changed the face of estrogen replacement therapy. The study found a small but insignificant increase in the risk of non-fatal heart attacks. There was no increase in heart disease in the estrogen plus progestin part of the WHI. Early results of the WHI found 4-6 more cases of invasive breast cancer for every 10,000 women in the study and tumors were harder to detect. But this result was not confirmed after more than 7 years of additional study. Estrogens may also lead to abnormal mammograms. An increased risk of a stroke was found in the WHI study. The risk of blood clots forming in the body was doubled in women taking hormone therapy. This study did show some benefits of long-term hormone replacement in colon cancer and osteoporosis, but these benefits may not outweigh the risks of hormone replacement therapy.
Women with liver damage or disease, blood-clotting problems, or abnormal vaginal bleeding whose cause is unknown, should not take estrogens.
Women who smoke cigarettes and take estrogen have a greater risk of cardiovascular side effects, including stroke and blood clotting.
Estrogens may increase the risk of endometriat cancer by 4.514 times in postmenopausal women taking them without progestin for prolonged periods of time; the risk depends on duration of treatment and dosage. Women who have a strong family history of breast cancer or who have breast nodules or cysts or an abnormal mammogram should be cautious about using estrogens. Women with estrogen-dependent cancer or breast cancer should not take estrogens, except some being treated for breast cancer that has spread. Women taking an estrogen for breast cancer that has spread to their bones can develop large increases in blood calcium.
Postmenopausal women taking estrogen are 2-3 times more likely to develop gallbladder disease.
Estrogens can raise blood pressure. Pressure usually returns to normal when the drug is stopped.
People with thrombophlebitis should avoid these drugs. The risk is greatest with very high dosages. Lower hormone dosages may not be a problem.
Estrogens should not be used to treat painful breast enlargement that sometimes develops after giving birth.
Estrogens can cause significant increases in blood triglycerides and cause pancreas inflammation in women with inherited blood-fat disorders.
Vaginal estrogen cream may stimulate bleeding of the uterus. It may also cause breast tenderness, vaginal discharge, and withdrawal bleeding if the product is suddenly stopped. Women with endometriosis may experience heavy vaginal bleeding.
Women taking hormone replacement therapy are at a 50% greater than normal risk of senile dementia.
Drospirenone, a progestin and an ingredient in Angeliq, can raise blood potassium levels in some people because it opposes the hormone aldosterone. It should not be used in people with conditions that can lead to high blood potassium such as kidney disease or a poorly functioning adrenal gland. Drospennone should be used with caution by women who we also taking other medicines that raise tl(QW potassium, such as nonsteroidal antiWkvmmMory drugs (NSAIDs), potassium-sparing diuretics, potassium supplements, angiotensin-converting enzyme (ACE) inhibitors, All receptor antagonists, and heparin. Your doctor may want to check your blood potassium level if you might be at risk of high blood potassium.
Possible Side Effects
v Most common: breast enlargement or tenderness, ankle and leg swelling, appetite loss, weight changes, water retention and bloating, nausea, vomiting, and abdominal cramps. The estrogen patch may cause rash, irritation, and redness where it is applied.
V Less common: bleeding gums, breakthrough vaginal bleeding, vaginal spotting or discharge, changes in menstrual flow, painful menstruation, premenstrual syndrome (PMS), absence of menstrual periods during and after estrogen use, uterine fibroid enlargement, vaginal Candida infection, a cystitis-like condition, mild diarrhea, yellowing of the skin or whites of the eyes, eye lesions, contact-lens intolerance, rash, hair loss, development of new hairy patches, migraine, mild dizziness, depression, increased sex drive (women), and decreased sex drive (men).
♦ Rare: stroke, blood-clot formation, dribbling or sudden passage of urine, loss of coordination, chest pain, leg pain, breathing difficulties, slurred speech, and changes in vision. Men who take large estrogen dosages for prostate cancer have a greater risk of heart attack, phlebitis, and blood clots in the lungs. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Phenytoin, ethotoin, mephenytoin, and topiramate may interfere with estrogen’s effects.
•    Estrogens may reduce the effect of oral anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
•    Estrogens may increase the side effects of antidepressants and phenothiazine sedatives.
•    Low estrogen dosages may increase 0\enolhiazine’s effectiveness.
% ‘ittrogens may increase cyclosporine and corticosteroid blood levels. Dosage adjustments of the non-estrogen drugs may be needed.
•    Estrogens may reduce the effectiveness of thyroid replacement therapy.
•    Rifampin, barbiturates, carbamazepine, St. John’s wort, and other drugs that stimulate the liver to break down drugs may reduce estrogen blood levels.
•    Estrogens may interfere with tamoxifen and bromocripline.
•    Women, especially those ova. 35, who smoke cigarettes and take estrogen have a much greater risk of developing stroke, hardening of the arteries, or blood clots in the lungs. The risk increases with age and tobacco use.
•    Estrogens interfere with many diagnostic tests. Make sure your doctor knows you are taking estrogen before conducting any blood tests or other diagnostic procedures.
Food Interactions
Estrogens may be taken with food to reduce nausea and upset stomach. Avoid drinking grapefruit juice if you are taking this drug.
Usual Dose
Dosage varies. All of these products, including the transdermal skin patch, may be taken continuously or on a cyclic schedule of 3 weeks on, 1 week off.
Tablets
Chlorotrianisene: 12-200 mg.
Conjugated estrogens: 0.3-30 mg.
Conjugated estrogens, synthetic: 0.625-1.25 mg. Esterified estrogens: 0.3-30 mg.
Estradiol: 0.5-30 mg.
Estropipate: 0.625-7.5 mg.
Ethinyl estradiol: 0.02-3.0 mg.
Estradiol Transdermal Patch (0.025, 0.0375, 0.05, 0.075, or 0.1 mg) Alora, Estraderm, and Esclim: 1 patch twice a week: or use 1
patch twice a week for 3 weeks, stop for 1 week, then start again. Climara and Fempatch: 1 patch every week; or use 1 patch once
a week for 3 weeks, stop for 1 week, then start again.
Estradiol Transdermal Spray: 1-3 Sprays (1.53 mg estradiol in each spray
face of the forearm, starting near the elbow. Do not allow the sprays to overlap each other. Allow the spray to dry for about 2 minutes and do not wash the arm for 30 minutes. Do not apply the spray to any other part of the body.
3Wkw1 Onext to each other every morning on the inner sur-Estradiol Gel: Spread 1 pumpful of the gel as thinly as possible over the entire area on the inside and outside of your arm from wrist to
shoulder, once a day at the same time every day.
Vaginal Cream
Conjugated estrogens: 0.52 g a day for 3 weeks; stop for 1 week,
then start again.
Dienestrol: 1 applicatorful 12 times a day for 12 weeks, half the
original dosage for another 12 weeks, then 1 applicatoviO 13 times
a week.
Estradiol: 24 g a day for 2 weeks, half the starting dosage for an-
other 2 weeks, then 1 g 13 times a week.
Estropipate: 24 g a day for 3 weeks; stop for 1 week, then start again.
Estradiol Ring
Insert once every 3 months.
Overdosage
Symptoms may include nausea and vaginal bleeding in adult women. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop breast pain or tenderness, swelling of the feet and lower legs, rapid weight gain, chest pain, breathing difficulties, pain in the groin or calves, unusual or persistent vaginal bleeding, missed menstrual period, lumps in the breast, sudden severe headache, dizziness or fainting, disturbances in speech or vision, weakness or numbness in the arms or legs, abdominal pain, sudden severe vomiting, depression, yellowing of the skin or whites of the eyes, or jerky or involuntary muscle movement.
Women taking estrogens or combined estrogen and progestin therapy should have yearly lamasN exams, perform monthly breast self -Paw i)26ions, and have regular mammograms.
Talk to your health care provider about ways to reduce risk factors for heart disease (blood-pressure control, improving your diet, stopping tobacco use) and osteoporosis (an appropriate diet, vitamin D and calcium supplements, weight-bearing exercise).
Tell your doctor if you are having surgery or require bedrest: your doctor may have you stop taking estrogen 4-6 weeks beforehand to prevent the risk of blood clots.
Your doctor should reevaluate your need for estrogen vaginal cream every 36 months. Do not stop using the drug suddenly because this may increase your risk of developing unpredicted or breakthrough vaginal bleeding.
Women using the cream who develop breast tenderness, start to bleed, or have other vaginal discharge should contact their doctors at once.
Estrogen skin patches should be applied to a clean, dry, non-oily, hairless area of intact skin, preferably on the abdomen. Do not apply it to your breasts or waist, or to any area where tightfitting clothes may loosen the patch from your skin. The application site should be rotated to prevent irritation, and each site should have a patch-free period for 7 days.
Good dental hygiene is important while taking estrogen because estrogen may increase your risk of oral infection. Dental work should be completed prior to starting estrogen, if possible.
Vaginal estrogen cream should be inserted high into the vagina, about 2/3 of the length of the applicator.
Press the vaginal ring into an oval and insert as deeply as possible in the upper 1/3 of the vagina.
Some of these products contain tartrazine (a commonly used orange dye and food coloring). If you are allergic to tartrazine or have asthma, check with your pharmacist to find out if your estrogen product contains this coloring agent.
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.
Authorities note that the risk of serious complications for an individual woman taking hormone replacement therapy is very small. Thus, you may decide to take hormones but your decision should be based on a complete discussion of the facts and your individual situation with your doctor. Continue to talk with your doctor regularly about weighing tt% i1%’Ks against the benefits of taking estrQ(;e5\.
Special Populations
Pregnancy/Breast-feeding: Estrogens harm the fetus and should never be used during pregnancy for any reason.
Estrogens pass into breast milk and reduce its flow. Nursing mothers who must take them should use infant formula.
Seniors: The risk of side effects increases with age, especially if you smoke. Women age 65 or older taking estrogens may be more likely to develop a stroke, blood clot, or dementia, a condition where people suddenly or gradually lose normal mental function and intellectual capacity.

Generic Name
Eszopiclone (ess-oh-PIK-lone)
Brand Name Lunesta
Type of Drug Sedative.
Prescribed For Insomnia.
General Information
Eszopiclone is a nonbenzodiazepine sleeping pill that is believed to work in much the same way as the drug zolpidem and as benzodiazepine-type sleeping pills and sedatives. Unlike the benzodiazepines, however, eszopiclone has little muscle-relaxing or antiseizure effects. This drug is rapidly absorbed and usually starts working within a few minutes. Eszopiclone causes little or no “hangover,” and there are no rebound effects after stopping the drug. In studies of eszopiclone, tolerance to its effects did not develop even after 6 months of continued use. Eszopiclone is broken down in the liver, and the level of this drug in the body does not increase after you take it for several days.
Cautions and Warnings
Do not take eszopiclone if you are allergic or sensitive to any of its ingredients.
People With severe liver disease should use eszopiclone with caution and must take less of this medication than those with normal liver function or mild liver disease.
Sleeping problems often result from a physical or psychological illness. Eszopiclone does not affect the underlying causes of
insomnia. It should be taken only with your doctor’s knowledge. If you cannot sleep even after 7-10 days of taking eszopiclone, con-
tact your doctor.
Eszopiclone has caused amnesia (memory loss), but this happens mostly at dosages larger than 2 mg per night.
Suddenly stopping eszopiclone after having taken it for some time may produce drug withdrawal (symptoms include fatigue, nausea, flushing, lightheadedness, crying, vomiting, stomach cramps, panic, nervousness, and general discomfort).
People with a history of substance abuse may be more likely to develop drug dependence on eszopiclone. Eszopiclone doses of 612 mg are similar to 20 mg of diazepam in their potential for abuse.
Eszopiclone is a nervous system depressant and may cause loss of coordination and concentration. It should be taken just before bedtime. People taking sleep medicine may experience unusual and complex reactions while asleep, such as driving, making phone calls, or cooking with no memory of the event. Eszopiclone may also interfere with normal activities the next day, especially if taken with alcohol.
Eszopiclone should be avoided by people with severe depression, severe lung disease, and sleep apnea (intermittently stopping breathing when you are asleep). You should not take this drug if you are drunk.
Possible Side Effects
Adults
Some side effects are more likely with larger doses (viral infection, dry mouth, dizziness, hallucinations, infections, rash, and unpleasant taste).
♦    Most common: headache, drowsiness, unpleasant taste, and lung infections.
✓    Common: dry mouth, dizziness, and nausea.
✓    Less common: nervousness, vomiting, viral infections, anxiety, confusion, depression, hallucinations, reduced sex drive, rash, male breast e”k-aigement and/or pain, painful meR%k5UMlrjn, chest pain, migraines, and swelling of the arms or legs.
♦    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.
Drug Interactions
•    Mixing eszopiclone with olanzapine can affect your coordination and ability to perform tasks.
•    Mixing eszopiclone with ketoconazole more than doubles blood levels of eszopiclone. Other drugs that may have a similar interaction include itraconazole, clarithromycin, nefazodone, troleandomycin, ritonavir, and nelfinavir.
•    Rifampin can be expected to drastically reduce the effectiveness of eszopiclone because it increases levels of liver enzymes that break down eszopiclone.
•    Avoid combining eszopiclone with alcohol and other nervous system depressants, including sedatives, narcotics, barbiturates, antidepressants, and antihistamines.
Food Interactions
For the most rapid and complete effect, take eszopiclone on an empty stomach at least 2 hours after a meal. It will take longer for eszopiclone to work if you have had a high-fat meal immediately before taking it.
Usual Dose
, abnormal dreaming, nery
Adult (q% 1% and over): 2-3 mg immediately before bedtime or after you are in bed and have trouble falling asleep. Eszopiclone can act very quickly.
Child (up to age 17): not recommended.
Senior: 1-2 mg immediately before bedtime.
People with liver disease: 1 mg.
Possible Side Effects (continued) Seniors
Some side effects are more com    the cluding dry mouth, pain, and unpleasant easant
♦    Most common: headache.
♦    Common: pain, dry mouth, diarrhea, rrhea, and upset
♦    Less common: accidental injury,
ousness, nerve pain, itching, and urinary• Rare: Rare side effects can occur in almost any part body. Contact your doctor if you
ou experience any side ef fect not listed above.
infection. of - , mon with larger doses in
Overdosage
Overdose can result in nervous system depression, from unconsciousness to light coma. Combining eszopiclone with alcohol or other nervous system depressants may be fatal or affect other body organs. One person took up to 36 mg of eszopiclone and fully recovered. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Eszopiclone may cause tiredness, drowsiness, and an inability to concentrate. Be careful when driving or performing any task that requires concentration on the day following a dose. Make sure you get 7-8 hours of sleep after taking eszopiclone.
People taking eszopiclone on a regular basis may develop a drug withdrawal reaction if the medication is stopped suddenly (see “Cautions and Warnings”).
Do not take a double dose of this medication.
Special Populations
Pregnancy/Breast-feeding: Some animal studies with doses of eszopiclone up to 800 times the human equivalent showed it did not affect a developing fetus, and other studies showed some modest effects. However, there is no information on the use of eszopiclone in pregnant women. If your doctor considers eszopiclone crucial for you, its potential benefits must be carefully weighed against its risks.
It is not known if eszopiclone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, who are likely to be more sensitive to eszopiclone and its side effects, should start on a 1 -mg dose and take the lowest effective dosage.
Generic Name
Etanercept (eh-TAN-er-sept)
Brand Name Enbrel
Type of Drug
Immune system modulator.
Prescribed For
Rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis.
General Information
Etanercept binds to a specific protein in the body known as tumor necrosis factor (TNF) and blocks it from interacting with cell surfaces. TNF is involved in normal inflammatory and immune responses and the inflammatory processes of rheumatoid arthritis, juvenile rheumatoid arthritis, and other conditions. Etanercept can also interfere with biological actions that are either caused or regulated by TNF.
Cautions and Warnings
Do not use etanercept if you are allergic or sensitive to any of its ingredients.
Serious infections and malignancies are possible in people using etanercept because of its ability to suppress the immune response. This may be more common in people with other conditions that predispose them to infections such as advanced or uncontrolled diabetes.
Levels of blood platelets and some white blood cells may be reduced in rare cases, leading to persistent fever, bruising, bleeding, and pale skin. Contact your doctor if any of these symptoms develop.
Etanercept may increase the risk of some nervous system disorders including multiple sclerosis.
Etanercept may cause or worsen congestive heart failure.
In rare cases people taking etanercept have developed a lupus-like syndrome which may disappear when the drug is discontinued.
People taking etanercept should not receive any live vaccines, because the body may not be able to respond as expected to the vaccine.
Possible Side Effects
RPndmt may develop at the site where etanercept is injected. Injection sites should be rotated among the thigh, abdomen, and upper arm to avoid excessive bruising or other skin damage.
Possible Side Effects (continued)
♦    Most common: infection, injection-site reactions, upper respiratory infection, headache, and runny nose.
♦    Common’. nausea, dizziness, sore throat. cough, weak-
ness, abdominal pain, rash, and respiratory problems.
♦    Less common: upset stomach, sinus irritation, vomiting.
swelling in the legs or feet, mouth sores, and hair loss.
✓    Rare: malignancy, stroke, seizure, tingling in the hands or feet, nervous system irritation similar to multiple sclerosis, eye inflammation, joint pain, generalized pain, appetite loss, blood vessel inflammation in the skin, dry eyes, lumps under the skin, fever, flu-like symptoms, weight gain, chest pain, flushing, diarrhea, taste changes, difficulty breathing, worsening of existing lung conditions, itching, and skin reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Do not mix etanercept in the same syringe as another drug.
•    Using etanercept with anakinra increases the risk of serious infections.
Food Interactions None known.
Usual Dose
Adult: rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis-50 mg a week. Plaque psoriasis: 50 mg twice a week, reducing to 50 mg a week after 3 months.
Child (age 4-17): 0.36 mg per lb. of body weight, up to 50 mg a week, 3-4 days apart.
Child (under age 4): not recommended.
Overdosage
In one study, ‘A patient accidentally self-administered 62 mg of etanercept twice a week for 3 weeks with no ill effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Etanercept is taken by injection under the skin. Be sure you understand how to measure the proper dose of etanercept and how
to self-inject it.
To mix and inject etanercept: Withdraw all the water supplied with the medicine into a syringe and slowly inject it into the vial containing etanercept. Swirl the mixture gently to avoid excess foaming in the vial. Do not shake the vial.
Do not combine etanercept with any other injectable drug. Etanercept may be stored in a refrigerator for up to 14 days after it is mixed.
Single-use pre-filled syringes must be refrigerated. Do not use past the provided expiration date.
If you forget to administer a dose, do so as soon as you remember. Remember that etanercept doses must be administered at least 3 days apart. Call your doctor or pharmacist if you have any questions about how to time your etanercept doses.
Special Populations
PregnancylBreast-feeding. The safety of using etanercept during pregnancy is not known. 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 who must take it should use infant formula.
Seniors: Seniors are more likely to develop infections while using etanercept.

Generic Name
Exemestane (ex-eh-MES-tane)
Bnj(kod WaYne Aromasin
Type of Drug Aromatase inhibitor.
Prescribed For
Breast cancer. Also prescribed for prostate cancer prevention.
General Information    Some breast cancers depend on the presence of the hormone estrogen to stimulate their growth. Depriving these cancers of estrogen is an effective way of treating the condition. Exemestane significantly reduces the amount of estrogen in the blood by binding permanently to an enzyme called aromatase, an essential element in the conversion of androgen (male hormones) to estrogen in premenopausal and postmenopausal women. Exemestane does not affect other hormones in the body. Exemestane is broken down in the liver.
Cautions and Warnings
Do not take exemestane if you are allergic or sensitive to any of its ingredients.
Exemestane may be prescribed for men and postmenopausal women only.
Possible Side Effects
✓    Most common: fatigue, hot flashes, pain, depression, sleeplessness, anxiety, nausea, and breathing difficulties.
✓    Common: flu-like symptoms, leg swelling, high blood pressure, dizziness, headache, vomiting, abdominal pain, leg swelling or other fluid retention, sweating, appetite loss, constipation, and coughing.
✓    Less common: increased appetite, diarrhea, fever, weakness, tingling in the hands or feet, broken bones, bronchitis, sinusitis, rash, itching, urinary infection, and swollen lymph glands.
♦    Rare: chest pain; confusion; reduced sensitivity to stimulation; upset stomach; joint, back, or other bone pain; respiratory infection; sore throat; runny nose; and hair loss. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Estrogen-containing drugs reduce the effectiveness of exemestane. Do not combine these drugs.
• Rifampin, phenytoin, carbamazepine, phenobarbital, and St. John’s wort may potentially reduce the effectiveness of
exemestane.
Food Interactions
Take this drug with a meal. The amount of exemestane absorbed into the blood is increased by 40% when taken with a high-fat meal.
Usual Dose
Adult: 25 mg once a day with or just after a meal. Dose adjustment is not needed in people with kidney or liver disease. Child: not recommended.
Overdosage
Doses as large as 600 mg have been well tolerated by women with advanced breast cancer. Overdose victims should be taken to a hospital emergency room for evaluation and treatment. ALWAYS bring the prescription bottle or container.
Special Information
If you forget a dose, skip the forgotten dose and continue with your regular schedule. Contact your doctor if you skip more than one dose.
Special Populations
Pregnancy/Breast-feeding: Exemestane is intended only for postmenopausal women. It can cause birth defects and miscarriage and should not be used by pregnant women or women who may become pregnant.
Exemestane may pass into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may take this drug without special precaution.

Generic Name
Exenatide (ex-EN-ah-tide)
Brand Name Byetta
7Vpe of Drug Incretin mimetic.
Prescribed For Type 2 diabetes.
General Information
Exenatide is a unique drug that improves blood sugar control in people with type 2 diabetes who have been unsuccessful with diabetes pills. It is added to existing therapy and does not replace other treatments. Exenatide has many of the same actions as GLP-1, a natural incretin hormone. It differs chemically and works differently from other diabetes medications, including insulin.
Exenatide begins working about 30 minutes after injection and continues to work for at least 8 hours. It helps the pancreas to release insulin into the blood in response to sugar levels, so insulin rises when blood sugar is high and declines as blood sugar declines. It reduces the production of a hormone called glucagon, which raises blood sugar. Exenatide also keeps food in the stomach longer, which in turn helps reduce the amount of sugar absorbed from dietary sources. Exenatide increases the number of beta cells (that produce insulin) in animals and may have the same effect in humans. This could help reduce the need for other medicines and improve diabetes control.
Cautions and Warnings
Do not take exenatide if you are allergic or sensitive to any of its ingredients.
This drug is not a substitute for insulin. Exenatide has only been studied together with metformin, glitazones, and/or sulfonylureas. It has not been studied with other diabetes pills or insulin.
People with severe kidney disease should not use exenatide.
People with severe stomach or intestinal disease should not use exenatide.
Inflammation of the pancreas can occur with this drug. Symptoms include nausea, vomiting, fever, rapid pulse, and painful and swollen abdomen that may develop slowly and worsen when you eat or may be severe and constant.
Low blood sugar may ziccurit you are taking exenatide with a S\00ny)urea-type antidiabetes drug or with a glitazone.
Antibodies to exenatide may develop, but antibody levels generally go down with time. Most patients who develop antibodies still have good sugar control and similar types of side effects as people who do not develop exenatide antibodies.
Possible Side Effects
♦    Most common: nausea, vomiting, diarrhea, and low blood sugar (when mixed with a sulfonylurea-type drug or metformin plus a sulfonylurea).
♦    Less common: low blood sugar (when mixed with a glitazone), feeling jittery, dizziness, headache, and upset stomach.
✓    Rare: rash, abdominal swelling and pain, constipation, and kidney failure. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Exenatide has been studied with a number of other medications commonly taken by people with diabetes (digoxin, lovastatin, lisinopril, and acetaminophen) and no significant interactions were noted.
•    Combining exenatide with a sulfonylurea-type drug may lead to hypoglycemia (low blood sugar). Your doctor may change your sulfonylurea dose to solve this problem.
•    Take all oral medicines at least 1 hour before you inject exenatide to ensure maximum absorption. If you must take oral drugs with food or meals, take them with a snack or meal when exenatide is not being injected. Exenatide extends the time that drugs remain in the stomach and may reduce the amount of medication absorbed when taken by mouth.
•    Exenatide may reduce the effectiveness of oral contraceptive pills. Take them at least 1 hour before an injection of exenatide.
•    Exenatide may increase the amount of warfarin in the body and increase the risk of bleeding.
Food Interactions
None known. Usual Dose
Adult: 5 or 10 mcg twice a day by subcutaneous injection %M)iT) an hour before breakfast and dk”"tj.
CAWVEOnafide has not been studied in children. Overdosage
The effects of an exenatide overdose are severe nausea, severe vomiting, and severe, rapid drops in blood sugar levels. An oral sugar source may help, but overdose victims should be taken to a hospital emergency room for evaluation and treatment. ALWAYS bring the exenatide pen with you.
Special Information
Each dose of exenatide must be given as an injection under the skin of the thigh, abdomen, or upper arm within 1 hour before your breakfast and dinner meals. For information on how to properly administer this drug, see page 1242.
If you forget a dose of exenatide, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Exenatide injection is clear and colorless. Do not use if it has any color, is cloudy, or if there are any particles floating in it.
Keep this drug in the refrigerator, and do not use it after the expiration date has passed.
This drug may lead to a loss of appetite and loss of body weight. Do not change your regular dosage if this happens to you.
Special Populations
PregnancylBreast-feeding. In animal studies using doses equal to 3 times the usual human dose, exenatide was shown to affect the growth of the fetus. If you are or might be pregnant and your doctor considers this drug crucial, its potential benefits must be weighed against its risks.
Small amounts of exenatide may pass into breast milk and may affect a nursing infant. Nursing mothers taking this drug should use infant formula.
Seniors: Seniors may take this drug without special restriction. Generic Name

Tags: AGE, allergic reactions, antiseizure, Bleeding, blood platelets, CHANGES, chest pain, colon cancer, Combining, daytime tiredness, difficulty, double dose, Drug Interactions, effectiveness, FUNCTIONS, General Information, hangover, hardening of the arteries, intentional overdose, ketoconazole, kidney disease, kidneys, liver disease, long periods of time, loss of appetite, male hormones, male reproductive system, maximum, muscle coordination, muscle weakness, pancreas inflammation, phenytoin, prostate, prostate cancer, rapid heartbeat, skin reactions, sleep disturbances, sleeping pills, stomach cramps, SUFFER, syndrome, testosterone, tingling in the hands, Transdermal, upset stomach, yellowing of the skin

Jul

16

Depression. Diagnosis, Treatment and FAQ.

July 16, 2009 | Leave a Comment

Drug Therapy

Fifty years ago “talking therapy” was considered essential in the treatment of depression. Psychologists and psychiatrists saw lots of patients who suffered from mild to moderate depression. But during the 1970s biological psychiatry took off. The medical profession embraced the theory that depression was primarily caused by an imbalance of chemicals in the brain. Many health professionals adopted the belief that a depressed person only needed antidepressant medication to normalize brain biochemistry. All you had to do was “feed your head” the right chemicals and the depression would disappear.
During those heady days many patients were given tricyclic antidepressants to soothe their troubled psyches. Medications like amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Janimine, Tofranil), and nortriptyline (Aventyl, Pamelor) were prescribed in huge numbers. Never mind that such drugs caused drowsiness, fatigue, constipation, dry mouth, dental problems, weight gain, blurred vision, urinary difficulties, dizziness, disturbed concentration, impaired memory, mental confusion, sexual dysfunction, and impotence.
Although these medications did help many people get out of the depths of despair, the side effects were sometimes as depressing as the depression itself. Imagine what it would be like to put on 30 or 40 pounds, feel mentally cloudy and constipated most of the time, and have no sex life. But insurance companies liked these medications. It seemed far more cost-effective to have an internist or a family practice doctor prescribe an antidepressant than to approve a lengthy series of counseling sessions with a psychologist or psychiatrist.
Then along came Prozac (fluoxetine). In 1987 when it was introduced, this antidepressant hardly made a splash. First-year sales were just barely respectable, but more than doubled in the second year. By the third year, Americans spent more on Prozac than on all other antidepressants combined. Everyone seemed to fall in love with Prozac—physicians, pharmacists, patients, and, most of all, the big payers (insurance companies and HMOs).
Prozac—a selective serotonin reuptake inhibitor, or SSRI—was so successful because it got great PR, and because it seemed to have fewer side effects than traditional tricyclic antidepressants. At least it was less likely to cause sedation, dizziness, constipation, or dry mouth. It also was more effective—or at least that was the impression among physicians and patients. There were never any data to support that belief, but that didn’t stop the media blitz. Prozac even made the cover of Newsweek and Time magazines. Once people decided it was the new wonder drug, other pharmaceutical manufacturers were desperate to get in the game. The race was on.
It wasn’t long before the wannabes started showing up, trying to claim a piece of the Prozac pie. Today the competitors include bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). Almost 190 million prescriptions are written for these antidepressants each year, with sales exceeding $12 billion.
Such coeds are being prescribed enthusiastically for a wide range of other health problems, too. The pharmaceutical industry has promoted some of these antidepressants for conditions such as obsessive-compulsive disorder, panic attacks, hot flashes, premenstrual distress, nervousness, and shyness (”social anxiety disorder”).
Almost from the beginning, though, these drugs have been controversial. In the original clinical trial for Prozac, 15 percent of patients in the study dropped out because they felt worse instead of better—a statistic that was not widely publicized. Anxiety, insomnia, restlessness, nausea, and tremors caused distress for some people. There also was a high incidence of sexual dysfunction with the SSRIs. But the real controversy has always swirled around whether Prozac and similar compounds could trigger thoughts of suicide or homicide in some people.
Antidepressants and Suicide
In 1988, we received a letter from a grieving physician. His daughter had been prescribed Prozac for an eating disorder; a month later she took her er life by hanging herself. This oph- thalmologist was convinced that Prozac had contributed to her tragic death. At the time, we discounted this story—which we now regret—and told him that depressed people sometimes take desperate action and may try to harm themselves when they start treatment. Later, he responded that his daughter had never been depressed, nor had she been acting like a person who planned to take her life.
In 1990 an article appeared in the American Journal of Psychiatry describing a half-dozen patients who developed “intense violent suicidal preoccupation after 2 to 7 weeks of fluoxetine treatment.” This report stirred up quite a lot of concern, but many psychiatrists downplayed the connection. When we asked the drug company and the FDA about this report, we were told that depressed people sometimes commit suicide and that the drug was not to blame.
Over the last 18 years we have heard of many other instances in which people became preoccupied with harming themselves or others after starting on an antidepressant. A man taking Zoloft awoke in the middle of the night with a strong urge to kill himself. A woman reported wild thoughts on Prozac about ramming her car into other cars and getting a gun to kill an irritating co-worker. Another woman told us that she experienced an overwhelming urge to open her car door and jump-out of the vehicle while it was going at 50 miles an hour down the highway.
My son Mike was prescribed Paxil for depression while he was a graduate teaching assistant at New Mexico State University. Around day 13 he slipped into a mood that I had never seen before. He never came out of it. Four days later he shot himself in the temple with a rifle. He had taken Paxil for 17 days.
I hold the FDA and GlaxoSmithKline (maker of Paxil) responsible for my son’s suicide. No one should ever have to look at a son or daughter’s tombstone!
Whenever we discussed our concerns with psychiatrists, drug companies, or FDA officials, we were told that such events were purely coincidental. Our federal watchdog insisted that the medicines could not have been responsible for such tragic outcomes. But when British drug regulators began warning physicians that SSRI-type medications might trigger suicidal thoughts, agitation, and self-injury in young patients, the whole ball of yarn began to come unraveled.
Eventually, an FDA staffer, Andrew Mosholder, MD, MPH, was given the task of analyzing 22 studies. His conclusion: “Short-term pediatric trials of antidepressant drugs demonstrate an increased rate of suicidal events with active drug compared to placebo.” He also said that there is not adequate information to tell if antidepressants other than Prozac are effective for children.

FDA JULY 1, 2005, PUBLIC HEALTH ADVISORY
•   Adults being treated with antidepressant medicines, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.
•   Close observation of adults may be especially important when antidepressant medications are started for the first time or when doses for the specific drugs prescribed have been changed.
•   Adults whose symptoms worsen while being treated with antidepressants, including an increase in suicidal thinking or behavior, should be evaluated by their health-care professional.

The idea that drugs designed to fight depression and prevent suicide could potentially make things worse for some kids seemed to shock FDA officials to the core. Initially, Dr. Mosholder was muzzled. Eventually, though, the data convinced even the FDA hardliners. Belatedly, the agency issued warnings about suicidal thinking and antidepressants. These cautions came far too late to prevent many terrible tragedies over nearly 2 decades. As difficult as it has been for psychiatrists and FDA officials to contemplate, people taking SSRI-type antidepressants are sometimes preoccupied with thoughts of suicide or homicide. Harvard psychiatrist Joseph Glenmullen,’ MD, has criticized the makers of SSRI-type antidepressants for delaying adequate warnings.”‘ The maker of Effexor XR added “homicidal ideation” to its label years after the drug was introduced. The company considers this a very rare adverse event and does not believe the drug can be causally linked to actual homicides. But there have been a number of high-profile violent events associated with antidepressants. Causal or not, this controversy continues to simmer. The entire SSRI-suicide story strikes us as mishandled. Just as with the Vioxx (rofecoxib) scandal, it has seemed to us that FDA officials have been more intent on protecting the pharmaceutical companies’ profits than the public health. To add even more confusion to this already sordid affair, the reputation these drugs have enjoyed as being highly effective against depression is now suspect. Remember that placebo-controlled trials are the gold standard that everyone is supposed to adhere to. Drug companies are required to show that their expensive antidepressants are significantly superior to a placebo. But an “analysis of 96 antidepressant trials between 1979 and 1996 showed that in 52 percent of them, the effect of the antidepressant could not be distinguished from that of placebo. In other words, “more than half of all recent clinical trials of commonly used antidepressants failed to show statistical superiority for the drug over placebo.”
That, dear reader, is almost beyond belief. It suggests that either placebos—sugar pills—are amazingly effective in relieving depression or that current antidepressants are not all that impressive.
Another overview of many clinical trials concludes that the latter is the case. It goes even further and suggests that “recent meta-analyses show selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo…. Antidepressants have not been convincingly shown to affect the long-term outcome of depression or suicide rates.” Of course, this kind of analysis relies on the statistical manipulation and combining of many smaller studies. As compelling as the conclusions may be, they do not substitute for really big, well-conducted trials.

The largest and most definitive study of depression and antidepressant medications was a $35 million project, funded by the National Institutes of Health, called the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial. This was no drug company whitewash. This was your tax money at work. What made this research so valuable was that the investigators looked at actual recovery from depression (”remission”), not just some symptom improvement. Recovery is, after all, what depressed patients really care about. The antidepressants used in the STAR*D trial were bupropion SR (Wellbutrin SR), citalopram (Celexa), sertraline (Zoloft), and venlafaxine XR (Effexor XR). When the long-awaited results were published in the New England Journal of Medicine (March 2006), they were surprisingly disappointing. About one-fourth of the patients achieved real remission, regardless of the type of antidepressant that was taken. What makes this so discouraging is that these patients got optimal treatment. They received intense evaluation and a level of care not usually available to the average patient. If the depressed folks in this study had been treated in a more typical manner, “the remission rate probably would have been significantly lower—perhaps even in the single digits.”That’s abysmal. If there is any good news that came out of the STAR*D research, it is that when a different antidepressant medication was substituted after initial treatment failure, about one in three patients finally did achieve remission. What this means is that antidepressants actually do what they are supposed to do (cure depression) about half the time. Depending upon your perspective, that means the glass is either half full or half empty.
We are happy to learn that 50 percent of the patients in this trial got better. But even under these ideal conditions, half did not, regardless of the type of medicine used. That means that an awful lot of people are suffering drug side effects without benefit. And since there were no placebo controls in STAR*D, we have no idea how many folks might have improved if they had received sugar pills instead of drugs. So how can you determine which antidepressant is best for you? In truth, it is extremely difficult for physicians and patients to make clear decisions about safety and effectiveness when it comes to these medications. Despite all the hype from the drug companies, it is hard to prove that one type of antidepressant is better than another one.
Newer drugs like Cymbalta affect both serotonin and another neurotransmitter called norepinephrine (hence their name serotonin/norepinephrine reuptake inhibitors, or SNRIs). This dual action is supposed to make such drugs more effective. It has certainly driven up the cost. A single Cymbalta pill can cost between $3 and $4. A Wall Street Journal review reported that when Cymbalta was compared head-tohead with venlafaxine (Effexor), an older drug in this class, “Cymbalta wasn’t significantly different from Effexor in treating depression.”
The bottom line is that there are no “best choices” when it comes to these kinds of antidepressants. All these drugs are roughly similar in effectiveness, and all have the potential to cause serious adverse reactions for some people. Anyone who experiences anxiety, agitation, irritability, and especially thoughts of violence toward himself or others should contact a health professional immediately!

Watch Out for Withdrawal!

There is one other complication associated with these antidepressants that is rarely discussed. Sudden discontinuation of drugs like Effexor, Paxil, Serzone, and Zoloft may cause unexpected symptoms. We have heard from many patients that they experienced dizziness, nausea, insomnia, headaches, nervousness, sweating, shakiness (like a bad hangover), weakness, visual disturbances, and an inability to concentrate. One reader called the problem “Paxil Head,” like having your head stuck in a blender.
I take Zoloft, and have tried to stop taking it several times. Each time I stop I experience a-very strange thing. Doctors, nurses, and pharmacists dismiss me like I’m a nut case, but I swear this is true. I get electrical shocklike sensations in my head and become extremely dizzy. I absolutely know this is associated with not taking Zoloft. Not 2 hours after I resume taking it again the symptoms, which are overwhelming, disappear completely. I would like to get off of this drug but have no idea how to do so, especially when I cannot function without it and no one recognizes I’m having any trouble. They just think I’m crazy.
What is so sad about this particular problem is that no one really knows how common withdrawal symptoms are. There are, as far as we can tell, few good guidelines for helping people overcome this complication. So we do not know how long people will experience dizziness, shocklike sensations, or nausea after they stop a drug like Zoloft. Drug companies are not particularly interested in developing protocols for discontinuing SSRI/SNRI-type medications, since they would then need to admit they have a problem on their hands. That means that patients and physicians are on their own. Gradual tapering over several weeks may be necessary. We have heard from some doctors that they switch patients over to fluoxetine and then taper it very slowly. That’s because Prozac lingers in the body and may be less likely to trigger withdrawal symptoms.

Fluoxetine (Prozac)

Fluoxetine is a stand-in for all SSRI-type drugs. Although there are subtle variations between medications in this class, there are more similarities than differences.
Side effects: Headache, nausea, dizziness, diarrhea, nervousness, anxiety, and insomnia are relatively common and may affect up to one-fourth of the patients who take SSRI-type medications. Some people may experience drowsiness or dizziness. Delayed ejaculation, inability to achieve orgasm, and decreased sexual desire are common complications of this entire class of drugs. Less frequent problems may include decreased appetite, indigestion, sweating, mania, dry mouth, heart palpitations, tremor, chills, constipation, blurred vision, memory problems, confusion, rash, and joint pains. Blood sugar control or thyroid function may be altered. Seizures, while uncommon, have been reported in roughly 0.1 to 0.2 percent of patients, an incidence comparable to that seen with older antidepressants. Any thoughts of suicide or violence must be reported to a physician immediately).
Downside: SSRI-type medications like Prozac can interact with many other drugs. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant.
Cost: Approximately $130 to $140 for a month’s supply of Prozac. Generic fluoxetine costs $16 to $20 for the same amount.
Despite all the controversy, we still think Prozac is worthy of consideration, especially since it is less likely to precipitate withdrawal symptoms when discontinued. And we are not convinced that other SSRI/SNRIs are more effective. Many people benefit dramatically from this or another SSRI or SNRI. Prozac is now available generically as fluoxetine, so the cost factor is less problematic. We’re not convinced, though, that all generic fluoxetine is created equal.

Bupropion (Wellbutrin)

This antidepressant is less likely to interfere with sexuality and may even be helpful for people who have experienced diminished libido. It is also available generically, so there is a cost savings. People tend to feel energized rather than sluggish when taking bupropion.
Side effects: Common complaints include insomnia, dry mouth, anxiety or agitation, headache, nausea, and dizziness. Less common adverse reactions that we are aware of include mania, seizures, irregular heart rhythms, skin rash, hallucinations, paranoia, high blood pressure, and migraine.
Downside: Bupropion can interact with many other medications. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant. Any thoughts of suicide or violence must be reported to a physician immediately!
Cost: Approximately $130 to $150 for a month’s supply of brand-name Wellbutrin SR; generic bupropion SR runs roughly $60 to $70 for a similar amount.
efit more from one antidepressant than another, this is mostly a process of trial and error. It may take 4 to 6 weeks to begin to see improvement, so it is important to give each medication a fair trial. If no success is achieved after a few drugs in the same class are tried, then it may be time to move on to another category.
Bupropion (Wellbutrin) may offer certain advantages over other SSRI-type drugs. For one thing, it is far less likely to interfere with sexuality. Some have even reported that it restores libido.
Some people do benefit from old-fashioned tricyclic-type antidepressants such as desipramine, imipramine, and nortriptyline. For people who become agitated or anxious on an SSRI/SNRI or find that bupropion keeps them wide awake, tricyclics may offer an acceptable alternative.
There is also a completely different kind of antidepressant that comes as a skin patch (Emsam). We will discuss it at the end of this chapter.

Tags: allergic reactions, Anxiety, being, bupropion, celexa, cognitive behavioral therapy, complication, cymbalta, dietary regimen, dizziness, dosage, drug interaction, effectiveness, Effexor, emsam, fish oil, fluoxetine, getting a divorce, HAVING, Head, high blood pressure, HOW, impotence, info, Insomnia, institute of mental health, light exposure, losing a pet, major depression, Medicine, mood disorder, national institute of mental health, nervousness, new england journal of medicine, norepinephrine, one-fourth, overwhelming challenge, paroxetine, prozac, recovery, remission, Research, serotonin, sexual side effects, shocklike, signs of depression, situation, st john s wort, success, sugar, suicidal thoughts, symptom, tailspin, thoughts of suicide, time, Treatment, venlafaxine, vitamin

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, 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.

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)
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.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. 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 pilafs 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.

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

Q. 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.

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.

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 for me.

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. 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

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 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.”

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.
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. 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.

Tags: abilify, abuse, acid, alcohol, allergic reactions, anaprox, anastrozole, Approaches, arimidex, aripiprazole, asacol, bowel movements, CANCER, CHANGES, coconut, constipation, cornerstones, course, cymbalta, damage, defecation, docusate, everything, fatty acids, FOODS, geodon, Gland, golf balls, ground flaxseed, irritation, Laxatives, maximum, Medications, mesalamine, milk of magnesia, minor complaint, objective measures, paroxetine, part, pharmacy, PLENTY, prescription products, psyllium, psyllium powder, rectal, rectum, relafen, risedronate, side, situation, stimulant, tract, training, venlafaxine, vitamin, zofran

Jul

14

PROSTATE CANCER WHAT’S THE DIAGNOSTIC SEQUENCE?

July 14, 2009 | Leave a Comment

PROSTATE CANCER: WHAT’S THE DIAGNOSTIC SEQUENCE?

A patient goes to a urologist for many reasons. More and more family physicians are doing rectal digital examinations and when they find a lump or nodule on the prostate refer the patient to a specialist. The urologist will confirm the digital diagnosis and then begin other tests to confirm or deny the first decision. He might do a biopsy of the prostate to test the tissue in the hard nodule. He almost certainly will do an ultrasound test and look at the findings on a sonogram or on a screen. There are also two blood tests he’ll do for further confirmation of a cancerous growth. As we pointed out before, there is no connection between an enlarged prostate and cancer. Usually the cancer does not press in on the urethra so there are none of the usual BPH symptoms which might get a man to go see his doctor. There could be some symptoms a man might feel such as pain in the upper thighs, the pelvis or lower back, serious weight loss and shortness of breath. Symptoms such as these might mean nothing unusual, or be a sign of some other physical problem or disease — or they could be from cancer.
If the pain is related to prostate cancer, it may be a sign that the disease has spread outside of the prostate, and often it is too late to save the patient. That’s why prostate cancer is often called a silent killer and the reason that preventive medicine must be practiced, the digital rectal exam, once a year.
Now, back to those tests to determine if the lump or nodule is cancer of the prostate. The drawing on the following page shows one way that cancer might grow in the prostate. This is viewed from the two lobes of the prostate that can be digitally examined. A biopsy is the use of a needle inserted through the perineum or the rectum to remove a sample of tissue from the suspected nodule. This can be done by feel by the urologist or with the help of ultrasound to locate the specific area.
A biopsy can be done in the doctor’s office or as an outpatient at a hospital and requires a local anesthesia. A relatively new way to take a biopsy is with what is called a “biopsy gun”. It isn’t a real. It’s a biopsy needle that is used through the rectum and guided by ultrasound, but is “fired” in and out so quickly that the patient feels pressure and hears the sound the device makes, but he feels almost no pain. No anethesia is given.
One urologist says he shows the patient the device and the noise it will. During the actual biopsy the patient jumps when he hears the sound, not because of pain. For most the use of the biopsy gun is quick, simple and painless. A lot easier than going to the hospital for a biopsy the old way. And that means it’s less costly as well for the patient. One patient said it was less painful for him than a shot in the arm.
The tissue core taken in the biopsy is evaluated to see if it is cancerous. Another technique known as fine-needle aspiration cytology is often used these days. Here a urologist inserts an extremely fine needle through the rectum and removes cells from the prostate in three, four or five different locations. The technique results in minimum pain for the patient and no anesthesia is required. If the tissue shows evidence of cancerous growth, the urologist usually will do more testing. This is to find out the placement of the cancer and the extent of it. One of these tests is the PSA test, the prostate specific antigen test. If the prostate is producing a higher level of antigen than usual, it is a good indication that cancer is present.
The other test, the PAP, or the prostate acid phosphatase, may reveal if the cancer has spread to other parts of the body. If the PAP is elevated, the urologist will follow up with chest X-rays and X-rays of the pelvic area as well as bone scans and perhaps a CAT scan if equipment is available.
There is another way that many men learn that they have cancer of the prostate. This happens during a routine TURP operation where BPH has resulted in an operation. The scrapings of tissue from the prostate are examined to see if they are benign or cancerous. If the pathologist reports there are some flakes that show cancer, the doctor then does more tests to determine the placement of the tumor, and the chance that he has already removed all of the cancerous tissue.
When cancer is found in this instance, it is usually an early beginning of the disease, and one that was not found, or was not in the right place to be discovered, with the digital exam. Again here more tests would be done and the prostate examined again to determine what procedure might be needed. This would be after the regular BPH surgery, since most evaluations of prostate tissue by a pathologist take two to three days in most areas on a routine basis.

Tags: allergic reactions, amantadine, anesthesia, antibiotic, antigen, Anxiety, avodart, biopsy, blood, bph symptoms, cancerous growth, cefdinir, Celebrex, clinda, clindamycin, Cough, diagnosis, digital rectal exam, disease, doxycycline, Drug, drug interaction, drugs, examination, family physicians, fatigue, flow mac, hormone, hospital, levonorgestrel, lithium, Medicine, naprosyn, naproxen, needle, nodule, paxil, pharmacy, physician, pregnancy, prescription, problem, procardia, prostate, prostate symptoms, pseudoephedrine, rabbit snuffles, rectal, surgery, testing, testosterone, Tetracycline, Treatment, trimethoprim sulfa, ultrasound test, upper thighs, wellbutrin, wellbutrin xl, zyrtec

Jul

3

Allergy Medications - Nasalcrom (Cromolyn)

July 3, 2009 | Leave a Comment

Allergy Medications Nasalcrom (Cromolyn)

Speaking of stabilizing mast cells, another way to do this is with a nasal spray. Cromolyn (NasalCrom) was first introduced as a prescription product in 1983. NasalCrom went over the counter in 1997. Cromolyn, the active ingredient in Nasalcrom.
This nonprescription nasal spray. is often ignored by doctors; but it is a valuable tool in the fight against nasal allergies. By stabilizing mast cells in the nose, NasalCrom makes it harder for histamine and other inflammatory chemicals to be released and do their dirty work.
Side effects: Cromolyn is very safe and does not cause drowsiness or rebound nasal congestion the way OTC nasal decongestants can. Some people may experience temporary sneezing, nasal burning, or a bad taste in their mouth.
Downside: You must use NasalCrom at least four times a day to really benefit. Some experts believe it is much less effective than intranasal corticosteroids.
Cost: Approximately $17 to $20 for a 1- to 2-month supply finally derived from an herb, the fruit of bishop’s weed (Ammi visnaga), which was traditionally used to treat asthma.
The compound cromolyn stabilizes highly sensitive mast cells in the lining of the nose and lungs so they can better resist the onslaught of pollen. It won’t cause drowsiness or cognitive impairment and, if used regularly, it is quite effective. Unlike decongestant nose sprays, there is no need to fear developing dependency.
cromolyn is available in eyedrops (Crolom) for itchy, red eyes due to allergies. There is also an aerosol inhaler (Intal) for treating asthma. Both products require a prescription, whereas NasalCrom does not require your physician’s assistance.
Q. I’m going to visit my daughter in a few weeks and she has two cats that have the run of the house. When I’m there, I suffer runny nose, watery eyes, and sneezing from the cat hairs that are all over the house and furniture.
Can you recommend something over-the-counter for me to take during the visit?
A. NasalCrom is a nasal spray that can be quite effective if taken preventively. You will need to start spritzing several days before arriving so you can stabilize the cells in your nose and protect them against cat allergens.
If you also took the oral antihistamine Claritin (loratadine), you might be able to minimize the sneezing and allergic reactions.

Tags: about wellbutrin, albuterol info, alcohol cr paxil umaxppc, allergic reactions, Allergy, allergy medications, Ammi, ammi visnaga, amoxicillin online no prescription, aspirin caffeine, Asthma, atenolol without prescription overnight delivery, augmentin discount, benedryl and zofran for nausea, buy fast shipping ultram, caffeine and glaucoma, caffeine free diets, caffeine health risks, can chloroquine cause heart rhythm problems, cognitive impairment, complications from vytorin, crolom, cromolyn, cymbalta and addral, dirty work, disulfiram 375mg how long till effective, effects lipitor negative side, estradiol and bone strength, flagyl, flagyl diarrhea, formula for nifedipine ointment, generic viagra new au, histamine, how to wean off singulair, hydrochlorothiazide erection problems, intal, intranasal, intranasal corticosteroids, least four times, leiner health products and claritin, levitra flomax interaction, lithium danger, lithium iron phosphate lifepo4, liver zocor, lovastatin versus, manufacturers of tamoxifen, mast cells, Medications, metformin 500 571, motrin vs ibuprofen for children, nasal allergies, nasal congestion, nasal decongestants, nasal spray, nasalcrom, neurotransmitter buspar, nonprescription, nursing implication for metronidazole, onslaught, pain from taking zyvox, penicillin g gram negative bacillus, phentermine vardenafil, plavix gas side effects, prednisone for headaches, prescription product, prolonged allergic reaction ampicillin, prozac conception, prozac overdose and parkinson disease, rebound, red eyes, runny nose, simvastatin fed pharmacokinetics, sucralfate and prilosec, testosterone hormone replacment in menopausal women, testosterone research oregon, venlafaxine reduces binging, watery eyes, where can i buy nolvadex online, ziprasidone and carbamazepine

Jul

1

Drugs for Allergy Treatment: Allegra, Aristocort, Astelin, Atarax, Atrovent, Benadryl, Clarinex, Claritin, Flonase, Periactin, Phenergan, Prednisolone, Rhinocort, Zyrtec

July 1, 2009 | Leave a Comment

Buy allergy treatment drugs online without a prescription. The following anti allergy drugs are for sale without rx at cheap price from internet pharmacy:

Allegra 30, 120 and 180 mg. Generic Allegra name is fexofendine. Purchase generic Allegra on line and save a lot of money buying cheaper drugs online. Choose between the doses of Allegra 180 mg or 120 mg or a minimum dose 30 mg. No prescription is needed to get Allegra without a prescription online. Allegra is one of the most widely prescribed antiallergic remedies today showing high success rate.

Aristocort 4 mg (with a generic name Triamcinolone). Buy cheap generic Aristocort on line without rx or visiting a doctor. Online Aristocort is much cheaper than the same drug on sale at a regular pharmacy shop. Your generic Aristocort order will be shipped immediately after you purchase Aristocort online without a prescription.

Astelin 10 ml. Buy Astelin without a prescription online at a low internet price. Generic Astelin online purchase requires no script and your order will be delivered within several days to your door. Get generic Astelin (Azelastine) without the need to over pay for expensive drugs offline.

Atarax 10 mg and 25 mg. Generic Atarax (Hydroxyzin) online cheap price makes internet Atarax purchase a very popular way to buy this important drug. Buy Atarax without a prescription online, but visit your doctor prior to purchasing this drug in internet generic pharmacy. Atarax 10 mg is cheaper than Atarax 25 mg, choose your dose correctly.

Atrovent 20 mcg online without a prescription is also available to buy from a trustable internet generic pharmacy. Buy Atrovent without the need to get a prescription and get your order delivered fast to your door. Generic for Atrovent is Aerovent which is the same high quality drug manufactured to all the standards and having full approval. Order Antrovert and start your allergy treatment.

Benadryl 25 mg (generic for Benadryl is Diphenhydramine). Buy Benadryl online without a prescription at a low discounted price without rx. Purchase generic Benadryl safely in internet pharmacy selling hundreds of popular drugs cheap. Benadryl and other drugs are high quality products and are available to get online without a prescription.

Clarinex 5 mg. You can purchase Clarinex online without a prescription too. Clarinex generic is the same drug as a brand version and is called Desloratadine. It is a powerful allergy treatment prescription medication which is sold on line without a prescription in 5 mg Clarinex dosage. The price per pill depends on the quantity of the product you are ordering. Get cheap Clarinex to begin your allergy treatment course.

Claritin buy online without a prescription or doctor visit. Order Claritin 10 mg on line no rx at a cheap price. Generic for Claritin is Loratadine and these are two identical drugs. Purchase Claritin easily online with all the popular payment methods and fast delivery worldwide taking several working day to deliver your Claritin online order to your door. Internet generic pharmacy has a huge list of allergy treatment drugs for sale online without a prescription and Claritin is one of them. Buy Loratadine generic Claritin and start important allergy tratment course for less.

Get Flonase online without a prescription from a comfort of your home and without a prescription. No prescription Flonase order is secure and is delivered really fast if you buy Flonase online at the generic pharmacy shop. Generic Flonase is called Fluticasone and is for sale in doses 50 mcg. Flonase without rx purchase is an easy and convenient way to get this drug, but it is a good idea to consult a doctor before you buy Flonase Fluticasone on line.

Periactin generic 4 mg. Order Periactin online without a prescription and get this important allergy fighting drug within several days. Purchase Periactin after the consultation with a doctor who will provide you with full information about this drug. Generic Periactin is Cyproheptadine and they are fully identical drugs which are available on sale online without rx, no prescription or doctor visits.

Phenergan 25 mg buy online without prescription at low discount price. You can buy Phenergan as well as other antiallergy remedies and prescription drugs in internet pharmacy without rx cheap. Your doctor may prescribe you with Phenergan and then you order generic Phenergan Promethazine without a prescription with fast worldwide delivery. Generic Phenergan online is available in 25 mg doses.

Prednisolone 20, 40 mg buy without a prescription online at discount internet generic price. Prednisolone is both an allergy and skin care treatment drug available on line without script in dosages 20 and 40 mg. Order Prednisolone without a prescription and get your order delivered fast and discretely packed. There are discounts for refill Prednisolone orders which is applied to all the other druggs from online pharmacy list too.

Rhinocort 100 mcg cheap generic price is attractive to buy this drug online. Buy Rhinocort online without a prescription (no rx needed), but learn all the drug information prior to purchasing. Generic for Rhinocort is Budesonide and they are two 100% identical drugs. Order Rhinocort online without a prescription and receive your order fast to start the treatment. Check the number of pills you require, because there is a discount for bigger orders.

Zyrtec 5 mg and 10 mg. Zyrtec online is sold without a prescription and it is cheaper than the same drug offline. Depending on the amount of your order and the dosage of Zyrtec to be purchased online, there is a system of discounts which is applied to all the further orders too. Order generic Zyrtec online without a prescription. Generic for Zyrtec is Cetirizine which is a popular allergy drug prescribed to millions of patients. You can buy Zyrtec online without a prescription.

Allergy is a general term applied to certain types of hypersensitivity reactions, some of which such as hayfever are well known, but the factors that cause such reactions vary widely in their nature. In brief, an allergic reaction is immunologically mediated, and originates in an exposure to an excitatory substance referred to as an antigen, which in sensitive individuals is followed by the production of antibodies. Antigens are often protein in nature, and eggs, peanut products, wasp and bee stings, as well as drugs, can function as antigens. Subsequent re-exposure to the antigen may give rise to an antigen-antibody reaction, which is linked with the release of cell-bound histamine and other spasmogens, which in turn act upon various tissues to produce the allergic response. The response may manifest itself in several ways, such as hayfever, rhinitis, bronchoconstriction and rash or urticaria. In severe allergic reactions (anaphylactic shock), an alarming fall in blood pressure may occur with respiratory distress, and requires the immediate i.m. injection of adrenaline solution (0.5-1 ml) together with i.v. hydrocortisone 200 mg and resuscitation measures.
It should be noted that the anaphylactic reactions that occur after the first dose of certain drugs, including contrast media, are more in the nature of an idiosyncratic-toxic reaction than an immunologically mediated response, but may be no less severe, and resuscitation facilities should always be available.

Buy online without a prescription Allegra, Aristocort, Astelin, Atarax, Atrovent, Benadryl, Clarinex, Claritin, Flonase, Periactin, Phenergan, Prednisolone, Rhinocort, Zyrtec.

In less severe allergic reactions such as hayfever and allergic rhinitis, antihistamines are widely used for symptomatic relief. They do not interrupt the chain of antigen-antibody-histamine release, but block the access of the released histamine to the sensitized tissues. Their action is palliative and not curative, and the response to treatment is often variable.
They are usually effective in hayfever, urticaria and insect bites, but are of no value in allergic asthma. Some antihistamines also have a sedative action, which may be useful in urticaria, but undesirable in other conditions. This sedative side-effect is less marked with some of the newer antihistamines. In overdose they may cause convulsions in young patients. The extended local application of antihistamines should be avoided, as antihistamines may themselves cause an allergic-type dermatitis. Side-effects include dry mouth, blurred vision and occasional gastrointestinal disturbances. Patients should be warned that drowsiness is a common side-effect that may affect car-driving ability. Attempts have been made to desensitize susceptible patients by injections of specific antigens, such as grass pollens. The method is not without risk, particularly in asthmatic patients, and should be carried out only by experts.

Approved names Brand names Daily dose range

acrivastine*                       Semprex                24 mg
asternizole*                      Hismanal, Pollen-Eze              10 mg
azatadine                          Optimine                                  2-4 mg
brompheniramine   Dimotane                                 12-32mg
cetrizine*                          Zirtek                                       10 mg
chlorpheniramine              Piriton   12-24mg
clemastine                        Tavegil                                     1-2 mg
cyproheptadine                 Periactin                                   8-32 mg
loratadine*                        Clarityn                                    10 mg
mezquitazine                    Primalan   5-10 mg
phenindamine*                 Thephorin   75-150 mg
pheniramine   Daneral SA   75-150mg
promethazine                   Phenergan                                 20-75 mg
terfenadine*                     Triludan                                    60-120 mg
trimeprazine                    Vallergan                                   30-100 mg
triprolidine                      Actidil, Pro-Actidil                     7.5-15 mg

*Antihistamine with reduced sedative effects

Generic Antiallergic Medicine and Their Active Ingredients

Product Name	Active Ingredient
abilify	aripiprazole	mental disorders
accupril	quinapril hydrochloride	hypertension, cardiovascular diseases
accutane	isotretinoin	skin care
aceon	perindopril erbumine	hypertension, cardiovascular diseases
aciphex	rabeprazole sodium	gastrointestinal tract
acticin	permethrin	skin care, antiparasitic
actigall	ursodiol (ursodeoxycholic)	urinary tract
actonel	residronate	osteoporosis
actoplus met	metformin and pioglitazone	diabetes
actos	pioglitazone hydrochloride	diabetes
adalat	nifedipine	hypertension, cardiovascular diseases
adalat cc	nifedipine	hypertension, cardiovascular diseases
advair diskus	fluticasone-salmeterol	respiratory tract, asthma
aggrenox	asiprin - dipyridamole	cardiovascular diseases
albenza	albendazole	antiparasitic
aldactone	spironolactone	diuretics
aldara	imiquimod	skin care
alesse	levonorgestrel bp + ethinylestradiol bp	womens health, birth control
allegra	fexofenadine hcl
allegra-d	fexofenadine-pseudophedrine
altace	ramipril	hypertension, cardiovascular diseases
amaryl	glimepiride	diabetes
amoxil	amoxicillin	antibiotics, bestsellers
anafranil	clomipramine	mental disorders, antidepressants
anafranil sr	clomipramine	mental disorders
antabuse	disulfiram	alcoholism
apcalis oral jelly	tadalafil	erectile dysfunction
aralen	chloroquine phosphate	antiparasitic
arava	leflunomide	anti-inflammatories, arthritis
arcoxia	etoricoxib	anti-inflammatories, arthritis, analgesics
aricept	donepezil	alzheimers and parkinsons
arimidex	anastrozole	womens health, cancer
aristocort	triamcinolone
artane	trihexyphenidyl	alzheimers and parkinsons
asacol	mesalamine	gastrointestinal tract, anti-inflammatories
asendin	amoxapine	antidepressants
atacand	candesartan	hypertension, cardiovascular diseases
atacand hct	candesartan hydrochlorothiazide	hypertension
atarax	hydroxyzine
atrovent	ipratropium bromide	respiratory tract
augmentin	amoxicillin and clavulanate	antibiotics
avalide	irbesartan hydrochlorothiazide	hypertension
avandamet	rosiglitazone-metformin	diabetes
avandaryl	rosiglitazone maleate - glimepiride	diabetes
avandia	rosiglitazone	diabetes
avapro	irbesartan	hypertension
avelox	moxifloxacin	antibiotics
aventyl	nortriptyline	antidepressants
avodart	dutasteride	mens health
aygestin	norethisterone bp	urinary tract, womens health, antidepressants
azelex	azelaic acid	skin care
azulfidine	sulfasalazine	anti-inflammatories
bactrim	trimethoprim and sulfamethoxazole	antibiotics
benicar	olmesartan	hypertension
benicar hct	olmesartan - hydrochlorothiazide	hypertension
benzac	benzoyl peroxide	skin care
betagan	levobunolol	eye care
betapace	sotalol	cardiovascular diseases
biaxin	clarithromycin	antibiotics
boniva	ibandronae sodium	osteoporosis, womens health
brethaire	terbutaline	respiratory tract, asthma
buspar	buspirone	mental disorders
bystolic	nebivolol	hypertension, cardiovascular diseases
caduet	amlodipine - atrovastatin	cholesterol
cafergot	ergotamine tartrate, caffeine	migraine
calan	verapamil	hypertension, cardiovascular diseases
calan sr	verapamil	hypertension, cardiovascular diseases
capoten	captopril	hypertension, cardiovascular diseases, diabetes
carafate	sucralfate	gastrointestinal tract
cardura	doxazosin	mens health, hypertension
cartia	diltiazem hcl	hypertension, cardiovascular diseases
cartia xt	diltiazem hcl	hypertension, cardiovascular diseases
casodex	bicalutamide	mens health, cancer
caverta	sildenafil citrate	erectile dysfunction
ceclor	cefaclor	antibiotics
ceclor cd	cefaclor	antibiotics
ceftin	cefuroxime	antibiotics
celebrex	celecoxib	gastrointestinal tract, womens health, anti-inflammatories, arthritis
celexa	citalopram hydrobromide	antidepressants
cellcept	mycophenolate mofetil	surgery
chloromycetin	chloramphenicol	antibiotics
cialis	tadalafil	erectile dysfunction, bestsellers
cialis soft	tadalafil	erectile dysfunction, bestsellers
cialis super active	tadalafil	erectile dysfunction
ciloxan	ciprofloxacin	antibiotics, eye care
cipro	ciprofloxacin	antibiotics, bestsellers
clarinex	desloratadine
claritin	loratadine
cleocin	clindamycin	antibiotics
clomid	clomiphene	womens health, bestsellers
clorpres	clonidine-chlorthalidone	hypertension
clozaril	clozapine	mental disorders
colcrys	colchicine	anti-inflammatories, arthritis
colofac	mebeverine	gastrointestinal tract
combivir	lamivudine - zidovudine	hiv
compazine	prochlorperazine	mental disorders
cordarone	amiodarone	cardiovascular diseases
coreg	carvedilol	hypertension, cardiovascular diseases
coumadin	warfarin	cardiovascular diseases
cozaar	losartan	hypertension, diabetes
crestor	rosuvastatin	cholesterol
crixivan	indinavir	hiv
cyclogyl	cyclopentolate	surgery, eye care
cycrin	medroxyprogesterone	urinary tract, womens health
cyklokapron	tranexamic acid	surgery
cymbalta	duloxetine	antidepressants, analgesics
cytotec	misoprostol	gastrointestinal tract
cytoxan	cyclophosphamide	cancer
danocrine	danazol
declomycin	demeclocycline	antibiotics
deltasone	prednisone	anti-inflammatories
demadex	torsemide	diuretics
depakote	divalproex	mental disorders, migraine, anticonvulsants
desogen	desogestrel-ethinyl estradiol	womens health, birth control
desyrel	trazodone	antidepressants
detrol	tolterodine	urinary tract
detrol la	tolterodine	urinary tract
dexone	dexamethasone
diamox	acetazolamide	diuretics
didronel	etidronate	osteoporosis, surgery
diflucan	fluconazole	antifungals, bestsellers
dilantin	phenytoin	surgery, anticonvulsants
diovan	valsartan	hypertension, cardiovascular diseases
diovan hct	valsartan-hydrochlorothiazide	hypertension
diprolene	betamethasone	skin care, anti-inflammatories
dostinex	cabergoline	womens health, alzheimers and parkinsons
droxia	hydroxyurea	cancer
duphaston	dydrogesterone	womens health
duricef	cefadroxil	antibiotics
effexor	venlafaxine	antidepressants
effexor xr	venlafaxine	mental disorders, antidepressants
elavil	amitriptyline	antidepressants
eldepryl	selegiline	alzheimers and parkinsons
elocon	mometasone
epivir	lamivudine	hiv
erectalis	tadalafil	erectile dysfunction
eriacta	sildenafil citrate	erectile dysfunction
estrace	estradiol	osteoporosis, womens health, anti-inflammatories
eulexin	flutamide	mens health, cancer
evista	raloxifene	osteoporosis, womens health, cancer
exelon	rivastigimine	alzheimers and parkinsons
famvir	famciclovir	antivirals, hiv
fansidar	sulfadoxine-pyrimethamine	antiparasitic
feldene	piroxicam	anti-inflammatories, arthritis, analgesics
femara	letrozole	womens health, cancer
flagyl	metronidazole	antibiotics
flomax	tamsulosin	mens health
floxin	ofloxacin	antibiotics
fosamax	alendronate	osteoporosis
frumil	amiloride and furosemide	diuretics
furacin	nitrofurazone	skin care, antibiotics
furadantin	nitrofurantoin	urinary tract, antibiotics
furoxone	furazolidone	gastrointestinal tract, antibiotics
geodon	ziprasidone	mental disorders
glucophage	metformin bp	diabetes
glucophage xr	metformin	diabetes
glucotrol	glipizide	diabetes
glucotrol xl	glipizide	diabetes
glucovance	glyburide(glibenclamide)-metformin	diabetes
grifulvin	griseofulvin	skin care, antifungals
gyne-lotrimin	clotrimazole	womens health, antifungals
hytrin	terazosin	mens health, hypertension
hyzaar	losartan-hydrochlorothiazide	hypertension
ilosone	erythromycin	skin care, antibiotics, respiratory tract, anti-inflammatories
imdur	isosorbide mononitrate	cardiovascular diseases
imitrex	sumatriptan	migraine
imodium	loperamide	gastrointestinal tract
imuran	azathioprine	arthritis, surgery
inderal	propranolol	hypertension, cardiovascular diseases, migraine
inderal la	propranolol	hypertension, cardiovascular diseases, migraine
indocin	indomethacin	anti-inflammatories, arthritis, analgesics
indocin sr	indomethacin	anti-inflammatories, arthritis, analgesics
intagra	sildenafil citrate	erectile dysfunction
isordil	isosorbide dinitrate	cardiovascular diseases
isordil sublingual	isosorbide dinitrate	cardiovascular diseases
kamagra	sildenafil citrate	erectile dysfunction, bestsellers
kamagra oral jelly	sildenafil citrate	erectile dysfunction
kamagra soft	sildenafil citrate	erectile dysfunction
keflex	cephalexin	antibiotics
kemadrin	procyclidine	alzheimers and parkinsons
kytril	granisetron	cancer
lamictal	lamotrigine	mental disorders, anticonvulsants
lamictal dispersible	lamotrigine	mental disorders, anticonvulsants
lamisil	terbinafine	antifungals
lamisil cream	terbinafine	antifungals
lamprene	clofazimine	antivirals
lanoxin	digoxin	cardiovascular diseases
lariam	mefloquine	antiparasitic
lasix	furosemide	diuretics, bestsellers
levaquin	levofloxacin	antibiotics
levitra	vardenafil	erectile dysfunction, bestsellers
lexapro	escitalopram	antidepressants
lioresal	baclofen	muscle relaxants
lipitor	atorvastatin	cholesterol
lithobid	lithium	mental disorders
lopid	gemfibrozil	cholesterol
lopressor	metoprolol	hypertension, cardiovascular diseases
lotemax	loteprednol	anti-inflammatories, surgery, eye care
lotensin	benazepril	hypertension
lotrel	benazepril - amlodipine	hypertension
lovegra	sildenafil citrate	womens health
loxitane	loxapine	mental disorders
lozol	indapamide	diuretics
lozol sr	indapamide	diuretics
luvox	fluvoxamine	antidepressants
maxalt	rizatriptan	migraine
maxaquin	lomefloxacin	antibiotics
mellaril	thioridazine	mental disorders
mentax	butenafine	skin care, antifungals
mestinon	pyridostigmine bromide	neurological disorders
metaglip	glipizide-metformin	diabetes
mevacor	lovastatin	cholesterol
mexitil	mexiletine hydrochloride, esmolol hydrochloride	cardiovascular diseases
micardis	telmisartan	hypertension
micardis hct	telmisartan - hydrochlorothiazide	hypertension
micronase	glyburide(glibenclamide)	diabetes
microzide	hydrochlorothiazide	hypertension
minipress	prazosin	mens health, hypertension
minocin	minocycline	antibiotics
mobic	meloxicam	anti-inflammatories, arthritis
moduretic	amiloride-hydrochlorothiazide	hypertension, diuretics
monopril	fosinopril	hypertension, cardiovascular diseases
motilium	domperidone	gastrointestinal tract
motrin	ibuprofen	anti-inflammatories, arthritis, analgesics
myambutol	ethambutol	respiratory tract
mysoline	primidone	anticonvulsants
naprosyn	naproxen	anti-inflammatories, arthritis, analgesics
neggram	nalidixic acid	urinary tract, antibiotics
neoral	cyclosporine	skin care, arthritis, surgery
neurontin	gabapentin	analgesics, anticonvulsants
nexium	esomeprazole	gastrointestinal tract
nimotop	nimodipine	cardiovascular diseases, analgesics
nizoral	ketoconazole	antifungals
nizoral cream	ketoconazole	antifungals
nolvadex	tamoxifen	womens health, cancer, bestsellers
norlutate	norethindrone acetate	womens health, urinary tract
noroxin	norfloxacin	urinary tract, antibiotics
norvasc	amlodipine	hypertension, cardiovascular diseases
norvir	ritonavir	hiv
ocuflox	ofloxacin	antibiotics, eye care
omnicef	cefdinir	antibiotics
optivar	azelastine
oxsoralen	methoxsalen	skin care
oxytrol	oxybutynin	urinary tract
pamelor	nortriptyline	antidepressants
parafon	chlorzoxazone	muscle relaxants
parlodel	bromocriptine	womens health, alzheimers and parkinsons
paxil	paroxetine	mental disorders, antidepressants
paxil cr	paroxetine	mental disorders, womens health, antidepressants
pepcid	famotidine	gastrointestinal tract
periactin	cyproheptadine
persantine	dipyridamole	cardiovascular diseases, surgery
phoslo	calcium acetate	urinary tract
pilagan	pilocarpine	surgery, eye care
plan b	levonorgestrel	womens health, birth control
plavix	clopidogrel	cardiovascular diseases
plendil	felodipine	hypertension
pletal	cilostazol	cardiovascular diseases
ponstel	mefenamic acid	womens health, anti-inflammatories, arthritis, analgesics
prandin	repaglinide	diabetes
pravachol	pravastatin	cholesterol
precose	acarbose	diabetes
premarin	conjugated estrogens	mens health, osteoporosis, womens health, cancer
prevacid	lansoprazole	gastrointestinal tract
priligy	dapoxetine	mens health, antidepressants, bestsellers
prilosec	omeprazole	gastrointestinal tract
principen	ampicillin	antibiotics
pro-banthine	propantheline	gastrointestinal tract
probalan	probenecid	arthritis
prograf	tacrolimus	surgery
propecia	finasteride	mens health, bestsellers
proscar	finasteride	mens health
protonix	pantoprazole	gastrointestinal tract
pyridium	phenazopyridine	urinary tract, analgesics
rebetol	ribavirin	antivirals
reglan	metoclopramide	gastrointestinal tract
relafen	nabumetone	anti-inflammatories, arthritis, analgesics
relenza	zanamivir	antivirals
remeron	mirtazapine	antidepressants
renagel	sevelamer hydrochloride	urinary tract
renova	tretinoin	skin care
requip	ropinirole	alzheimers and parkinsons
retrovir	zidovudine	hiv
revia	naltrexone	alcoholism
rheumatrex	methotrexate	skin care, arthritis, cancer
risperdal	risperidone	mental disorders
robaxin	methocarbamol	muscle relaxants
rocaltrol	calcitriol	urinary tract
rulide	roxithromycin	antibiotics
seromycin	cycloserine	antibiotics, respiratory tract
seroquel	quetiapine	mental disorders
silagra	sildenafil citrate	erectile dysfunction
sinemet	carbidopa-levodopa	alzheimers and parkinsons
sinemet cr	carbidopa-levodopa	alzheimers and parkinsons
sinequan	doxepin	antidepressants
singulair	montelukast
sporanox	itraconazole	antifungals
starlix	nateglinide	diabetes
strattera	atomoxetine	mental disorders
stromectol	ivermectin	antiparasitic
suhagra	sildenafil citrate	erectile dysfunction
sumycin	tetracycline	antibiotics
suprax	cefixime	antibiotics
sustiva	efavirenz	hiv
symmetrel	amantadine	alzheimers and parkinsons, antivirals
synthroid	thyroxine	cancer, surgery, bestsellers
tadacip	tadalafil	erectile dysfunction
tadalis sx	tadalafil	erectile dysfunction
tamiflu	oseltamivir	antivirals
tavist	clemastine
tegretol	carbamazepine	analgesics, anticonvulsants, neurological disorders
temovate	clobetasol	skin care, anti-inflammatories
tenoretic	atenolol-chlorthalidone	hypertension
tenormin	atenolol	hypertension, cardiovascular diseases
tequin	gatifloxacin	antibiotics, respiratory tract
theox cr	theophylline	respiratory tract, asthma
thorazine	chlorpromazine	mental disorders
ticlid	ticlopidine	cardiovascular diseases
timoptic	timolol	eye care
tofranil	imipramine	antidepressants
topamax	topiramate	migraine, anticonvulsants
trandate	labetalol	hypertension
trecator-sc	ethionamide	antibiotics, respiratory tract
trental	pentoxifylline	cardiovascular diseases
trial packs		erectile dysfunction
tricor	fenofibrate	cholesterol
trileptal	oxcarbazepine	anticonvulsants
urispas	flavoxate	urinary tract
uroxatral	alfuzosin	mens health
valtrex	valacyclovir	skin care, antivirals
vantin	cefpodoxime	antibiotics
vaseretic	enalapril-hydrochlorothiazide	hypertension
vasotec	enalapril	hypertension, cardiovascular diseases
veetids	penicillin v	antibiotics
ventolin	albuterol (salbutamol)	respiratory tract, asthma
vepesid	etoposide	cancer
vermox	mebendazole	antiparasitic
viagra	sildenafil citrate	erectile dysfunction, bestsellers
viagra soft	sildenafil citrate	erectile dysfunction, bestsellers
viagra super active	sildenafil citrate	erectile dysfunction
vibramycin	doxycycline	antibiotics, antiparasitic
videx	didanosine	hiv
vigora	sildenafil citrate	erectile dysfunction
viracept	nelfinavir	hiv
volmax cr	albuterol (salbutamol)	respiratory tract, asthma
voltaren	diclofenac sodium	anti-inflammatories, arthritis, analgesics
vytorin	simvastatin ezetimibe	cholesterol
wellbutrin sr	bupropion	antidepressants
xenical	orlistat	obesity
xylocaine	lidocaine	anti-inflammatories, analgesics, surgery
yasmin	drospirenone - ethinyl estradiol	womens health, birth control
zagam	sparfloxacin	antibiotics, respiratory tract
zanaflex	tizanidine	muscle relaxants
zantac	ranitidine	gastrointestinal tract
zebeta	bisoprolol fumarate	hypertension
zelnorm	tegaserod	gastrointestinal tract
zerit	stavudine	hiv
zestoretic	lisinopril-hctz	hypertension
zestril	lisinopril	hypertension, cardiovascular diseases
zetia	ezetimibe	cholesterol
ziac	biosoprolol - hydrochlorothiazide	hypertension
ziagen	abacavir	hiv
zithromax	azithromycin	antibiotics, bestsellers
zocor	simvastatin	cholesterol
zofran	ondansetron	gastrointestinal tract
zovirax	acyclovir	antivirals
zyloprim	allopurinol bp	urinary tract
zyprexa	olanzapine	mental disorders
zyrtec	cetirizine

Tags: Aerovent, Allegra 120 mg, allegra 180, Allegra 30 mg, allegra on line, allergic reactions, allergic response, allergic rhinitis, allergy drugs, allergy treatment, aristocort, Aristocort 4mg, Astelin 10 ml, atarax, Atarax 10 mg, Atarax 25 mg online, atrovent, Atrovent 25 mcg, Atrovent buy online, avodart, Azelastine, Benadryl 25 mg, Benadrylno prescription buy online, budesonide, buy Allegra without a prescription, buy Atarax cheap generic, buy generic Zyrtec, cetirizine, cheap Claritin online, Clarinex 5 mg, Clarinex generic buy, Claritin 10mg, Cyproheptadine, desloratadine, diphenhydramine, Fexofendine, Flonase, Flonase 50 mcg, fluticasone, generic name, get Aristocort online, hydrocortisone, Hydroxyzin, internet pharmacy, internet price, loratadine, Periactin 4 mg, Periactin without a prescription, Phenergan 25 mg, Phenergan order online, Prednisolone 40 mg, Prednisolone allergy treatment internet order, prescription drugs, promethazine, purchase Astelin, Rhinocort 10 mcg, Rhinocort fast delivery, triamcinolone, worldwide delivery, Zyrtec 10 mgPrednisolone 20 mg, Zyrtec 5 mg

Popular Drugs

Generic Drugs

Categories

Aug

13