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Aug
13
Entecavir - Guaifenesin - Epoetin - Sildenafil Citrate - Ergoloid Mesylates
August 13, 2009 | Leave a Comment
Generic Name
Entecavir (m-M-ah-veer)
Brand Name Baraclude
Information in this monograph also applies to:
Generic Ingredient: Telbivudine Tyzeka
Type of Drug Antiviral.
Prescribed For
Chronic hepatitis B infection in adults.
General Information
Entecavir is a prescription medicine for adults with chronic hepatitis B virus (HBV) infection in which the virus is multiplying and damaging the liver. Entecavir can reduce the amount of virus in the body, make it harder for new liver cells to be infected by the virus, and improve the general condition of the liver. They work by attacking HBV polymerase, an enzyme essential to the reproduction of the hepatitis B virus inside an infected cell. These drugs are eliminated from the bodj,4kalbe kidney. Telbivudine does not wGCK alg4msl HIV infection and can be taken together with HIV drug therapy. These medicines do not cure HBV or stop you from spreading HBV to others, generally through sexual contact or exposure to infected blood. The HBV virus can live outside the body for one week.
Cautions and Warnings
Do not take these medicines if you are allergic or sensitive to any
of their ingredients.
Entecavir should be used with caution in people who have both HIV and HBV because of possible HIV resistance developing after entecavir is taken.
Severe worsening of HBV has occurred in people who stopped taking this medication.
These drugs can lead to further liver damage. In rare cases, they have been associated with liver failure that resulted in death. The safety of this drug in people who have had a liver transplant is not known.
These drugs are eliminated through the kidneys. People with kidney disease may require lower doses.
Telbivudine has also been associated with lactic acidosis, a condition in which excess lactic acid in the body causes the blood to become acidic. Feeling very weak or tired, experiencing unusual Muscle pain, difficulty breathing, stomach pain with nausea and vomiting, feeling cold—especially in your arms and legs, feeling dizzy or lightheaded, and a fast or irregular heartbeat may be signs of lactic acidosis. It is a medical emergency and must be treated in the hospital. This has happened in some people taking these medications.
Possible Side Effects
Entecavir
♦ Most common: headache, fatigue, dizziness, and nausea.
✓ Less common: diarrhea, upset stomach, vomiting, tiredness, and sleeplessness.
✓ Rare: Rare side effects may affect almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Telbivudine
✓ Most common: upper respiratory infection, latigue, not feeling well, missO2 tenderness or weakness, abdominal pain, nasal irritation, and sore throat.
♦ Common: flu or flu-like symptoms, diarrhea or loose stools, and throat pain.
✓ Less common: fever, joint pain, rash, back pain, dizziness, muscle ache, sleeplessness, and upset stomach.
Drug Interactions low in-
• These drugs do not affect liver enzymes and have a
teraction potential.
• Drugs that affect kidney function may affect blood concentrations of entecavir and telbivudine.
• Other hepatitis B treatments (lamivudine, adefovir, cy-
closporine, and pegylated interferon-alpha 2a) do not affect
either entecavir or telbivudine and are not affected by them. Food Interactions
Take entecavir at least 2 hours after a meal and 2 hours before the next meal. Telbivudine may be taken without regard to food or meals. Usual Dose
Entecavir
Adult and Child (age 16 and over): 0.5-1 mg once daily. People with kidney failure may be treated with as little as 0.05-0.1 mg a day. Child (under age 16): not recommended.
Telbivudine
Adult and Child (age 16 and over): 600 mg once daily. People with moderate to severe kidney failure may be treated with a single 600 mg dose every 2, 3, or 4 days depending on the seriousness of kidney disease.
Child (under age 16): not recommended.
Overdosage
There are no reports of entecavir overdose. People taking single doses up to 40 mg or multiple doses up to 20 mg per day for up to 14 days had no unusual side effects. One person accidentally took an overdose with no consequences. People taking up to 1800 mg a day of telbivudine had no increase in side effects. Overdose victims should be taken to a hospital emergency room for treatment, where dialysis may be necessary to remove the drug from the blood. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor il you develop muscle aches, pains, or weakness; ‘it your skin or the white part of your eyes turns yellow; if your urine becomes dark; if your bowel movements turn light in color; if you don’t feeling like eating food for several days or longer; if you become nauseous; or if you have lower stomach pain. These can be signs of a serious liver problem called hepatotoxicity, which has occurred in some people taking these medications.
Your hepatitis B may get worse or become very serious if you stop taking these medications. Do not stop taking them or change your daily dose without talking to your doctor.
If you forget to take your daily entecavir dose, take it as soon as you remember but do not take a double dose. Call your doctor if you forget to take 2 or more doses in a row.
Entecavir oral solution is a ready-to-use product and should not be mixed with water or any other liquid product. Each bottle of the oral solution comes with a dosing spoon that is calibrated in 1 -mL increments, up to 10 mL. Hold the spoon upright and gradually fill it to the mark next to the prescribed dose. Drink the liquid directly from the dosing spoon. Your pharmacist can help you properly measure your medication dose. Rinse the dosing spoon with water after each daily dose and allow it to air dry.
Special Populations
Pregnancy/Breast-feeding: Animal studies of entecavir revealed slowed development of the skeleton. Animal studies of telbivudine did not reveal any effects on the developing fetus. However, it is not known if either medicine is safe to use during pregnancy or if it helps prevent the hepatitis B virus from passing on to a developing fetus. If your doctor considers entecavir or telbivudine crucial for you, potential benefits must be carefully weighed against their risks. A data bank has been established to collect information from doctors on pregnant women who do take these medicines.
These medicines may pass into breast milk. Nursing mothers who must take these drugs should use infant formula.
Seniors: Dosage reduction may be needed in seniors because of normal declines in kidney function.
Brand Name
Entex PSE
Generic Ingredients
Guaifenesin + Pseudoephedrine Hydrochloride M
Other Brand Names
Anatuss LA Coldmist Jr.
Aquatab D Dosepack Coldmist LA
Coldmist Congess Jr.
Congess SR Nasabid
Congestac Nasabid-SR
Deconsal LA Nasatab LA
D-Feda 11 PanMist
Durasal U PanMist-Jr.
Duratuss AM/PM PanMist LA
Dynex Profen 11
Endal-SR Pseudovent
Guaimax-D Sudal 60/500
Guaipax PSE SudaI120/600
Guaitab Sudal SR
Guaituss PE Syn-RX
Guai-Vent PSE Touro LA
losal El Tuss-LA
Maxifed V-Dec-M
Maxifed G Versacaps
Med-RX Zephrex
Miraphen PSE Zephrex LA
The information in this profile also applies to the following drugs:
Generic Ingredients: Guaifenesin + Ephedrine Hydrochloride 19 Broncholate Bronkaid
Generic Ingredients: Guaifenesin + Phenylephrine Hydrochloride 91
Deconsal Il PhenaVent
Deconsal Pediatric PhenaVent D
Endal PhenaVent LA
Entex LA PhenaVent PED
Liquibid D Rescon GG
Liquibid-D 1200 Sinupan
Liquibid-PD Sinuvent PE
Type of Drug
Decongestant and expectorant combination.
Prescribed For
Cold or allergy and for nasal congestion, runny nose and cough associated with other upper respiratory conditions.
General Information
The decongestant ingredient in Entex PSE, pseudoephedrine, dramatically reduces congestion and stuffiness. The decongestant ingredients ephedrine and phenylephrine act similarly. The expectorant, guaifenesin, is used to help loosen thick mucus that may contribute to chest congestion; the effectiveness of guaifenesin and other expectorants has not been established. There are other drugs on the market using this same general formula—an expectorant plus a decongestant—but they use different decongestant ingredients or a combination of decongestants plus guaifenesin. Nothing cures a cold or allergy, but Entex PSE may provide relief from symptoms.
Cautions and Warnings
Do not take Entex PSE if you are allergic or sensitive to any of its ingredients.
Entex PSE may cause anxiety or nervousness or interfere with sleep.
Do not use Entex PSE if you have ventricular tachycardia (quickened heartrate), or hypertension (high blood pressure).
Entex PSE should be used with extreme caution in those with heart disease, other heart rhythm disorders, thyroid disease, diabetes, glaucoma, stomach ulcer, urinary blockage, or a prostate condition.
Entex PSE should not be used over extended periods of time to treat persistent or chronic cough especially one that may be caused by cigarette smoking, asthma, or emphysema.
Possible Side Effects
Mritl common: anxiety, restlessness, sleeplessness, tension, excitation, dizziness, drowsiness, and headache.
♦ Less common: nausea, vomiting, upset stomach, low blood pressure, heart palpitations, chest pain, rapid or slow heartbeat, abnormal heart rhythms, irritability, euphoria (feeling Possible Side Effects (continued)
“high”), eye irritation and tearing, hysterical reaction, appetite loss, kidney stones, urinary difficulties in men with a prostate condition, weakness, loss of facial color, and breathing difficulties.
Drug Interactions
• Entex PSE should be avoided if you are taking a monoamine oxidase inhibitor (MAGI) antidepressant for depression or hypertension because the MAGI may cause a very rapid rise in blood pressure or increase side effects such as dry mouth or nose, blurred vision, and abnormal heart rhythms.
• The decongestant in Entex PSE may interfere with bloodpressure-lowering medication.
Food Interactions
Take Entex PSE with food if it upsets your stomach.
Usual Dose
Adult and Child (age 12 and over): 1 tablet or capsule twice a day or 2 tsp. of liquid 4 times a day.
Child (age 6-11):1/2-1 tablet or 1 capsule twice a day or 1 tsp. of liquid 4 times a day.
Overdosage
Most cases of overdose are not severe. Symptoms include sedation, sleepiness, increased sweating, and increased blood pressure. Hallucinations, convulsions, nervous system depression, and breathing difficulties are more prominent in older adults. Most cases of overdose are not severe. Induce vomiting with ipecac syrup—available at any pharmacy. Call your local poison control center or a hospital emergency room before doing this. If you lseey, treatment. ALWAYS bring the prescription bottle or container.
-SIDt’dial Information
Call your doctor if your side effects are severe or gradually become intolerable.
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.
Special Populations
Pregnancy/Breast-feeding: Women who are or might be pregnant should avoid Entex PSE. When your doctor considers this drug crucial, its potential benefits must be carefully weighed
against its risks.
The decongestant in Entex PSE may pass into breast milk. Nursing mothers who must take Entex PSE should consider using in-
fant formula.
Seniors: Seniors are more sensitive to the effects of Entex PSE.
Generic Name
Epoetin (EE-poh-eh-tin)
Brand Names Epogen
Type of Drug
Red-blood-cell growth stimulator.
Prescribed For
Anemia; may also be used for reducing the need for blood or redblood-cell transfusions.
General Information
Epoetin is a natural hormone that stimulates the bone marrow to produce red blood cells. It is used for anemia that does not respond to iron supplements. In most cases of anemia, there are plenty of red blood cells circulating, but they lack iron. People who need epoetin do not have enough red blood cells. Epoetin stimulates the production of new red blood cells to carry needed oxygen.
Cautions and Warnings
Do not use epoetin if you are allergic or sensitive to albumin or products manufactured from animal cells.
People with urtvaRtmliked high blood pressure should not use epoetin.
Some people with chronic kidney failure and severe anemia should not take epoetin. Epoetin is not a replacement for emergency blood transfusion.
Epoetin is not intended for anemia caused by folate or iron deficiency, hemolysis, or gastrointestinal bleeding.
Procrit People using epoetin may require anticoagulant medicine to prevent blood clotting during treatment. Tell your doctor it you have any blood-clotting disorders.
In rare cases, people taking epoetin may have seizures. Avoid driving or any other activities where a sudden seizure could be dangerous. Do not take epoetin if you have a history of seizures or strokes.
Epoetin should be avoided in patients with blood cancers such as lymphoma, because it can act as a growth factor for the tumor.
If your hemoglobin levels become too high, your chance of heart attack, stroke, heart failure, blood clots, and death is increased. It is important to have your blood tested and adjust dosage of epoetin accordingly throughout treatment.
Possible Side Effects
Side effects reported in studies of epoetin were similar to those reported with an inactive placebo (sugar pill).
♦ Most common: high blood pressure, headache, constipation, diarrhea, nausea, joint pain, fever, fatigue, itching, rash, and difficulty breathing.
✓ Common: swelling, vomiting, chest pain, skin reactions at the site of injection, weakness, dizziness, urinary infections, diarrhea, upset stomach, blood clots, anxiety, tingling in the hands or feet, and trunk pain.
✓ Rare: stroke and heart attack. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult: starting dose-23-69 units per 1b. of body weight 3 times a week by intravenous or subcutaneous injection. Final dose is based on response and need. Surgery patients take 138 units per lb. for 10 days before Surgery or 276 units once a week for 3 weeks before surgery and another dose on the day of surgery. Dialysis patients take epoetin once a week.
Child (under age 12): 23 units per lb. of body weight 3 times a week by intravenous or subcutaneous injection. Final dose is based on response and need.
Child (under 1 month): not recommended.
Overdosage
Little is known about the effects of epoetin overdose. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
People taking epoetin should have regular blood tests to assure the drug is working well. Your doctor may want to take blood samples twice a week for several weeks and then test your blood regularly.
Epoetin has been used by athletes to enhance physical performance. This is called blood doping and has resulted in several deaths because the percentage of red blood cells in a blood sample can reach hazardous levels.
Epoetin must be stored in a refrigerator.
Most patients will need to take iron supplements with this drug.
This drug can be given by injection under the skin. For more in-
formation on how to properly administer this drug, see page 1242.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that epoetin may enter fetal circulation. When this drug is considered crucial by your doctor its potential benefits must be carefully weighed against its risks.
It is not known if epoetin passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use this product without special precaution.
Type of Drug
Erectile Dysfunction Drugs
Generic Ingredient: Sildenafil Citrate
Viagra Revatio
Generic Ingredient: Tadalafil Cialis
Generic Ingredient: Vardenafil Levitra
Prescribed For
Erectile dysfunction (ED). sildenafil is also prescribed for pulmonary
hypertension.
General Information
The chemical nitric oxide is released in the penis during sexual stimulation. Nitric oxide causes the release of an enzyme called cyclic guanosine monophosphate (cGMP), which increases blood flow into the penis, producing an erection. cGMP is broken down by the enzyme phosphodiesterase type 5 (PDE5). In men with low levels of cGMP, these medicines help achieve and maintain an erection by inhibiting PDE5, thus causing higher levels of cGMP. ED can be the result of nerve, blood vessel, or psychological problems. These drugs, which are effective in about 70% of men, only help when poor blood flow is the cause of the dysfunction. Women have reported some benefit from sildenafil, although it has been widely studied only in men. Vardenafil and tadalafil are intended only for men. These medicines start working in 30-60 minutes and their effects usually last from 2-4 hours, although some have noted an effect for 24 hours or more. Some drug interactions and kidney or liver diseases extend this time. Tadalafil begins working in 30-60 minutes and can remain in the body for more than 2 days, much longer than the other medicines in this group. Low-dose tadalafil may be taken every day for chronic ED.
Pulmonary hypertension, a rare disease in which high pressure in the blood vessels moves from the heart to the lungs, is sometimes treated with sildenafil.
Cautions and Warnings
Do not take ED drugs if you are allergic or sensitive to any of their ingredients.
These medicines lower blood pressure and should be avoided if you have high (greater than 170/100) or low (less than 90/50) blood pressure. Several people have died from a sudden blood-pressure drop after combining erectile dysfunction medications with other medications that can reduce blood pressure.
These Medicines should never be taken by those taking heart medications called nitrates, as fatal reactions have occurred.
People with heart disease may experience heart problems with sildenafil or vardenafil, including a heart attack. These reactions can occur during or shortly after sexual activity.
Avoid these medicines if you have had a heart attack, stroke, or life-threatening abnormal heart rhythms in the past 6 months, or if you have heart failure, unstable angina pectoris, damage to the penis, or a progressive eye disease called retinitis pigmentosa. Blindness is a rare side effect of sildenafil and may be a problem with all of these medications.
People taking sildenafil or vardenafil have experienced difficulties seeing blue or green colors and may see things with a blue tinge surrounding them. This happens because they affect an enzyme in the eye. The effect clears up after the drug passes out of the body.
People with kidney or liver damage retain these medicines in their bodies longer than people whose kidneys and liver function normally. People with kidney or liver problems should always begin with the lowest possible dosage.
People with priapism (painful erection lasting more than 6 hours) or a condition that predisposes them to priapism—such as leukemia, multiple myeloma, or sickle cell anemia—should be cautious about taking these medicines.
Vardenatil and sildenafil should be avoided by people with stomach or bleeding ulcers because its effect on these conditions is not known.
Possible Side Effects
Sildenafil
✓ Most common: headache and flushing.
♦ Less common: upset stomach, stuffy nose, urinary tract infection, diarrhea, rash, dizziness, seizure, anxiety, prolonged and possibly painful erection, double vision, visual changes, bloodshot eyes, burning eyes, swelling in the eye, and blood vessel diseases in the retina.
✓ 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.
Tadalafil
I Most common: headache.
✓ Common: upset stomach. Back pain and muscle aches can develop 12-24 hours after taking tadalafil and go away on their own after 2 days.
Possible Side Effects (continued)
♦ Less common: flushing, nasal congestion, and arm or leg
pain.
♦ Rare-. prolonged or painful erections. Other rare side ef-
fects can occur in almost any part of the body. Contact
your doctor if you experience any side effect not listed
above.
Vardenafil
✓ Most common: headache and flushing.
✓ Less common: upset stomach, sinus infection, flu-like symptoms, dizziness, and nausea.
♦ Rare: prolonged or painful erection. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Do not combine any of these drugs with nitrates (such as nitroglycerin) and other drugs that lower blood pressure. The combination can cause a sudden, rapid drop in blood pressure.
• Do not take vardenafil if you are taking an alpha blocker (such as alfuzosin, doxazosin, prazosin, tamsulosin, or terazosin). Tadalafil may be taken only with tamsulosin. You may take sildenafil at its lowest possible dose with an alpha blocker, but you must separate the doses by at least 4 hours.
• Combining cimetidine and sildenafil leads to a substantial (more than 50%) increase in the amount of sildenafil in the blood.
• Erythromycin, itraconazole, ketoconazole, and protease inhibitors (used to combat HIV) can cause sildenafil blood levels to almost double. Vardenafil levels can increase by 400-1000% when combined with these medicines. It you are taking one of these medicines, do not take more than the %west possible dose of your ED drug. Do not take tadalafil more than once every 3 days if you are also taking one of these medicines.
• Rifampin can be expected to reduce the effect of ED medicines by reducing the amount of drug in the blood. Other
drugs that may reduce the effects of these drugs are carbamazepine, phenobarbital, and phenytoin.
• Dihydrocodeine—a widely used prescription pain reliever—may increase the effects of sildenafil, yielding substantially prolonged erections, sometimes lasting for hours.
• Do not combine sildenafil, tadalafil, and vardenafil. The effects of combining these drugs are not known.
• Do not take vardenafil if you are taking any medicine to treat an abnormal heartbeat, including amiodarone, procainamide, quinidine, and sotalol.
• Combining sildenafil with selective serotonin reuptake inhibitors (SSRIs) or tacrolimus may increase the risk of sildenafil side effects.
• Alcohol adds to the blood-pressure-lowering effects of these medicines.
Food Interactions
Grapefruit juice may increase the amount of these drugs in the blood. Taking sildenafil with a high-fat meal reduces the amount of drug absorbed. Tadalafil and vardenafil may be taken without regard to food or meals.
Usual Dose
Sildenafil
Adult: 50 mg taken about 1 hour before sexual activity. Individual doses can range from 25-100 mg. The maximum dosing frequency is once a day.
Senior: Begin with 25 mg and gradually increase dosage as needed.
Tadalafil
Adult: 10 mg taken about 1 hour before sexual activity. Individual doses can range from 2.5-20 mg. Do not take more than 1 dose of tadalafil a day.
Senior: Begin with 5 mg and gradually increase dosage as needed.
Adult: 10 mg taken about 1 hour before sexual activity. Individual doses can range from 5-20 mg.
Senior: Begin with 5 mg and gradually increase dosage as needed.
Overdosage
sildenafil and tadalafil overdose are likely to produce exaggerated drug side effects. Vardenafil overdose may cause neck pain, muscle aches, or vision changes. Call your local poison control center or hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor and do not engage in sexual activity if the erection produced by ED drugs is painful or lasts 4 or more hours, or if you experience dizziness, nausea, or chest pain after taking an ED drug. In rare cases, men taking ED drugs have reported a sudden decrease or loss of vision and/or hearing. Call your doctor right away if you experience this adverse side effect.
People who use organic nitrates for gardening or other purposes can experience a severe and dangerous blood pressure drop if they take sildenafil or vardenafil. It is not known how long you have to wait to resume nitrate use.
These drugs do not protect against sexually transmitted diseases.
Special Populations
Pregnancy/Breast-feeding: There is no evidence that sildenafil or vardenafil harm the fetus; however, they are not intended for pregnant women or nursing mothers.
Seniors: Men age 65 and over eliminate these drugs more slowly than younger men and should begin with the lowest possible dosage.
Generic Name
Ergoloid Mesylates (ER-goe-loid
MES-il-ates) (GI
Brand Names Caerimal
Hydergine
Type of Drug Psychotherapeutic agent.
Hydrogenated Ergot Alkaloids
Prescribed For
Age-related decline in mental capacity.
General Information
Ergoloid mesylates are used to treat decreased mental capacity of unknown cause in people over age 60. These drugs should not be used for any condition that is treatable with another drug or that may be reversible. People who respond to ergoloid mesylates are likely to have Alzheimer’s disease or some other cause of dementia. Nobody knows exactly how ergoloid mesylates produce their effect, but they improve the supply of blood to the brain in test animals, reduce their heart rate, and improve muscle tone in blood vessels. Some studies show the drugs to be very effective in relieving mild symptoms of mental impairment, while others find it to be only moderately effective. They are most beneficial in people whose symptoms are due to the effects of high blood pressure in the brain.
Cautions and Warnings
Do not take ergoloid mesylates if you are allergic or sensitive to any of their ingredients or you have psychotic symptoms or psychosis.
Ergoloid mesylates should be used with caution in people with liver disease, low blood pressure, or slow heartbeat.
Possible Side Effects
Ergoloid mesylates do not produce serious side effects.
♦ Common: When taken under the tongue, these drugs may
cause irritation, nausea, or upset stomach. Other side ef-
fects are drowsiness, slow heartbeat, and rash.
Drug Interactions None known.
Food Interactions
Do not eat, drink, or smoke while you have an ergoloid mesylates pill under your tongue.
Usual Dose
Starting dose is 1-2 mg 3 times a day. Increase as needed. Do not exceed 12 mg a day.
Overdosage
Symptoms include blurred vision, dizziness, fainting, flushing, headache, appetite loss, nausea, vomiting, stomach cramps, and stuffy nose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
The effects of ergoloid mesylates are gradual and frequently not seen for up to 6 months. A 6-month period of treatment with ergoloid mesylates is recommended before your doctor can fully evaluate your response to the drug. Your doctor should periodically reevaluate your condition to determine if ergoloid mesylates treatment is still needed and that it is working for you.
Dissolve sublingual tablets under the tongue. Do not chew or crush them; they are not effective if swallowed whole.
If you forget a dose, skip it and go back to your regular schedule. Do not take a double dose. Call your doctor if you miss 2 or more consecutive doses.
Special Populations
Pregnancy/Breast-feeding: Ergoloid mesylates may interfere with fetal development. When these drugs are considered crucial by your doctor, their potential benefits must be carefully weighed against their risks.
Ergoloid mesylates pass into breast milk. Nursing mothers who must take these drugs should use infant formula.
Seniors: Seniors are more likely to develop side effects, especially hypothermia (low body temperature).
Generic Name
Erythromycin (eh-rith-roe-MYE-sin) 10
Brand Names
Akre-mycin Eryderm
Arr/S Erygel
E-Base Ery-Tab
E-Glades Erythra-derm
E-Mycin PCE Eryc
The information in this profile also applies to all forms of erythromycin:
Generic Ingredient: Erythromycin Estolate LN
Generic Ingredient: Erythromycin Ethylsuccinate E.E.S. Pediamycin EryPed
Generic Ingredients: Erythromycin Ethylsuccinate + Sulfisoxasole
Eryzole Pediazole
Generic Ingredient: Erythromycin Stearate Erythrocin Stearate
Type of Drug Macrolide antibiotic.
Prescribed For
Infections of virtually any part of the body: upper and lower respiratory tract infections; sexually transmitted diseases; urinary tract infections; infections of the mouth, gums, or teeth; and infections of the nose, ears, or sinuses. It is prescribed for acne and may be used for mild to moderate skin infections. Erythromycin is effective against diphtheria and dysentery. It is also prescribed for legionnaires’ disease, rheumatic fever, whooping cough, and bacterial endocarditis. It is prescribed to patients with pelvic inflammatory disease as an alternative to penicillin. The eye ointment is used to prevent newborn gonococcal or chlamydial eye infections.
General Information
Erythromycin and other macrolide antibiotics are either bactericidal (bacteria-killing) or bacteriostatic (inhibiting bacterial growth), depending on the organism in question and amount of antibiotic present. Erythromycin is deactivated by stomach acid, so the tablet form is made to bypass the stomach and dissolve in the intestine.
Since the action of this antibiotic depends on its concentration in the invading bacteria, kk is crucial that you follow your doctor’s ISNVKi10ns regarding the spacing of doses as well as the number of days you must take the medication—otherwise, this antibiotic may be much less effective.
Cautions and Warnings
Do not take erythromycin if you are allergic or sensitive to any of its ingredients or to any macrolide antibiotic.
Erythromycin is excreted primarily through the liver. People with liver disease or damage should consult their doctors. Those on long-term therapy with erythromycin should have periodic blood tests. If you restart erythromycin after having experienced liver damage, it is likely that symptoms will recur within 48 hours.
Erythromycin estolate has occasionally produced liver problems (symptoms include fatigue, nausea, vomiting, abdominal cramps, and fever). If you are susceptible to stomach problems, erythromycin may cause mild to moderate stomach upset; discontinuing the drug will reverse this condition.
Colitis (bowel inflammation) has been associated with all antibiotics and can range from mild to life-threatening (see “Possible Side Effects”),
Possible Side Effects
• Most common: nausea, vomiting, stomach cramps, and diarrhea. Colitis (symptoms include severe abdominal cramps and severe, persistent, and possibly bloody diarrhea) may develop. Side effects of the topical erythromycin include peeling, dryness, itching, and oiliness.
♦ Less common: hairy tongue, itching, irritation of the anal or vaginal region, eye irritation, and skin tenderness. If any of these symptoms appear, call your physician immediately.
♦ Rare: hearing loss—which reverses itself after the drug is stopped and occurs most often in people with liver and kidney problems—and abnormal heart rhythms. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Antacids may slightly affect the release of erythromycin from your body. This effect is not considered important.
• Do not combine erythromycin with astemizole or terfenadine.
• Erythromycin may slow the breakdown of carbamazepine (an anticonvulsant prescribed for seizures). Avoid this combination.
• Mixing erythromycin with rifabutin or rifampin can interfere with the antibiotic’s effect and increase the risk of intestinal side effects.
• Do not combine erythromycin and pimozide. Two people died after combining pimozide and a macrolide antibiotic.
• Erythromycin may neutralize penicillin. It may also neutralize the antibiotics lincomycin and clindamycin.
• Erythromycin interferes with the elimination of theophylline
from the body, possibly leading to theophylline overdose.
• Mixing erythromycin with a statin cholesterol-lowering drug increases the risk of developing a potentially fatal condition involving severe muscle pain and destruction.
• Do not mix erythromycin with sparfloxacin, ketoconazole, itraconazole, fluconazole, diltiazem, verapamil, troleandomycin, mibefradil, nefazodone, or clarithromycin. These mixtures can lead to severe, possibly fatal, abnormal heart rhythms. Grepafloxacin (another fluoroquinolone) should only be mixed with erythromycin in hospitalized patients whose hearts can be monitored during treatment.
• Combining erythromycin and alfentanil (an injectable pain reliever), bromocriptine, buspirone, digoxin, disopyramide, ergotamine, cyclosporine, methylprednisolone (a corticosteroid), tacrolimus, vinblastine, or benzodiazepines (such as alprazolam, diazepam, midazolam, and triazolam) increases the risk of drug side effects.
• Erythromycin estolate may increase the liver side effects of other drugs that affect the liver.
• Erythromycin may increase the anticoagulant (blood-thinning) effects of warfarin in people who take it regularly, especially older adults. People taking this combination should be tested regularly.
• Erythromycin may increase the effects of caffeine.
Food Interactions
Grapefruit juice slows the breakdown of erythromycin, increasing the amount of drug in the blood. For optimum effectiveness, take erythromycin base and erythromycin stearate on an empty stomach with a 6-8 oz. glass of water 1 hour before or 2 hours after meals. Other forms of erythromycin can be taken without regard to food or meals.
\huall Dose
Tablet and Suspension
Adult: 250-400 mg every 6 hours, taken 1 hour before meals, or 500 mg every 12 hours. Maximum dose is 4 g a day.
Child: 15-25 mg per lb. of body weight a day in divided doses depending on age, weight, and severity of infection.
Eye Ointment 1/2 inch 2-6 times a day.
Topical Solution: Apply morning and night.
Doses of erythromycin ethylsuccinate are 60% higher due to differences in chemical composition.
Overdosage
Overdose may cause severe side effects, especially nausea, vomiting, stomach cramps, and diarrhea. Mild hearing loss, ringing or buzzing in the ears, or fainting may also occur. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the prescription bottle or container.
Special Information
Erythromycin is used instead of penicillin for mild to moderate infections in people who are allergic to penicillin. Erythromycin is not the antibiotic of choice for severe infections.
Erythromycin products should be stored at room temperature, except for oral and topical liquids, which should be kept in the refrigerator.
Call your doctor if you develop nausea; vomiting; diarrhea; stomach cramps; severe abdominal pain; rash, itching, or redness; dark or amber-colored urine; yellowing of the skin or whites of the eyes; or any severe or persistent side effect.
If you forget a dose of oral erythromycin, take it as soon as you remember. If it is almost time for your next dose, space the next 2 doses over 4-6 hours, then continue with your regular schedule. Do not take a double dose.
Remember to complete the full course of therapy prescribed even if you feel well before you finish the medication.
Special Populations
Pregnancy/Breast-feeding: Erythromycin passes into the fetal circulation. Erythromycin estolate has caused mild liver inflammation in about 10% of pregnant women who took it and should not be used if you are or might be pregnant. Other forms of erythromycin have been used sale)y without difficulty.
Erythromycin passes into breast milk. Nursing mothers who must take erythromycin should use infant formula.
Seniors: Seniors with liver disease should use caution. Seniors taking high doses of erythromycin may be at an increased risk of hearing loss.
Aug
1
Chlorpromazine
August 1, 2009 | Leave a Comment
Generic Name
Chlorpromazine (klor-PROE-muh-zene) Al
Brand Names
Sonazine Thorazine*
The information in this profile also applies to the following drugs: Generic Ingredient: Fluphenazine Hydrochloride RE Generic Ingredient: Thioridazine Hydrochloride 0 Generic Ingredient: Trifluoperazine Hydrochloride
‘Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Phenothiazine antipsychotic.
Prescribed For
Psychotic disorders; moderate to severe depression with anxiety; agitation or aggressiveness in disturbed children; intractable pain; and senility. May also be used to relieve nausea, vomiting, hiccups, restlessness, acute intermittant porphyria, and apprehension before surgery or other procedures.
General Information
Chlorpromazine and other phenothiazines act upon a portion of the brain called the hypothalamus. Phenothiazines affect parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Chlorpromazine is available in suppositories and as liquid for those who have trouble swallowing tablets.
Cautions and Warnings
Do not take chlorpromazine if you are AeTgic or sensitive to any oVilsingredients or to any phenothiazine drug. Do not take it if you have very low blood pressure, Parkinson’s disease, or blood, liver, kidney, or heart disease.
Chlorpromazine may depress the cough reflex. People have accidentally choked to death because the cough reflex failed to protect them. Because of its effect in reducing vomiting, chlorpro-mazine may obscure symptoms of disease or toxicity due to over-
dose of another drug.
Use chlorpromazine under your doctor’s strict supervision if you have glaucoma, epilepsy, ulcers, or urinary difficulties.
Avoid exposure to extreme heat, because this drug may upset your body’s temperature-control mechanism. Do not allow the liquid forms of this drug to come in contact with your skin because they are highly irritating.
Chlorpromazine may cause unusually high or low levels of cholesterol.
Possible Side Effects
♦ Most common: drowsiness, especially during the first or second week of therapy. If drowsiness becomes troublesome, contact your doctor.
V Less common: changes in blood components, including anemias, raised or lowered blood pressure, abnormal heart rate, heart attack, sensitivity to light, and faintness or dizziness.
V 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.
Jaundice (symptoms include yellowing of the whites of the eyes or skin) may appear; when it does, it is usually within the first 2-4 weeks of treatment. Normally the jaundice goes away when the drug is discontinued, but there have been cases when it has not.
Phenothiazines may produce extrapyramidal side effects, including spasm of the neck muscles, rolling back of the eyes, convulsions, difficulty swallowing, and symptoms associated with Parkinson’s disease. These side effects seem very serious but usually disappear after the drug has been withdrawn; however, symptoms affecting the face, tongue, or jaw may persist for as long as several years, especially in older adults with a history of brain damage.
Chlorpromazine may cause an unusual increase in psychotic symptoms or may cause paranoid reactions, tiredness, lethargy, restlessness, hyperactivity, confusion at night, bizarre dreams, sleeplessness, depression, decreased sex drive, increased appetite, or euphoria (feeling “high”).
Drug Interactions
• Be cautious about taking chlorpromazine with over-the-
counter cough, cold, or allergy medications, barbiturates, al-
cohol, sleeping pills, narcotics or other sedatives, or any other
drug that may produce a depressive effect.
• Aluminum antacids may reduce the effectiveness of phenothiazine drugs.
• Chlorpromazine may reduce the effectiveness of bromocriptine and appetite suppressants.
• Anticholinergic drugs may reduce the effectiveness of chlorpromazine and increase the chance of side effects.
• Phenothiazine drugs may counter the blood-pressurelowering effect of guanethidine.
• Taking lithium together with a phenothiazine drug may lead to disorientation, loss of consciousness, or uncontrolled muscle movements.
• Combining propranolol and a phenothiazine drug may lead to unusually low blood pressure.
• Combining tricyclic antidepressants with a phenothiazine drug can lead to antidepressant side effects.
• Chlorpromazine may reduce the effectiveness of epinephrine and norepinephrine.
• Cigarette smoking reduces the amount of chlorpromazine in your blood. Smokers may need larger doses.
Food Interactions
Take liquid chlorpromazine with fruit juice or other liquids. You may also take it with food if it upsets your stomach.
Usual Dose
Adult: 30-1000 mg or more a day, individualized according to your disease and response.
Child (age 6 months and over): 0.25 mg per lb. of body weight every 4-6 hours, up to 200 mg or more a day, depending on disease, age, and response.
Chitty (under 6 months): not recommended.
Overdosage
Overdose symptoms include depression, extreme weakness, tiredness, lowered blood pressure, agitation, restlessness, uncontrolled muscle spasms, convulsions, fever, dry mouth, abnormal heart rhythms, and coma. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or
container.
Special Information
Call your doctor at once if you develop sore throat, fever, rash, weakness, visual problems, tremors, muscle movements or twitching, yellowing of the skin or whites of the eyes, or darkening of the urine.
Do not stop taking chlorpromazine without your doctor’s knowledge. It may take several weeks before this drug takes effect.
This drug may cause drowsiness. Use caution when driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorpromazine may cause unusual sensitivity to the sun and may turn your urine reddish brown to pink.
If dizziness occurs, avoid rising quickly from a sitting or lying position and avoid climbing stairs. Use caution in hot weather, because this drug may make you more prone to heat stroke.
If you are using sustained-release capsules, do not chew them or break them—swallow them whole. Liquid forms of phenothiazines must be protected from light. Do not take them out of their opaque bottles.
If you take chlorpromazine more than once a day and forget to take a dose, take it right away if you remember within an hour. If you do not remember within an hour, skip the dose you forgot and continue with your regular schedule. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue your regular schedule the next day. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Infants born to women taking this drug have experienced side effects—including jaundice and nervous system effects. Check with your doctor about taking chlorpromazine if you are or might be pregnant.
This drug may pass i”W breast milk. Nursing mothers who must take chlorpromazine should use infant formula .
Seniors: Seniors are more sensitive to the effects of this drug and usually achieve desired results with lower dosages. Some experts feel that seniors should receive ‘/,-1/4 the usual adult dose.
Aug
1
Cetirizine
August 1, 2009 | Leave a Comment
Generic Name
Cetirizine (seh-TERE-ih-zene)
Brand Name Zyrtec
The information in this profile also applies to the following drugs:
Generic Ingredient: Azelastine
Generic Ingredient: Fexofenadine 91 Allegra
Generic Ingredient: Levocetirizine 91 Xyzal
Type of Drug Antihistamine.
Prescribed For
Azelastine: runny nose, sneezing, nasal itching, and post-nasal drip. Cetirizine: stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal and year-round allergy, and for other symptoms of allergy such as rash, itching, and hives; also prescribed for chronic itching and for asthma. Fexofenadine: sneezing, stuffy and runny nose; scratchy throat and mouth; and itchy, watery, and red eyes caused by seasonal allergies. Levocetirizine: stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal and year-round allergy, and for other symptoms of allergy such as rash, itching, and hives; also prescribed for chronic itching.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from the cell at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes. Cetirizine causes less sedation than older antihistamines and appears to be just as effective. Levocetirizine is the active portion of the cetirizine molecule and is as effective as cetirizine with a similar side effect profile.
Cautions and Warnings
Do not take cetirizine if you are allergic or sensitive to any of its ingredients.
People with kidney disease should receive reduced dosages of cetirizine and levocetirizine. Do not take these drugs if kidney disease is severe. Children with kidney disease should not receive levocetirizine.
Possible Side Effects
✓ Common: headache, drowsiness, fatigue, dry mouth, bitter taste in the mouth, dizziness, runny nose, and sore throat.
✓ Less common: nosebleeds, stuffy nose, sneezing, cough, nausea, upset stomach, changes in bowel habits, nervousness, and fever (children).
♦ Rare: fainting and weight gain. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Cimetidine may increase the level of azelastine in the blood.
• Cetirizine is less likely than other antihistamines to interact with drugs.
• Ritonavir increases the amount of levocetirizine and slows its breakdown in the body. This may result in increased levocetirizine side effects.
Food Interactions
• Ceterizine and levocetirizine may be taken without regard to food or meals.
Usual Dose
Azelastine Nasal Spray
Adult and Child (age 12 and over): 1-2 sprays in each nostril twice a day.
Child (age 5-11): 1 spray in each nostril twice a day.
Cetirizine
Adult and Child (age 6 and over): 5-10 mg once a day depending on symptoms. Reduce dosage in people with kidney disease. Child (age 1-5): 2.5-5 mg a day.
Child (age 6 months-1 year): 2.5 mg a day.
Fexofenadine
Adult (age 12 and over): 60 mg twice a day or 180 mg once a day. People with kidney disease should take 60 mg a day.
Child (age 6-11): 30 mg twice a day.
Levocetirizine
Adult and Child (age 12 and over): 5 mg every evening.
Child (age 6-11): 2.5 mg (1h tablet) every evening. Dosage for children should not exceed 2.5 mg a day. Child (under age 6): not recommended.
Overdosage
Drug overdose is likely to cause severe side effects. Overdose victims should be Oven ipecac syrup—available at any pharmacy—to make them vomit and be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Use extra caution while doing anything that requires concentration, such as driving a car or operating hazardous machinery.
Report sore throat, unusual bleeding, bruising, tiredness, weakness, or any other unusual side effect to your doctor. Do not combine these drugs with alcohol or other nervous system depressants. Do not put azelastine nasal solution into your eyes.
If you forget to take a dose of cetirizine, 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.
Special Populations
Pregnancy/Breast-feeding: Oral antihistamines are generally considered safe for use during pregnancy. But do not take any antihistamine without your doctor’s knowledge if you are or might become pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of antihistamine pass into breast milk. Nursing mothers who must take cetirizine should use infant formula.
Seniors: Antihistamines are more likely to cause dizziness, sleepiness, and confusion in seniors. Dosage reduction may be recommended depending on kidney function.
Jul
16
COUGH
Trying to ease a cough ough can be a frustrating exper*ence. If it arrived with a cold or another upper respiratory tract infection, it’s likely to go away eventually, but those 2 or 3 weeks of suffering until it does can be miserable. Way back before the end of the last century, Americans could buy cough medicines that worked. Codeine-containing antitussive syrups were widely available without prescription. Physicians also recommended terpin hydrate, an expectorant, from the late 1800s until the early 1990s. In theory, an expectorant simply loosens up the stuff in the lungs and makes it easier to cough up. But many people found that terpin hydrate offered more benefit.
Q.For years I used terpin hydrate as an expectorant when I had a cough. It worked. It was sold over the counter and one small bottle would last me the entire cold season. Over-the-counter cough remedies on the market today are no better than water. They just do NOT work. Is terpin hydrate still available? I’ve never found another cough syrup that works so well, but I can’t find it in my local drugstores.
A. Terpin hydrate was a popular cough medicine from the late 1800s until the early 1990s. Then the FDA banned it on the grounds that it had not been proven effective.
As an expectorant, terpin hydrate was supposed to loosen mucus and relieve coughs. It was derived from natural sources such as oil of turpentine or compounds found in oregano, thyme, and eucalyptus. Terpin hydrate is no longer available in the United States. Instead, you may want to try a different old-fashioned remedy. Vicks VapoRub contains similar ingredients: oil of turpentine, thymol, and eucalyptol. Don’t take it internally. Just rub it on the chest or the soles of the feet to ease a cough.
Another approach is thyme tea. Use 1/2 teaspoon of dried thyme leaves from the kitchen spice shelf per cup of tea. Some people like to add lemon and honey. Others prefer chicken bouillon for flavor. Terpin hydrate was removed from the market because the FDA did not receive enough data to support its use when they were reviewing over-the-counter (OTC) drugs for effectiveness. (A high-ranking FDA official admitted to us off the record that he had used it and found it helpful. But the agency needed real data, not testimonials.) Perhaps the fact that it had been around for so long and no one company had a strong vested interest in it meant that no one wanted to invest in research on tenpin hydrate. Or maybe it really doesn’t work quite as well as people believed. But in any event, after it was banned, Americans needed to look for other cough remedies.
Codeine Cough Medicine
Codeine at prescription doses is generally considered an effective cough suppressant, but even the lower-dose OTC forms are becoming much harder to find. If you have a cough, your doctor might write you a prescription. It is legal in some states for people to buy low-dose codeine cough syrups if they sign for them. Presumably, that step offers extra security against abuse. But even where OTC codeine is legal, many chain drugstores won’t sell it without a prescription. They simply don’t want to be bothered. If you live in a state where codeine may be sold without a prescription, check with an independent pharmacy. Otherwise, ask your physician about a prescription. Codeine can be constipating, and long-term use can lead to dependence. But for a short-term annoying hack, this is a very helpful medication. Codeine not only is a good cough medicine, it also is extremely good for relieving pain. When combined with aspirin or acetaminophen, it practically sets the standard for pain relief. Codeine can also be useful in alleviating diarrhea, though it isn’t necessarily the first choice for that problem.
Side effects: Constipation, drowsiness, upset stomach Downside: Can cause dependence. May require a prescription.
Cost: Approximately $6 to $10 for a bottle.
Dextromethorphan
By far the most readily available cough medicine is dextromethorphan. It is the primary ingredient in most OTC cough syrups, including Robitussin DM (the DM stands for dextromethorphan) and many other popular brands. Dextromethorphan has been almost the only choice for nonprescription cough relief for years. It is considered fairly safe because (unlike codeine) it is not classified as a narcotic. The effectiveness of dextromethorphan has been questioned, however. The American College of Chest Physicians issued guidelines in 2006 on the diagnosis and management of cough that discourage the use of dextromethorphan or any other OTC cough medicine. According to Richard Irwin, MD, the head of the committee that developed the guidelines, “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough.” That’s a pretty discouraging view, since very few coughs actually warrant a doctor’s attention. If the cough has lasted for more than a couple of weeks, or if you are otherwise sick, then you should by all means see your doctor. But a regular cough from a cold probably won’t benefit from anything your doctor can do.
Home Remedies
There’s no good evidence for most of the home remedies that we are going to suggest. No one has done studies to see if thyme tea or horehound drops will really help. On the other hand, these approaches are inexpensive, so you can try them and judge for yourself if they work.
Vicks VapoRub
Vicks VapoRub shouldn’t really be classified as a home remedy. It is, after all, a perfectly respectable OTC product that has been a popular way to treat colds for more than a hundred years. According to the history, North Carolina pharmacist Lunsford Richardson set out to formulate a vaporizing cold’ salve for his own family. His children had come down with bad chest colds and the standard treatments of the day were messy and unsatisfactory.
The result of his effort was Vicks VapoRub. With its distinctive blue jar and unforgettable aroma, Vicks became known around the world as a remedy for congestion and other cold symptoms. It still contains the original formula: menthol, camphor, eucalyptus oil, cedarleaf oil, nutmeg oil, thymol, and turpentine oil in a petrolatum base. Parents everywhere rub Vicks VapoRub on their children’s chests to ease their coughs. Many of the herbal oils in this old-fashioned salve seem to help ease a cough. Menthol is found in many cough drops, and thymol has a reputation for fighting cough. VapoRub is even approved by the FDA for relieving congestion and cough. You could apply it to the throat and chest, as the instructions suggest, but go ahead and try it on the soles of the feet for a nighttime cough.
Downside: Not for internal use. Keep away from broken skin. Do not apply inside nostrils. No studies confirm that applying Vicks to the soles of the feet will work to calm cough. Cost:Approximately $6 to $10 for a jar, which will last quite a while
My son continues to have problems with ear infections, although he had tubes put in them at 8 months old. He is now 30 months old and has an ear infection with nasal and chest congestion.
I was looking for home remedies for coughs when I found your Web site. I read the idea of putting Vicks VapoRub on the soles of the feet Within 10 minutes be was asleep without a cough.
We heard from a nurse who had learned from someone in her church that Vicks could be smeared on the soles of the feet to ease a nighttime cough. As she admitted, this sounded a little crazy, but she was desperate enough to try it on her 4-year-old daughter. When she did, they both finally were able to sleep through the night. We don’t know why Vicks on the soles of the feet would work any better than Vicks on the chest. Perhaps it doesn’t. But we do know that we have heard from hundreds of people who have tried this trick and had success. We have used it ourselves and been pleased. Be sure to put on socks to protect the bed sheets. Coughs frequently are a consequence of colds, and chicken soup is a time-honored cold remedy. Beyond its long history of use for this purpose (the Jewish philosopher Maimonides is said to have recommended it), there is even research to demonstrate its value or relieving congestion from colds. So it is little wonder that chicken soup flavored with thyme can be helpful.
Q. My husband recently had a spell of heavy, nonproductive coughing and couldn’t reach his doctor. Robitussin DM didn’t do a thing. He went 2 nights with very little sleep and was miserable. I made him some chicken soup for supper, and after he ate a bowl of it he stopped coughing. During the night he started up again. With more chicken soup, the coughing stopped immediately and he finished the night sleeping well. I recalled what I’d put into the soup, and zeroed in on two herbs from my garden—three fresh sage leaves and some dried thyme. On the Internet I found that sage can calm a cough and thyme has been widely used as cough medicine. I made him 2 cups of thyme tea before he went to bed the next evening and he slept the whole night through. I think our experience shows that thyme is a good remedy to keep around until the doctor calls back.
Thyme
Thyme contains compounds such as thymol and carvacrol. This herb is listed in the PDR for Herbal Medicines as indicated for cough. and bronchitis. One to 2 grams of dried thyme leaves (1/2 to 1 teaspoon) are used to make a cup of tea. The recommended daily dosage is 10 grams spaced over the course of the day. Chicken soup with thyme is one way to get the essence of thyme. Another is to make a cup of thyme tea. Ordinary thyme leaves from the kitchen spice cupboard will work just fine-1/2 teaspoon to a cup of hot water, steeped for about 5 minutes. One reader reported getting a cough remedy over the counter when traveling in Germany. She found it very useful, much better than Robitussin DM, and wondered what it was. The medicine, called Makatussin, came as drops to be put on a sugar cube or in tea and contained Thymianfluidextrakt and Sternanisol. These are extract of thyme and star anise oil.
The German government has approved both herbs for colds and coughs, confirming what our readers have found for themselves.
Other Herbs
A number of other herbs have traditionally been used for uncomplicated coughs. Licorice is classic for sore throat and cough. It can raise blood pressure, so we don’t recommend it for people with hypertension, but for short-term use, it could be helpful. Menthol seems to have been approved by the FDA, since it is found in most OTC cough drops (as well as Vicks VapoRub). Linden flower tea is a European favorite for cough, but may be difficult to find in this country. Elderberry flowers can also be collected and dried for use in tea as a “homegrown” cough remedy. You’d have a hard time finding elderberry flowers in a store, although there are some elderberry products that use the berries themselves, rather than the flowers.
Q. With my high blood pressure, it’s hard to find cold or cough medicine that is safe. My sister recommended black elderberry extract and zinc. It did the trick.
A. Elderberry-flower tea is a traditional remedy for colds and coughs. Many herbalists believe elderberry is more effective than echinacea.
Studies of zinc used against colds have produced mixed results, some positive but others negative. Neither remedy should increase blood pressure, though.
Ginger tea is one of our favorite cold remedies, and it also may help to ease a cough. One animal study found that a component of ginger called shogaol worked at least as well as dextromethorphan against cough. That may mean simply that shogaol is just as good as placebo, now that the effectiveness of dextromethorphan is in question. Nevertheless, ginger tea is tasty and not very expensive.
Another old-fashioned approach to calming a cough is horehound. Candies flavored with this herb are still available in some stores and catalogs (such as the Vermont Country Store) that pride themselves on carrying old-time products. There’s no good research for any of these herbal products, but also no indication that they would cause any serious reactions, either.
Some people find that sucking on a piece of hard candy works quite well to ease a daytime cough, whether or not the candy has any active ingredients such as licorice or menthol in it. One scientist has suggested that part of the reason most cough syrup is sweet is not only to mask the nasty flavor of dextromethorphan, but also to recruit the brain’s own opioids, endorphins, in calming the cough. 161 Since opioids are very effective against cough, this is an appealing hypothesis.
Chocolate
Another possible remedy fora simple cough may surprise you. Chocolate lovers though we are, we never suspected that theobromine, one of the essential components of chocolate and cocoa, would have any benefit against cough. But that is exactly what British researchers found in experiments with guinea pigs.” They gave the guinea pigs citric acid to make them cough, then gave them theobromine purified from cocoa. The theobromine overcame the induced cough. An experiment in humans confirmed that theobromine is also effective against coughs in people.
The question is, how much chocolate does it take, and in what form? Unfortunately, we do not have an answer to that extremely practical issue. The researchers used theobromine alone, which is not available to the rest of us. But all of us have access to chocolate. You could do some experiments of your own to find the most palatable and effective cough-suppressing chocolate. ,
Here’s what pediatrician Alan Greene, MD, says about using chocolate against cough:
How much chocolate would this be? Chocolate preparations vary widely, depending on their cocoa content but dark chocolate often has up to about 450 milligrams of theobromine per ounce. Milk chocolate has far, far less. Two ounces of dark chocolate was about the amount of theobromine used for the adults.
Theobromine has been tested and shown to be effective in suppressing a cough. We don’t know of any way to get theobromine except to eat some chocolate, preferably dark chocolate. Savor it, and remember that it has other health benefits if consumed in moderation.
Side effects: Allergy is possible.
Downside: Dose unknown. Excess chocolate consumption -may lead to weight gain.
Cost: Highly variable, no prescription dispensing fees
Half that maybe plenty for kids (but of course there is still a lotto learn about this marvelous food). Will that much chocolate keep them awake? Even though theobromine is structurally related to caffeine, studies have shown it doesn’t interfere with sleep at those amounts. I used some fine dark chocolate for my own family during our latest viral cough illness, and our coughs disappeared nicely. What a pleasant way to get through a cold!
One other odd cough remedy may be worth a try. This one has not been tested in guinea pigs, but some people find that drinking Concord grape juice helps to ward off colds and ease coughs. There is research demonstrating that Concord grape juice has measurable anti-inflammatory activity. But we don’t know what component of grape juice, if any, might be contributing to its cough-calming effect.
Q. My wife used to get sore throats every winter. They’d hang on for weeks and develop into aloud, hacking cough. Until she recovered, neither of us would get much sleep.
Then I remembered that my sister had a similar problem with her four growing boys. In desperation, she tried a remedy she read about. drinking -red” grape juice regularly.
My wife and I started drinking a glass of Concord grape juice every day fall through spring, and the prob-lem vanished. Since then, we’ve almost never had a bad cough.
We drink half a glass of grape juice and add a half glass of water. Do you know why this works?
A. Purple grape juice has a surprising number of potential health benefits. Research has shown that it can reduce bad cholesterol, lower blood pressure, and help keep blood vessels flexible. There are even some data to suggest that certain ingredients in grapes may support the immune system. Whether this effect would help ward off sore throats and coughs we do not know.
Treating Cough in Children
It is hard on parents to listen to a child coughing away. It may even be hard on the youngster. Sometimes coughs keep them awake at night. And because children are so susceptible to colds and other respiratory tract viruses, they seem to get a lot of coughs. But parents should refrain from rushing to the drugstore for cough remedies. A study published in Pediatrics found that the two main ingredients in OTC cough medicine, dextromethorphan and diphenhydramine, were no better at easing children’s coughs than a placebo syrup was.
According to the lead author, Ian Paul, MD, assistant professor of pediatrics at Penn State Hershey Medical Center, “One of the conclusions you could come to from the results of our study is that these medicines don’t work [for kids]. And in fact this is what evidence-based reviews of the medical literature have found before, that the existing evidence doesn’t support the use of these medicines for acute cough due to a cold . In addition, these medicines are not without risk. According to Dr. Paul, the children who received the standard ingredient in most cough medicines, dextromethorphan (DM), had a harder time falling asleep. That’s the last thing an anxious parent wants for a sick kid.
What to do? For a nighttime cough, we are partial to Vicks on the soles of the feet. Grape juice is certainly popular with most youngsters and would be worth a try.
Concord grape juice has anti-inflammatory properties, but we don’t know of any studies that confirm it has cough suppressant activity.
Side effects: None known.
Cost: About $4 to $5 for a 64-ounce bottle.
ing the day, a lunch of chicken soup with thyme in it would not be amiss. We don’t know for sure that any of these remedies will work for kids, though. We have received many testimonials on vanquishing kids’ coughs with Vicks, however, so we suspect it is likely to help.
Conclusions
These suggestions are not intended for a cough that has lasted longer than a few weeks, or one that is accompanied by fever, pain, or other symptoms of serious illness. They are aimed primarily at the annoying but not dangerous cough that often crops up at the tail end of a cold or the “flu” and hangs in there even though the patient is feeling much better otherwise.
When it comes to coughs and colds, be very cautious about medicating children. Although there are lots of products on the market aimed at kids, very few have been tested on children. And often, when they are tested on children, they don’t seem to work very well. For youngsters, less is definitely better.
• Codeine-containing cough syrup is one of the most effective remedies for cough. It may be difficult to purchase without a prescription. But if your cough is troubling you, ask your doctor to write one. Don’t overuse it, because it can be constipating.
• Vicks VapoRub, with its familiar aroma of menthol, camphor, and eucalyptus, is worth trying. If you don’t want to put it on your chest, try it on the soles of your feet (under your socks) for a cough-free night.
• Chicken soup with thyme is a comfort food that could help control a cough.
• Several herbal teas may be helpful. Try ginger, mint (menthol), elderflower, or linden flower tea. Sweetening the tea slightly with honey may help the brain’s own opioids kick in to help with that cough.
• Suck on hard candy flavored with licorice or horehound.
• The theobromine found in chocolate is active against cough. Perhaps the best way to get it is to melt a square or two of dark chocolate in your mouth.
• Concord grape juice has its enthusiasts, and very little risk.
Jul
15
Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.
July 15, 2009 | Leave a Comment
Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.
Prostatitis is a catch-all expression covering various types of inflammation of the prostate. It is not as serious as enlargement of the prostate, and especially not as serious as cancer of the prostate. It can, however, be a very difficult condition to treat and can sometimes drag on for several years. In prostatitis, the tiny glands in the prostate become infected, inflamed or clogged - either with thickened secretions or with small gravel-like stones. As we have seen in Chapter 1, the prostate is a complex system of glands, cells, tubules and ducts. Once infection gets a hold in this complicated network, it is hardly surprising that it can be very difficult to eradicate.
Even when it has been treated - and even when it seems as though it has been successfully treated - it can still come back. And in the absence of successful treatment, it can flare up for years, with depressing regularity.
THREE TYPES OF PROSTATITIS
There are three main types of prostatitis. These are:
• Acute bacterial infection.
• Chronic infection, which may be bacterial or non-bacterial.
• Prostatodynia, which may cause the symptoms of prostate pain without any obvious signs of inflammation or infection.
DIAGNOSIS OF PROSTATITIS
Prostatitis is sometimes difficult to diagnose. In general, the person best qualified to diagnose prostatitis is a doctor specialising in urology or genito-urinary medicine clinical trials. Your doctor may refer you to a special genito-urinary (GU) clinic. This does not mean that your doctor suspects that you are suffering from a sexually-transmitted disease. It simply means that genitourinary clinics have the best experience and equipment to investigate and treat your symptoms. The staff are used to dealing with this kind of problem, and will do so sympathetically and in confidence, so you have no need to feel embarrassed. You are likely to have a number of tests as part of the investigation of your symptoms. These may include some, or all, of the following:
• A digital rectal examination, which means that the doctor inserts a lubricated gloved finger into the rectum and gently palpates, or feels, the prostate through the front wall of the rectum, which lies against the back of the gland. If you have prostatitis, the prostate will feel boggy, soft and tender. A digital rectal examination should not hurt,
though it may be uncomfortable if the prostate is inflamed and therefore tender to the touch. A lot of men are embarrassed to have one, but they shouldn’t be: doctors are used to doing this and have a very matter-of-fact attitude to it.
• Swabs from the end of the penis, which are taken by gently inserting a sterile cotton bud into the end of the penis and taking any fresh discharge.
* Urine tests to check for cloudiness, signs of protein or blood, and threads of cellular niaterial, which are then examined under the microscope for pus cells or bacteria.
® Urine cultures to see if any bacteria grow, which should also distinguish between infection in different parts of the urinary tract.
• A blood test to check for a raised white cell count.
• Routine screening for sexually-transmitted diseases such as chlamyclia.
• The doctor will look for a discharge from the penis, and for signs of inflammation and soreness both on the penis and in the testicles. If prostatitis is untreated, or it’ drug treatment is unsuccessful, there is a risk that the prostate gland may become full of pus 5 online sildenafil citrate . Not surprisingly, this can have dreadful consequences. It may eventually burst, releasing pus into the urethra, which will discharge from the tip of the penis. And it may also result in severe infection elsewhere in the urinary tract.
ACUTE BACTERIAL INFECTION
This is an uncommon complaint. It is usually caused by bacteria from the intestines. These find their way into the urinary system, either through the urethra or through the bloodstream or lymphatic fluids.
Sometimes there is a link with organisms that cause a sexually-transmitted disease, such as gonorrhoea or chlarnydia. Sometimes, too, the fungus that causes thrush (Candida) is responsible.
Symptoms
These can happen suddenly and can include one or several of the following:
• Feeling generally under the weather.
• Chills or fever.
• An aching feeling around the thighs and genitals.
• A deep pain in the perineurn, which is the area between the pouch containing the testicles, known as the scrotum, and the anus.
• Low back pain.
• Pain in the lower abdomen.
• Pain on passing water.
• Blood in the urine.
• Difficulty in passing water.
• Increased frequency of passing water.
• Urine may be cloudy or smelly.
• Pain on ejaculation.
Diagnosis
The doctor will probably perform a digital rectal examination by inserting a lubricated gloved finger into the rectum. He will then feel the prostate through the wall of the rectum. If a man has prostatitis, the prostate will probably feel hot, swollen and tender. The doctor will then do a series of tests on a sample of urine and On urethral secretions obtained after massaging the prostate gland, in order to investigate the cause of the infection.
Treatment
Acute bacterial prostatitis, when symptoms come on suddenly, is the most dramatic form of the disease, but it is also the form that responds best to treatment. A prolonged course of antibiotic tablets is prescribed. This is usually for at least four weeks. Acute infection responds well to antibiotics, probably because the intense inflammation allows the drugs to penetrate into the interior of the gland. Symptoms should begin to show some improvement within the first few days. Sometimes, though, infection may persist in the prostate, in spite of treatment, and it is necessary to have careful follow-up treatment to make sure that the condition has cleared up. If this does not happen, the condition may tend to recur and chronic prostatitis will usually result. Occasionally, though rarely, infection may cause the gland to swell sufficiently for the urethra to be squeezed shut. This causes urinary outflow obstruction . It necessitates urgent admission to hospital, where urinary flow is eased by inserting a catheter directly into the bladder. With rest and the administration of antibiotics, the infection will usually clear up well in only a few days.
CHRONIC PROSTATITIS
Chronic prostatitis is more common than acute prostatitis, but is much more difficult to eradicate. There are two types of chronic prostatitis, which can be bacterial or non-bacterial. Chronic bacterial prostatitis Swelling occurs rapidly and this traps the bacteria in the gland, as the usual drainage channels become blocked. Prostatic secretions may coat the offending bacteria, which then harden to form tiny stones, or crystals. This protects them from being attacked by the body’s immune system or by antibiotics. This explains the repeated flare-ups that tend to occur in chronic bacterial prostatitis. This means, too, that the condition can be difficult to treat successfully. Some sufferers may even be unlucky enough to suffer from recurrent symptoms throughout their lives.
Symptoms
These vary from one person to another. They may include any, or several, of the following:
• Frequency in passing water.
• Pain on passing water.
• Pain in the prostate, genitals or rectum.
• Swelling of the testes.
• Lower back pain.
• Watery discharge from the penis.
• Pain on ejaculation.
• Blood in the semen.
• Premature ejaculation.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.
Fertility
There is some evidence that chronic bacterial prostatitis may impair. This may probably be true in all cases of prostatitis, but seems to be especially true of chronic bacterial prostatitis. Analysis of the prostatic fluid of men with chronic bacterial prostatitis has shown significant changes in both the physical properties and the chemical constituents of the fluid. It is thought that these changes may well affect the quality of the semen, and thus the level of fertility. It is not unusual for doctors to hear the wives of men with chronic bacterial prostatitis complain that they are finding it difficult to become pregnant. A sperm count and sperm quality assessment can be done to find out how much a man’s fertility has been affected.
Chronic non-bacterial prostatitis
This is a complaint in which inflammation is present without any signs of infection. In other words, prostate secretions contain white pus cells, but no bacteria. It is not known exactly what causes chronic non-bacterial prostatitis, but several theories have been suggested. One is that it is caused by abnormal emptying of the bladder, which forces urine into the prostate channels and ducts, where it causes irritation and inflammation. This may be triggered, or aggravated, if a man jogs or plays any strenuous sport on a
full bladder. Another theory is that some men produce thicker prostate secretions, which are perhaps more acid then normal. These secretions are unable to drain away through the narrow ducts and therefore build up to cause irritation and swelling.
Symptoms
The most common symptoms of chronic non-bacterial prostatitis are:
• Frequency in passing water.
• Pain on passing water.
• Pain or ache in the prostate, genitals or rectum.
• Lower back pain, especially after sexual intercourse.
• Discharge from the urethra, especially after intercourse.
Treatment
Any chronic infection is difficult to treat, particularly when inflammation and swellings trap the infection inside the gland. In the case of chronic bacterial prostatitis, a course of the appropriate antibiotic, depending on which bacterium is responsible for the condition, will be prescribed for at least six weeks. Sometimes antibiotics may be required for as long as three months, or even longer. Chronic non-bacterial prostatitis can be treated with a natural food supplement derived from rye pollen extracts, which
has been shown to reduce inflammation, irritation and swelling, though improvement may not be apparent for at least three months and full recovery may take as long as six months or even more. Swelling, inflammation and pain may be helped by anti-inflammatory painkillers such as ibuprofen.
Self-help
Chronic non-bacterial prostatitis is sometimes relieved by an increased frequency of ejaculation. This can be brought about through intercourse, of course, but if this does not happen it may equally be brought about by masturbation. Ejaculation drains the prostate of any excess secretions and causes a temporary increase in blood. Both these things help to flush away any toxins. In some cases, however, an increased frequency of ejaculation only makes the problem worse.
PROSTATODYNIA
This is characterised by the usual symptoms of prostate problems, including pain, but with no evidence of inflammation or infection in the gland. Prostate secretions look perfectly normal and contain no pus cells. Prostatodynia is surprisingly common and accounts for around one third of all cases where men experience the symptoms of chronic prostatitis.
Symptoms
The symptoms of prostatodynia are therefore similar to those of chronic prostatitis. They may often also include psychosexual problems.
Symptoms include the following:
• Frequency in passing water, sometimes with associated pain.
• Pain in the prostate, genitals or rectum.
• Lower back pain.
• Watery discharge from the penis.
• Blood in the semen (haemospermia).
• Premature ejaculation.
• Pain on erection.
• Pain on ejaculation.
• Low sex drive.
• A diminished volume of semen.
• Impotence.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.
Treatment
Prostatodynia can be difficult to treat. Painkillers are not usually helpful. It is, however, likely to have a physical cause, such as spasm of the pelvic muscles, which may be brought on by stress and anxiety. In this case, tranquillisers may be prescribed in order to reduce muscular spasm in the gland, though it is not a good idea to take these in the long-term as they can become addictive. Recent studies have suggested that prostate pain can be relieved by microwave hyperthermia. The technique was originally developed at the Beilinson Medical Centre, Petah Tiqva, in Israel in the early 1980s and is now attracting a lot of interest in other countries. An hour’s treatment is usually given weekly for six weeks.
Other treatments that have been tried for prostatodynia include:
• Acupuncture.
• Laser irradiation.
• Muscle-relaxant drugs, such as diazepam.
• Antispasmodic drugs.
Self-help
As in chronic non-bacterial prostatitis, symptoms may be worsened when ejaculation is infrequent, in which case the pain may be caused by prostatic gland engorgement. Symptoms may therefore be relieved by an increased frequency of ejaculation, as a result of either intercourse or masturbation. Ejaculation drains the prostate of any excess secretions
and causes a temporary increase in blood supply. In some cases, however, an increased frequency of ejaculation only makes the problem worse. Sitting in a hot bath for half an hour can help to warm up the prostate gland. Relaxation techniques may also be used to relax the muscles and as an alternative to muscle-relaxant drugs. The combination of regular exercise and a high-fibre diet will help keep the bowels regular, which is particularly important for men suffering from prostatodynia. This is of special benefit to those men who sit at a desk for most of the day, as both constant sitting and constipation tend to increase prostate congestion. Symptoms of prostatodynia may be triggered by the nicotine in cigarettes and by alcohol or caffeine, so it is best to reduce consumption of all three. It may also be advisable to consult an allergy specialist who may be able to identify foods that you should avoid.
Natural treatments
Rye pollen extracts have been shown in clinical trials in Europe to help ease the symptoms of prostatitis, particularly chronic non-bacterial prostatitis and prostatodynia. They reduce inflammation and ease irritation. They may take as long as three months before they show any improvement, which may then continue over the next three months. Rye pollen
extracts, such as Cernilton and ProstaBrit, are available from health food stores.
Jul
3
Leukotriene Modifier Montelukast (Singulair)
We used to think Singulair was a very cool drug. It is an oral prescription medicine that blocks the effects of those inflammatory chemicals called leukotrienes. So, it only made sense to us that a drug like Singulair would relieve symptoms. This medication is widely prescribed to ease the breathing problems associated with asthma. Research suggests, however, that Singulair is only modestly effective for alleviating itching, sneezing, congestion, and runny nose. It is roughly comparable to antihistamines such as loratadine (Claritin). One study reported that Singulair, which costs more than $3 per pill, was no more effective than the oral decongestant pseudoephedrine (Sudafed) for relieving typical allergy symptoms. 56 Generic pseudoephedrine is far less expensive than Singulair. It is harder to purchase these days because pharmacists can only dispense it from behind the counter. You don’t need a prescription, but you will have to sign for it. Too many people used pseudoephedrine to make the illegal drug methamphetamine, so states and the federal government cracked down on easy access.
The research demonstrating that pseudoephedrine is quite effective in relieving allergy symptoms has forced us to reevaluate this old and inexpensive vasoconstrictor. It works by shrinking blood vessels in the nose. Perhaps that’s why so many drug companies now add this OTC ingredient to their antihistamines. Whenever you see a D appended to the name of an allergy medicine, you can pretty much assume that there is a decongestant on board, and frequently it is pseudoephedrine. It is found in Allegra-D, Claritin-D, Clarinex-D, Zyrtec-D, and other similar formulations.
Corticosteroid Nasal Sprays
Most allergy experts believe that these steroid sprays are the most effective treatments available and should be the first-line therapy. They are not likely to cause drowsiness or sedation and should be safe for people who must drive or operate machinery.
Side effects: Nasal irritation, stinging, burning, and bleeding. Other adverse reactions may include sore throat (and, rarely, yeast infections), headache, nausea, and cough. Rare adverse reactions may include perforation of the septum, nasal ulcers, reduced growth. rate in children, glaucoma, cataracts, and asthma symptoms.
Downside: These drugs are pricey and may alter the senses of taste and smell.
Cost: Approximately $85 to $95 for brand•name nasal sprays. Generic flunisolide is $35 to $40 per bottle.
O.I would like to point out a side effect of allergy medications that contain pseudoephedrine for nasal decongestion. Taking Claritin-D left me completely unable to fall asleep. I was literally up all night with a racing heartbeat. I have had insomnia problems before, so I did not immediately associate this with the medication and continued to take it for 5 days. I was so sleep deprived that I couldn’t work. I finally read the warning about nervousness, dizziness, or sleeplessness. I called my doctor, who said I should switch to Claritin (non-D). On this drug I sleep like a baby. I found that some OTC allergy medicines I had taken for years also contain pseudoephedrine. I suspect this contributed to my earlier insomnia problems. I urge anyone with insomnia to check all medications for pseudoephedrine. It does not affect everyone, but some of us just can’t handle even a small amount.
A. Millions of people struggle with insomnia and many don’t realize that the medicines they take may be contributing to their problem.
Decongestants aren’t the only culprits. Antihistamines, antidepressants, asthma medicines, blood pressure pills, and pain relievers are some of the drugs that can cause insomnia.
As popular as pseudoephedrine may be, there are some side effects to be alert for. Many people complain of insomnia, anxiety, agitation, headache, nausea, dizziness, and tremor. The most serious adverse reactions are elevated blood pressure and irregular heart rhythms. Men with prostate enlargement must avoid this decongestant because it can make urination much more difficult.
Jul
3
Allergy: Corticosteroid Nasal Sprays
July 3, 2009 | Leave a Comment
Corticosteroid Nasal Sprays
The big revolution in allergy treatment involves the use of steroid nasal sprays. Allergists have known for decades that cortisone-like drugs (prednisone, for example) can dampen the reactions of an overactive immune system and calm allergy symptoms amazingly well. The trouble is that relief comes at a stiff price. So many side effects are associated with oral corticosteroids that few physicians would ever consider prescribing such medications for nasal allergy symptoms except as a last resort. Even then, cautious doctors prescribe medications like prednisone for the shortest period of time necessary. Adverse reactions can include irritability, insomnia, anxiety, high blood pressure, potassium depletion, headache, nausea, and dizziness.
Not surprisingly, people wanted the benefits of steroids without the risks. That’s where nasal sprays come in. There are about a half- dozen different intranasal corticosteroids available by prescription. Most experts would say that these formulations are the most effective allergy treatment available. Although it may take a week for the benefits to reach peak effect, these sprays should relieve allergy symptoms such as itching, sneezing, and congestion quite well. They are pricey, however. A small bottle can run $85 to $95. At the time of this writing, generic flunisolide costs around $40. We cannot say whether one spray is better or safer than another.
The general consensus is that there are few, if any, systemic side effects associated with topical steroids. In other words, the experts do not believe people absorb enough of the drugs into the system to cause much, if any, concern.55 One study did report growth suppression in children, but other research has not confirmed this complication. There have been rare reports of nasal perforation (creating a hole between the nostrils) and increased pressure within the eyes. More common are local reactions such as irritation and burning in the nose, sore throat, nasal dryness, nosebleed, and headache.
GENERIC/BRAND NAME
Beclomethasone
Beconase AQ
Budesonide
Rhinocort Aqua
Flunisolide
Nasarel
Fluticasone
Flonase
Mometasone
Nasonex
Nasacort AQ
Triamcinolone
Still generic Singulair is widely prescribed to ease the breathing problems because of asthma.
Jul
3
Allergy Medications: Antihistamines
July 3, 2009 | Leave a Comment
Antihistamines
Antihistamines have been the mainstay of allergy treatment for decades. The so-called first-generation drugs like diphenhydramine (Benadryl), brompheniramine (Dimetane, Dimetapp), and chlorpheniramine (Chlor-Trimeton) are linked to drowsiness and cognitive impairment 47 Second-generation antihistamines such as cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), and loratadine (Claritin) have been promoted as nonsedating. Because they were supposed to be so much safer and better tolerated than the old-fashioned drugs, many came with a very steep price tag ($2 to $3 per pill). But there is growing concern that when given in doses that are adequate to relieve allergy symptoms, even these newer compounds may cause some sedation in some patients and produce mild impairment.48 Researchers now believe that “a clear and consistent distinction between sedating and nonsedating antihistamines does not exist.”‘
What this means is that the allergy victim is truly caught on the horns of a dilemma. Suffering with allergies makes you spacey, sleepy, and irritable and can impair your ability to function. Antihistamines can also cause sedation and impair performance. If such drugs only partially control symptoms (a fairly common situation), then you may end up with the worst
Claritin used to be the most widely prescribed antihistamine on the market. When it lost patent protection, the company took it OTC. Compared to many of the older nonprescription antihistamines, loratadine is probably less likely to cause drowsiness at recommended doses. We have seen no data to suggest that it is less effective than pricier prescription antihistamines.
Side effects: Headache, sleepiness, dry mouth, fatigue, jitteriness, and stomach upset. Liver problems may be a rare adverse reaction. Downside: More expensive than old-fashioned antihistamines. Insurance companies may deny you affordable access to drugs like Allegra now that loratadine is available OTC. Loratadine may cause sedation and impair driving in susceptible people. Do not assume you are safe behind the wheel. Cost: Approximately $5 to $10 for a month’s supply when purchased generically in bulk. The brand-name Claritin can cost two to four times that much.
In such a confusing situation, we would normally suggest that the allergy sufferer experiment with a variety of antihistamines to try and determine which one works best and is least troublesome in terms of side effects. The difficulty is that people are notoriously bad at assessing their level of impairment. There is a warning on the label of Benadryl and many other OTC allergy medicines reminding users that “marked drowsiness may occur” and urging them to “be careful when driving a motor vehicle or operating machinery.” Such cautions are as meaningless as telling a drunk to be careful behind the wheel. In fact, researchers have reported that diphenhydramine”had a greater impact on driving than alcohol did. These scientists discovered that “drowsiness ratings were not a good predictor of impairment, suggesting that drivers cannot use drowsiness to indicate when they should not drive.”
By the way, did you know that you could be arrested for driving while impaired after taking an OTC allergy pill? If your driving skills are not up to par, an officer can give you a ticket even though you have no alcohol in your system.
So, dear reader, we have no easy answers. We would like to say, if you have allergies, do not drive, especially if you are taking antihistamines. That would be the only prudent thing. We know that some people will disobey such a suggestion, however. Some experts believe that fexofenadine (Allegra) may be one of the least sedating and safer antihistamines to take if you must drive. Others point out that even this non-sedating antihistamine may pose problems at higher doses. If driving or operating machinery is essential or if you must make important decisions, we encourage you to look for other options besides oral antihistamines.
There is now a prescription antihistamine nasal spray called azelastine (Astelin). It is fairly fast acting but has the disadvantage of requiring twice-daily nasal spritzing. Some data suggest it may be as effective as oral antihistamines. Side effects may include a bitter taste in the mouth (20 percent of patients), headache, drowsiness (11 percent of patients), nasal burning or inflammation, sore throat, dry mouth, sneezing, fatigue, and dizziness. A 1 -ounce bottle can cost $75 to $85. Not exactly a perfect solution to the problem, eh?