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.
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 Medications - Nasalcrom (Cromolyn)
July 3, 2009 | Leave a Comment
Allergy Medications Nasalcrom (Cromolyn)
Speaking of stabilizing mast cells, another way to do this is with a nasal spray. Cromolyn (NasalCrom) was first introduced as a prescription product in 1983. NasalCrom went over the counter in 1997. Cromolyn, the active ingredient in Nasalcrom.
This nonprescription nasal spray. is often ignored by doctors; but it is a valuable tool in the fight against nasal allergies. By stabilizing mast cells in the nose, NasalCrom makes it harder for histamine and other inflammatory chemicals to be released and do their dirty work.
Side effects: Cromolyn is very safe and does not cause drowsiness or rebound nasal congestion the way OTC nasal decongestants can. Some people may experience temporary sneezing, nasal burning, or a bad taste in their mouth.
Downside: You must use NasalCrom at least four times a day to really benefit. Some experts believe it is much less effective than intranasal corticosteroids.
Cost: Approximately $17 to $20 for a 1- to 2-month supply finally derived from an herb, the fruit of bishop’s weed (Ammi visnaga), which was traditionally used to treat asthma.
The compound cromolyn stabilizes highly sensitive mast cells in the lining of the nose and lungs so they can better resist the onslaught of pollen. It won’t cause drowsiness or cognitive impairment and, if used regularly, it is quite effective. Unlike decongestant nose sprays, there is no need to fear developing dependency.
cromolyn is available in eyedrops (Crolom) for itchy, red eyes due to allergies. There is also an aerosol inhaler (Intal) for treating asthma. Both products require a prescription, whereas NasalCrom does not require your physician’s assistance.
Q. I’m going to visit my daughter in a few weeks and she has two cats that have the run of the house. When I’m there, I suffer runny nose, watery eyes, and sneezing from the cat hairs that are all over the house and furniture.
Can you recommend something over-the-counter for me to take during the visit?
A. NasalCrom is a nasal spray that can be quite effective if taken preventively. You will need to start spritzing several days before arriving so you can stabilize the cells in your nose and protect them against cat allergens.
If you also took the oral antihistamine Claritin (loratadine), you might be able to minimize the sneezing and allergic reactions.