Aug
13
Fenofibrate - Finasteride - Fioricet - Fiorinal - Fiorinal with Codeine
August 13, 2009 | Leave a Comment
Generic Name
Fenofibrate (fen-oe-Flli-brace) IM
Brand Names
Antara TriCor
Lipoten Triglide Lofibra
Type of Drug
Anti-hyperlipidemic (blood-fat reducer).
Prescribed For
High blood cholesterol and/or triglycerides; also prescribed for syndrome X, a condition which increases the risk of type 2 diabetes.
General Information
Fenofibrate works by interfering with the body’s ability to make triglyceride and by increasing its breakdown by enzymes in the body. It also reduces levels of uric acid, total cholesterol, low-density lipoprotein (LDL) cholesterol—the “bad” cholesterol—and other blood lipids. High-density lipoprotein (HDL) cholesterol—the “good” cholesterol—levels are increased. This drug should only be used in people with very high triglyceride levels who are at risk for pancreatitis (inflammation of the pancreas) and have not responded to other treatments, including statin drugs. Generic fenofibrate is not equivalent to the TriCor brand because of a new product formulation and should not be substituted for the brand unless your doctor approves of the switch.
Cautions and Warnings
Do not take fenofibrate if you are allergic or sensitive to any of its ingredients.
People taking fenofibrate and other triglyceride-lowering drugs are mate WOV to die from causes unrelated to triglyceride levels. Fenofibrate reduces the risk of a heart attack or other cardiac event in people with high triglyceride levels and low levels of HDL cholesterol, especially among people with diabetes. The evidence for this benefit is not as strong as it is for the statin drugs.
People taking fenofibrate and gemfibrozil may develop pancreatitis (inflammation of the pancreas).
People with liver or severe kidney disease should avoid fenofibrate. People with less severe kidney disease require reduced
dosage.
People taking fenofibrate are more likely to develop gallstones.
Fenofibrate can destroy muscle cells, leading to kidney failure, especially when combined with a statin cholesterol-lowering drug see “Drug Interactions”).
Possible Side Effects
• Most common: abnormal liver function, abdominal pain, and respiratory disorders.
♦ Common: rash, headache, upset stomach, pain, weakness, tiredness, and flu-like symptoms.
♦ Less common: joint pain, abnormal heart rhythms, reduced sex drive, dizziness, increased appetite, sleeplessness, tingling in the hands or feet, nausea, vomiting, diarrhea, abdominal pain, constipation, stomach noise or gas, frequent urination, vaginal irritation, runny nose, cough, sinus irritation, eye irritation, blurred vision, conjunctivitis (pinkeye). earache, and tiny particles inside the eye (”floaters”).
♦ Rare: allergic reactions including severe rash, itching, liver inflammation or enlargement, gallstones, gallbladder disease, muscle aches, and increased sensitivity to the sun. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Combining fenofibrate and a statin cholesterol-lowering drug (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) can lead to severe muscle pain, muscle cell destruction, and kidney failure. If you have extremely high blood-fat levels, the potential benefits of this combination may outweigh the risks. In people taking this combination, the health of muscles and kidneys must be monitored regularly via blood tests.
• Fenofibrate increases the effects of anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
• Combining fenofibrate and cyclosporine can increase the risk of kidney toxicity. This combination should only be used if it is absolutely necessary and the lowest possible dosage is
taken.
• If you are taking cholestyramine or colestipol (both are used
to reduce blood-fat levels) as well as fenofibrate, take the
fenofibrate at least 1 hour before or 4-6 hours after these
drugs.
Food Interactions
All forms of fenofibrate, except TriCor, should be taken with food to get the best effect. TriCor may be taken without regard to food or meals.
Usual Dose
These products may not be substituted for each other because of important dosage differences.
Antara
Adult: 43-130 mg a day with food.
Senior: Begin with 43 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
Lofibra
Adult: 67-200 mg a day with food.
Senior: Begin with 67 mg a day. This beginning dosage also applies to people with kidney disease.
Child: not recommended.
Lipofen
Adult: 50-150 mg a day with food.
Senior: Begin with 50 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
TriCor
Adult: 48-145 mg a day.
Senior: Begin with 48 mg a day. This dosage also applies to
people with kidney disease. Child; mk recommended.
Triglide
Adult: 50-160 mg a day.
Senior: Begin with 50 mg a day. This dosage also applies to
people with kidney disease. Child: not recommended.
Overdosage
Little is known about the effects of fenofibrate overdose. Victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
People should take fenofibrate only after a triglyceride- lowering diet and other medications have failed. While taking fenofibrate, follow the diet recommended by your doctor.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: Fenofibrate causes fetal injury and death in animal studies. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
This drug should not be taken by nursing mothers because of its potential to affect the nursing infant.
Seniors: Seniors are more likely to experience side effects and should never start with more than the lowest recommended dosage.
Generic Name
Finasteride (fin-ASS-ter-ide) 19
Brand Names
Proscar Propecia
The information in this profile also applies to the following drug:
Generic Ingredient: Dutasteride Avodart
Type of Drug
Alpha-reductase inhibitor and androgen hormone inhibitor.
Prescribed for
Benign prostatic hyperplasia (BPH) and male-pattern baldness. May also play a role in preventing prostrate cancer.
General Information
Finasteride works by interfering with the action of the enzyme alphareductase, which converts testosterone into 5-dihydrotestosterone (DHT). By suppressing DHT levels, finasteride reduces the size of the prostate in most men who take the drug for BPH. You may need to take finasteride for 6-12 months before its effects can be
assessed.
Urine flow improves in about 60% of men taking finasteride for BPH and symptoms improve in about 30%. In one study, men experienced a significant regression in prostate size after 3 months, and the reduction was maintained through the 12-month study period: these men experienced a significant improvement in urine flow that could be maintained up to 36 months.
Studies of finasteride for hair loss on the top and back-middle of the scalp show new hair growth in 65-80% of men taking the drug continuously for 2 years. The drug must be taken for 3 months or more before it begins to have an effect and must be taken continuously to maintain hair growth. Once you stop taking this drug, any new hair you have grown is likely to fall out in the next 12 months. Between 14-17% of men taking the drug continued to lose hair throughout the study period.
Finasteride has been studied as therapy following radical prostatectomy surgery and in the prevention of first-stage prostate cancer, acne in women, and unusual hairiness.
Cautions and Warnings
Do not take finasteride if you are allergic or sensitive to any of its ingredients.
This drug should not be used in women or children. Pregnant women must not handle the tablets and capsules because of the risk to the fetus.
People who do not respond to finasteride may have a condition that causes BPH-like symptoms, such as prostate cancer, bladder or nerve disorders, or physical obstruction of the urinary tubes. Finasteride cannot be used to treat these conditions.
Because it is broken down in the liver, finasteride must be used with caution by people with liver disease.
Finasteride may mask symptoms of prostate cancer by causing a reduction in the level of prostate-specific antigen (PSA), an increasingly acknowledged indicator of prostate cancer.
Possible Side Effects
Side effects are generally mild and often subside with continued use of the drug.
Drug Interactions
• Finasteride may reduce the effectiveness of theophylline and aminophylline, although dosage adjustments usually are not required.
• Finasteride affects the PSA blood test used for prostate cancer screening. Be sure your doctor knows you are taking this drug if you have a PSA test done or are being tested for prostate cancer.
• Dustasteride blood levels may increase when mixed with ritonavir, ketoconazole, cimetidine, and ciprofloxacin, all of which are inhibitors of a liver enzyme called CYP3A4. Blood levels of dutasteride also increase with verapamil and diltiazem.
Food Interactions
You may take finasteride with food if it upsets your stomach.
Usual Dose
Outasteride
Adult: 0.5 mg (1 capsule) once a day. Child: not recommended.
Finasteride
Adult: BPH-5 mg once a day. Male-pattern baldness-1 mg once a day.
Child: not recommended.
Women should not take finasteride. Overdosage
S%’& Ptecls are unlikely. Doses of dutasteride as high as 400 mg a day have been taken with no adverse side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Possible Side Effects (continued)
v Common: impotence, loss of sex semen, breast tenderness an
• and drug sensitivity reaction
• rash.
x drive, decreased amount nd enlargement, testicular ions including lip swelling Special Information
Women who are or might be pregnant should not handle crushed finasteride tablets because small amounts of the drug may be absorbed into the blood, possibly affecting the fetus.
If your sexual partner is or might be pregnant and you start taking finasteride, you must wear a condom during sex to avoid directly exposing her to finasteride in the semen.
Semen volume may decrease while on finasteride. Impotence or reduced sex drive is also a risk.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss a dose for 2 or more days.
Special Populations
Pregnancy/Breast-feeding: This drug is not intended for women. Finasteride will harm the fetus if taken during pregnancy. It is not known if finasteride passes into breast milk.
Seniors: Seniors with liver disease should use this drug with caution.
Brand Name
Fioricet
Generic Ingredients
Acetaminophen + Butalbital + Caffeine 91
Other Brand Names
Americet Femcet
Dolgic LQ Margesic
Dolgic Plus Medigesic
Esgic Repan
Esgic-Plus Triad
Type 101 Drug
Barbiturate and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fioricet is one of many combination products containing a barbiturate—butalbital—and an analgesic—acetaminophen. Products of this kind also often contain a sedative or a narcotic. Other analgesic combinations, such as Rorinal, substitute aspirin for
acetaminophen.
Cautions and Warnings
Do not take Fioricet if you are allergic or sensitive to any of its ingredients.
Use this drug with caution if you have kidney or liver disease or a history of porphyria.
Chronic (long-term) use of Fioricet may lead to drug dependence or addiction. It is not recommended for multiple or recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an inability to concentrate. Alcohol increases the CNS depression caused by this drug.
The safety and effectiveness of these medications have not been established in children under age 12.
For additional information see “Cautions and Warnings” in Acetaminophen (page 7).
Possible Side Effects
♦ Most common: lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, upset stomach and a feeling of intoxication.
V Less common: weakness, headache, agitation, tremor, uncoordinated muscle movement, disorientation, dry mouth, constipation, facial flushing, changes in heart rate, palpitations, feeling faint, urinary difficulties, rash, and itching.
For additional information see “Possible Side Effects” in Acet-
aminophen (page 7).
Drug Interactions
• Combining Fioricet with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
These medications may reduce the effectiveness of corticosteroids, contraceptives containing estrogen, beta blockers (e.g. propranolol), doxycycline, felodipine, griseofulvin, nifedipine, phenylbutazone, quinine, theophylline, warfarin, and tricyclic antidepressants.
For additional information see “Drug Interactions” in Acetaminophen (page 7).
Food Interactions
Fioricet is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not exceed 6 doses a day.
Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, facial flushing, sweating, and thirst. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fioricet may cause drowsiness. Be careful when driving or performing any task that requires concentration.
You should avoid alcohol while taking this medication.
Do not take Fioricet for longer or in amounts greater than prescribed.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping Fioricet may lead to withdrawal symptoms.
Call your doctor if your headache or pain persists or gets worse, or if you develop side effects that are bothersome or persistent.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one and continue
W<tkh IV61 schedule. Do not take a double dose.
For additional information see “Special Information” in Acetaminophen (page 7).
Special Populations
Pregnancy/Breast-feeding: Fioricet should not be taken during pregnancy. It is associated with birth defects, prolonged labor and delayed delivery, and breathing problems in newborns. Regular use of Fioricet during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fioricet passes into breast milk. Breast-feeding while using Fioricet may cause babies to become tired, short of breath, or have a slow heartbeat. Nursing mothers who must take this drug should use infant formula.
Seniors: Fioricet may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal
Generic Ingredients
Aspirin + Butalbital + Caffeine &9
Other Brand Names
Butalgen Fiorimor
Farbital Fortabs
Fiorigen Lanorinal
Type of Drug
Barbiturate and analgesic (pain reliever) combination. Prescribed For
Symptom relief of tension headache.
General Information
Pain relief products often combine an analgesic with a sedative. The analgesic ingredient in Fiorinal is aspirin; other brand-name products, such as Esgic and Fioricet, contain acetaminophen. The sedative ingredient in pain-relief combinations may be a barbiturate, narcotic, or other sedative. Fiorinal contains the barbiturate butalbital. Fiorinal also contains caffeine, which is ofte” \Ased in analgesic combinations that km,-M beadache because it enhances kkNt %m-relieving effect of aspirin.
Cautions and Warnings
Do not take Fiorinal if you are allergic or sensitive to any of its ingredients.
Do not give Fiorinal to children or teenagers with chickenpox or flu-like symptoms due to the aspirin content and danger of
Reye’s syndrome.
Use Fiorinal with extreme caution if you suffer from peptic ulcer,
problems with blood clotting or other bleeding disorders, or are
about to have surgery.
This drug should be used with caution if you have kidney or
liver disease, diabetes, or a history of porphyria.
Long-term use of this drug may cause drug dependence and addiction. It is not recommended for the treatment of multiple recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an
inability to concentrate. Alcohol increases the CNS depression caused by butalbital.
The safety and efficacy of Fiorinal use in children under age 12 has not been established.
For additional information see “Cautions and Warnings” in Aspirin (page 110).
Possible Side Effects
✓ Most common: lightheadedness, dizziness, and sedation.
♦ Less common: nausea, vomiting, flatulence, and rash. For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Combining Fiorinal with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
• Fiorinal may enhance the effects of oral anticoagulants (blood thinners), oral antidiabetes drugs, insulin, and mmsteroidal anti-inflammatory drugs ~VASAYDs).
• F10final may decrease the effectiveness of medications taken for gout, including probenicid and sulfinpyrazone.
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal is best taken on an empty stomach but may be taken with
food if it upsets your stomach.
usual Dose
1-2 tablets or capsules every 4 hours or as needed. Do not exceed
6 doses a day. Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin, lowered heart rate or blood pressure, nausea, vomiting, stomach pain, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose are rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, and bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fiorinal may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking Fiorinal.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take Fiorinal for longer or in amounts greater than prescribed.
Call your doctor if your headache pain persists or gets worse, or if you develop any bothersome or persistent side effect.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
PregriancylBreast-feeding. Fiorinal should not be taken during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. Fiorinal increases the risk of birth defects and may cause breathing or bleeding prob-lems in newborns. Regular use of Fiorinal during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal passes into breast milk. Breast-feeding while using Fiorinal may cause tiredness, shortness of breath, or slowed heartbeat in the baby. Nursing mothers who must take Fiorinal should use infant formula.
Seniors: Fiorinal may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal with Codeine
Generic Ingredients
Aspirin + Butalbital + Caffeine + Codeine Phosphate 19
Type of Drug
Barbiturate, narcotic, and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fiorinal with Codeine is one of many combination products containing a barbiturate, an analgesic, and a narcotic. In Fiorinal with Codeine, butalbital is the barbiturate, aspirin is the analgesic, and codeine is the narcotic. These products often also contain a sedative, and acetaminophen may be substituted for aspirin.
Cautions and Warnings
Do not take Fiorinal with Codeine if you are allergic or sensitive to any of its ingredients. Even recommended doses of aspirin can cause severe allergic reaction in those with an aspirin allergy.
Do not take this medication if you suffer from peptic ulcer, bleeding disorders, or a history of porphyria.
Use this medication with cautiOi) 11 you have kidney or liver
disease of diabetes.
Fiorinal with Codeine may cause postural low blood pressure (symptoms include dizziness or fainting when rising from a sitting or lying position).
Long-term use of this drug may cause drug dependence or addiction.
It is not recommended for treatment of multiple, recurrent head-
aches.
Fiorinal with Codeine is a respiratory depressant and affects the
central nervous system (CNS), producing sleepiness, tiredness, or inability to concentrate. Alcohol increases the depression caused
by codeine and butalbital.
Do not give Fiorinal with Codeine to children or teenagers with
chickenpox or flu-like symptoms. The aspirin content presents the
danger of Reye’s syndrome.
For additional information see “Cautions and Warnings” in As-
pirin (page 110).
Possible Side Effects
✓ Most common: dizziness, sleepiness, nausea, and vomiting.
♦ Less common: dry mouth, difficulty swallowing, heartburn, rapid heart rate, leg pain and muscle fatigue, urinary problems, rash, fever, earache, stuffy nose, and ringing in the ears. Narcotic analgesics may aggravate convulsions in those who have had them.
For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Interaction with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, or other drugs that produce sedation may cause tiredness, drowsiness, and trouble concentrating.
• Taking Fiorinal with Codeine with a monoamine oxidase inhibitor antidepressant may cause increased central nervous system effects.
• This medication may reduce the effectiveness of medications for the treatment of gout including probenicid and sulfapyrazone.
• Fiorinal with Codeine may enhance the effects of blood thin- ners, oral antidiabetes drugs, insulin, and anti-inflammatory drugs (NSAIDs).
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal with Codeine is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not ex-
ceed 6 doses a day.
Overdosage
Usual overdose symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose include rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, or bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking this drug.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take this drug for longer or in amounts greater than prescribed.
Call your doctor if you experience breathing difficulties, or persistent nausea, vomiting, or constipation.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
Pregnancy/Breast-teeding-. Fiorinal with Codeine should not be used during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. This drug increases the risk of birth defects and may cause breathing or bleeding problems in newborns. Regular use of Fiorinal with Codeine during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal with Codeine passes into breast milk. Breast-feeding while using this drug may cause tiredness, shortness of breath, or a slow heartbeat in the baby. Nursing mothers who must take this drug should use infant formula.
Seniors: This drug may have a greater depressant effect on seniors. Other effects that may be more prominent are stimulation, disorientation, lightheadedness, and dizziness or fainting when rising suddenly from a sitting or lying position.
Aug
1
Cholinesterase Inhibitors
August 1, 2009 | Leave a Comment
Type of Drug
Cholinesterase Inhibitors
(KO-lin-ESS-tuh -rase)
Brand Names
Generic Ingredient.- Donepezil
Aricept Aricept ODT
Generic Ingredient: Galantamine
Razadyne Razadyne ER
Generic Ingredient: Rivastigmine
Exelon Exelon Transdermal System
Generic Ingredient: Tacrine Cognex
Prescribed For
Alzheimer’s disease. Also used for vascular dementia, dementia associated with Parkinson’s disease, poststroke aphasia (problems with language), and improvement of memory in multiple sclerosis patients.
General Information
Cholinesterase inhibitors work by increasing the function of certain receptors in the brain that are stimulated by the hosmone acetylcholine. They do t.Ns by interfering with cholinesterase, the 1617yme that breaks down acetylcholine. People with Alzheimer’s disease (a degenerative condition of the central nervous system) develop a shortage of this brain chemical early in the disease. There is no evidence that cholinesterase inhibitors reverse the degenerative effects of Alzheimer’s, but they may slow the rate at which the disease worsens.
Cautions and Warnings
Do not take cholinesterase inhibitors if you are allergic or sensitive to any of their ingredients.
Cholinesterase inhibitors must be discontinued before surgery because they increase the effects of anesthetic drugs.
People with heart disease should use cholinesterase inhibitors with caution because they may slow heart rate and cause fainting. Two studies of people with mild symptoms of Alzheimer’s disease taking galantamine revealed a higher rate of death from heart attack, stroke, or sudden death.
Cholinesterase inhibitors may be expected to cause increased stomach acid production and increased activity of the gastrointestinal tract. Possible complications include ulcers or bleeding. Alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may worsen this effect.
Using cholinesterase inhibitors may also lead to urinary blockage, increase the risk of generalized seizures, and worsen asthma or other pulmonary diseases. Use with caution if you have these conditions.
People with severe liver dysfunction should not take galantamine or tacrine.
Possible Side Effects
People taking cholinesterase inhibitors generally experience side effects at about the same rate as those taking a placebo (sugar pill).
♦ Most common: headache, general pain, accidents, nausea, diarrhea, sleeplessness, and dizziness.
✓ Common: tiredness, vomiting, appetite loss, and muscle cramps.
♦ Less common: arthritis, depression, abnormal dreams, fainting, black-and-blue marks, and weight loss.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Cholinesterase inhibitors interfere with anticholinergic drugs (often prescribed for stomach disorders).
• Cholinesterase inhibitors can be expected to increase the ef-
fects of cevimeline, surgical anesthetic drugs, and drugs that
irritate the stomach and intestines, such as aspirin, ibupro-
fen, and other NSAIDs.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be slowed by ketoconazole, itraconazole, quinidine, delavirdine, indinavir, nelfinavir, ritonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, norfloxacin, clarithromycin, diltiazem, erythromycin, fluconazole, fluvoxamine, celecoxib, chlorpheniramine, clomipramine, cocaine, doxorubicin, fluoxetine, halofantrine, halopendol, levopromazine, methadone, mibefradil, paroxetine, ranitidine, terbinafine, mifepristone, nefazodone, and grapefruit juice.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be increased by efavirenz, nevirapine, barbiturates, carbamazepine, corticosteroids, phenytoin, pioglitazone, and rifampin.
Food Interactions
Donepezil can be taken with or without food.
Galantamine and rivastigmine should be taken with morning and evening meals.
The rivastigmine transdermal system patch can be used without regard to meals.
Food reduces the absorption of tacrine into the blood. It is best taken on an empty stomach, but you can take it with food if it upsets your stomach.
Usual Dose
Donepezil
Adult: 5 or 10 mg once a day.
Galantamine
Adult: 8-32 mg a day.
Rivastigmine
Adult: 3-12 mg a day, divided into 2 doses.
RiVUtq1M&A0Y2nsdermaI patch
Adult: Apply one 4.6-mg patch every day to start. Dose may be increased to one 9.5-mg patch every day.
Tacrine
Adult: 40-160 mg a day, divided into 4 doses.
Overdosage
Cholinesterase inhibitor overdose can be very serious. Symptoms include severe nausea, vomiting, salivation, sweating, slow heart rate, low blood pressure, slow breathing rate, convulsions, muscle weakness, and collapse. Take the overdose victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Donepezil should be taken just before bedtime.
Follow the special package directions for rivastigmine solution.
Do not remove the rivastigmine patch from its packaging until just before you are ready to apply it. Apply the patch to clean, dry, and hairless skin on the upper or lower back, upper arm, or chest that is also free of any powder, oil, moisturizer, or lotion that could keep the patch from sticking to your skin properly; skin should also be free of cuts, rashes, and irritations. Avoid places where the patch can be rubbed off by tight clothing. When changing your patch, apply your new patch to a different spot of skin (for example, on the right side of your body one day, then on the left side the next day). Do not use the same spot more than once every 14 days. Wear only one patch at a time and change it every.24 hours. If the patch falls off, apply a new patch for the rest of the day, then replace the patch the next day at the same time as usual.
Tobacco or nicotine use increases the rate at which tacrine and rivastigmine are cleared from the body.
If you forget a dose and take your medication once a day, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with the regular schedule. If you take your medication 2 or more times a day, take your dose as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: One animal study of a cholinesterase inhibitor indicated a small risk of birth defects. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks.
It is not known if cholinesterase inhibitors pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors with moderate kidney function loss should not take galantamine. Dosage adjustments are not needed for donepezil, tacrine, or rivastigmine.
Jul
16
Acetaminophen
July 16, 2009 | Leave a Comment
Generic Name
Acetaminophen (uh-SEE-tuh-MIN-uh-fen) RE
Brand Names
Acephen Mapap-
Aceta Mapap Children’s
Acetaminophen Uniserts Mapap Extra Strength
Apacet Mapap Infant Drops
Aspirin Free Anacin Maximum Maranox
Strength Neopap
Aspirin Free Pain Relief Oraphen-PD
Dynafed, Children’s JR Panadol*
Dynafed EX Redutemp
Dynafed Extra Strength Silapap
Feverall Silapap Children’s
Feverall, Infants Silapap Infants
Genapap” Tapanol
Genebs Tempra*
Liquiprin Tylenol*
*Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug
Antipyretic and analgesic.
Prescribed For
Relief of pain and fever for people who cannot or do not want to take aspirin or a nonsteroidal anti-inflammatory drug (NSAID). Acetaminophen may be given to children about to receive a
DTP vaccination to reduce the fever and pain that commonly follow the vaccination.
General Information
Acetaminophen is generally used to relieve pain and fever associated with the common cold, flu, viral infections, or other disorders where pain or fever may occur. It is also used to relieve pain in people who are allergic to aspirin, or those who cannot take aspirin because of potential interactions with other drugs such as oral anticoagulants. It can be used to relieve pain from a variety of sources, including arthritis, headache, muscle ache, menstrual cramping, and tooth and periodontic pain, although it does not reduce inflammation.
Cautions and Warnings
Do not take acetaminophen if you are allergic or sensitive to any of its ingredients. Do not take acetaminophen for more than 10 days in a row (5 days for children) unless directed by your doctor. Do not take more than is prescribed or recommended on the package.
Use this drug with extreme caution if you have kidney or liver disease or viral infections of the liver. Large amounts of alcohol increase the liver toxicity of large doses or overdoses of acetaminophen. Avoid alcohol if you regularly take acetaminophen. Some people are more sensitive to this effect than others.
Possible Side Effects
This drug is relatively free from side effects when taken in recommended doses. For this reason it has become extremely popular, especially among those who cannot take aspirin. V Rare: large doses or long-term use may cause liver dam-
age, rash, itching, fever, lowered blood sugar, stimulation,
yellowing of the skin or whites of the eyes, and/or a change
in the composition of your blood. Contact your doctor if
you experience any side effect not listed above.
Drug Interactions
o Large doses of barbiturate drugs, carbamazepine, phenytoin and similar drugs, izoniazid, rifampin, and sulfinpyrazone may increase the chances of liver toxicity if taken with acetaminophen.
• Alcoholic beverages increase the chances for liver toxicity
and possible liver failure associated with acetaminophen.
Food Interactions
None known.
Usual Dose
Adult and Child (age 12 and over): 325-650 mg 4-6 times a day,
or 1000 mg 3-4 times a day. Avoid taking more than 4 g (twelve
325-mg tablets) a day for long periods of time. Child (age 11): 480 mg 4-5 times a day. Child (age 9-10): 400 mg 4-5 times a day. Child (age 6-8): 320 mg 4-5 times a day. Child (age 4-5): 240 mg 4-5 times a day. Child (age 3): 160 mg 4-5 times a day. Child (age 1-2): 120 mg 4-5 times a day.
Child (age 4-11 months): 80 mg 4-5 times a day. Child (under age 4 months): 40 mg 4-5 times a day.
Overdosage
Acetaminophen is a commonly used ingredient in many over-the-counter (OTC) medications. Always check the list of ingredients when using more than one OTC medication to ensure that the combined dosage is within guidelines and to avoid accidental overdose.
Acute acetaminophen overdose may cause nausea, vomiting, sweating, appetite loss, drowsiness, confusion, abdominal tenderness, low blood pressure, abnormal heart rhythms, yellowing of the skin and whites of the eyes, and liver and kidney failure. Liver damage has occurred with 12 extra-strength tablets or 18 regular-strength tablets, but most people need larger doses-20 extra-strength or 30 regular-strength tablets—to damage their livers. Regular use of large doses for long periods-30004000 mg a day for a year—can also cause liver damage, especially if alcohol is involved. In case of overdose, induce vomiting as soon as possible with ipecac syrup—available at any pharmacy —and take the victim to a hospital emergency room. ALWAYS bring the acetaminophen bottle or container.
Special Information
Unless abused, acetaminophen is a beneficial, effective, and relatively nontoxic drug. Follow package directions and call your doctor if acetaminophen does not relieve pain in 10 days for adults or 5 days for children. Call your doctor if fever gets worse or persists longer than 3 days.
Alcoholic beverages will worsen the liver damage that acetaminophen can cause. People who take this drug on a regular basis should limit their alcohol intake.
If you forget to take a dose, take it as soon as you remember. If it is within an hour of your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Acetaminophen ‘is considered safe during pregnancy when taken in usual doses. Taking continuous high doses of the drug may cause birth defects or interfere with fetal development. Three cases of congenital hip dislocation appear to have been associated with acetaminophen. Check with your doctor before taking this drug if you are or might be pregnant.
Small amounts of acetaminophen may pass into breast milk, but the drug is considered harmless to nursing infants.
Seniors: Seniors may take acetaminophen as directed by a doctor.
Jul
15
DIAGNOSIS AND TREATMENT OF PROSTATE CANCER.
July 15, 2009 | Leave a Comment
DIAGNOSIS
In most cases, cancer develops in the outer part of the prostate gland, where it can be felt as a small, hard lump sertraline depression .
Cancer of the prostate is usually diagnosed during a digital rectal examination claritin news . If the prostate gland is cancerous, it
will feel hard and knobbly antibiotic bactrim uses .
The diagnosis may be confirmed in a number of ways cost of singulair . These include:
• Ultrasound scanning of the prostate gland, whereby a probe is inserted into the rectum and detects tumours as
abnormal echoes of sound twins clomid .
• Urography, also known as pyelography, which is a procedure for obtaining X-rays of the urinary tract, which
involves introducing a radio-opaque medium into the bloodstream cymbalta exhaustion .
• Prostatic biopsy, whereby a sample of tissue is removed for examination under the microscope ethoheptazine asprin meprobamate . This is probably
the most reliable way of determining whether a growth is benign or malignant tetracyclines azithromycin or erythromycin . A small sample of tissue is removed from
the tumour under local anaesthetic with a fine needle prescribe soma .
• A blood test, which measures the level of the protein prostate specific antigen (PSA) pic of clonidine hcl . This is a protein
manufactured only by prostate cells cytoxan adriamycin dexamethasone . If the blood test reveals a normal level of PSA -that is less than 4 ng/ml - there
is very little chance of prostate cancer metoclopramide ekg . If it reveals a level of PSA that is between 4 and 10 ng/ml, there is a 20 per
cent chance of prostate cancer side effects of the medication methotrexate . And, if the level is above 10 ng/ml, there is a 60 per cent chance of prostate cancer clarithromycin 500mg tablets .
Unfortunately, small cancerous growths are often not revealed by this test, which can give both false negatives and false
positives lisinopril and viagra interaction . It has a useful role, though, in conjunction with other tests, such an ultrasound scan or a CT scan action attack celebrex class heart .
• A blood test for anaernia lithium 3.6 volt ls 14500 c .
• A blood test to check kidney function levitra market share .
• A blood test which measures the level of prostatic acid phosphatase (PAP) sertraline hcl 25 mg tablet . This is a blood enzyme which indicates
whether prostate cancer has spread to form secondary bone cancer clozapine and drooling .
• A bone scan, which will enable doctors to ascertain how far the cancer has spread into the bones lithium chrysler . This is only
done once prostate cancer has been confirmed pharmacy penegra weight loss silagra cumwithuscom .
• A CT scan, which uses an electronic X-ray detector to build up a 3-D picture of your body in cross-section, as if
a slice had been taken from it no rx seroquel . This will enable doctors to see how far the cancer has spread into surrounding tissues benzoyl peroxide pregnancy .
• A lymphangiogram, which involves injecting a special dye into the lymph vessels and monitoring their progress 5buy sildenafil without prescription .
This enables doctors to see if cancer has reached the pelvic lymph nodes lexapro and withdraweral .
If your doctor finds a lump stop taking zyprexa . 800 mg ibuprofen high . testosterone powder suppliers .
If your doctor finds a lump during a digital rectal examination, you should try not to worry metronidazole and marijuana . This is easier said than
done but it is reassuring to know that most lumps are not in fact cancerous warfarin monitoring reporting inr nurses . It is estimated that in around half of the
cases sent for further tests, no trace of cancer is found depo provera geldings . A lump may be due to a bladder stone or it may have some other
benign cause purchase paroxetine .
ROUTINE SCREENING
How early prostate cancer is detected depends, to a large extent on where you live soma carisoprodol tablets 250 mg . In the UK, routine screening does
not, on the whole, happen as a matter of course, which means that few cancers - substantially under half - are caught in
the early stages finasteride and flomax . In the US, on the other hand, most men are screened annually, with the result that rather more cancers
of the prostate - well over half - are picked up in the early stages buy cheap tramadol tramadol ultram .
Routine screening can be done in several ways ducation sp cialis e gen ve . These include:
• A blood test measuring the level of the protein prostate specific antigen (PSA)
• A digital rectal examination, whereby the doctor feels the prostate through the rectum to see whether it has
become hard and knobbly clindamycin dosages .
• Transrectal ultrasound (TRUS) of the prostate gland paroxetine tab 40mg .
The value of screening
This is a highly controversial question, as there is some doubt as to whether or not the early treatment of prostate
cancer actually increases the chances of a cure what is apo ranitidine .
Prostate cancer tends to be a cancer associated with old age and cancers tend to grow more slowly as you get older imitrex nasal spray china .
Because prostate cancer is so slow-growing, there are many elderly men suffering from this disease who never actually die
of it castrate testosterone nmol l . Many of them die of something else before their cancer becomes life-threatening celebrex monograph .
Research into the value of early intervention continues buy online prilosec . The Medical Research Council in the UK is currently researching
this very question, with the help of urologists throughout the country what is naproxen 250mg used for .
The earlier the better?
It is sometimes possible to detect prostate cancer early enough to treat it successfully, but this is not always the case
and it is therefore not certain that the earlier the cancer is detected the better the chances of a cure zithromax albuterol medrol pack . Cancer of the
prostate is not always consistent in its response to treatment zoloft alternitive .
Sometimes it spreads rapidly and can cause death in a very short time - even as short a time as a year from diagnosis topamax ventriculomegaly .
Sometimes, on the other hand - more often than not, in fact - it progresses very slowly and can be kept under control for
a long time engles urso follmer . And sometimes it causes no symptoms at all, and it is only known that the patient suffered from it when a
postmortem is done after the patient has died from some other, quite different cause soma purchase to oklahoma usa .
National screening programmes for prostate cancer would be very expensive define clotrimazole . They are unlikely to be set up in Britain
until there are better ways of identifying which cases would benefit most from treatment naprelan 421 extended relief .
In the meantime, and until the results become available, many doctors are particularly keen on annual prostate specific
antigen (PSA) blood tests to detect early prostate trouble realize monohydrate fenil prednisone . This is not always available on the NHS lamisil distributor .
TREATMENT
Prostate cancer may be treated in a number of ways naltrexone for extended-release injectable suspension . Treatment varies widely from country to country, even from one
urologist to another absence seizures depakote . This is an unpredictable disease, and there is plenty of room for argument as to which treatment is
likely to be better ketoconazole 2 cream nizoral cream .
Treatment varies, in any case, according to how early the cancer has been discovered and on how far it has spread doxycycline herbal alternatives . If it
has spread beyond the prostate gland, the specialist is likely to decide that it is better to aim treatment at
controlling the condition rather than attempting to cure it atenolol impotence causing problem taking .
Treatment also depends on the patient - how old he is, and how well he is protonix for sale . In some cases, the side-effects of treatment
may outweigh the benefits, particularly as about half of all men aged between 70 and 80 develop prostate cancer which
never spreads beyond the prostate and which never becomes life-threatening is desyrel safe . In these cases, the best treatment of all is
no treatment avandia side effects etc .
However, if treatment is decided on, it may be done in the following ways:
• The surgical removal of the prostate, which is known as prostatectomy (see Chapter 7) usage of coumadin therapy .
• Radiotherapy, which involves passing radiation through the diseased tissue and so destroying the abnormal cells
or slowing down their development clotrimazole topical . This is usually given externally and done every day for several weeks depakote er effects testosterone . Radiotherapy is
particularly recommended for early prostate cancers, when it has the same success rate as surgery, and for particularly
large tumours within the prostate antabuse isnt working for me . Side-effects include diarrhoea, rectal discomfort, painful urination and blood in the
urine buy discount metformin without presciptions . It can also cause impotence as a result of the effects of radiation on the blood vessels supplying the penis metformin ranitidine .
If the cancer has spread to other parts of the body, patients may benefit from reducing their level of the male hormone
testosterone effexor xr and problems it treats . This can be done by:
• Orchidectomy, which is the surgical removal of the testes keyword lipitor . Surgical castration is obviously a drastic measure,
which can be very traumatic for the patient motrin vs aspirin . The testes may be replaced by egg-shaped implants which are inserted in the
scrotum to look and feel as much like the real thing as possible stay awake caffeine pills . Orchidectomy has several unpleasant side-effects, such
as hot flushes (a bit like those experienced by menopausal women), impotence and loss of libido zidovudine treatment .
• The administration of oestrogen drugs, which have the unfortunate side-effects of breast enlargement and the
reduction of libido soma posion the well .
• The administration of anti-androgens, which block the action of testosterone and thereby inhibit further growth
and spread of cancer clear liquid diet and caffeine .
• The administration of drugs that block the release of the pituitary hormone, which, in turn, controls the release
of testosterone femara and long term use . Known as medical castration, this has the inevitable side-effects of hot flushes, impotence and a low
sex drive, but is as effective as surgical castration and not as traumatic, either physically or psychologically thc and protonix . The
other great advantage that medical castration has over surgical castration is that it can be reversed tramadol and hydrocodone addiction . Drug therapy has
improved considerably in recent years, and injections these days may only need to be given every 12 weeks australia viagra cialis purchase .
• The administration of an anti-androgen in combination with medical castration ryobi lithium ion drill .
• Radiotherapy, which shrinks the prostate gland or relieves the pain of secondary bone cancer, if it exists duloxetine for oab .
OUTLOOK
Overall survival with prostate cancer at five years is 20 per cent paxil drug family . If the cancer is diagnosed at an early stage, the
outlook is very good diazepam withdrawal and zoloft . According to the Cancer Research Fund, as many as 43 per cent live for five years or more following
diagnosis errin norethindrone tablets instructions . If, on the other hand, the cancer has already spread beyond the prostate gland and fails to respond to hormone
treatment, the outlook is poor picture of risperdal .
Taking a positive approach
It is well worth bearing in mind that those patients suffering from cancer - any kind of cancer - who are able to develop
and maintain a positive approach to their illness usually cope better with it, and actually fare better, than those
patients who get very depressed and negative in their outlook deprenyl testosterone . Some doctors actually believe that a positive approach
helps to reinforce the body’s natural defence mechanisms and immune responses, and may therefore enable a person to fight
an illness - and to win cheap inexpensive viagra .
Eating for a healthy prostate
There is a much lower incidence of prostate cancer in some parts of the world, which indicates that certain diets may
well protect against prostate cancer, while others may actually trigger it what is methocarbamol 750 . In particular, men in China and Japan are
known to have a lower incidence of prostatitis, enlarged prostate and prostate cancer than their counterparts in the
West causes high female testosterone cure . If Eastern men move to the West, their incidence rate rises again, indicating that they do not have an inherited
protection and suggesting that it is their way of life and eating habits while living in the East that offer them
protection finasteride generic india . The traditional Eastern diet is low in fat, consisting of soya products, fish, grains and vegetables,
particularly yellow, orange, red and green vegetables, and those from the cabbage and turnip families (see also DIET,
Chapter 10) positive paxil effects .
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs) side-effects and downsides
July 5, 2009 | Leave a Comment
NSAID Nastiness
The biggest recognized drawback to NSAIDs has always been their tendency to cause digestive tract distress. That’s because of how they work in the body. These drugs block the manufacture of a class of chemicals called prostaglandins. These hormonelike compounds have a profound impact on cells throughout the body.
f you sprain your ankle, have a tooth extracted, or develop arthritis, you will experience pain, redness, warmth, and inflammation. This is in large measure due to prostaglandins made by a protein called cyclooxygenase-2 (COX-2). Blocking their formation with NSAIDs like ibuprofen or naproxen means there is less inflammation and pain.
But some prostaglandins made by another protein, COX-1, are beneficial. They protect the stomach lining from damage. If you disrupt their production by blocking COX-1 with NSAIDs, many people complain of symptoms such as nausea, indigestion, abdominal pain, constipation, and diarrhea. It is estimated that more than half of the people taking NSAIDs experience unpleasant gastrointestinal (GI) symptoms.68
Far more worrisome are ulcers, which can bleed or, in the worst case, perforate. A bleeding ulcer or a hole in the stomach wall can very quickly turn into a life-threatening crisis. All too often there are no early warning symptoms that someone is on the verge of disaster.
Although it is hard to know exactly how many people are affected each year, experts estimate that more than 100,000 are hospitalized because of complications caused by NSAIDs and more than 16,000 die.’ The researchers admit these numbers are probably conservative.
Although most physicians have known for a long time that NSAIDs can be hard on the stomach, they didn’t realize that the same drugs can be disastrous for the small intestine. That’s because until recently the small intestine could not be examined directly. Now a small video camera the size of a capsule can be swallowed and the image it transmits can be monitored on a television as the capsule passes into the small intestine.
“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain largely a ’silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem. 70 Furthermore, the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDs “7l
—Michael M. Wolfe et al., The New England Journal of Medicine, 1999
Investigators discovered in a preliminary study that 71 percent of the patients taking NSAIDs had erosions or ulcers in their small intestine, compared to only 10 percent of those not taking these drugs.72 This unexpected finding suggests that NSAID damage to the intestinal tract is even more common and serious than previously suspected.
Frequently, aspirin is sold with an enteric coating that protects the stomach from harm. The coating is designed to dissolve in the small intestine instead, releasing the aspirin there. When we asked gastroenterologist Waqar Qureshi, MD, chief of endoscopy at Baylor University and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, about such formulations, he said, “Enteric-coated drugs might, in fact, cause more damage than regular medications.”" This is because the damage occurs in the small intestine, where the tissue is less resistant to irritating chemicals than the stomach is and where the damage may go undetected.
The COX-2 Catastrophe
With such GI toxicity associated with_ NSAIDs, it’s hardly any wonder that doctors and patients were excited to learn about COX-2 inhibitors. Vioxx, Bextra, and Celebrex were introduced with the idea that they would be gentler on the stomach than other NSAIDs. That’s because these newfangled members of the class were supposed to be “selective.” They would block only the COX-2 enzyme, relieving inflammation as well as aspirin or other NSAIDs do. By sparing the COX-1 enzyme, prostaglandins would be created to protect the stomach from irritation. The promise: pain relief with much less risk of digestive upset or stomach ulcers.
As soon as COX-2 inhibitors were introduced in 1999, they took off like rocket ships. Aggressive advertising directed at consumers and enthusiastic prescribing by physicians turned Celebrex and Vioxx into overnight sensations. Tens of millions of people started popping these pills in the hope that they would relieve pain without the usual problems.
There was just one big oops. By selectively blocking the COX-2 enzyme to relieve inflammation, a crucial prostaglandin called prostacyclin was also reduced. This compound is our friend. It dilates blood vessels and keeps the sticky part of blood, called platelets, from clumping together to form clots. Without adequate amounts of prostacyclin circulating throughout the body, there is an increased risk of blood clots that can trigger heart attacks and strokes.
Early in the development of COX-2 inhibitors some researchers worried that there could be cardiovascular dangers. In 2000, a large Vioxx study suggested that the pain reliever could cause an increased risk of heart attacks and other vascular complications. 74
Neither the FDA nor the manufacturer acted on those early warning flags. In one of the darkest hours in the history of American medicine, millions were allowed to continue taking COX-2 inhibitors until the fall of 2004. By then the handwriting was on the wall. First Vioxx and then Bextra were pulled off the market. In the interim, it is estimated that more than 100,000 people who had been taking COX-2 inhibitors suffered heart attacks and strokes.75 According to FDA safety officer David Graham, MD, as many as 40,000 people may have died .71
The Broken Promise
If COX-2 inhibitors like Vioxx, Bextra, and Celebrex had truly protected the digestive tract from damage, it might have been easier to justify their approval, aggressive marketing tactics, and high prices. But an editorial in the Journal of the American Medical Association described the science behind COX-2 inhibitors as a “house of cards” based on wishful thinking. They were marketed “with unrealistic expectations about pain relief, marked gastrointestinal protection, and safety.”77
Canadian researchers tracked hospital admissions caused by gastrointestinal bleeding before and after the introduction of COX-2 inhibitors (Vioxx, Celebrex, and Mobic). Instead of dropping when the new drugs became available, as investigators had expected, the rate of hemorrhage and hospitalization for older people paradoxically rose by 10 percent .78 British researchers asked a similar question: Would COX-2 inhibitors be easier on the stomach than traditional NSAIDs? The an-
FDA NSAID WARNING
“NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, m ocardial infarction [heart attack], and stroke, which can be fatal.-71 rt
—FDA Public Health Advisory, April 7, 2005
saver: There was no evidence to suggest that the newer drugs were less harmful to the digestive tract.” In hindsight, it looks as if we were all sold an expensive bill of goods.
Other NSAID Troubles
No sooner did the FDA wake up to the risk of heart attacks and strokes associated with COX-2 inhibitors than the agency had to deal with the possibility that other NSAIDs might pose a similar problem. Decades after these drugs began to be marketed, the FDA reviewed the data and decided that all such prescription pain relievers should carry a stronger black-box warning.
The FDA goes on to warn that people with risk factors for cardiovascular disease are especially vulnerable to these life-threatening problems. That includes almost everyone with arthritis. If you accumulate enough birthdays to develop osteoarthritis, you are bound to have some hardening of the ar-
OTHER NSAID ADVERSE EFFECTS
• High blood pressure
• Fluid retention, edema
• Congestive heart failure
• Stomach ulcer (bleeding)
• Perforation of the stomach
• Perforation of the small intestine
• Perforation of the large intestine
• Kidney damage
• Severe allergic reaction
• Skin rash (toxic)
• Itching
• Stevens-Johnson syndrome
• Liver damage
• Blood disorders (anemia)
• Asthma worsening
teries. But that’s not all. The FDA has gone on to emphasize other problems with NSAIDs as well.
It is easy for your eyes to glaze over when looking at such a list. You may also assume that some of these potential side effects are rare events, but that could be a dangerous assumption. A study of older and potentially sicker patients revealed a startling incidence of kidney damage associated with Celebrex. More than 20 percent of the people taking this COX-2 inhibitor experienced kidney toxicity (fluid retention, high blood pressure, and kidney failure).81 If patients had some kidney impairment before the study started (a common situation in older people), the likelihood of kidney toxicity jumped to more than 50 percent! We assume other NSAIDs are likely to have a similar effect on kidney function.
NSAID Survival Strategy
By now it should be clear that nonsteroidal anti-inflammatory drugs, including the COX-2 inhibitors, can be trouble with a capital T! They aren’t all that effective for arthritis, especially of the knee. Some NSAIDs may actually contribute to joint deterioration if they are taken for years. Then there’s the risk of serious side effects like bleeding ulcers, hypertension, heart
Aspirin
Aspirin prevents blood clots and lowers the risk of heart attacks and strokes. Unlike other NSAlDsJt does not raise blood pressure.
Aspirin remains the best buy for pain relief. At pennies a day, it reduces the inflammation that is at the root of so many chronic ailments, including arthritis, diabetes, and Alzheimer’s disease. Regular aspirin users seem to develop fewer cancers of the colon, rectum, prostate, pancreas, ovary, skin, lung, and breast.
Downside: Damage to the stomach lining. The potential for indigestion, gastritis, and ulcers makes this drug inappropriate for many. Bleeding or perforated ulcers can be life threatening. Anyone on long-term aspirin therapy must be under medical supervision.
Cost: Approximately $2 to 5 per month
ASPIRIN AND BAKING SODA
Although it will not be identical to Alka-Seltzer, you can create your own buffered, soluble aspirin. In a glass, combine:
• 2 uncoated aspirins
• 8 ounces club soda or sparkling water
•’/p teaspoon baking soda
• Juice from 1/4 wedge lemon
Wait till the aspirins dissolve and then drink. This formula is not appropriate for people on a sodium-restricted diet.
attacks, strokes, and kidney or liver damage. Why would anyone in his or her right mind take such medicine?
The most obvious answer is that there aren’t very many pharmaceutical alternatives. Doctors have relatively little to offer beyond NSAIDs when it comes to pain and inflammation. And sometimes you hurt so much that you need something to help you move your bones around. When used in the short-term and with appropriate safeguards, it may be possible to take an NSAID. But which one should you consider?
Aspirin remains our first choice by far. No other NSAID or OTC pain reliever has ever been proven more effective. In addition, aspirin reduces the risk of heart attacks and thrombotic (clotting) strokes. As a bonus, there is growing evidence that aspirin may diminish the likelihood of developing many common cancers. We discourage the use of enteric-coated aspirin because this merely moves the aspirin to the small intestine, where it can do serious damage.
Our preferred method for taking aspirin is as a liquid. In Europe, Australia, Canada, New Zealand, and dozens of other countries you can find several soluble, effervescent aspirin products. Brands like Aspro and Disprin are very popular because all you do is drop the aspirin tablets into a glass of water, where they fizzle and dissolve within seconds. This makes them a little faster acting and possibly a little less irritating to the stomach (though there is no guarantee of protection).
Soluble aspirin never really caught on in the United States, except in the form of Alka-Seltzer. It is a combination of as-pirin, sodium bicarbonate, and citric acid advertised for relief of “acid indigestion, sour stomach, heartburn with headache, body aches and pains.” The trouble with Alka-Seltzer is that it’s way more expensive than plain aspirin and there’s too much sodium for folks who have congestive heart failure or salt-sensitive hypertension.
If you would prefer not to pay an arm and a leg for fizzy aspirin, you could make your own soluble aspirin for a fraction of the cost. All you have to do is buy some club soda or sparkling water. Drop two regular-strength aspirin tablets in the fizzy water and let them dissolve. It will take a couple of minutes.
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs)
July 5, 2009 | Leave a Comment
NSAIDs
After the roller-coaster ride with cortisone, you would think that the medical establishment would have been more careful about the next big thing. Maybe doctors were so anxious to find something safer for arthritis that they didn’t appreciate that they might be jumping from the frying pan into the fire.
Aspirin was the first nonsteroidal anti-inflammatory drug (NSAID). It was introduced in 1899 and was a mainstay of arthritis treatment for most of a century. Aspirin works a little differently from other drugs in this class and has advantages that make it unique. For almost 100 years aspirin was the Rodney Dangerfield of the drugstore. It got relatively little respect. Because aspirin was available over the counter, it took physicians a long time to appreciate how valuable it could be against heart attacks, strokes, and even cancer. Because it has been around for so many years, doctors have often assumed that newer medicines would provide better pain relief. And they (and their patients) have often been disappointed.
The launch of prescription indomethacin (Indocin) in 1965 really put NSAIDs on the map. These drugs became some of the most successful pharmaceuticals of their time. Whenever a new anti-inflammatory drug came along, it generated tremen-
NON-ASPIRIN NSAIDS
• Celecoxib (Celebrex)
• Diclofenac (Cataflam, Voltaren)
• Etodolac (Lodine)
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid)
• Ibuprofen (Advil, Motrin, etc.)
• Indomethacin (Indocin)
• Ketoprofen (Orudis, Oruvail)
• Ketorolac (Toradol)
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Anaprox, Naprosyn)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Sulindac (Clinoril►
• Tolmetin (Tolectin)
dons excitement. Drugs like sulindac (Clinoril), piroxicam (Feldene), ibuprofen (Motrin), and naproxen (Naprosyn) had their time in the limelight. Then along would come something newer and doctors would switch their allegiance.
Those of us who have observed this game of medicinal musical chairs for more than 40 years have become somewhat cynical about this class of pain relievers. The fickle switching from one drug to another suggests to us that no particular NSAID really stands out. There have not been really great head-to-head clinical trials that prove one drug is superior to another or significantly safer than others in the class.
If truth be told, these drugs really don’t work all that well when it comes to relieving the pain and inflammation of arthritis, especially of the knee. Despite the fact that tens of millions of people have spent countless billions of dollars on these medications, there are surprisingly few data demonstrating long-term benefit with their use. A scientific analysis of 23 different studies was published in the British Medical Journal in 2004. This meta-analysis involved more than 10,000 patients and revealed a shocking discovery: “NSAIDs can reduce short-term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support prolonged use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.”‘
What a bombshell! This review of the world’s medical literature on NSAIDs concluded that such drugs are reasonable only for short-term use. But arthritis is a long-term affair. The only conclusion we can draw: Regular use of such drugs is inappropriate for a chronic condition like arthritis.
Even more alarming, some evidence suggests that these medications may actually be harmful to arthritic joints. 61,62,63 Researchers in the Netherlands followed more than 1,600 patients for several years. Patients who had been taking the NSAID diclofenac (Arthrotec, Cataflam, Voltaren) experienced greater joint deterioration as determined by x-ray evidence. The authors concluded, “Our data suggest that diclofenac may not be harmless and may induce accelerated progression of hip and knee OA [osteoarthritis].”64
OTC Mistake?
When NSAIDs like ibuprofen (Advil, Cap-Profen, Excedrin 113, Genpril, Haltran, lbuprin, Ibuprohm, Ibu-Tab, Medipren, “OTC analgesics including NSAIDs are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects. -,65
—C. Mel Wilcox et al., Journal of Rhouniatology, 2005
Midol IB, Motrin IB, Nuprin, Pamprin IB, Profen, etc.) and naproxen (Aleve) were approved for over-the-counter (OTC) sale, millions of people were delighted to have access to these powerful anti-inflammatory drugs. An Rx-to-OTC switch was a radical concept back in 1984. Even though the FDA assured consumers that such drugs were so safe that they did not require medical supervision, many physicians opposed the plan. They feared that side effects such as rash, fluid retention, high blood pressure, gastritis, and ulcers might make these drugs too dangerous for casual use. The FDA ignored the worriers.
Dear reader, we cannot tell you whether the decision to make NSAIDs available OTC was a blessing or a curse. The FDA has been incredibly inept at keeping track of adverse reactions to prescription medications. The agency’s track record on nonprescription pills is even worse. So, we really do not know how many ulcers, heart attacks, or other serious complications have occurred because of easy access to NSAIDs.
What we do know is that people are gobbling down these drugs almost like candy. Based on scientific surveys (Roper and the National Consumers League), it is estimated that 23 million Americans use a nonprescription NSAID (ibuprofen or naproxen) every day.” Only about one in five consumers bothers to read the directions on the label and fewer than one in three checks out dosing instructions. Perhaps that’s why one-fourth of them take more than the recommended dose. Scarier still, roughly half of the people surveyed were unaware of the potential for NSAID toxicity or just plain didn’t care.
Jul
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Drugs for Asthma Treatment
July 1, 2009 | Leave a Comment
Asthma
Bronchial asthma is a spasmodic obstructive disease of the airways, and symptoms may vary from wheeziness to severe bronchoconstriction that can be fatal. Attacks may be precipitated by exposure to allergens, which may vary from house dust to pollen, fungal spores and animal hair. In some susceptible patients certain drugs,
including aspirin, may initiate a severe asthmatic attack. Treatment is basically with
drugs that have a relatively selective bronchodilatory action, and, in the case of those
drugs given by aerosol inhalation, patients must be given careful instruction in the optimum response is to be obtained. Ephedrine and
use of the inhaler device if the optii
isoprenaline have been used in asthma, but have been virtually replaced by salbutamol and other more selective P,-adrenoceptor stimulants. Adrenaline also has a powerful bronchodilator action, but it may cause cardiac arrhythmias, and it is now used mainly in acute anaphylaxis. (See page 10.)
Salbutamol, now widely used, may be given orally by aerosol inhalation, or, in acute conditions, by injection. Ipratropium and oxitropium are anticholinergic agents with a relatively selective bronchodilator action, and are of value in patients who cannot tolerate sympathomimetic agents of the salbutamol type. Other bronchodilators are the xanthines aminophylline and theophylline, but side-effects
Some long-acting may limit their use. ome xanthine products have a sustained action associated with reduced side-effects, but such products are not necessarily bioequivalent, and a change from one product to another should not be made without good cause. Corticosteroids are also of value in both the prophylaxis and treatment of asthma, and those given by inhalation are beclomethasone, budesonide and fluticasone. The recently introduced salmeterol is a derivative of salbutamol intended for use together with inhaled corticosteroid therapy in the prophylactic treatment of asthma. It has a slow initial action, but twice daily treatment is claimed to give relief over 24 hrs. Other drugs for the prophylaxis of asthma are sodium cromoglycate and nedocromil, given by oral inhalation of a dry powder. Ketotifen is an antihistamine with some of the properties of sodium cromoglycate.
Approved names Brand names
bambuterol Bambec
eformoterol Foradil
fenoterol Berotec:
reproterol Bronchodil
salbutamol Salbulin,
Ventolin, Volmax
Aerolin Autohaler, aerosol inhalation Salbulin, Ventolin products
salmeterol Serevent
terbutaline Bricanyl, Monovent
tulobuterol Respacal other stimulat
orciprenaline Alupent
oxitropium Oxivent
xanthines
aminophylline Pecram, Phyllocontin Continua 119
theophylline Choledyl, Lasma, Nuelin,
Slo-Phyllin, Theo-Dur, Uniphyllin
beclomethasone Becotide, Becodisks, Becloforte
budesonide Pulmicort
fluticasone Flixotide
sodium Intel cromoglycate
ketoprofen Zaditen
nedocromil Tilade anticholinergic agents
pratroplum Atrovent
oxitropium Oxivent