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Proventil (Albuterol)
July 10, 2011 | Leave a Comment
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Aug
1
Chlorpheniramine Maleate
August 1, 2009 | Leave a Comment
Generic Name
Chlorpheniramine Maleate
(KLOR-ten-ERE-uh-mene MAL-ee-ate) M
Brand Names
Aller-Chlor Efidac 24
Chlor-Trimeton Pediox S
Chlor-Trimeton Allergy 8 Hour Prohist+8 Chlor-Trimeton Allergy 12 Hour QDALL AR
The information in this profile also applies to the following drugs: Generic Ingredient: Cyproheptadine Hydrochloride 0
Generic Ingredient: Dexchlorpheniramine Maleate 19
Type of Drug Antihistamine,
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy, and other symptoms of allergy such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from body cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients.
Use chlorpheniramine maleate with care if you have a history of thyroid disease, heart disease, high blood pressure, or diabetes. This drug should be avoided or used with extreme care if you have narrow-angle glaucoma, stomach ulcer or other stomach problems, enlarged prostate, or problems passing urine. It should not be used by people who have deep-breathing problems such as asthma, emphysema, or chronic bronchitis.
Possible Side Effects
V Less common: rash or itching, sensitivity to bright light, increased sweating, chills, lowered blood pressure, headache, rapid heartbeat, sleeplessness, dizziness, disturbed coordination, confusion, restlessness, nervousness, irritability, euphoria (feeling “high”), tingling in the hands or feet, blurred or double vision, ringing in the ears, upset stomach, appetite loss, nausea, vomiting, constipation, diarrhea, urinary difficulties, chest tightness, wheezing, stuffy nose, and dryness of the mouth, nose, or throat. Young children may also develop nervousness, irritability, tension, and anxiety.
Drug Interactions
• chlorpheniramine maleate should not be taken with a mono-amine oxidase inhibitQ(aMkdepiessank, because the combination may cause severe side effects.
• The effects of sedatives, benzodiazepines such as diazepam, and sleeping medications will be increased when any of these drugs is combined with chlorpheniramine maleate. It is extremely important for your doctor to know if you are taking any other medication with chlorpheniramine maleate so that the dosage of that medication can be properly adjusted.
• Anti chol inergenics may cause an increase in side effects of chlorpheniramine maleate.
• Be extremely cautious when drinking alcoholic beverages while taking this drug, which enhances the intoxicating and sedating effects of alcohol.
Food Interactions
You may take this drug with food if it upsets your stomach.
Usual Dose
chlorpheniramine
Adult and Child (age 13 and over): 4 mg every 4-6 hours; do not take more than 24 mg a day.
Child (age 6-12): 2 mg every 4-6 hours; do not take more than 12 mg a day.
Child (age 2-5): 1 mg every 4-6 hours; do not take more than 4 mg a day.
chlorpheniramine, Sustained-Release
Adult and Child (age 13 and over): 8-12 mg at bedtime, or every 8-12 hours during the day; do not take more than 24 mg a day. Child (age 6-12): 8 mg during the day or at bedtime.
Child (under age 6): not recommended.
Cyproheptadine
Adult and Child (age 15 and over): 4-20 mg a day; do not exceed 32 mg a day.
Child (age 7-14): 4 mg 2-3 times a day; do not exceed 16 mg a day.
Child (age 2-6): 2 mg 2-3 times a day; do not exceed 12 mg a day.
Dexchlorpheniramine
Adult and Child (age 12 and over): 2 mg every 4-6 hours. Child (age 6-11): 1 mg every 4-6 hours.
Child (age 2-5): 0.5 mg every 4-6 hours.
Dexchlorpheniramine, Sustained-Release
Adult and Child (age 12 and over): 4-6 mg every 8-10 hours and at bedtime.
Child (age 6-11): 4 mg once a day and at bedtime. Child (under age 6): not recommended.
Tripelennamine
Adult and Child (age 12 and over): 25-50 mg every 4-6 hours; do not take more than 600 mg a day. Adults may take up to 3100-mg, sustained-release tablets a day, although this much is not usually needed.
Child (under age 12): 2 mg per lb. of body weight a day in divided doses; no more than 300 mg a day should be given.
Overdosage
Symptoms of overdose include depression or stimulation, especially in children; dry mouth: fixed or dilated pupils; flushing of the skin; upset stomach; unsteadiness; and convulsions. Overdose victims should be made to vomit as soon as possible with ipecac syrup—available at any pharmacy—to remove excess drug from the stomach. Take the victim to a hospital emergency room immediately if the victim is unconscious.or if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause tiredness or loss of concentration: Be extremely cautious when driving or doing anything that requires close attention.
If you forget a dose of this drug, 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
PregnancylBreast-feeding., Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of some antihistamines pass into breast milk. NV ing mothers who must take chlorpheniramine maleate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects. Dosage reduction may be needed.
Aug
1
Cevimeline
August 1, 2009 | Leave a Comment
Generic Name
Cevimeline (seh-VIM-ih-lene) 9
Brand Name Evoxac
Type of Drug Cholinergic.
Prescribed For
Dry mouth in people with syndrome.
General Information
Sj6gren’s syndrome jS a group 0j symptoms related to a lack of bodily secretions. People with this condition have very dry eyes and mucous membranes, facial lesions, and neck swelling. It often occurs in menopausal woman and is often associated with rheumatoid arthritis, poor blood circulation in the legs, and tooth decay. Cevimeline increases secretions in the mouth by binding to specific nervous system receptors and causing the release of more saliva.
Cautions and Warnings
Do not take cevimeline if you are allergic or sensitive to any of its
ingredients.
This drug may make breathing more difficult and worsen lung conditions such as asthma, chronic bronchitis, or chronic obstructive pulmonary disease (COPD).
Eye conditions like glaucoma or inflammation of the iris may be worsened by cevimeline.
Cevimeline may affect the heart, and some people with severe heart disease, including those with a history of severe angina or heart attack, may not be able to compensate for this effect.
Cevimeline may worsen gallstones and kidney stones and should be avoided by people with a history of these conditions.
Cevimeline may cause visual blurring, especially at night.
Possible Side Effects
✓ Most common: excessive sweating, headache, nausea, sinus irritation, respiratory infection, runny nose, and diarrhea.
✓ Common: upset stomach, abdominal pains, urinary infection, coughing, and sore throat.
✓ Less common: vomiting, back pain, injury, rash, conjunctivitis (pinkeye), dizziness, bronchitis, severe joint pain, fatigue, bone pain, sleeplessness, hot flushes, excess salivation, chills, and anxiety.
✓ Rare: frequent urination, weakness, and flushing. 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
• Combining cevimeline with a beta blocker can lead to heart rhythm disturbances.
• Cevimeline may interfere with the effects of anticholinergics, found in Some medications for abdominal or stomach spasms or cramps.
• Cholinergics such as bethanechol, donepezil, physostigmine, pilocarpine, and pyridostigmine can add to the effects of cevimeline.
• Some drugs may interfere with the breakdown of cevimeline in the liver, increasing the chance of drug side effects. These include amiodarone, celecoxib, chlorpheniramine, cimetidine, ciprofloxacin, clarithromycin, clomipramine, cocaine, diltiazem, erythromycin, fluconazole, fluoxetine, halofantrine, indinavir, itraconazole, ketoconazole, methadone, mibefradil, nelfinavir, paroxetine, quinidine, ranitidine, ritonavir, saquinavir, and terbinafine.
Food Interactions
Grapefruit juice may interfere with the breakdown of cevimeline in the liver, increasing the chance of drug side effects. Food interferes with the absorption of cevimeline into the bloodstream. Take this drug on an empty stomach.
Usual Dose
Adult: 30 mg 3 times a day. Child: not recommended.
Overdosage
Overdose symptoms can include exaggerated drug side effects including headache, visual impairment, excess tearing and/or sweating, difficulty breathing, stomach or intestinal spasms, nausea, vomiting, diarrhea, changes in heart rhythm, blood pressure changes, shock, mental confusion, and tremors. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
cevimeline may cause blurred vision, possibly interfering with driving or performing tasks that require reliable vision, especially at night or in low light.
If you sweat excessively while taking cevimeline, be sure to drink a lot of water. Excessive sweating can lead to dehydration.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Pregnant women should take cevimeline only if it is considered crucial by your doctor, since its effect on the developing fetus is not known.
It is not known if cevimeline passes into breast milk, but nursing mothers who must take this drug should consider using infant formula.
Seniors: Older adults should be cautious about using this drug because of its possible effects on the kidney, liver, and heart, and on other diseases or medications.
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
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. If 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. 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 ”
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. 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.
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 .
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.” 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?
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 arteries. 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.
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
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.
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
• 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
Corticosteroids in Arthritis Treatment
July 5, 2009 | Leave a Comment
Corticosteroids
When cortisone was first introduced in the 1950s it was heralded as a wonder drug. Doctors became overnight heroes because they helped patients who had been crippled by rheumatoid arthritis get out of bed and begin functioning again. Even people with milder conditions like osteoarthritis, allergies, asthma, and eczema were thrilled because corticosteroids relieved their symptoms amazingly well. But the very reason these medications were so successful was also their Achilles’ heel. As great as they are at easing inflammation, they profoundly affect cells throughout the body. Taking high doses for long periods of time is a little like dancing with the devil.
Once people woke up to the downside of steroids, the drugs lost their luster and fell into disfavor. Don’t get us wrong, though. These medications are incredibly valuable, especially for short-term use. People experiencing an arthritis flare-up, a bad ’sunburn, or a terrible case of poison ivy will benefit im- mensely from a pulsed dose of corticosteroids. When Joe went deaf in one ear, a course of prednisone restored his hearing. If used cautiously and with respect for their risks, these drugs can be extremely valuable. But using corticosteroids regularly to treat arthritis is a slippery slope.
COMMON CORTICOSTEROIDS
• Cortisone
• Dexamethasone
• Hydrocortisone
• Methylprednisolone
• Prednisolone
• Prednisone
• Triamcinolone
• Cataracts
• Osteoporosis
• Diabetes
• Spontaneous fractures
• Bone deterioration
• Insomnia
• Irritability
• Glaucoma
• Fluid retention
• Weight gain
• Moon face
CORTICOSTEROIDS
• Infections
• High blood pressure
• Blood clots
• Potassium loss
• Stomach ulcers
• Muscle weakness
• Menstrual disturbances
• Impaired wound healing
• Fatigue
• Steroid “psychosis”
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
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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.
Jul
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Allergy: Butterbur (Petasites hybridus)
July 3, 2009 | Leave a Comment
Butterbur (Petasites hybridus)
Another interesting allergy treatment involves the herb butter-bur. This botanical medicine has been used to treat symptoms of migraine headaches, asthma, and allergy. It has anti-inflammatory activity and blocks the formation of compounds called leukotrienes (pronounced lew-co-TRY-eens). These rascals cause all sorts of mischief in the nose, including itching, sneezing, swelling, and congestion. In some respects, leukotrienes may be even more of a problem than histamine. Leukotrienes contribute to the inflammatory cascade that underlies both allergy and asthma. The prescription asthma and allergy drug Singulair (montelukast) also works by inhibiting leukotriene formation. Swiss researchers compared butterbur with the antihistamine cetirizine (Zyrtec) in a randomized, double-blind study. They found that both products were equally effective at controlling symptoms, but butterbur was significantly less sedating than Zyrtec.
Q. I have suffered from chronic sinusitis, which in turn led to bronchitis and frequently into pneumonia. My physician put me on Allegra and then switched me to Clarinex.
I continued to have sinusitis and pneumonia annually for 5 years, so my doctor sent me to an allergist. He diagnosed several allergies and added a prescription for Nasacort to the Clarinex.
Two years ago, having suffered through another bout of sinusitis and pneumonia, I saw an integrative alternative medicine physician. He took me off Clarinex and prescribed butterbur, stinging nettles, and quercitin instead. I’ve taken this combination for 2 years and it has reduced the frequency of the sinusitis.I read that I should take butterbur only 6 weeks a year. Now I am concerned about the danger of liver damage.
A. Pharmacologist David Kroll, PhD, offered this clarification on butterbur. “I wanted to follow up on a reader who wrote to your newspaper column regarding the potential liver toxicity of butterbur (Petasites hybridus), an herb that’s become popular due to positive efficacy trials in migraine prevention and allergic rhinitis. While the herb is potentially toxic to the liver, it shouldn’t be a problem with high-quality products like Petadolex. I do-fear that some less honorable companies may latch onto this herb and not take such care with the high-tech extraction process that is necessary to reduce the risk. That might lead to some major liver injury cases.”
There is one fly in the ointment, however. Concerns have been raised about potential liver toxicity associated with compounds in butterbur. If the herbal preparation is not manufactured under very stringent quality-control conditions, there could be problems. As a result, we suggest that people use butterbur only temporarily (say, for 6 weeks during hay fever season) and that they monitor their liver enzyme activity with medical supervision. One product that should be safe is Petadolex. The German manufacturer is Weber and Weber, and it is available in the United States.
Jul
3
Allergy: Air Filters and Dehumidification
July 3, 2009 | Leave a Comment
Air Filters and Dehumidification
It is impossible to eliminate all the airborne allergens that trigger symptoms, but you can reduce the amount of dust floating around your rooms. Forget the old-fashioned fiberglass filters that only capture large particles. That is like trying to catch mosquitoes with a fishnet. We are not big fans of ozone-type air “purifiers” either. The fine folks at Consumer Reports warn that many small room-size ionizing air cleaners (or “electrostatic precipitators”) can generate ozone. As far as we’re concerned, ozone is the last thing someone with allergies or asthma needs, since it can be irritating and decrease lung function. Our first choice in air-cleaning technology is the HEPA (high-efficiency particulate air) filter. These devices are made of densely packed fibers that look like thick paper. The filters are pleated or folded and look like a mini-accordion. That way they maximize the air’s contact with the filter. Industrial-strength HEPA filters are used in computer clean rooms, pharmaceutical manufacturing plants, and hospitals, where it is essential to trap very small dust particles.
To install a whole-house HEPA filter you will need professional help. Ask a heating and air-conditioning (HVAC) expert whether they can retrofit such a system for your home. We think the Aprilaire Media Air Cleaner (formerly Space-Gard) is the place to start. This HEPA-type filter achieves 99 percent efficiency for particles bigger than five microns and 95 percent efficiency for the smallest one-micron-sized particles. (Pollen and mold spores usually range from 10 to 100 microns.) The longer you use the filter, the more efficient it becomes, at least to a point. It should be changed every one to two years.
If you cannot afford either a HEPA filter or an electronic air cleaner, consider the less efficient, do-it-yourself 4-inch American Air Filter for around $40 or the 1-inch 3M Filtrete for about $25. These should fit into your existing air return system in place of the old-fashioned filter you may be using.
We find it astonishing that there hasn’t been more clinical research on home air filtration. Pharmaceutical companies have spent hundreds of millions, if not billions, of dollars testing drugs to relieve symptoms. Only a pittance has been devoted to air quality in the home and its relationship to symptom relief.
One review of the available research concluded that “Among patients with allergies and asthma, use of air filters is associated with fewer symptoms. A small study showed that a HEPA air cleaner could reduce the amount of cat allergen levels in the house, but it did not demonstrate improvement in nasal symptom scores. Another tiny study showed that a HEPA filter could reduce dog allergens in the air.
A pilot study in two daycare centers demonstrated that when a HEPA filter was combined with a dehumidification system, airborne fungal spores were substantially diminished . Most people do not realize how serious dampness and humidity are for the home environment. Wherever there is moisture, mold has a marvelous opportunity to multiply. Mold spores can be highly allergenic.
The solution is to get rid of the source of the moisture and keep dampness under control by dehumidifying. The drier your home castle, the less likely it is that there will be mold, mildew, and dust mites. These latter nasty little critters live in mattresses, bedding, carpets, and furniture. Mite poop is also highly allergenic and is responsible for many people’s discomfort. Dry air makes it harder for mites to flourish.
By the way, we used to encourage folks with allergies or asthma to encase their mattresses and pillows with allergen-impermeable bed covers. The goal was to separate the allergy sufferer from the mite poop. Sadly, well-conducted clinical trials have established conclusively that this effort is ineffective.
Aprilaire Whole-House Air Cleaner
This high-efficiency particulate air (HEPA)-type filter is highly efficient, uses no electricity, lasts 1 to 2 years, and captures most pollen, mold spores, and large dust particles. The box that holds the filter needs to be installed next to your furnace by a heating, ventilating, and air-conditioning (HVAC) professional.
An alternative to the HEPA-type air filter is the Aprilaire Model 5000 Electronic Air Cleaner. Consumer Reports consistently gives this system its highest score.26
Downside: The Aprilaire HEPA-type filter needs to be changed every year or two. Initial installation requires a professional. The electronic alternative is pricey.
Cost: Initial installation of the HEPA filter box is done by your HVAC expert. Should cost less than $200. A packet of two filters is $50 to $60. The Aprilaire Model 5000 Electronic Air Cleaner is roughly $600. Installation can run an additional $200.