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Estazolam - Estrogens - Eszopiclone - Exemestane - Exenatide

August 13, 2009 | Leave a Comment

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

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

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

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

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

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

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.

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Jul

16

Adapalene

July 16, 2009 | Leave a Comment

Generic Name
Adapalene (uh-DAP-uh-lene)
Brand Name Differin
Type of Drug Anti-acne.

Prescribed For Acne.
General Information
Adapalene is similar to a retinoid. Retinoids are compounds related to vitamin A and are used in acne treatment. When adapalene is applied to an acne lesion, it modifies several of the processes involved in skin cell function. It reduces inflammation in the acne lesion and slows the formation of the material that fills the lesion. Very little adapalene is absorbed through the skin.
Cautions and Warnings
Do not use adapalene if you are allergic or sensitive to any of its ingredients. If you are sunburned, wait until your sunburn clears before applying adapalene to your skin. Avoid sun or sunlamp exposure while using adapalene. If you must be in the sun, be sure to apply sunscreen or wear protective clothing over areas where you have applied adapalene. Extreme wind or cold can also be irritating to skin where adapalene has been applied.
Adapalene can irritate the skin if used in combination with products such as medicated or abrasive soaps or cleansers, astringents, or soaps and cosmetics with a strong drying effect. Avoid products containing sulfur, resorcinol, or salicylic acid.
Adapalene can be highly irritating if it gets into your eyes or if it is applied to your lips, the angles of your nose, mucous membranes, cuts, abrasions, or sunburned or damaged skin. Avoid using depilatories or waxing while using adapalene.
Possible Side Effects
V Most common: redness, irritation, dryness, scaling, itching, and burning are common after applying adapalene to your skin. These effects usually occur during the first 24 weeks of adapalene use and subside as treatment continues. Symptoms may be severe enough to cause you to stop using adapalene; call your doctor if this happens to you.
V Rare: skin irritation, stinging sunburn, and worsening acne. Contact your doctor if you experience any side effect not listed above.

Drug Interactions
None known.
Usual Dose
Adult and Child (age 12 and over): Wash affected areas with a mild or soapless cleanser and apply a thin layer of adapalene at bedtime.
Child (under age 12): not recommended.
Overdosage
Chronic ingestion of adapalene can cause liver toxicity and other side effects associated with swallowing large amounts of vitamin A. Swallowing adapalene gel is extremely dangerous for pregnant women, who should not take more vitamin A than is contained in their prenatal vitamins. Infants who swallow adapalene should be taken to a hospital emergency room for treatment.
Special Information
Stop using adapalene and call your doctor if you develop a severe skin reaction or any sign of drug allergy or reaction (symptoms include rash, hives, itching, changes in complexion, and breathing difficulties or irregularities).
Adapalene may exacerbate your acne at first, but you should see improvement within 2 weeks.
If you must be in the sun, be sure to apply sunscreen or wear protective clothing over areas to which you have applied adapalene.
Using more than a thin film of adapalene does not produce better results and may be more irritating to the skin.
If you forget to apply a dose of adapalene, apply it as soon as you remember. If it is almost time for your next application of adapalene, skip the dose you forgot and continue with your regular schedule.
Special Populations
PregnancylBreast-feeding., Animal studies of adapalene have shown no effects on the fetus. Since the effect of adapalene on pregnant women is not known, the drug should be used only when the possible benefits outweigh the risks.
It is not known if adapalene passes into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors may use this drug without special precautions.

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Jul

16

Acitretin

July 16, 2009 | Leave a Comment

Generic Name
Acitretin (ah-sih-TREH-tin)
Brand Name
Soriatane
Type of Drug Antipsoriatic.
Prescribed For
Severe psoriasis; also prescribed for a variety of other skin conditions.
General Information
Acitretin is related to vitamin A and prescription drugs such as etretinate and isotretinoin. Acitretin is produced when etretinate is broken down in the body and its effects are very similar to etretinate. The way that acitretin works is not known. Its full benefit is not likely to be seen until you have taken it for 2 or 3 months. Your doctor is urged to use this medication only in cases of severe psoriasis that have not responded to other treatments because of the risks associated with acitretin.
Cautions and Warnings
Do not take acitretin if you are allergic or sensitive to any of its ingredients. Women who take acitretin must not be pregnant during treatment or for 3 years after the completion of treatment. It is not known if acitretin taken by men before conception is also a risk to the fetus.
A small number of people taking this drug have developed liver damage including jaundice (symptoms include yellowing of the skin and whites of the eyes). Acitretin has also been associated with hepatitis. People with kidney failure have much less acitretin in their blood than people with normal kidneys. Caution is advised for people with liver or kidney damage.
Cholesterol levels rise in 25-560/6 of people taking acitretin. Very large increases in triglycerides may be responsible for the few cases of pancreatitis (pancreas inflammation) that have been reported. Your doctor should measure your blood fat levels before you start taking acitretin and monitor them weekly or biweekly until your response to the medication has been determined. People with diabetes, who are obese, or who have a history of these conditions are at increased risk for high cholesterol levels as are people who drink alcohol excessively.
Drugs similar to acitretin have been associated with pseudo-tumor cerebri (increased pressure in the brain). Symptoms of pseudotumor cerebri include visual disturbances, headache, nausea, and vomiting. Report these or any unusual symptoms to your doctor at once.
People taking acitretin who had spine or bone—including knee or ankle—problems before starting the drug may find that their problems worsen while on the drug.
People with diabetes may find it more difficult to control their blood sugar while on acitretin.
Possible Side Effects
✓    Most common: hair loss or change in texture, peeling skin, and inflammation of the lips.
✓    Common: dry eyes, chills or stiffness, dry skin, fingernail problems, itching, rash, tingling in the hands or feet, increased sensory awareness, loss of some sections of skin, sticky skin, and runny nose.
✓    Less common: drying and thickening of eye tissue; eye irritation; eyebrow or eye lash loss; changes in appetite; swelling; fatigue; hot flashes; flushing; sinus irritation; headache; pain; earache; insomnia; depression; Bell’s palsy; crusting of the eyelids; blurred vision; conjunctivitis (pinkeye); double vision; itchy eyes or eyelids; cataracts; swelling inside the eye; unusual sensitivity to bright light; dry mouth; nausea; stomach pain; diarrhea; bleeding gums; joint; back; and muscle pain; and worsening of existing spinal problems.
✓    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
• People combining acitretin and glyburide (an antidiabetic) may have unusually low blood-sugar levels. Your doctor may have to adjust your diabetic treatment program while you are taking acitretin.
•    Combining acitretin with methotrexate increases the risk of liver damage.
•    Acitretin reduces the effectiveness of low-progestin oral contraceptives (the “mini-pill”). If you are taking one of these contraceptives, switch to another type of birth control and use at least one other contraceptive method for at least 3 years after treatment is completed.
•    Combining alcohol with acitretin produces acitretin’s parent compound, etretinate. Etretinate stays in the body much longer than acitretin and may therefore affect the fetus for an even longer period of time than might acitretin. Avoid alcoholic beverages.
•    Do not take a vitamin A supplement that has more than the standard minimum daily requirement (1000 mcg). Excess vitamin A plus acitretin exposes you to possible vitamin A toxicity.
•    Combining acitretin with tetracyclines may increase the risk of severe pressure on the brain.
•    Notify your doctor if you are taking etretinate, isotretinoin, oral or topical tretinoin, or cyclosporine.
Food Interactions
Acitretin is best absorbed when taken with food or meals. Usual Dose
Adult: 25-50 mg a day with your main meal. Dosage may increase after 4 weeks to 25-75 mg a day. Dosage must be individualized to your specific needs.
Child: not recommended.
Overdosage
Symptoms of acitretin overdose include vomiting, headache, and vertigo. Call your local hospital emergency room or local poison control center for more information. ALWAYS bring the prescription bottle or container.
Special Information
Contact your doctor at once if you become pregnant while taking acitretin or in the 3 years following treatment. The risk of birth defects persists as long as the drug is in your body. In one case,

small amounts of etretinate were found in blood plasma and fatty tissue more than 5 years after treatment.
Some people have experienced decreased night vision while taking acitretin. Be careful when driving at night.
Report visual disturbances, headache, nausea, vomiting, or anything unusual to your doctor at once.
Do not drink any alcoholic beverages during acitretin treatment and for at least 2 months after treatment has been completed. Avoid excess vitamin A (see “Drug Interactions”).
Some birth control methods, including low-dose progestin contraceptives and tuba) ligation may fail while taking this drug. Use at least one additional form of contraception while taking acitretin to avoid pregnancy.
You may have problems tolerating contact lenses while you are taking acitretin.
Do not donate blood while taking acitretin or for 3 years afterwards because your blood might be given to a pregnant woman.
Avoid exposure to excessive sunlight or to sunlamps because of unusual sensitivity caused by acitretin.
If you forget to take a dose of acitretin, take it with food 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.
A worsening of psoriasis may initially occur with treatment, and the full benefit of acitretin may not be seen for 2-3 months.
Special Populations
Pregnancy/Breast-feeding: Acitretin causes birth detects and may damage the fetus. Women who take acitretin must be sure they are not pregnant before starting therapy by using reliable contraception for at least 1 month before starting the drug and taking a pregnancy test within 1 week of starting treatment. Women must use 2 reliable contraceptive methods during treatment and for 3 years following the completion of treatment.
Acitretin may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors have twice as much acitretin in their blood as do younger adults but may take acitretin without special precaution.

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Jul

16

CONSTIPATION. COMPLETE INFORMATION.

July 16, 2009 | Leave a Comment

CONSTIPATION

• Get enough fluid and fiber

• Eat prunes, apples, or apricots

• Sprinkle ground flaxseed on cereal

• Chew sugarless gum

• Use psyllium powder

• Try docusate for less straining

• Use milk of magnesia for quick relief (occasional use)

• Ask your doctor about a prescription for Mira Lax

Many people feel that regularity is the key to good health. Is this true or is it a myth? Grandmothers around the world have promoted daily bowel movements for generations, but there is no evidence that a trip to the bathroom each morning is necessary. People vary in the frequency that suits them best. Some do well on a schedule of no more than three times a week. Others feel good on a schedule as frequent as a few times a day.
Constipation is defined as unsatisfactory defecation, but doctors and patients don’t always agree on what is most important. Physicians may prefer objective measures like the number of days between bowel movements. But people may be as concerned about consistency as frequency. They complain about the effort of passing hard “golf balls” or “bricks.”
Sometimes physicians dismiss constipation as a minor complaint. While it is not usually life threatening, constipation can be serious. Almost 100,000 people are hospitalized each year for constipation-related problems. Many more suffer considerable distress and reduced quality of life as a result of this common condition.

SOME DRUGS THAT MAY LEAD TO CONSTIPATION

•    Abilify (aripiprazole)
•    Actonel (risedronate)
•    Anaprox (naproxen)
•    Arimidex (anastrozole)
•    Asacol (mesalamine)
•    Casodex (bicalutamide)
•    Cataflam (diclofenac)
•    Catapres (clonidine)
•    Cenestin (synthetic conjugated estrogens)
•    Clinoril (sulindac)
•    Clorpres (clonidine and chlorthalidone)
•    Clozaril (clozapine)
•    Cognex (tacrine)
•    C6rdarone (amiodarone)
•    Covers-HS (verapamil)
•    Creon (pancreatin)
•    Cymbalta (duloxetine)
•    Detrol (tolterodine)
•    Ditropan XL (oxybutyn n)
•    Duragesic (fentanyl►
•    EC-Naprosyn (naproxen)
•    Effexor (venlafaxine)
•    Ferrara (letrozole)
•    Geodon (ziprasidone)
•    Gleevec (imatinib)
•    Imdur (isosorbide mononitrate)
•    Kadian (morphine sulfate)
•    Kytril (granisetron)
•    Lexapro (escitalopram)
•    Lotronex (alosetron)
•    Lyrics (pregabalin)
•    Meridia (sibutramine)
•    Mirapex (pramipexole)
•    Myfortic (mycophenolic acid)
•    Nalfon (fenoprofen)
•    Naprosyn (naproxen)
•    Orap (pimozide)
•    OxyContin (oxycodone)
•    Pacerone (amiodarone)
•    Pancrease MT (pancrelipase)
•    Paxil (paroxetine)
•    Permax (pergolide)
•    Rapamune (sirolimus)
•    Relafen (nabumetone)
•    Remeron (mirtazapine)
•    Requip (ropinirole)
•    Retrovir (zidovudine)
•    Risperdal (risperidone)
•    Rythmol (propafenone)
•    Thalomid (thalidomide)
•    Topamax (topiramate)
•    Vicodin (hydrocodone and acetaminophen)
•    Zofran (ondansetron)
•    Zoloft (sertraline)
•    Zyprexa (olanzapine)
Fluids and fiber are the cornerstones of constipation prevention. Those who are constipated are often urged to drink more water. Adequate fluid (at least 6 glasses of water a day) is essential, but unless someone is actually dehydrated, drinking extra water does not solve the problem of hard stools.If constipation arises suddenly or if it starts to interfere with everyday activities, it makes sense to check in with your doctor. There are some conditions, such as an underactive thyroid gland or Parkinson’s disease, that can lead to constipation. In those cases the underlying disease needs to be treated.

Warning signs that should trigger a doctor’s visit include blood in the stool or bleeding from the rectum; dark, tarry stool; weight loss of 10 pounds or more; a family history of colon cancer; or a positive Hemoccult test, a way of identifying invisible blood in the stoo1. Be sure to tell the doctor about any of these issues, so the proper workup can be done.
People taking medications or even supplements should also check with their doctor to see whether one of these might be responsible. A surprising number of prescription drugs can trigger constipation as a side effect. Because of the impact that constipation can have on their sense of well-being, patients sometimes become upset if doctors don’t warn them that a prescribed medication may interfere with bowel function. Narcotics are among the most notorious offenders, but there are many others. Sometimes, switching to a different medicine can ease the problem. The physician should always be involved in such a decision, because some of these drugs may be essential treatment for a serious condition such as cancer or AIDS.
Dietary Approaches
For uncomplicated constipation, focus on increasing the high-fiber foods in the diet. Sometimes, people buy a loaf of softand-squishy “wheat” bread and figure that’s all they need to do to get extra fiber. Wrong! Unfortunately, the “wheat” label may just be a marketing ploy. Consumers need to read the ingredient list to see if the first ingredient is whole-wheat flour. That’s a good start.
Even better is to actually consume the whole grains in pilafs or porridges, which is one reason we are so fond of steel-cut oats. (Also, they taste wonderful.) One of our favorite high-fiber breakfasts is steel-cut oats with extras: blackberries or pieces of apple, together with walnuts or almonds, topped with a sprinkling of freshly ground flaxseed. To boost the protein content of this breakfast, we stir in some egg white while the oats are cooking.

FOODS THAT ARE HIGH IN FIBER
•    Apples    0    Lima beans
•    Barley    0    Oat bran
•    Beans    0    Oats (steel-cut)
•    Blackberries    0    Pears
•    Bran    a    Popcorn
•    Bran cereal    0    Prunes
•    Broccoli    0    Raisins
•    Bulgur wheat    0    Split peas
•    Chickpeas    0    Uncle Sam Cereal
•    Fiber One cereal    6    Wheat berries
•    Figs    •    Winter squash
•    Lentils

Q. My wife is bedridden with emphysema and osteoporosis. Her fractured vertebrae are due to the steroids she takes for emphysema.
The doctor suggested calcium to strengthen her brittle bones. Then she had a problem with bowel movements because of not getting any exercise.
This caused her great distress until she tried eating a quarter of an apple every evening. The apple has made her regular again.
A. Thanks so much for reminding us all of the importance of fiber in the diet. This may help explain the wis-dom behind Grandmother’s recommendation of an apple a day.

Prunes
Why are the marketers changing the name of prunes to “dried plums”? While it is an accurate designation, it’s not particularly catchy. Instead, it is an attempt to get away from the image of self-treatment for constipation that “prune” or “prune juice” conjures up.

Q. A year ago I had a serious problem with constipation (over 2 weeks!). I tried everything I could, including Metamucil, Ex-Lax, milk of magnesia, and a Fleet enema with no results. A visit to the doctor resulted in a prescription but still no relief. Then I remembered. Prunes are laxatives. I bought some prune juice with pulp and drank 4 ounces a day with plenty of water. Within a few days I was back to normal. For a few months I drank some every other morning to keep me regular. Now I only need it once a week. Prune juice with pulp is my salvation.
A. Prunes are a time-honored home remedy for constipation. Researchers have confirmed what grandmothers always knew: Prunes stimulate the digestive tract.
In 1951 scientists discovered an ingredient in prunes that is closely related to the chemical laxative oxyphenisatin. This product was taken off the market when it was linked to liver damage.
Experts for the Harvard Health Letter suggest, “it is unlikely that moderate consumption [of prune juice] would cause any problems, but prune use, like everything else, should be prudent.”

Prunes are said to be loaded with antioxidant phytonutrients, so they are a healthy choice if consumed in moderation. They are not the only dried fruit that can be helpful in an attempt to overcome constipation. Dried figs and even apricots provide a little variety. They may not have any specifically laxative components, but they certainly are good sources of fiber, and some people find them quite helpful. Dried apricots (two a day) and plenty of water can relieve constipation. It helps me and has helped my friends.

Flaxseed

Another source of fiber is not nearly as well known as prunes. Flaxseed has long been used as a source of soluble fiber. It is one of the ingredients in an old-fashioned cold cereal, Uncle Sam Cereal. Once marketed as a “natural laxative,” it is now being touted as a low-glycemic-index or low-carb food. The primary ingredients are wheat berries and flaxseed. Both should help to keep things moving in the right direction.
Constipation has been my problem for more years than I want to count Psyllium seed barely works.
My solution is flaxseeds ground in my coffee grinder I keep it in small batches in the refrigerator and take’/ teaspoon with a glass of juice or water daily. Sometimes I sprinkle it on my cereal or put it in a fruit smoothie. I like the nutty taste and it has been like a miracle for me.

Ground flaxseed is a good source of soluble. fiber. Not only is it helpful against constipation, it can aid in lowering cholesterol and may help reduce the hot flashes of menopause. Flaxseed is an excellent plant source of omega-3 fatty acids.
Downside: Keeps well until ground, then is susceptible to going rancid. Keep ground flaxseed in the refrigerator for no more than 10 days to 2 weeks.
Cost: Approximately $4 to $5 per month (around 130 a dose).

Besides combating constipation, flaxseed is an excellent source of omega-3 fatty acids and has the added advantage of lowering cholesterol at least modestly. The seeds keep well, but once they are ground (a blender or a coffee grinder works well), they go rancid quickly. Ground flaxseed meal should be kept in the refrigerator or even in the freezer. Someone with a tendency to constipation might well want to get in the habit of incorporating ground flaxseed into meals.
Another way to get the benefits of flax is to make a solution. Simmer 2 tablespoons of flaxseed in 3 quarts of water for 15 minutes. Cool the liquid and strain it. It should be kept in the refrigerator. Add 2 ounces a day to fruit juice.

Sugarless Gum

It might be surprising to learn that something as simple and inexpensive as sugarless gum could counter constipation quite effectively. By the way, the converse is also true. People sometimes have problems with chronic diarrhea because of their gum-chewing habits. Sugarless candy has the same impact. Pick a flavor that you like and experiment to find the right dose. The “sugar alcohols” used to sweeten sugarless gummaltitol, sorbitol, mannitol, and xylitol—are not absorbed from the digestive tract. They act as “osmotic laxatives.” Chewing sugarless gum does not contribute to tooth decay. A gum containing xylitol might even help fight ear infections.
Side effect: Diarrhea
Downside: Many sugarless gums contain aspartame, which some people prefer to avoid.
Cost: Approximately 70 to 150 a dose

Q. I read with interest and sympathy a letter about problems with constipation. I wanted to share something that has helped me. After hearing some people complain that sugar-free jelly beans gave them diarrhea if eaten in quantity. I decided to see if they would help my frequent constipation. I have found that if I eat 30 sugar-free jelly beans with a glass of water half an hour before bedtime, I stay regular. I hope this idea might help others with the same problem.
A. Thanks for the tip. Many people find that the sweeteners in sugar-free candy can cause diarrhea. How clever of you to turn that side effect to your advantage! Each person will have to experiment to find the right “dose.”

Over-the-Counter Remedies

Laxatives are among the most popular products in the pharmacy. Hundreds of millions of dollars are spent each year on these over-the-counter remedies. But overuse of such products can be a serious problem.

Q. My 19-year-old daughter and her girlfriend have been taking laxatives for weight control for several months. They also take over-the-counter diet pills.
My main concern is about the abuse of laxatives. Would you please print the harmful effects laxatives can cause? She won’t listen to me!
A. Chronic laxative abuse can undermine the body’s ability to eliminate waste on its own. We have heard from many elderly people who started using laxatives in their youth and became dependent upon them.

We are more concerned, however, about the potential interactions these young women might experience. Strong laxatives can deplete the body of potassium.
Laxatives are not an effective tool for lasting weight loss. Dietary counseling and exercise may be more helpful in the long run.

We generally suggest that people avoid stimulant chemicals like aloe, cascara sagrada, senna, and castor oil. These can be irritating to the digestive tract. Some of these compounds can interfere with proper nutrition, and chronic use might make a person more susceptible to weakened bones.

Bulk-Forming Laxatives

The first step in treating constipation is to increase your intake of fiber. Since dietary fiber may not be enough, there are several possible sources of fiber sold as “bulking agents” in the pharmacy. Psyllium is a naturally derived fiber from blond ispaghula seed (Plantago ovata). It can usually be bought quite inexpensively. There are also some alternative types of fiber.
Adequate fluid intake is crucial when taking fiber. Swallowing fiber such as psyllium without enough water could lead to choking as a result of the product clumping and swelling in the esophagus. Other digestive tract blockage is also possible if fluid intake is inadequate.
If psyllium is not satisfactory, other possible fiber sources are available. Polycarbophil (Equalactin, FiberCon, Fiber-Lax, Konsyl Fiber) may be the next step.

Sold under a number of brand names, including Metamucil, Fiberall, Konsyl, Perdiem Fiber Therapy, Reguloid, and Serutan. Store brands, available in most drugstore chains, are more economical. Psyllium (I tablespoon in 8 ounces of water three times a day) is approved both for constipation and for lowering. cholesterol. It may take a few days to observe the effects. Psyllium is considered safe for daily use. Sugar-free brands may be more economical, but most contain aspartame, which some people would rather avoid. No bulk-forming laxative should be taken if the person is nauseated, vomiting, running a fever, or suffering abdominal pain. Such symptoms deserve prompt medical attention.
I’ve had such frustration with constipation over the years. I’ve tried a lot of remedies, but the ones that worked were too harsh. Then a friend told me about UniFiber. It is a very fine powder, and I combine it with canned peaches or homemade oat bran muffins. It really regulates my system with no diarrhea or cramping.

Stool Softeners
When the main problem is that the stool is hard, the best remedy may be a stool softener. These are also recommended for people who have had abdominal or colorectal surgery or an episiotomy during labor and delivery and must avoid straining.
Old-fashioned mineral oil is the best-known product in this category. It should be used for only a short time, though. Mineral oil is petroleum-based and is not absorbed into the body. But it can interfere with the absorption of important fat-soluble nutrients, such as vitamin A, vitamin D, vitamin E, and vitamin K. Over weeks or months, this could be detrimental to health.
The doctors’ choice in stool softeners is usually docusate sodium or docusate calcium. Although the evidence of their effectiveness is not strong, 118 they are widely used. They might work better in a postsurgical situation than they do for chronic constipation.
Dacusate Sodium
Available as Colace and Ex-Lax Stool Softener, and generically under various store brand names. Acts as a wetting agent to help stool absorb more water and thus become softer. Expect this product to take up to 3 or 4 days to work.
Side effects: Rash, throat irritation, nausea Cost: Approximately 250 to 500 per dose

This usually works fairly rapidly, within several hours. Each dose should be taken with 8 ounces of water. It is intended for occasional use only.
Side effects: Diarrhea, nausea, weakness
Downside: This laxative contains magnesium, so it should not be used by people with kidney disease. It may disrupt the balance of minerals and fluid in the body.
Cost: Approximately 600 to 750 per dose
Osmotic Laxatives
Compounds that attract water into the digestive tract add moisture to the stool. This softens it and may even help hurry it along. Such agents are called osmotic laxatives. We’ve already discussed sugarless gum, which works in this manner. It also exemplifies the downside of these laxatives: Getting the balance just right can be difficult. It’s not rare for a person to experience diarrhea as a side effect if the dose is too high. Some old familiar remedies fall into this category. Both Epsom salts and milk of magnesia are osmotic laxatives.
Prescription Laxatives
Chronic constipation can be extremely frustrating. If lifestyle changes and over-the-counter approaches are unsuccessful, people turn to their doctors hoping for a miracle. In this situation, miracles are few and far between. Physicians do have a few drugs they can prescribe that may be helpful. One is a type of osmotic laxative called lactulose (Chronulac, Duphalac, Kristalose) that has been around quite a long time. This is a type of sugar that is not absorbed well, so it pulls water into the intestines. It may take a day or 2 to produce results, and it can result in cramping, gas, or diarrhea.
There is another option as well. A prescription laxative containing polyethylene glycol, an ingredient quite similar to those used for cleansing the colon prior to a colonoscopy, can be used for desperate cases. MiraLax is not supposed to be used for more than 2 weeks at a time, however. MiraLax is an osmotic laxative.
The doctors’ big gun in prescription products is Zelnorm

Contains polyethylene glycol, or PEG. It comes as a powder to be dissolved in juice, water, coffee, or tea. Expect results in 2 to 4 days. Do not use for more than 2 weeks.
Side effects: Diarrhea, abdominal cramping, nausea, gas Downside: Prolonged or excessive use may upset the balance of fluids * and minerals in the body or result in laxative dependence.
Cost: Approximately $1.40 to $2 per dose; one dose per day
(tegaserod). It was developed for people who have irritable bowel syndrome with h constipation as the predominant symp- tom. It has also been approved for chronic constipation in adults under the age of 65. Your doctor will be able to evaluate if this last resort is appropriate for you. There have been instances of serious, dehydrating diarrhea that required hospitalization. Another dangerous side effect that worries us is ischemic colitis, a condition in which blood supply to part of the intestine shuts down. It has not been established whether Zelnorm was responsible for this frightening complication. Nevertheless, this drug is probably appropriate only when everything else has failed.
10 Tips for Combating Constipation
1. Pay attention to your diet. Getting plenty of fiber and fluid is essential. In addition, though, some foods tend to be constipating. Cheese has a reputation in this regard, but coconut, which can help ease diarrhea, may be constipating if too much is eaten. Other people have warned of the effects of pomegranate, mango, or peanut butter. The tannins in tea may also contribute to constipation.
2. Sip warm water with a tablespoon of blackstrap molasses. This sweetener contains a number of minerals. Some people find it a tasty way to cope with constipation. Another old-fashioned home remedy for constipation is drinking lemon juice in a cup of hot water first thing in the morning. Afterward, rinse your mouth with plain water, to protect your teeth.

3. Simmer 2 tablespoons of flaxseed in 3 quarts of water for 15 minutes. Cool, strain, and add 2 ounces of the liquid to orange juice every day. An alternative is to use freshly ground flaxseed on cereal or other foods.
4. Chew sugar-free gum. Experiment to find the appropriate dose. Or, if you prefer, eat sugar-free candy. Either may ease constipation; don’t overdo it.
5. Take psyllium powder in 8 ounces of water. For when you’re traveling, Metamucil makes psyllium cookies that are easier to carry, but they’re also more expensive and higher in calories.
6. Stay away from traditional laxative herbs such as aloe, cascara sagrada, and senna. They are harsh and overstimulate the digestive tract. Very occasional use may be acceptable, but overuse can lead to dependence. Instead, try dong quaff, ginger, or milk thistle.
7. Load up on vitamin C. Some people find that about 2,000 milligrams a day is enough to trigger diarrhea. Finding the dose that works for you and backing off just slightly is one approach that may work. Do not try this if you have ever had kidney stones, because excess vitamin C raises oxalate excretion and might increase the risk of a recurrence.159
8. Stir a couple teaspoons of Swedish bitters into a cup of water. Hot water or herb tea may work best. It also comes in capsules that are convenient when traveling.
9. Experiment with a bulk-forming laxative. Some people find that UniFiber or Citrucel works better for them than psyllium.
10. Make sure you get enough magnesium, especially if you are taking calcium supplements. Calcium carbonate can be constipating, but magnesium can help offset this tendency. We generally advise people that a dose above 300 milligrams of magnesium per day may cause diarrhea. The maximum short-term dose of magnesium advised on the label of Phillips’ Milk of Magnesia is 2,000 milligrams for adults. Do not take magnesium or milk of magnesia if you have kidney disease.
Conclusions
Constipation accompanied by pain, nausea, vomiting, or fever should not be ignored. It deserves medical attention. Even without such symptoms, persistent constipation should also be brought to a physician’s attention. Uncomplicated constipation may respond to home treatment.
•    Begin with diet. Make sure you get six to eight 8-ounce glasses of water or other fluids daily. Concentrate on increasing fiber, and make sure you get 25 to 35 grams daily.
•    Ask your doctor to check whether a medical condition or medication may be causing your constipation.
•    Eat fruit. Apples, dried apricots, and (in moderation) dried plums, aka prunes, are a wonderful way to establish regularity when needed.
•    Sprinkle ground flaxseed on your food, or take a solution of simmered flaxseed in juice.
•    Chew sugarless gum or enjoy sugar-free candy for its laxative effect.
•    Take psyllium as directed, with an 8-ounce glass of water.
•    Docusate may soften stools and ease straining.
•    Milk of magnesia may give relatively quick relief, but should not be overused. It’s off-limits for anyone with kidney trouble.
•    Drugs such as MiraLax are intended for short-term use of less than 2 weeks.

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

Jul

15

Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.

July 15, 2009 | Leave a Comment

Prostatitis. DIAGNOSIS OF PROSTATITIS. CHRONIC PROSTATITIS. ACUTE BACTERIAL INFECTION.

Prostatitis is a catch-all expression covering various types of inflammation of the prostate. It is not as serious as enlargement of the prostate, and especially not as serious as cancer of the prostate. It can, however, be a very difficult condition to treat and can sometimes drag on for several years. In prostatitis, the tiny glands in the prostate become infected, inflamed or clogged - either with thickened secretions or with small gravel-like stones. As we have seen in Chapter 1, the prostate is a complex system of glands, cells, tubules and ducts. Once infection gets a hold in this complicated network, it is hardly surprising that it can be very difficult to eradicate.
Even when it has been treated - and even when it seems as though it has been successfully treated - it can still come back. And in the absence of successful treatment, it can flare up for years, with depressing regularity.

THREE TYPES OF PROSTATITIS

There are three main types of prostatitis. These are:
• Acute bacterial infection.
• Chronic infection, which may be bacterial or non-bacterial.
• Prostatodynia, which may cause the symptoms of prostate pain without any obvious signs of inflammation or infection.

DIAGNOSIS OF PROSTATITIS

Prostatitis is sometimes difficult to diagnose. In general, the person best qualified to diagnose prostatitis is a doctor specialising in urology or genito-urinary medicine clinical trials. Your doctor may refer you to a special genito-urinary (GU) clinic. This does not mean that your doctor suspects that you are suffering from a sexually-transmitted disease. It simply means that genitourinary clinics have the best experience and equipment to investigate and treat your symptoms. The staff are used to dealing with this kind of problem, and will do so sympathetically and in confidence, so you have no need to feel embarrassed. You are likely to have a number of tests as part of the investigation of your symptoms. These may include some, or all, of the following:

• A digital rectal examination, which means that the doctor inserts a lubricated gloved finger into the rectum and gently palpates, or feels, the prostate through the front wall of the rectum, which lies against the back of the gland. If you have prostatitis, the prostate will feel boggy, soft and tender. A digital rectal examination should not hurt,
though it may be uncomfortable if the prostate is inflamed and therefore tender to the touch. A lot of men are embarrassed to have one, but they shouldn’t be: doctors are used to doing this and have a very matter-of-fact attitude to it.
• Swabs from the end of the penis, which are taken by gently inserting a sterile cotton bud into the end of the penis and taking any fresh discharge.
* Urine tests to check for cloudiness, signs of protein or blood, and threads of cellular niaterial, which are then examined under the microscope for pus cells or bacteria.
® Urine cultures to see if any bacteria grow, which should also distinguish between infection in different parts of the urinary tract.
• A blood test to check for a raised white cell count.
• Routine screening for sexually-transmitted diseases such as chlamyclia.
• The doctor will look for a discharge from the penis, and for signs of inflammation and soreness both on the penis and in the testicles. If prostatitis is untreated, or it’ drug treatment is unsuccessful, there is a risk that the prostate gland may become full of pus 5 online sildenafil citrate . Not surprisingly, this can have dreadful consequences. It may eventually burst, releasing pus into the urethra, which will discharge from the tip of the penis. And it may also result in severe infection elsewhere in the urinary tract.

ACUTE BACTERIAL INFECTION

This is an uncommon complaint. It is usually caused by bacteria from the intestines. These find their way into the urinary system, either through the urethra or through the bloodstream or lymphatic fluids.
Sometimes there is a link with organisms that cause a sexually-transmitted disease, such as gonorrhoea or chlarnydia. Sometimes, too, the fungus that causes thrush (Candida) is responsible.

Symptoms

These can happen suddenly and can include one or several of the following:
• Feeling generally under the weather.
• Chills or fever.
• An aching feeling around the thighs and genitals.
• A deep pain in the perineurn, which is the area between the pouch containing the testicles, known as the scrotum, and the anus.
• Low back pain.
• Pain in the lower abdomen.
• Pain on passing water.
• Blood in the urine.
• Difficulty in passing water.
• Increased frequency of passing water.
• Urine may be cloudy or smelly.
• Pain on ejaculation.

Diagnosis

The doctor will probably perform a digital rectal examination by inserting a lubricated gloved finger into the rectum. He will then feel the prostate through the wall of the rectum. If a man has prostatitis, the prostate will probably feel hot, swollen and tender. The doctor will then do a series of tests on a sample of urine and On urethral secretions obtained after massaging the prostate gland, in order to investigate the cause of the infection.

Treatment

Acute bacterial prostatitis, when symptoms come on suddenly, is the most dramatic form of the disease, but it is also the form that responds best to treatment. A prolonged course of antibiotic tablets is prescribed. This is usually for at least four weeks. Acute infection responds well to antibiotics, probably because the intense inflammation allows the drugs to penetrate into the interior of the gland. Symptoms should begin to show some improvement within the first few days. Sometimes, though, infection may persist in the prostate, in spite of treatment, and it is necessary to have careful follow-up treatment to make sure that the condition has cleared up. If this does not happen, the condition may tend to recur and chronic prostatitis will usually result. Occasionally, though rarely, infection may cause the gland to swell sufficiently for the urethra to be squeezed shut. This causes urinary outflow obstruction . It necessitates urgent admission to hospital, where urinary flow is eased by inserting a catheter directly into the bladder. With rest and the administration of antibiotics, the infection will usually clear up well in only a few days.

CHRONIC PROSTATITIS

Chronic prostatitis is more common than acute prostatitis, but is much more difficult to eradicate. There are two types of chronic prostatitis, which can be bacterial or non-bacterial. Chronic bacterial prostatitis Swelling occurs rapidly and this traps the bacteria in the gland, as the usual drainage channels become blocked. Prostatic secretions may coat the offending bacteria, which then harden to form tiny stones, or crystals. This protects them from being attacked by the body’s immune system or by antibiotics. This explains the repeated flare-ups that tend to occur in chronic bacterial prostatitis. This means, too, that the condition can be difficult to treat successfully. Some sufferers may even be unlucky enough to suffer from recurrent symptoms throughout their lives.

Symptoms

These vary from one person to another. They may include any, or several, of the following:

• Frequency in passing water.
• Pain on passing water.
• Pain in the prostate, genitals or rectum.
• Swelling of the testes.
• Lower back pain.
• Watery discharge from the penis.
• Pain on ejaculation.
• Blood in the semen.
• Premature ejaculation.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.

Fertility

There is some evidence that chronic bacterial prostatitis may impair. This may probably be true in all cases of prostatitis, but seems to be especially true of chronic bacterial prostatitis. Analysis of the prostatic fluid of men with chronic bacterial prostatitis has shown significant changes in both the physical properties and the chemical constituents of the fluid. It is thought that these changes may well affect the quality of the semen, and thus the level of fertility. It is not unusual for doctors to hear the wives of men with chronic bacterial prostatitis complain that they are finding it difficult to become pregnant. A sperm count and sperm quality assessment can be done to find out how much a man’s fertility has been affected.

Chronic non-bacterial prostatitis

This is a complaint in which inflammation is present without any signs of infection. In other words, prostate secretions contain white pus cells, but no bacteria. It is not known exactly what causes chronic non-bacterial prostatitis, but several theories have been suggested. One is that it is caused by abnormal emptying of the bladder, which forces urine into the prostate channels and ducts, where it causes irritation and inflammation. This may be triggered, or aggravated, if a man jogs or plays any strenuous sport on a
full bladder. Another theory is that some men produce thicker prostate secretions, which are perhaps more acid then normal. These secretions are unable to drain away through the narrow ducts and therefore build up to cause irritation and swelling.

Symptoms

The most common symptoms of chronic non-bacterial prostatitis are:
• Frequency in passing water.
• Pain on passing water.
• Pain or ache in the prostate, genitals or rectum.
• Lower back pain, especially after sexual intercourse.
• Discharge from the urethra, especially after intercourse.

Treatment

Any chronic infection is difficult to treat, particularly when inflammation and swellings trap the infection inside the gland. In the case of chronic bacterial prostatitis, a course of the appropriate antibiotic, depending on which bacterium is responsible for the condition, will be prescribed for at least six weeks. Sometimes antibiotics may be required for as long as three months, or even longer. Chronic non-bacterial prostatitis can be treated with a natural food supplement derived from rye pollen extracts, which
has been shown to reduce inflammation, irritation and swelling, though improvement may not be apparent for at least three months and full recovery may take as long as six months or even more. Swelling, inflammation and pain may be helped by anti-inflammatory painkillers such as ibuprofen.

Self-help

Chronic non-bacterial prostatitis is sometimes relieved by an increased frequency of ejaculation. This can be brought about through intercourse, of course, but if this does not happen it may equally be brought about by masturbation. Ejaculation drains the prostate of any excess secretions and causes a temporary increase in blood. Both these things help to flush away any toxins. In some cases, however, an increased frequency of ejaculation only makes the problem worse.

PROSTATODYNIA

This is characterised by the usual symptoms of prostate problems, including pain, but with no evidence of inflammation or infection in the gland. Prostate secretions look perfectly normal and contain no pus cells. Prostatodynia is surprisingly common and accounts for around one third of all cases where men experience the symptoms of chronic prostatitis.

Symptoms

The symptoms of prostatodynia are therefore similar to those of chronic prostatitis. They may often also include psychosexual problems.
Symptoms include the following:
• Frequency in passing water, sometimes with associated pain.
• Pain in the prostate, genitals or rectum.
• Lower back pain.
• Watery discharge from the penis.
• Blood in the semen (haemospermia).
• Premature ejaculation.
• Pain on erection.
• Pain on ejaculation.
• Low sex drive.
• A diminished volume of semen.
• Impotence.
• If the doctor feels the prostate during a digital rectal examination, it may feel boggy, soft and squelchy.

Treatment

Prostatodynia can be difficult to treat. Painkillers are not usually helpful. It is, however, likely to have a physical cause, such as spasm of the pelvic muscles, which may be brought on by stress and anxiety. In this case, tranquillisers may be prescribed in order to reduce muscular spasm in the gland, though it is not a good idea to take these in the long-term as they can become addictive. Recent studies have suggested that prostate pain can be relieved by microwave hyperthermia. The technique was originally developed at the Beilinson Medical Centre, Petah Tiqva, in Israel in the early 1980s and is now attracting a lot of interest in other countries. An hour’s treatment is usually given weekly for six weeks.
Other treatments that have been tried for prostatodynia include:
• Acupuncture.
• Laser irradiation.
• Muscle-relaxant drugs, such as diazepam.
• Antispasmodic drugs.

Self-help

As in chronic non-bacterial prostatitis, symptoms may be worsened when ejaculation is infrequent, in which case the pain may be caused by prostatic gland engorgement. Symptoms may therefore be relieved by an increased frequency of ejaculation, as a result of either intercourse or masturbation. Ejaculation drains the prostate of any excess secretions
and causes a temporary increase in blood supply. In some cases, however, an increased frequency of ejaculation only makes the problem worse. Sitting in a hot bath for half an hour can help to warm up the prostate gland. Relaxation techniques may also be used to relax the muscles and as an alternative to muscle-relaxant drugs. The combination of regular exercise and a high-fibre diet will help keep the bowels regular, which is particularly important for men suffering from prostatodynia. This is of special benefit to those men who sit at a desk for most of the day, as both constant sitting and constipation tend to increase prostate congestion. Symptoms of prostatodynia may be triggered by the nicotine in cigarettes and by alcohol or caffeine, so it is best to reduce consumption of all three. It may also be advisable to consult an allergy specialist who may be able to identify foods that you should avoid.

Natural treatments

Rye pollen extracts have been shown in clinical trials in Europe to help ease the symptoms of prostatitis, particularly chronic non-bacterial prostatitis and prostatodynia. They reduce inflammation and ease irritation. They may take as long as three months before they show any improvement, which may then continue over the next three months. Rye pollen
extracts, such as Cernilton and ProstaBrit, are available from health food stores.

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