Aug
1
Cholestyramine
August 1, 2009 | Leave a Comment
Generic Name
Cholestyramine (kol-es-TYE-rah-meen) 0
Brand Names
LoCHOLEST Questran
LoCHOLEST Light Questran Light Prevalite
The information in this profile also applies to the following drugs:
Generic Ingredient: Colesevelam Hydrochloride WelChol
Generic Ingredient: Colestipol Hydrochloride Colestid
Type of Drug
Anti -hyperli pidemic (blood-fat reducer).
Prescribed For
High blood-cholesterol levels; generalized itching associated with bile duct obstruction—cholestyramine only; colitis; digitalis or thyroid overdose; and pesticide poisoning.
General Information
Cholestyramine resin lowers blood-cholesterol levels by absorbing bile acids in the bowel. Since the body uses cholesterol to make the bile acids—needed to digest fat—fat digestion can only continue by making more bile acid from blood cholesterol. This results in lower blood-cholesterol levels 4-7 days after starting cholestyramine.
Cholestyramine w3Cks entirely Within the bowel and is never absorbed into the bloodstream. Though usually given 3-4 times a day, there appears to be no advantage to taking it more often than twice a day. The cholesterol-lowering effect of cholestyramine may be increased when it is taken with an HMG-CoA inhibitor or nicotinic acid. In some kinds of hyperlipidemia, colestipol may be more effective in lowering total blood cholesterol than clofibrate.
Cautions and Warnings
Do not use cholestyramine if you are allergic or sensitive to any of its ingredients or if your bile duct is blocked. The powder form should not be taken dry; doing so may result in the inhalation of powder into your lungs or a clogged esophagus.
If you are being treated for hypothyroidism, diabetes, kidney or blood vessel disorder, obstructive liver disease, or alcholism, consult your doctor before taking cholestyramine.
Cholestyramine may cause or worsen constipation and hemorrhoids. Most constipation is mild, but some people may need to stop the medication or take less of it.
Possible Side Effects
✓ Most common: constipation, which may be severe and in rare cases result in bowel impaction. Hemorrhoids may be worsened.
♦ Less common: abdominal pain and bloating, and bleeding disorders or black-and-blue marks due to interference with the absorption of vitamin K, a necessary factor in the blood clotting process. One person developed night-blindness because the medication interfered with vitamin A absorption into the blood. Other side effects include belching, gas, nausea, vomiting, diarrhea, heartburn, and appetite loss. Your stool may have an unusual appearance because of a high fat level.
✓ Rare: Rare side effects can affect your mouth, stomach and intestines, muscles and joints, mental status, urinary tract, and breathing. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
O Cholestyramine interferes with the absorption of virtually all oral drugs, including acetaminophen, amiodarone, aspirin, cephalexin, chenodiol, clindamycin, clofibrate, contraceptive drugs, corticosteroids, diclofenac, iopanoic acid, iron, digitalis drugs, furosemide, gemfibrozil, glipizide, hydrocortisone, imipramine (an antidepressant), methyldopa, mycophenolate, nicotinic acid, penicillin, phenobarbital, phenytoin, piroxicam, propranolol, tetracycline, thiazide diuretics, thyroid drugs, tolbutamide, trimethoprim, ursodiol, warfarin and other anticoagulant (blood-thinning) drugs, and vitamins A, D, E, and K. Take other medications at least 1 hour before or 4-6 hours after taking cholestyramine.
Food Interactions
Take this medication before meals. The powder may be mixed with soda, water, juice, cereal, or pulpy fruits, such as applesauce or crushed pineapple. Cholestyramine bars should be thoroughly chewed and taken with plenty of fluids. Colestipol pills are swallowed whole.
Usual Dose
Cholestyramine: 4 g (1 packet) or 1 level scoopful taken 1-2 times a day or up to 6 times a day.
Colesevelam: 6 tablets once a day or in 2 divided doses. Colestipol: 2-16 g (1-6 packets) once a day or in divided doses.
Overdosage
The most severe effect of overdose is obstruction of the gastrointestinal tract. Take the overdose victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Do not swallow the granules or powder in their dry form. Prepare each packet of powder by mixing it with soup, cereal, or pulpy fruit or by adding the powder to a 6-oz. glass of liquid, such as a carbonated beverage. If some of the drug sticks to the sides of the glass, rinse it with liquid and drink the remainder.
Constipation, gas, nausea, and heartburn may occur and then disappear with continued use of this medication. If constipation is a problem, your doctor may recommend drinking more fluids and taking a fiber supplement. Call your doctor if these side effects persist or if you develop unusual problems such as bleeding from the gums or rectum.
If you miss a dose of cholestyramine, skip it and continue with your regular scheduke. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: While cholestyramine does not affect the fetus directly, it may prevent the absorption of vitamins A, D, and E and other nutrients essential to the fetus’ proper development–even when you take, a prenatal vitamin supplement.
When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Cholestyramine is not absorbed into the body. However, reduced absorption of vitamins A, D, and E and other nutrients may make your milk less nutritious. Nursing mothers who must take cholestyramine should use infant formula.
Seniors: Seniors are more likely to experience side effects, especially those relating to the bowel.
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs)
July 5, 2009 | Leave a Comment
NSAIDs
After the roller-coaster ride with cortisone, you would think that the medical establishment would have been more careful about the next big thing. Maybe doctors were so anxious to find something safer for arthritis that they didn’t appreciate that they might be jumping from the frying pan into the fire.
Aspirin was the first nonsteroidal anti-inflammatory drug (NSAID). It was introduced in 1899 and was a mainstay of arthritis treatment for most of a century. Aspirin works a little differently from other drugs in this class and has advantages that make it unique. For almost 100 years aspirin was the Rodney Dangerfield of the drugstore. It got relatively little respect. Because aspirin was available over the counter, it took physicians a long time to appreciate how valuable it could be against heart attacks, strokes, and even cancer. Because it has been around for so many years, doctors have often assumed that newer medicines would provide better pain relief. And they (and their patients) have often been disappointed.
The launch of prescription indomethacin (Indocin) in 1965 really put NSAIDs on the map. These drugs became some of the most successful pharmaceuticals of their time. Whenever a new anti-inflammatory drug came along, it generated tremendons excitement. Drugs like sulindac (Clinoril), piroxicam (Feldene), ibuprofen (Motrin), and naproxen (Naprosyn) had their time in the limelight. Then along would come something newer and doctors would switch their allegiance.
NON-ASPIRIN NSAIDS
• Celecoxib (Celebrex)
• Diclofenac (Cataflam, Voltaren)
• Etodolac (Lodine)
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid)
• Ibuprofen (Advil, Motrin, etc.)
• Indomethacin (Indocin)
• Ketoprofen (Orudis, Oruvail)
• Ketorolac (Toradol)
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Anaprox, Naprosyn)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Sulindac (Clinoril►
• Tolmetin (Tolectin)
Those of us who have observed this game of medicinal musical chairs for more than 40 years have become somewhat cynical about this class of pain relievers. The fickle switching from one drug to another suggests to us that no particular NSAID really stands out. There have not been really great head-to-head clinical trials that prove one drug is superior to another or significantly safer than others in the class.
If truth be told, these drugs really don’t work all that well when it comes to relieving the pain and inflammation of arthritis, especially of the knee. Despite the fact that tens of millions of people have spent countless billions of dollars on these medications, there are surprisingly few data demonstrating long-term benefit with their use. A scientific analysis of 23 different studies was published in the British Medical Journal in 2004. This meta-analysis involved more than 10,000 patients and revealed a shocking discovery: “NSAIDs can reduce short-term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support prolonged use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.”‘
What a bombshell! This review of the world’s medical literature on NSAIDs concluded that such drugs are reasonable only for short-term use. But arthritis is a long-term affair. The only conclusion we can draw: Regular use of such drugs is inappropriate for a chronic condition like arthritis.
Even more alarming, some evidence suggests that these medications may actually be harmful to arthritic joints. Researchers in the Netherlands followed more than 1,600 patients for several years. Patients who had been taking the NSAID diclofenac (Arthrotec, Cataflam, Voltaren) experienced greater joint deterioration as determined by x-ray evidence. The authors concluded, “Our data suggest that diclofenac may not be harmless and may induce accelerated progression of hip and knee OA [osteoarthritis].
OTC Mistake?
When NSAIDs like ibuprofen (Advil, Cap-Profen, Excedrin 113, Genpril, Haltran, lbuprin, Ibuprohm, Ibu-Tab, Medipren, “OTC analgesics including NSAIDs are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects.
Midol IB, Motrin IB, Nuprin, Pamprin IB, Profen, etc. and naproxen (Aleve) were approved for over-the-counter (OTC) sale, millions of people were delighted to have access to these powerful anti-inflammatory drugs. An Rx-to-OTC switch was a radical concept back in 1984. Even though the FDA assured consumers that such drugs were so safe that they did not require medical supervision, many physicians opposed the plan. They feared that side effects such as rash, fluid retention, high blood pressure, gastritis, and ulcers might make these drugs too dangerous for casual use. The FDA ignored the worriers.
Dear reader, we cannot tell you whether the decision to make NSAIDs available OTC was a blessing or a curse. The FDA has been incredibly inept at keeping track of adverse reactions to prescription medications. The agency’s track record on nonprescription pills is even worse. So, we really do not know how many ulcers, heart attacks, or other serious complications have occurred because of easy access to NSAIDs.
What we do know is that people are gobbling down these drugs almost like candy. Based on scientific surveys (Roper and the National Consumers League), it is estimated that 23 million Americans use a nonprescription NSAID (ibuprofen or naproxen) every day.” Only about one in five consumers bothers to read the directions on the label and fewer than one in three checks out dosing instructions. Perhaps that’s why one-fourth of them take more than the recommended dose. Scarier still, roughly half of the people surveyed were unaware of the potential for NSAID toxicity or just plain didn’t care.