Aug
13
Econazole - Efalizumab - Eflornithine - Enalapril - Enfuvirtide - Entacapone
August 13, 2009 | Leave a Comment
Generic Name
Econazole (ee-KON-uh-zole) 92
Brand Name Spectazole
Type of Drug Antifungal.
Prescribed For
Fungal infections of the skin, including athlete’s foot. jock itch, and ringworm.
General Information
Econazole nitrate can kill fungal organisms that may have penetrated to deep layers of the skin. Very small amounts of econazole are absorbed into the bloodstream.
Cautions and Warnings
Do not use econazole if you are allergic or sensitive to any of its ingredients.
Do not apply econazole cream in or near your eyes.
Long-term application of this product to large areas of skin may cause liver damage.
Possible Side Effects
♦ Most common: burning, itching, stinging, and redness in the areas to which the cream has been applied.
Drug Interactions None known.
Usual Dose
Adult: Apply enough of the cream to cover affected areas with a thin layer 1-2 times a day.
Overdosage
Accidental ingestion may cause nausea, upset stomach, drowsiness, and liver inflammation or damage. Call your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Clean the affected areas before applying econazole cream, unless otherwise directed by your doctor. Dry the infected area thoroughly and wear loose-fitting clothes to keep the area cool and dry.
Call your doctor if the treated area burns, stings, or becomes red.
This product can be expected to relieve symptoms within 1 or 2 days after you begin using it. Follow your doctor’s directions for the complete 2-4-week course of treatment to gain maximum benefit. Stopping the drug too soon can lead to a relapse.
If you forget a dose of econazole, apply 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 apply a double dose.
Special Populations
Pregnancy/Breast-feeding: When given by mouth to pregnant animals in high doses, econazole was toxic to the fetus. It should be strictly avoided during the first 3 months of pregnancy. During the last 6 months of pregnancy, it should be used only if absolutely necessary.
Econazole may pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors may take this drug without special restriction.
Efalizumab (ef-ah-LIZ-u-mab)
Brand Name Raptiva
Type of Drug
Immune system suppressant.
Prescribed For
Chronic to severe plaque psoriasis.
General Information
Efalizumab is a manmade antibody that works by binding to specific areas of certain white blood cells called leukocytes. This prevents the leukocytes from interacting with other cells and interrupts inflammation that is involved in the development of patches of psoriatic skin. The molecule that efaluzimab interacts with is found on many other key cells found in the immune system, and this is the source of many of the drug’s more serious side effects.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients.
People taking efalizumab are at a greater risk of infection because it suppresses the immune system. Contact your doctor if you develop any kind of infection, including a common cold. Serious infections may require hospitalization.
The chances of malignancy may be increased by efalizumab because it suppresses the immune system. People with any type of cancer should not use this drug.
Efalizumab may lead to bleeding because it can cause a drastic reduction in blood-platelet counts. People with a history of low blood-platelet counts should be extremely cautious about using efalizumab.
Psoriasis can get worse or recur during or after efalizumab treatment in a small number of people. Call your doctor immediately if your condition worsens while you are taking efalizumab.
Possible Side Effects
Headache, fever, nausea, and vomiting are common alter taking the very first dose of elaki7umab. A “conditioning” dose of about 0.3 mg per lb. of body weight is often given to minimize these reactions.
V Most common: headache, infections, chills, nausea, and pain.
V Common: muscle aches, flu-like symptoms, itching, and fever.
Possible Side Effects (continued)
✓ Less common: back pain, arthritis, lung inflammation, and
acne.
♦ Rare: psoriasis, arthritis, joint pain, malignancy, low blood-platelet count, and drug allergy or sensitivity. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Efalizumab is an immune system suppressant and should not be combined with other immune suppressant drugs because of the increased risk of infection and malignancy.
• Combining vaccines (live and acellular) with efalizumab may exaggerate the body’s response to the vaccine and increase the risk of developing the disease against which the vaccination is being administered. People taking etalizurnab should not receive vaccines.
Food Interactions None known.
Usual Dose
Adult: 0.3 mg per lb. of body weight to start. Then about 0.5 mg per lb. of body weight once a week on the same day. The maximum dose is 200 mg by subcutaneous injection. Mix your dose immediately before it is to be injected and throw away any unused medicine.
Child: not recommended.
Overdosage
Doses up to 4 times the recommended dose have been taken for 10 weeks without additional side effects. However, overdose victims should be taken to a hospital emergency room for observation. ALWAYS bring the prescription bottle or container.
Special information
See your doctor regularly while you are taking efaluzima6. Regular blood tests are required to make sure your blood platelets are not unusually low.
Tell your doctor if you gain or lose weight, since doses of efaluzimab are based on how much you weigh.Tell your doctor about all medicines you are taking including other medicines for psoriasis, non-prescription drugs, vitamins,
and herbal supplements.
Store unused medicine in the refrigerator. Throw away medicine that has been mixed but not used.
Call your doctor immediately if you develop bleeding gums, black-and-blue marks, any kind of infection, begin to bruise easily, or if you are told by another doctor that you have any kind of cancer.
This drug is given by injection under the skin. For more information on how to properly administer this drug, see page 1242.
Special Populations
Pregnancy/Breast-feeding: It is not known how efaluzimab will affect a growing fetus. Animal studies using doses equal to 30 times the human dose showed no adverse effects. While animal studies of efaluzimab reveal no damage to the fetus, this drug should be used only during pregnancy after carefully weighing its potential benefits against its risks.
It is not known if efaluzimab passes into breast milk, although it might affect the nursing infant’s developing immune system. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors should be cautious about using efaluzimab because of the increased risk of infection.
Generic Name
Eflornithine (eh-FLOOR-nih-thene)
Brand Name
Vaniga,
Type of Drug
Hair growth retardant.
Prescribed For
Removal of unwanted facial hair by women.
General Information
This drug has only been studied for its ability to prevent hair growth on the face and chin and should not be used on other body areas. It works by interfering with enzymes in the skin necessary for hair growth, slowing the rate at which hair will grow. Improvement may be seen as soon as 4-8 weeks after you start using eflornithine, but the condition will return within 8 weeks after you stop using it.
Cautions and Warnings
Do not use eflornithine if you are allergic or sensitive to any of its ingredients.
For external use only; do not ingest.
Possible Side Effects
Eflornithine side effects are similar to those of a placebo (sugar pill).
✓ Most common: acne, bumps, or small pustules on the skin. V -Common: stinging.
✓ Less common: headache, dizziness, burning, itching, redness, tingling, irritation, rash, hair loss, upset stomach, and appetite loss.
✓ Rare: fainting, ingrown hairs, inflamed hair follicles, facial swelling, nausea, bleeding, contact dermatitis, inflammation of one or both lips, herpes breakout, numbness, and dilated blood vessels and pores on the nose and cheeks. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult and Child Me 11 anti over): Apply a thin layer of cream to ai ected areas and rub in thoroughly 2 times a day at least 8 hours apart. Do not wash your face until at least 4 hours after you have applied eflornithine cream. Wait at least 5 minutes after hair removal to apply eflornithine.
Child (under age 12): not recommended.
Overdosage Little is about the effects of eflornithine overdose or acci-
Li known
dental ingestion. Call your local poison control center for more information. ALWAYS bring the prescription container.
Special Information
If you forget to apply a dose of eflornithine, apply it as soon as you remember. Bear in mind that at least 8 hours must elapse between doses and you cannot wash the area for another 4 hours after application. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule.
This product slows hair growth. It is not a depilatory. You will have to continue shaving, tweezing, or using another hair removal technique.
Wait several minutes after application of eflornithine before applying cosmetics or sunscreen.
Use only on your face and neck.
Call your doctor if your skin becomes irritated or if you develop other side effects. If skin irritation continues, you may have to stop using eflornithine.
Special Populations
Pregnancy/Breast-feeding: Eflornithine cream may cause birth defects. 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 should use infant formula.
Seniors: Seniors may use eflornithine without special restriction.
Generic Name
Enalapril (uh-NAL-uh-pril)
Brand Name
Vasotec
Combination Product
Ggner;c Ingredients: Enalapril + Hydrochlorothiazide RE Vaseretic
Type of Drug
Angiotensi n -converting enzyme (ACE) inhibitor.
Prescribed For
Hypertension (high blood pressure), heart failure, diabetic kidney disease, and heart attack treatment when the function of the left ventricle has been affected. Also prescribed for kidney failure, kidney hypertension, managing people with a high risk of heart disease, chronic kidney disease, and preventing a second stroke.
General Information
Enalapril maleate and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving symptoms of heart failure. Enalapril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation. Enalapril begins working about 1 hour after you take it and continues to work for 24 hours.
Cautions and Warnings
Do not take enalapril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients taking enalapril or those undergoing venom immunization.
Swelling of the face, extremities, or throat has been known to occur with enalapril, which can be dangerous (see “Special Information”).
Enalapril occasionally causes very low blood pressure.
Enalapril may affect your kidney function, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of treatment. Dosage adjustment of enalapril is necessary if you have reduced kidney function.
Enalapril can affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
Enalapril may cause serious Injury or death to the fetus if taken duriRcA pregnancy. Pregnant women should not take enalapril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
♦ Most common-. dizziness, fatigue, headache, and chronic cough. The cough usually goes away a few days after you stop taking the medication.
♦ Less common: chest tightness or pain, dizziness when rising from a sitting or lying position, fainting, abdominal pain, nausea, vomiting, diarrhea, bronchitis, urinary tract infection, breathing difficulties, weakness, and rash.
♦ 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.
For additional information about enalapril + felodipine, see Felodipine, page 471.
Drug Interactions
• The blood-pressure-lowering effect of enalapril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid drop in blood pressure should be used with caution if you are taking enalapril.
• Enalapril may increase the effects of lithium; this combination should be used with caution.
• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the blood-pressure-lowering effects of enalapril and other ACE inhibitors. The combination may cause reductions in kidney function.
• Enalapril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
• Antacids and enalapril should be taken at least 2 hours apart.
• Capsaicin may trigger or aggravate the cough associated with enalapril therapy.
• Indomethacin may reduce the blood-pressure-lowering effects of enalapril.
• Phenothiazine sedatives and antiemetics may increase the ef - feZIS of enalapril.
• Rifampin may reduce the effects of enalapril.
• The combination of allopurinol and enalapril increases the chance of side effects. Avoid this combination.
• Enalapril affects blood levels of digoxin. More digoxin in the blood increases the chance of digoxin-related side effects, while less digoxin in the blood can compromise its effectiveness.
• Severe sensitivity reactions can occur in those taking allo-
purinol.
For additional information about enalapril + felodipine, see Felodipine, page 471.
Food Interactions
You may take enalapril with food if it upsets your stomach.
Usual Dose
Enalapril
Adult: 5-40 mg a day in 1 or 2 doses. People with poor kidney function need less medication.
Enalapril + Felodipine
Adult: 1-2 tablets a day.
Overdosage
The principal effect of enalapril overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Enalapril can cause swelling of the face, lips, hands, or feet. This swelling can also affect the larynx (throat) or tongue and interfere with breathing. If this happens, go to a hospital emergency room at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, persistent rash, or loss of taste perception.
Some people who start taking enalapril after they are already on a diuretic (an agent that increases urination) experience a rapid drop in blood pressure after their first doses or when their dosage is increased. To prevent this from happening, your doctor may tell you to stop taking your diuretic 2 or 3 days before starting enalapril or to increase your salt intake during that time. The diuretic may then be restarted gradually.
You may gO dizzy if you rise to your feet too quickly from a sitting or lying position when taking enalapril.
Avoid strenuous exercise or very hot weather because heavy
sweating or dehydration can cause a rapid drop in blood pressure.
While taking enalapril, avoid over-the-counter diet pills, decon-
gestants, and other stimulants that can raise blood pressure. Also,
do not take potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you take enalapril once a day and forget to take a dose, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take enalapril twice a day and miss a dose, take it right away. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might become pregnant should not take ACE inhibitors. Sexually active women of childbearing age who must take enalapril must use an effective contraceptive method to prevent pregnancy. If you become pregnant, stop taking the medication and call your doctor immediately.
Small amounts of enalapril pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug due to age-related losses in kidney or liver function.
Generic Name
Enfuvirtide (en-M-ir-tide)
fusing to healthy CD4 cells, a key part of the human immune system. This helps fight HIV by having fewer HIV-infected cells as well as a healthier immune system to fight off the HIV virus. Enfuvirtide is always prescribed in combination with other antiviral medicines. It is possible for the HIV virus to become resistant to enfuvirtide, but this drug can work against types of the virus that have become resistant to other anti-HIV therapies.
Cautions and Warnings
Do not take enfuvirtide if you are allergic or sensitive to any of its ingredients. Symptoms of drug allergy can include generalized itching, rash, severe chills, and low blood pressure. In rare cases, enfuvirtide triggers severe hypersensitivity. Patients experiencing symptoms (a combination of rash, fever, nausea, and/or respiratory distress) should stop using enfuvirtide and seek medical attention immediately.
People taking enfuvirtide may be more likely to develop bacterial pneumonia. See your doctor regularly and report any difficulty breathing or unusual respiratory reactions.
Enfuvirtide may raise blood sugar levels, worsen diabetes, or trigger latent diabetes. People with diabetes who take this drug may need to have the dosage of their anti-diabetes medication adjusted.
Possible Side Effects
✓ Most common: allergic skin reaction at the site of injection (symptoms include itching, rash, and swelling of tissue under the skin), diarrhea, nausea, fatigue, and sleeplessness.
✓ Common: tingling in the hands or feet, depression, anxiety, cough, sinusitis, herpes infection, weight loss, appetite loss, weakness, itching, and muscle ache.
✓ Less common: taste changes, small skin tumors, flu infection, constipation, abdominal pain, pancreas inflammation, conjunctivitis and lymph gland inflammation.
‘T Rare: Rare side effects can affect the blood, immune system, kidneys, urinary tract, and central nervous system. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
Enfuvirtide is not broken down in the liver and does not affect liver enzyme systems, so it is not likely to be involved in common drug
interactions.
Food Interactions
None known. Usual Dose
Adult and Child (age 17 and over): 90 mg injected under the skin into the upper arm, thigh, or abdomen twice a day.
Child (age 6-16): 0.91 mg per lb. of body weight twice a day, up to 90 mg per injection. Be sure to increase enfuvirtide dosage as your child’s weight increases.
Child (under age 6): not recommended.
Overdosage
Little is known about the effects of enfuvirtide overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Enfuvirtide is not a cure for HIV It will not prevent you from transmitting the HIV virus to another person; you must still practice safe sex. People taking this drug may still develop opportunistic infections and other complications associated with HIV infection.
This drug is given by injection under the skin. For information on how to properly administer this drug, see page 1242.
Do not use a vial of enfuvirtide if the final solution has particles floating in it. It should be completely clear, colorless, and have no bubbles in the vial.
You may keep solutions of enfuvirtide in the refrigerator and use them for up to 24 hours after they have been mixed. After that, they must be thrown away.
Tell your doctor if you are pregnant, become pregnant, os plan to become pregnant.
Do not stop taking this, or any other anti-HIV medicine, without first consulting your doctor.
Special Populations
Pregnancy/Breast-feeding: While animal studies of enfuvirtide reveal no damage to the fetus, this drug should only be used during pregnancy after carefully weighing its potential benefits against its risks. A national registry has been established to gather information on pregnant women who take this drug.
It is not known if enfuvirtide passes into breast milk. Nursing mothers with HIV should always use infant formula, regardless of whether they take this drug, to avoid transmitting the virus to their child.
Seniors: The effects of enfuvirtide in seniors is unknown.
Generic Name
Entacapone (in-TACK-a-pohn)
Brand Name Comtan
Type of Drug Antiparkinsonian.
Prescribed For
Parkinson’s disease patients for whom levodopa + carbidopa loses its effectiveness between doses.
General Information
Entacapone is always used in combination with levodopa + carbidopa. Some patients experience signs and symptoms of an end-of-dose “wearing-off” effect with these drugs. Entacapone enhances the effect of levodopa + carbidopa by reversing the action of an enzyme known as catechol-O-methyltransferase (COMT), which is primarily responsible for breaking down levodopa in the body.
Cautions and Warnings
Do not take entacapone If yOU are allergic or sensitive to any of At *Ingredients.
Do not take entacapone with phenelzine or tranyleypromine, as a very serious reaction may occur.
People with liver disease should use entacapone with caution as they may accumulate twice as much of this drug in their blood as people with normal liver function.
Entacapone has been rarely associated with the formation of fibrous tissues in unusual places such as the urinary tract and lungs. It has also caused fluid in the lungs.
Entacapone may cause kidney toxicity.
Entacapone may increase the risk of dizziness or fainting when rising from a sitting or lying down position.
Hallucinations have been reported with other Parkinson’s disease drugs.
Possible Side Effects
♦ Most common: difficulty performing voluntary muscle functions, excessive muscle activity, nausea, urine discoloration, and diarrhea.
♦ Common: reduced muscle activity, dizziness, fatigue, constipation, and abdominal pain.
✓ Less common: low blood pressure and fainting when rising from a sitting or lying position, hallucinations, anxiety, agitation, gastritis or other stomach disorders, dry mouth, vomiting, increased sweating, back pain, taste changes, shortness of breath, easy bruising, weakness, and bacterial infection.
♦ Rare: muscle damage or death, high fever, and confusion. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Do not mix entacapone with the monoamine oxidase inhibitor (MAGI) antidepressants phenelzine or tranylcypromine. Entacapone may be taken with the MAGI selegiline.
• Other drugs broken down by COMT will also be affected by entacapone. Isoproterenol, epinephrine, ephedrine, norepinephrine, isoetharine, and others will interact with entacapone, even when taken by inhalation. The result may be increased heart rate, wybylh m ias, and excessive changes in Uwd pressure.
• Cholestyramine, probenecid, erythromycin, rifampin, ampicillin, and chloramphenicol may interfere with the elimination of entacapone from the body.
• Entacapone may enhance the effects of sedatives and other nervous system depressants.
Food Interactions
This drug may be taken with or without food.
Usual Dose
Adult: 200 mg with each levodopa + carbidopa dose, up to
1600 mg a day.
Child: not recommended.
Overdosage
Theoretically, a massive entacapone overdose could prove lethal by completely inhibiting COMT throughout the body. There have been no reports of significant entacapone overdose. Doses up to 800 mg have been taken and side effects were mainly abdominal pain and loose stools. Other effects that might be expected include difficulty breathing, loss of muscle coordination, reduced level of activity, and convulsions. Overdose victims should be taken to a hospital emergency room as soon as possible. ALWAYS bring the prescription bottle or container.
Special Information
Always take your entacapone dose together with your levodopa + carbidopa dose. If you forget a dose, take it as soon as you remember. If it is within 2 hours of your next dose, skip the dose you forgot and continue with your regular schedule.
This drug can cause dizziness, nausea, sweating, or fainting when rising quickly from a sitting or lying position, especially at the beginning of treatment.
Increased body movements and twitching, twisting, or uncontrolled tongue, lip, face, arm, or leg movement may occur. If this happens, your doctor may need to adjust your dose of levodopa + carbidopa.
Exercise caution when performing tasks, such as driving, that require coordination and concentration until your body has become accustomed to the effects of entacapone.
Gradually reducing the dose of entacapone decreases some drug side effects.
Rapid withdrawal can cause high fever, sweating, unstable blood pressure, stupor, and muscular rigidity. Patients who stop using entacapone should be monitored.
Entacapone can cause your urine to turn a brownish-orange color. This change is harmless.
Special Populations
Pregnancy/Breast-feeding: Entacapone causes birth defects, miscarriage and abortion in pregnant animals. When this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
Entacapone passes into the breast milk of animals but no information on humans is available. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may take this drug without special precaution.
Aug
12
Dimenhydrinate - Diphenhydramine Hydrochloride - Disopyramide - Dofetilide
August 12, 2009 | Leave a Comment
Generic Name
Dimenhydrinate (dye-men-HYE-drih-nate) A
Brand Names
Calm-X Dramamine
Dimetabs Triptone
The information in this profile also applies to the following drugs: Generic Ingredient: Meclizine 91
Antivert Bonine
An tOmA 2S Meni-D
Antivert 50 Ru-Vert-M Antrizine
Type of Drug
Antihistamine and antiemetic (an agent that prevents or relieves nausea and vomiting).
Prescribed For
Nausea, vomiting, vertigo, and dizziness associated with motion
sickness.
General Information
Dimenhydrinate, which depresses middle ear function, is a mixture of diphenhydramine—an antihistamine believed to be the active ingredient—and another ingredient. Meclizine is an antihistamine. It takes a little longer to start working than dimenhydrinate, but its effects last much longer. Meclizine does a better job of preventing motion sickness than treating its symptoms. It takes 30 minutes to 1 hour to work and lasts for 12-24 hours.
Cautions and Warnings
Do not take dimenhydrinate if you are allergic or sensitive to any of its ingredients. Newborn babies should not be given this drug.
People with a prostate condition, stomach ulcer, intestinal obstruction, bladder problems, difficulty urinating, glaucoma, asthma, or abnormal heart rhythms should use dimenhydrinate only while under a doctor’s care.
Because it controls nausea and vomiting, dimenhydrinate may hide the symptoms of appendicitis or overdoses of other drugs.
Possible Side Effects
✓ Most common: drowsiness.
♦ Less common: confusion; nervousness; excitation; restlessness; headache; sleeplessness, especially in children; tingling; heavy or weak hands; fainting; dizziness; tiredness; rapid heartbeat; low blood pressure; heart palpitations; blurred or double vision; difficult or painful urination; increased sensitivity to the sun; appetite loss; nausea; vomiting; diarrhea; upset stomach; constipation; nightmares; rash; drug reaction (symptoms include rash, itching, hives, and breathing difficulties); ringing or buzzing in the ears-, dry mouth, nose, or throat; stuffy nose-, wheezing: and increased chest phlegm OT chest tightness.
Drug Interactions
• This drug should not be taken with a monoamine oxidase inhibitor antidepressant.
• Taking dimenhydrinate with an alcoholic beverage, other antihistamine, sedative, or other central-nervous-system (CNS)
depressant may cause excessive dizziness, drowsiness, or other signs of depression.
• Side effects of anticholinergics may be increased when taken with dimenhydrinate.
• Combining dimenhydrinate and certain antibiotics that cause dizziness or other ear-related side effects may mask early signs of these side effects, especially in infants and children.
Food Interactions
Take dimenhydrinate with food or milk if it upsets your stomach.
Usual Dose
Dimenhydrinate
Adult and Child (age 13 and over): 50-100 mg-1 or 2 tablets or 4-8 tsp.-30 minutes prior to travel; then every 4-6 hours; do not take more than 400 mg a day.
Child (age 6-12): 25-50 mg-1/2 or 1 tablet or 2-4 tsp.—every 6-43 hours; do not take more than 150 mg a day.
Child (age 2-5): up to 25 mg-1/2 or 1 tablet or 2 tsp.-every 6-8 hours; do not take more than 75 mg a day.
Child (under age 2): Consult your doctor.
Meclizine
Adult and Child (age 13 and over): 25-50 mg 1 hour before travel; repeat every 24 hours for duration of journey. Up to 100 mg a day in divided doses may be needed to control dizziness from other causes.
Child: not recommended.
Overdosage
Symptoms of overdose include drowsiness, clumsiness, unsteadiness, feeling faint, facial flushing, and dry mouth, nose, or throat. Convulsions, coma, and breathing difficulties may also develop. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
N1 Maximum effectiveness against motion sickness, take dimenhydrinate 1-2 hours before traveling; it may still be effective if taken 30 minutes before traveling.
This drug may cause drowsiness: Be extremely cautious when driving, operating hazardous machinery, or doing anything that requires concentration.
Dimenhydrinate may cause dry mouth, nose, or throat. Sugarless candy, gum, or ice chips can usually relieve these symptoms. Constant dry mouth may increase the likelihood of developing tooth decay or gum disease. Pay special attention to oral hygiene while you are taking dimenhydrinate, and contact your doctor if dry mouth lasts more than 2 weeks.
If you forget to take a dose of dimenhydrinate, 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: Animal studies suggest that meclizine may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant —especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of dimenhydrinate may pass into breast milk. Dimenhydrinate may also slow milk production. Nursing mothers who must take dimenhydrinate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects and should take the lowest effective dose.
Generic Name
Diphenhydramine Hydrochloride
(dye-fen-HYE-druh-mene hye-droe-KLOR-ide) 91
Brand Names
40 Winks
AllerM,ly,
AllerMax Maximum Strength Altaryl Children’s Allergy Banophen
Banophen Allergy
Benadryl Allergy
Benadryl Children’s Allergy* Benadryl Children’s Dye Free Benadryl Dye Free Allergy
Liquid Gels
Children’s Pediacare Nighttime Cough’
Compoz Gel Caps
Compoz Nighttime Sleep Aid Diphen AF
Diphenhist
Dormin
Dytuss
Genahist
Midol PM
Miles Nervine
Nytol Quick Caps
Nytol Quick Gels Maximum Strength
Scot-Tussin Allergy*
Siladryl
Simply Sleep
Sleep-Eze 3
Sleepinol Maximum Strength Sleepwell 2-Nice
Snoozefast
Sominex Original Formula Sylphen Cough
TheraFlu Thin Strips Multi Symptom
Triaminic Thin Strips Cough and Runny Nose
Tusstat
Unisom
‘Some products in this brand-name group are alcohol- or sugar-free.
Type of Drug Antihistamine.
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy and for other symptoms of allergy such as itching, rash, and hives; also prescribed for motion sickness, insomnia, and Parkinson’s disease.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction), drying the nose, throat, and eye secretions. Diphenhydramine is the most common active ingredient found in nonprescription sleep aids.
Cautions and Warnings
This drug should not be used if you are allergic or sensitive to any of its ingredients. It should be avoided or used wilt extreme care if you have narrow-angle glaucoma, stomach ulcer, intestinal abslmcfion, other stomach problems, difficulty urinating, or enlarged prostate. It should not be used by people who have sleep apnea or deep-breathing problems such as asthma. Use with care if you have a history of thyroid disease, heart disease, emphysema, chronic bronchitis, or high blood pressure.
Drug Interactions
• This drug should not be taken with a monoamine oxidase inhibitor antidepressant.
• The effects of sedatives, sleeping medications, and other central-nervous-system (CNS) depressants will be intensified when combined with diphenhydramine hydrochloride; it is extremely important that doses of these drugs are properly adjusted.
• This drug increases the intoxicating and sedating effects of alcohol.
Food Interactions
Take this drug with food if it upsets your stomach.
Usual Dose
Allergy
Adult: 25-50 mg 3-4 times a day.
Child (over 20 tbs.): 12.5-25 mg 3-4 times a day.
Nighttime Sedation
Adult and Child (age 12 and over): 25-50 mg at bedtime.
couqh. SIN%
Adult and Child (age 12 and over): 25 mg every 4 hours; do not take more than 150 mg in 24 hours.
Child (age 6-12): 12.5 mg every 4 hours; do not take more than 75 mg in 24 hours.
mouth, and weakness.
g, rash, sensitivity to bright light, per-
s, lowering of blood pressure, head-
t, sleeplessness, dizziness, disturbed sion, restlessness, nervousness, irri- eling “high”), tingling and weakness of lurred or double vision, ringing in the , appetite loss, nausea, vomiting, con- urinary difficulties, thickening of lung s of the chest, wheezing, nasal stuffi-
h, nose, or throat.
Possible Side Effects
✓ Common: drowsiness
✓ Less common: itching
• fever, chills
• rapid heartbeat
confusion
euphoria (feelin
hands or feet, blurre
• upset stomach
• diarrhea, secretions, tightnes
• and dry
Child (age 2-6): 6.25 mg every 4 hours; do not take more than
25 mg in 24 hours.
Child (under age 2): not recommended.
Thin Strips
TheraFlu
Adult and Child (age 12 and over): 1 strip every 4 hours; do not take more than 6 strips in 24 hours.
Triaminic
Child (age 6-12): 1 strip every 4 hours; do not take more than 6 strips in 24 hours.
Overdosage
Symptoms of overdose include depression or stimulation—especially in children; dry mouth; fixed or dilated pupils; flushing; and upset stomach. Overdose victims should be made to vomit with ipecac syrup—available at any pharmacy. Take the overdose victim to a hospital emergency room immediately if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be extremely cautious when driving or operating hazardous equipment.
If you are taking this medication for motion sickness, take the first dose at least 30 minutes prior to exposure.
If you forget to take a dose of diphenhydramine hydrochloride, 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: Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 miDMIns of pregnancy—because newborns may have severe reactions to antihistamines.
SMM) amounts of antihistamine pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects and may require lower dosages.
Generic Name
Disopyramide (die-soe-PIE-rah-mide) 92
Brand Names Norpace
Type of Drug Antiarrhythmic.
Prescribed For Abnormal heart rhythms.
General Information
Disopyramide phosphate slows the rate at which nerve impulses are carried through heart muscle, reducing the response of heart muscle to those impulses. It acts on the heart similarly to the more widely used antiarrhythmic medications procainamide hydrochloride and quinidine sulfate. Disopyramide is often prescribed for people who do not respond to other antiarrhythmic drugs.
Cautions and Warnings
Do not take disopyramide if you are allergic or sensitive to any of its ingredients or if you have heart block, unless you have a cardiac pacemaker.
This drug can worsen heart failure or trigger severely low blood pressure. It should be used in combination with another antiarrhythmic agent or beta blocker with caution.
In rare instances, disopyramide has caused a reduction in blood-sugar levels. Therefore, the drug should be used with caution by diabetics, older adults—who are more susceptible to this effect—and people with poor kidney or liver function. Ask your doctor if you should have your blood-sugar levels checked while taking this drug.
Because of its anticholinergic effects, men with a severe prostate condition and people who have glaucoma, myasthenia gravis, or severe difficulty uritx;aA:jng should use disopyramide with caution.
People with liver or kidney disease must take a reduced dose of disopyramide.
Potassium levels affect the action of disopyramide. People with blood potassium levels that are out of the normal range must correct this imbalance before starting disopyramide.
Norpace CR
Possible Side Effects
♦ Most common: dry mouth, urinary difficulty, and constipation.
♦ Common: blurred vision; dry eyes, nose, and throat; frequent urination; nausea; stomach pain or bloating; gas; dizziness; fatigue; headache; and nervousness.
♦ Less common: itching, rashes, muscle weakness, generalized aches and pains, not feeling well, low blood-potassium levels, increases in blood-cholesterol and triglyceride levels, heart failure, and low blood pressure.
♦ 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
• Phenytoin and rifarnpin may increase the rate at which the body removes disopyramide from the blood. Your disopyramide dose may need alteration if this combination is used. Other drugs known to increase drug breakdown by the liver, such as barbiturates and primidone, may also have this effect.
• Other antiarrhythmic drugs, such as procainamide and quinidine, may increase the effect of disopyramide, making dosage reduction necessary. At the same time, disopyramide may reduce the effectiveness of quinidine.
• When disopyramide is combined with a beta-blocking drug, increased disopyramide effects, additive effects, or depression of heart function may result.
• Azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, telithromycin, and verapamil may increase the amount of disopyramide in your blood, causing abnormal heart rhythms or other cardiac effects.
• Disopyramide may reduce the effectiveness of oral anticoagulant (blood-thinning) drugs. Your doctor should check your anticoagulant dosage to be sure you are getting the right amount.
• Hydantoins may cause a decrease in the effectiveness of disopyramide.• Disopyramide may increase the amount of digoxin in your blood, though the amount of the increase is not likely to af-
fect your heart.
• St. John’s wort may decrease disopyramide levels.
Food Interactions
Disopyramide should be taken on an empty stomach at least 1
hour before or 2 hours after meals. Usual Dose
Adult: 400-800 mg a day (divided into 2 or 4 doses for the immediate-release form). In severe cases, 400 mg every 6 hours may be required. This level of dosage should be monitored in the hospital. The sustained-release preparation is taken every 12 hours. People with reduced kidney function should receive a lower dosage, depending on the degree of kidney function present. People with liver failure should take 400 mg a day.
Child (age 13-18): 2.5-7 mg a day per lb. of body weight. Child (age 5-12): 4.5-7 mg a day per lb. of body weight. Child (age 1-4): 4.5-9 mg a day per lb. of body weight.
Child (under age 1): 4.5-13.5 mg a day per lb. of body weight.
Overdosage
Overdose symptoms are breathing difficulties, abnormal heart rhythms, and unconsciousness. In severe cases, overdosage can lead to death. Overdose victims should be made to vomit with ipecac syrup—available at any pharmacy—to remove any remaining drug from the stomach. Call your doctor or poison control center before doing this. If you must go to a hospital emergency room, ALWAYS bring the prescription bottle or container. Prompt and vigorous treatment can mean the difference between life and death in severe overdosage.
Special Information
Disopyramide may cause symptoms of low blood sugar: anxiety, chills, cold sweats, drowsiness, excessive hunger, nausea, nervousness, rapid pulse, shakiness, uaus~M% weakness, tiredness, or cool, pale skim If kNSN)appens to you, eat some chocolate, candy, U rilher high-sugar food, and call your doctor at once.
Disopyramide can cause dry mouth, urinary difficulty, constipation, or blurred vision. Call your doctor if these symptoms become severe or intolerable, but do not stop taking the medication without your doctor’s approval.
If disopyramide is required for a child and capsules are not appropriate, your pharmacist can make a liquid product. Do not do this at home: This medication requires special preparation. The liquid should be refrigerated and protected from light and should be thrown away after 30 days.
Do not crush, chew, or open sustained-release capsules.
If you forget to take a dose of disopyramide, take it as soon as possible. However, if it is within 4 hours of your next dose, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feeding: Do not take this drug if you are pregnant or planning to become pregnant while using it, because it will pass into the fetus and may affect its development. When disopyramide is considered crucial by your doctor, its potential benefits must carefully be weighed against its risks.
Disopyramide passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of this drug.
Generic Name
Dofetilide (DOH-fet-a-lyed)
Brand Name Tikosyn
Type of Drug Antiarrhythmic.
Prescribed For
Specific abnormal heart rhythms.
General Information
Dofetilide is used to establish and maintain normal sinus rhythm in the heart. Dofetilide is available only to hospitals and doctors who receive specific training and education on how to use this drug because of the risks associated with using it.
Cautions and Warnings
Do not take dofetilide if you are allergic or sensitive to any of its ingredients.
Dofetilide is reserved for people whose abnormal heart rhythms have not responded to other drugs. People taking dofetilide must be in a hospital or other facility for at least 3 days where appropriate blood tests can be performed to monitor kidney and heart function.
This drug is cleared through the kidneys. Poor kidney function increases the amount of dofetilide in the body. Liver disease has no effect on dofetilide blood levels.
Dofetilide, like other antiarrhythmic drugs, can cause severe and sometimes fatal abnormal rhythms of its own.
Do not take dofetilide without first talking to your doctor if you have a low blood level of potassium or magnesium.
Women may be at a greater risk for some arrhythmias caused by dofetilide.
Possible Side Effects
Serious heart arrhythmias can develop in up to 31b% of patients taking up to 1000 mcg a day of dofetilide. People taking daily doses above 1000 mcg a day are at up to 5 times greater risk for arrhythmias.
• Most common: headache, chest pain, and respiratory infection.
♦ Common: difficulty breathing, nausea, and dizziness.
♦ Less common: flu; sleeplessness; accidental injury; back pain; diarrhea; abdominal pain; angina; anxiety: joint pain; weakness; atrial and ventricular arrhythmia; high blood pressure; pain; heart palpitations; swollen legs, ankles, or arms; sweating; and urinary infections.
♦ Rare: some arrhythmias, heart attack, hives, slow heartbeat, stroke, facial or other paralysis, tingling in the hands or feet, cough, liver damage, migraine, fainting, and sudden death. Contact your doctor if you experience any side effect not listed above.
‘D?Ug Interactions
Dofetilide should not be given with drugs that are known to interact with it. Dofetilide must be stopped at least 2 days before any potentially interacting drug is taken.
• Do not mix dofetilide with any product containing verapamil, a calcium channel blocker, or trimethoprim, used for urinary infections. These combinations can substantially raise the amount of dofetilide in the blood.
• Some drugs may increase the amount of dofetilide in the blood by inhibiting enzymes that break it down in the liver. They include delavirdine, indinavir, btonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, clarithromycin, cannabis, diltiazem, erythromycin, fluconazole, fluvoxamine, itraconazole, ketoconazole, mifepristone, nefazodone, norfloxacin, mibefradil, selective serotonin reuptake inhibitors (SSRIS), troleandomycin, and zatirlukast.
• Some drugs may reduce the amount of dofetilide in the blood by stimulating enzymes that break it down in the liver, including efavirenz, nevirapine, carbamazepine, corticosteroids, modafanil, phenobarbital and other barbiturates, phenytoin, pioglitazone, and rifampin. Amiloride, metformin, megestrol, and triamterene can interfere with the elimination of dofetilide via the kidney, raising blood levels of the drug.
• Other drugs that can increase the effects of dofetilide are Other antiarrhythmic drugs, bepridil, phenothiazines, and tricyclic antidepressants.
• Mixing dofetilide with digoxin may lead to a ventricular arrhythmia called torsade de pointes. Thiazides, furosemide, and other potassium-depleting diuretics can also increase the risk of this arrhythmia.
Food Interactions
Grapefruit juice may increase dofetilide blood levels.
Usual Dose
Adult: 125-500 mcg twice a day.
Child (under 18 years): not recommended.
Overdosage
Dofetilide overdose is likely to cause significant heart rhythm problems. Overdose victims must be treated symptomatically by their cardiologist.
Special Information
Read all information supplied to you before you begin taking this medication and read it again if anything in your treatment program changes.
Tell your doctor about any changes in your prescription or nonprescription drug use or in your use of vitamins, minerals, and other dietary supplement products.
Be sure that any other doctor or hospital that treats you and might prescribe another drug knows you are taking dofetilide.
Call your doctor at once if you develop any signs of altered electrolyte balance including excessive or prolonged diarrhea, sweating, vomiting, appetite changes, or excessive thirst.
If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Dofetilide causes birth defects in animal studies. Pregnant women should take this drug only after discussing with their doctors its potential benefits and risks.
It is unknown whether dofetilide passes into breast milk. Nursing mothers who take it should consider using infant formula.
Seniors: Older adults may take this drug without special restriction.
Aug
12
Dicyclomine - Digoxin - Diltiazem
August 12, 2009 | Leave a Comment
Generic Name
Dicyclomine (dih-SYE-kloe-meen) 10j
Brand Names
Bemote Dilomine
Bentyl Di-Spaz
Bycloft),e Or-Tyl Dibent
Type of Drug
Antispasmodic and anticholinergic.
Prescribed For
Irritable bowel, spastic colon, and similar digestive problems; also prescribed for colic in children over age 6 months.
General Information
Dicyclomine hydrochloride has been used for many years to calm “nervous stomach.” It and other anticholinergics work by blocking the effects of the neurohormone acetylcholine in the gastrointestinal (GI) tract. This reduces the mobility of the GI tract and slows the production of enzymes and other secretions.
Cautions and Warnings
Do not take dicyclomine if you are allergic or sensitive to any of its ingredients.
Dicyclomine should not be used by those with obstructive disease of the GI or urinary tract, severe ulcerative colitis, reflux esophagitis, acute bleeding with unstable heart function, myasthenia gravis, or glaucoma.
Dicyclomine should not be used in infants less than age 6 months or by breastfeeding mothers.
This drug should be used with caution if you have heart disease, Down’s syndrome, spastic paralysis, reduced mobility of the stomach and lower esophagus, fever, urinary difficulties, enlarged prostate, hiatal hernia, intestinal paralysis, kidney or liver disease, rapid heartbeat, hyperthyroidism (overactive thyroid gland), high blood pressure, or ulcerative colitis.
Dicyclomine reduces your ability to sweat and may lead to heat exhaustion and heatstroke, which can be life-threatening. Avoid extended heavy exercise and limit your exposure to high temperatures.
Anticholinergenic psychosis has been reported by those taking anticholinergenics, but it usually resolves within 24 hours after discontinuation of the drug.
Possible Side EfferkS
♦ Common: dry mouth, dizziness, blurred vision, nausea, and lightheadedness.
V Less common: drowsiness, weakness, nervousness, constipation, and decreased sweating.
Possible Side Effects (continued)
♦ Rare: drug allergy (symptoms include rash, itching, lives,
and breathing difficulties), confusion, eye pain, dizziness
when rising quickly from a sitting or lying position, a bloated
feeling, difficult or painful urination, headache, memory
loss, and vomiting. Contact your doctor if you experience
any side effect not listed above.
Drug Interactions
• Antacids containing calcium or magnesium, citrates, sodium bicarbonate, and carbonic anhydrase inhibitor drugs may increase dicyclomine’s therapeutic effect and side effects.
• Combining dicyclomine with other anticholinergic drugs including atropine, belladonna, clidinium, glycopyrrolate, hyoscyamine, isopropamide, propantheline, and scopolamine may intensify side effects.
• Dicyclomine may reduce stomach acidity and blood levels of oral ketoconazole (an antifungal).
• Dicyclomine may decrease the therapeutic effects of anti-glaucoma medications. Taking dicyclomine with corticosteroids used to treat glaucoma may be hazardous.
• Dicyclomine may counteract the effect of metoclopramide in reducing nausea and vomiting.
• Taking dicyclomine with a narcotic pain reliever may cause severe constipation.
• Taking this or any drug that slows the movement of stomach and intestinal muscles with a potassium chloride supplement –especially one in wax-matrix tablet form—may lead to excessive irritation of the stomach.
• Combining dicyclomine with amantadine, certain drugs to control heart rhythm, antihistamines, nitrates or nitrites, may increase dicyclomine side effects.
• Dicyclomine may increase the effects of atenolol and digoxin.
• Pftn0hiazine drugs, monoamine oxidase inhibitor antidepressants, benzodiazepines, and tricyclic antidepressants may increase side effects of dicyclomine. The effectiveness of phenothiazines to control psychotic symptoms may be decreased.
Food Interactions
Take dicyclomine on an empty stomach, a half hour before or 2 hours after a meal.
Usual Dose
Adult: 80-160 mg a day in 4 divided doses. Seniors should receive the lowest possible dosage and increase only as needed. Child (age 2 and over): 5-10 mg 3-4 times a day.
Child (age 6 months-2 years): 5-10 mg of syrup 3-4 times a day. Child (under 6 months): not recommended.
Overdosage
Symptoms include blurred vision; clumsiness; confusion; breathing difficulties; dizziness; drowsiness; dry mouth, nose, or throat; rapid heartbeat; fever; hallucinations; weakness; slurred speech; excitement, restlessness, or irritability; warmth; and dry or flushed skin. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Children taking dicyclomine may be more likely to develop high body temperature in hot weather and other side effects and should be carefully watched for side effects. Dicyclomine should not be given to infants or children unless the doctor decides that its use is absolutely necessary.
Call your doctor if you develop diarrhea, rash, flushing, eye pain, dry mouth, urinary difficulties, constipation, increased sensitivity to light, or any bothersome or persistent side effect.
Brush and floss your teeth regularly while taking this drug. Because dicyclomine may cause dry mouth, you may be more likely to develop cavities or other dental problems. Ice or hard candy may relieve dry mouth.
Constipation may be treated by using a laxative.
Dicyclomine may make you drowsy or tired and cause blurred vision. Be careful when driving or doing any task that requires concentration.
If you forget take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: A few cases of human malformation were linked to dicyclomine, but studies have shown that the drug has no effect on the fetus. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Dicyclomine can reduce the amount of milk produced. Infants given dicyclomine may faint, go limp, and develop breathing problems and seizures. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more susceptible to side effects, especially memory loss, changes in mental state, and glaucoma. Seniors may obtain maximum benefit with smaller dosages.
Generic Name
Digoxin (dih-JOX-in) A
Brand Names Digitek
Lanoxicaps
Lanoxin
Type of Drug Cardiac glycoside.
Prescribed For
Congestive heart failure (CHF) and other heart conditions involving a very rapid heartbeat.
General Information
Digoxin works directly on heart muscle. It improves the heart’s pumping ability or helps to control its beating rhythm. People with heart failure often develop swelling of the lower legs, feet, and ankles; digoxin improves these symptoms by improving blood cir-
Digoxin is generally used as part of the lifelong treatment of CHF.
Cautions and Warnings
Do not use digoxin if you are allergic or sensitive to it. Digoxin allergies are rare.
Digoxin should not be used in people with ventricular fibril-
lation.
Digoxin should be used with caution in people with sick sinus
syndrome or incomplete AV block, as it may cause a worsening of these conditions.
Digoxin has been used to treat obesity. The risk of fatal heart rhythms associated with such treatment makes it extremely dangerous as weight-loss medication. Many heart disease symptoms may be associated with digoxin. Report any unusual side effects to your doctor at once.
Kidney disease may increase blood levels of digoxin. Your dosage may need adjustment.
Long-term use of digoxin may cause the body to lose potassium, especially since it is generally used in combination with diuretics (agents that increase urination). For this reason, be sure to eat a balanced diet and high-potassium foods—bananas, citrus fruits, melons, and tomatoes.
Digoxin should be used with caution in people with electrolyte disorders.
Digoxin requirements vary with thyroid status. If you are taking digoxin and your thyroid status changes, your doctor will have to alter your digoxin dosage.
Possible Side Effects
Adult and Senior
♦ Common: dizziness, headache, nausea, and diarrhea.
✓ Less common: appetite loss, vomiting, weakness, apathy, drowsiness, blurred or yellow-tinted vision, seeing halos around bright lights, depression, psychoses, confusion or disorientation, restlessness, hallucinations, delirium, seizure, nerve pain, abnormal heart rhythms, and slow pulse.
✓ Rare: Enlargement of the breasts has been reported after long-term use of digoxin. Contact your doctor if you experience any side effect not listed above.
Child
T Children are more likely to develop abnormal heart rhythms before they see yellow or green halos or spots and before they develop nausea, vomiting, diarrhea, or stomach pain. Any abnormal heart rhythms that develop while a child is taking digoxin should be assumed to be a side effect.
Drug Interactions
• Drugs that may increase the effect of digoxin are alprazolam, amiloride aminoglycoside antibiotics, amiodarone, anticholinergic drugs, benzodiazepines, captopril, clarithromycin, diltiazem, diphenoxylate, dipyridamole, erythromycin, esmolol, felodipine, flecainide, hydroxychloroquine, ibuprofen, indomethacin, itraconazole, nifedipine, nitrendipine, omeprazole, propafenone, propantheline, quinidine, quinine, spironolactone, tetracycline, tolbutamide, triamterene, and verapamil.
• Drugs that may decrease blood levels of digoxin include aminoglutethimide, aminoglycosides, aminosalicylic acid, antacids, anti-cancer combinations, antidiabetes medication, antihistamines, barbiturates, cholestyramine, colestipol, cyclosporine, kaolin-pectin mixtures, metoclopramide, oral kanamycin, oral neomycin, oral sulfonylureas, phenylbutazone, phenytoin and related anti-seizure drugs, rifampin, St. John’s wort, sucralfate, and sulfasalazine.
• Disopyramide may alter the effects of digoxin, although the exact interaction is not well understood.
• Thiazide and loop diuretics, furosemide, ethacrynic acid, and bumetanide increase digoxin’s effect and increase the risk of side effects.
• Spironolactone may increase or decrease the side effects of digoxin; amiloride may reduce the effect of digoxin on the force of heart contraction.
• The effects of digoxin on the heart may be additive to those of ephedrine, epinephrine and other stimulants, beta blockers, calcium salts, procainamide, and rauwolfia drugs.
• Digoxin dosage must be adjusted when it is combined with a thyroid drug.
Food Interactions
These drugs may generally be taken without regard to meals. Taking your medication after a high-fiber meal reduces the amourxtcil drug absorbed into your blood.
Usual OQSS
Adult and Child (age 10 and over): starting dosage—known as the digitalizing or loading dose—is about 4-7 mcg per lb. of body weight. Digitalization may also be accomplished with a lower dosage over 7 days. Maintenance dosage 0.125-0.5 mg; it must be corrected for kidney function. For seniors, a lower dosage is required.
Child (under age 1o): starting dosage-5-30 mcg per lb. of body weight. Maintenance dosage-20-35% of the starting dosage. Careful measurement of your child’s digoxin dosage is crucial to safe and effective treatment.
Overdosage
Adult: Symptoms include appetite loss, nausea, vomiting, diarrhea, headache, weakness, apathy, blurred vision, yellow or green spots or halos before the eyes, yellowing of the skin or whites of the eyes, and changes in heartbeat.
Senior: Vomiting, diarrhea, and eye trouble are frequently seen. Child: An early sign is a change in heart rhythms.
Call your doctor immediately if any of these symptoms appear. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Take each day’s dose at the same time of day.
Do not stop taking digoxin without your doctor’s knowledge.
Lanoxicaps are better absorbed than tablet forms of digoxin. For this reason, each dose of Lanoxicaps is slightly lower than the corresponding digoxin tablet.
Avoid over-the-counter diet and cold medications containing stimulants.
Call your doctor at once if you develop side effects.
There may by some variation between digoxin tablets from different manufacturers. Do not change drug brands without telling your doctor.
Check your pulse every day—your doctor will teach you how—and call your doctor if it drops below 60 beats per minute.
If you forget a dose and remember at least 12 hours before your next dose, take it right away. If you do not remember until it is less than 12 hours before your next dose, skip the one you forgot and continue with your regular schedule. Do “lot take a double dose. Call your doctor if you M1 a dose for 2 or more days.
Special Populations
Pregnancy/Breast-feeding: Digoxin crosses into the fetal circulation. While digoxin is sometimes used during pregnancy to treat fetal heart disease, women who are or might be pregnant should not take digoxin without their doctor’s approval. When your doc-tor considers this drug crucial, its potential benefits must be care-
fully weighed against its risks.
Small amounts of digoxin pass into breast milk. Nursing mothers who take digoxin should use infant formula.
Seniors: Seniors are more sensitive to digoxin’s effects, especially appetite loss. Seniors with impaired renal function may need lower
dosages.
Generic Name
Diltiazem (dil-TYE-uh-zem) 92
Brand Names
Cardizem Dilt-CD
Cardizem CD Diltia XT
Cardizem LA Diltzac
Cartia XT Taztia XT
Dilator XR Tiazac
Type of Drug
Calcium channel blocker.
Prescribed For
Angina pectoris, chronic stable angina, Raynaud’s disease, prevention of second heart attacks, tardive dyskinesia (severe side effects associated with antipsychotic and other drugs), and hypertension (high blood pressure).
General Information
Diltiazem hydrochloride is one of many calcium channel blockers available in the U.S. These drugs block the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage of calcium interferes with the contraction of these muscles, which in turn dilates (widens) the veins and ves sels that supply blood to them. This ditatk”q effect reduces blood pressure, the amount 0 Oxygen used by the heart muscle, and the ~1A 0 blood vessel spasm. Diltiazem is therefore useful in treating not only hypertension but also angina pectoris, a condition related to poor oxygen supply to the heart muscle and characterized by brief attacks of chest pain.
Diltiazem affects the movement of calcium only into muscle cells; it has no effect on calcium in the blood.
Cautions and Warnings
Do not take d,1taz&m1f you are allergic or sensitive to any of its
ingredients.
Diltiazem can slow your heart and interfere with normal electrical conduction. For people with a condition called sick sinus syndrome, this can result in temporary heart stoppage.
Diltiazem should not be taken if you are having a heart attack or if you have lung congestion. Diltiazem should be taken with caution by people with heart failure because it can worsen that condition.
Low blood pressure may occur, especially in people also taking a beta blocker.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken once daily—have a greater chance of having a heart attack than people taking beta blockers or another medicine for the same purposes. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Diltiazem can cause severe liver damage and should be taken with caution if you have had hepatitis or any other liver condition.
Caution should also be exercised if you have a history of kidney problems, although no clear tendency toward causing kidney damage is seen with this drug.
Possible Side Effects
♦ Common: dizziness, lightheadedness, weakness, head-
ache, and fluid accumulation in the hands, legs, or feet.
✓ Less common: low blood pressure, fainting, increase or decrease in heart rate, abnormal heart rhythm, heart failure, nervousness, fatigue, nausea, rash, tingling in the hands or feet, hallucinations, temporary memory loss, difficulty sleeping, diarrhea, vomiting, constipation, upset stomach, itching, unusual sensitivity to sunlight, paxnlu) or stiff joints, liver inflammation, and increased urination, especially at night.
Drug Interactions
• Diltiazem taken with a beta-blocking drug for hypertension is usually well tolerated, but may lead to heart failure in people with already weakened hearts.
• Calcium channel blockers, including diltiazem, may add to
the effects of digoxin. This effect is not observed with any
consistency, however, and only affects people with a large
amount of digoxin already in their systems.
• Cimetidine and ranitidine increase the amount of diltiazem in the bloodstream and may account for a slight increase in the drug’s effect.
• Diltiazem may increase blood levels of cyclosporine, carbamazepine, encainide, and theophylline, and thus increase the chance of side effects from these drugs.
• Diltiazem may cause a decrease in blood lithium levels, possibly undermining lithium’s antimanic effect.
• Calcium channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
Diltiazem is best taken on an empty stomach, at least 1 hour before or 2 hours after meals.
Usual Dose
Immediate-Release Products 30-60 mg 4 times a day.
Sustained-Release/Extended-Release Products Cardizem CD: 120-480 mg once a day. Cardizem LA: 120-540 mg once a day. Cartia XT: 120-300 mg once a day. Dilacor XR: 180-480 mg once a day. Dilt-CD: 120-360 mg once a day. Diltia XT: 180-480 mg once a day. Diltzac: 120-360 mg once a day. Taztia XT: 120-150 mg once a day. Tiazac: 120-360 mg once a day.
Overdosage
Symptoms of diltiazem overdose are very low blood pressure and reduced heart rate. Overdose victims must be made to vomit with 1J)8C2c syrup—available at any pharmacy—within 30 minutes of taking the overdose. Do not induce vomiting if the victim has fainted or is convulsing. If overdose symptoms have developed or more than 30 minutes have passed, vomiting is of little value. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special information
Call your doctor if you develop any of the following symptoms! swelling of the hands, legs, or feet-, severe dizziness; constipation or nausea; or very low blood pressure.
Do not open, chew, or crush sustained-release capsules of
diltiazem.
If you take your diltiazem 3 or 4 times a day and forget a dose, take it as soon as you remember. Space the remaining doses throughout the rest of the day. If you take diltiazem 1 or 2 times a day and forget to take 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. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: In animal studies. high doses of diltiazem interfered with the development of the fetus. Diltiazem should not be taken by women who are or might be pregnant. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks.
Because diltiazem passes into breast milk, nursing mothers taking this drug should use infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug because it takes longer to pass out of their bodies.
Aug
1
Chlorpromazine
August 1, 2009 | Leave a Comment
Generic Name
Chlorpromazine (klor-PROE-muh-zene) Al
Brand Names
Sonazine Thorazine*
The information in this profile also applies to the following drugs: Generic Ingredient: Fluphenazine Hydrochloride RE Generic Ingredient: Thioridazine Hydrochloride 0 Generic Ingredient: Trifluoperazine Hydrochloride
‘Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Phenothiazine antipsychotic.
Prescribed For
Psychotic disorders; moderate to severe depression with anxiety; agitation or aggressiveness in disturbed children; intractable pain; and senility. May also be used to relieve nausea, vomiting, hiccups, restlessness, acute intermittant porphyria, and apprehension before surgery or other procedures.
General Information
Chlorpromazine and other phenothiazines act upon a portion of the brain called the hypothalamus. Phenothiazines affect parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Chlorpromazine is available in suppositories and as liquid for those who have trouble swallowing tablets.
Cautions and Warnings
Do not take chlorpromazine if you are AeTgic or sensitive to any oVilsingredients or to any phenothiazine drug. Do not take it if you have very low blood pressure, Parkinson’s disease, or blood, liver, kidney, or heart disease.
Chlorpromazine may depress the cough reflex. People have accidentally choked to death because the cough reflex failed to protect them. Because of its effect in reducing vomiting, chlorpro-mazine may obscure symptoms of disease or toxicity due to over-
dose of another drug.
Use chlorpromazine under your doctor’s strict supervision if you have glaucoma, epilepsy, ulcers, or urinary difficulties.
Avoid exposure to extreme heat, because this drug may upset your body’s temperature-control mechanism. Do not allow the liquid forms of this drug to come in contact with your skin because they are highly irritating.
Chlorpromazine may cause unusually high or low levels of cholesterol.
Possible Side Effects
♦ Most common: drowsiness, especially during the first or second week of therapy. If drowsiness becomes troublesome, contact your doctor.
V Less common: changes in blood components, including anemias, raised or lowered blood pressure, abnormal heart rate, heart attack, sensitivity to light, and faintness or dizziness.
V Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Jaundice (symptoms include yellowing of the whites of the eyes or skin) may appear; when it does, it is usually within the first 2-4 weeks of treatment. Normally the jaundice goes away when the drug is discontinued, but there have been cases when it has not.
Phenothiazines may produce extrapyramidal side effects, including spasm of the neck muscles, rolling back of the eyes, convulsions, difficulty swallowing, and symptoms associated with Parkinson’s disease. These side effects seem very serious but usually disappear after the drug has been withdrawn; however, symptoms affecting the face, tongue, or jaw may persist for as long as several years, especially in older adults with a history of brain damage.
Chlorpromazine may cause an unusual increase in psychotic symptoms or may cause paranoid reactions, tiredness, lethargy, restlessness, hyperactivity, confusion at night, bizarre dreams, sleeplessness, depression, decreased sex drive, increased appetite, or euphoria (feeling “high”).
Drug Interactions
• Be cautious about taking chlorpromazine with over-the-
counter cough, cold, or allergy medications, barbiturates, al-
cohol, sleeping pills, narcotics or other sedatives, or any other
drug that may produce a depressive effect.
• Aluminum antacids may reduce the effectiveness of phenothiazine drugs.
• Chlorpromazine may reduce the effectiveness of bromocriptine and appetite suppressants.
• Anticholinergic drugs may reduce the effectiveness of chlorpromazine and increase the chance of side effects.
• Phenothiazine drugs may counter the blood-pressurelowering effect of guanethidine.
• Taking lithium together with a phenothiazine drug may lead to disorientation, loss of consciousness, or uncontrolled muscle movements.
• Combining propranolol and a phenothiazine drug may lead to unusually low blood pressure.
• Combining tricyclic antidepressants with a phenothiazine drug can lead to antidepressant side effects.
• Chlorpromazine may reduce the effectiveness of epinephrine and norepinephrine.
• Cigarette smoking reduces the amount of chlorpromazine in your blood. Smokers may need larger doses.
Food Interactions
Take liquid chlorpromazine with fruit juice or other liquids. You may also take it with food if it upsets your stomach.
Usual Dose
Adult: 30-1000 mg or more a day, individualized according to your disease and response.
Child (age 6 months and over): 0.25 mg per lb. of body weight every 4-6 hours, up to 200 mg or more a day, depending on disease, age, and response.
Chitty (under 6 months): not recommended.
Overdosage
Overdose symptoms include depression, extreme weakness, tiredness, lowered blood pressure, agitation, restlessness, uncontrolled muscle spasms, convulsions, fever, dry mouth, abnormal heart rhythms, and coma. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or
container.
Special Information
Call your doctor at once if you develop sore throat, fever, rash, weakness, visual problems, tremors, muscle movements or twitching, yellowing of the skin or whites of the eyes, or darkening of the urine.
Do not stop taking chlorpromazine without your doctor’s knowledge. It may take several weeks before this drug takes effect.
This drug may cause drowsiness. Use caution when driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorpromazine may cause unusual sensitivity to the sun and may turn your urine reddish brown to pink.
If dizziness occurs, avoid rising quickly from a sitting or lying position and avoid climbing stairs. Use caution in hot weather, because this drug may make you more prone to heat stroke.
If you are using sustained-release capsules, do not chew them or break them—swallow them whole. Liquid forms of phenothiazines must be protected from light. Do not take them out of their opaque bottles.
If you take chlorpromazine more than once a day and forget to take a dose, take it right away if you remember within an hour. If you do not remember within an hour, skip the dose you forgot and continue with your regular schedule. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue your regular schedule the next day. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Infants born to women taking this drug have experienced side effects—including jaundice and nervous system effects. Check with your doctor about taking chlorpromazine if you are or might be pregnant.
This drug may pass i”W breast milk. Nursing mothers who must take chlorpromazine should use infant formula .
Seniors: Seniors are more sensitive to the effects of this drug and usually achieve desired results with lower dosages. Some experts feel that seniors should receive ‘/,-1/4 the usual adult dose.
Aug
1
Chlordiazepoxide
August 1, 2009 | Leave a Comment
Generic Name
Chlordiazepoxide (klor-dye-az-uh-PDX-ide) 91
Brand Name
Librium
Type of Drug Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, agitation, and withdrawal symptoms of alcoholism; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Chlordiazepoxide is a member of the group of drugs known as benzodiazepines.
Benzodiazepines work by a direct effect on the brain. They can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant. Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects, and are usually as effective, if not more so.
Cautions and Warnings
Do not take chlordiazepoxide if you are allergic or sensitive to any of its ingredients or to another benzodiazepine, including clonazepam.
Chlordiazepoxide can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other condkjo(\SiVN\,NhjCb chlordiazepoxide should be used with caution are severe depression, especially with suicidal tendencies, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease.
Chlordiazepoxide should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage. It has also produced similar reactions among hyperactive and aggressive pediatric patients.
Chlordiazepoxide is not intended for more than 3-4 months of continuous use. Your condition should be reassessed before continuing chlordiazepoxide beyond that time.
Chlordiazepoxide may be addictive. Drug withdrawal may develop if you stop taking it after only 4 weeks of regular use, but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state.
Dosage of chlordiazepoxide should be decreased gradually over 4-8 weeks after prolonged use.
Possible Side Effects
Weakness and confusion may occur, especially in seniors and in those who are sickly.
♦ Most common: mild drowsiness during the first few days of therapy.
✓ Less common: depression, lethargy, disorientation, edema, headache, inactivity, slurred speech, stupor, dizziness, tremor, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, inability to fall asleep, and occasional liver - dysfunction. If you experience any of these symptoms, stop taking the medicine and contact your doctor immediately.
♦ 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
• Chlordiazepoxide is a central-nervous-system depressant. Avoid alcohol, other sedatives, narcotics, barbiturates, mono-amine oxidase inhibitor and other antidepressants, and antihistamines. Taking chlordiazepoxide with these drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Smoking may reduce the effectiveness of chlordiazepoxide by increasing the rate at which it is broken down by the body.
• The effects of chlordiazepoxide may be prolonged when it is
taken with cimetidine, contraceptive drugs, disulfiram, flu-
oxetine, isoniazid, ketoconazole, metoprolol, probenecid,
propoxyphene, propranolol, rifampin, or valproic acid.
• Theophylline may reduce chlordiazepoxide’s sedative effects.
• If you take antacids, separate them by at least 1 hour from your chlordiazepoxide dose to prevent them from interfering with the passage of chlordiazepoxide into the bloodstream.
• Chlordiazepoxide may increase blood levels of digoxin and the chances for digoxin toxicity.
• Levodopa + carbidopa’s effectiveness may be reduced by chlordiazepoxide.
• Phenytoin blood concentrations may be increased when taken with chlordiazepoxide, resulting in possible phenytoin toxicity.
Food Interactions
Chlordiazepoxide is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Adult: 5-100 mg a day. This range is due to individual response related to age, weight, disease severity, and other characteristics.
Child (age 6 and over): may be given if deemed appropriate by a doctor. Starting dose-5 mg 2-4 times a day. Maintenance dose—up to 30 mg a day for some children, but must be individualized to obtain maximum benefit.
Child (under age 6): not recommended.
Overdosage
Symptoms of overdose are confusion, sleepiness, poor coordination, lack of response to pain such as a pin prick, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be lakes to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Chlordiazepoxide can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
If you forget a dose of chlordiazepoxide, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Chlordiazepoxide may cause birth defects if taken during the first 3 months of pregnancy. Avoid chlordiazepoxide while pregnant.
Chlordiazepoxide may pass into breast milk. Nursing mothers who must take chlordiazepoxide should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of chlordiazepoxide and generally require smaller doses to achieve the same effect.
Jul
16
Aliskiren
July 16, 2009 | Leave a Comment
Generic Name
Aliskiren (ah-LISS-kih-ren)
Brand Name Tekturna
Combination Product
Generic Ingredients: Aliskiren + Hydrochlorothiazide Tekturna HCT
Type of Drug
Direct renin inhibitor. Prescribed For
High blood pressure.
General Information
Renin is produced by the kidney in response to a reduction in blood volume and the amount of blood passing through the kidney. Once in the blood, renin reacts with other hormones to forma very powerful blood vessel constrictor called angiotensin E that directly raises blood pressure. Renin also works with a hormore called aldosterone to raise blood pressure and it prevents sodium from being eliminated from the body. This increases the amount of water in the system, raising blood volume and increasing blood pressure. Aliskiren inhibits renin and all of its actions, thereby !owering blood pressure. The blood pressure lowering is usually seen with 2 weeks of starting on treatment. When aliskiren treatment is stopped, blood pressure gradually rises to pre-treatment levels. Only about 21/2% of any dose is absorbed into the blood and it takes about a week to reach a steady level in the blood. Most of the drug that is absorbed is broken down in the liver. The rest passes out of the body unchanged in the urine. Aliskiren may be used alone or with other hypertensives, however its use with maximum doses of an ACE inhibitor has not been adequately studied.
Cautions and Warnings
Do not take aliskiren if you are allergic or sensitive to any of its ingredients.
Angioedema swelling of the face, hands or feet, tongue, or throat can occur at any time during aliskiren treatment. If this happens, stop taking the medicine and go to your doctor’s office or a hospital emergency room for treatment. This reaction can interfere with your breathing.
The safety of aliskiren in people with moderate to severe kidney disease is not known.
The combination of aliskiren and an ACE inhibitor can lead to high blood levels of potassium.
Aliskiren may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, it should still be considered a useful blood pressure treatment.
Possible Side Effects
✓ Common: nausea, dizziness, and sleeplessness.
✓ Less common: diarrhea, abdominal pain, upset stomach, GERD, cough, rash high blood uric acid levels, gout, kidney stones, headache, nose and throat irritation, fatigue, upper respiratory infection, and back pain.
✓ Rare: difficulty breathing; swelling of the hands, face, eyes, or whole body; and seizures. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Mixing aliskiren with irbesartan can reduce the amount of aliskiren into the blood by 50%. This may reduce the effectiveness of aliskiren.
• Aliskiren has been studied together with both hydrochlorothiazide and valsartan and can be combined with them in blood pressure management. It has been used with amlodipine but may not be better than high dose amlodipine alone.
• Aliskiren’s interaction with ACE inhibitors is not yet fully known.
• Atorvastatin and ketoconazole slow the breakdown of aliskiren, resulting in an increase of aliskiren blood levels by 50% or more. Dosage adjustment may be necessary.
Aliskiren can reduce blood levels of the diuretic furosemide, reducing the diuretic’s effect.
Food Interactions
Aliskiren can be taken without regard to food or meals. Avoid taking it with high fat meals because they can drastically reduce the amount of aliskiren absorbed into the blood.
Usual Dose
Adult (age 18 and over)
Tekturna: 50-300 mg at the same time every day. Tekturna HCT. 1 tablet a day.
Child: not recommended. Overdosage
The most likely symptom of overdose is low blood pressure (symptoms include dizziness and fainting). If you think you have taken an overdose, call your doctor or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor at once if you develop swelling of the face, eyes, lips, tongue, or throat; difficulty swallowing or breathing; hoarseness; or other signs of a drug reaction or allergy.
If you forget a dose, take it as soon as you remember. If you do not remember until it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Aliskiren can injure or kill a developing fetus. Pregnant women should not take aliskiren. Women who suspect they are pregnant must call their doctor at once and stop taking aliskiren when pregnancy is confirmed. In those rare cases where aliskiren is considered life-saving for the mother and there is no substitute for aliskiren, your doctor may advise that you continue on the medicine and then check your baby’s development with periodic ultrasound examinations.
It is not known if this drug passes into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors may have higher blood levels of aliskiren and be more susceptible to drug side effects, but starting dose adjustment is not required.
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.
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.
Jul
16
Depression. Diagnosis, Treatment and FAQ.
July 16, 2009 | Leave a Comment
DEPRESSION
• Report suicidal thoughts to a health professional
• Ask your doctor if fluoxetine (generic) is appropriate for you
• Discuss bupropion if sexual side effects from fluoxetine become a problem
• Consider cognitive behavioral therapy
• Try vigorous exercise 5 days a week
• Spend time outside in the sun or get a bright light
• Add fish oil to your dietary regimen
• Ask your doctor if St. John’s wort would be safe
• Inquire about Emsam when other treatments fail
Almost everyone knows what it’s like to feel sad. Losing a pet, a friend, or a loved one is devastating. Being fired or getting a divorce can send you into a tailspin. An accident or a serious disease affects not only the physical body but also the psyche. Fora while there is little pleasure to be had in life. It can be as if darkness has settled into your bones and sucked the joy right out of the marrow.
Most of us eventually recover from the boulders that are dropped on us. But some people never manage to dig themselves out of a hole. According to the National Institute of Mental Health, major depression affects about 15 million people each year. One in five of us will experience some form of depression sometime during our lifetime. 175
When the fog descends, people may forget what it’s like to feel happy. Sleep becomes next to impossible–or all you want to do. Food loses its appeal and its flavor. Those with major depression often have a low energy level; they find it hard to mobilize themselves to finish projects or visit friends or family. They feel gloomy and down in the dumps for weeks or even months. They doubt their abilities and feel pessimistic much of the time. Just remembering simple things becomes an overwhelming challenge. They may experience thoughts of suicide—a hallmark of major depression.
Such a mood disorder requires professional help immediately. Let us repeat that. If any of the symptoms below apply
SIGNS OF DEPRESSION
• Feeling sad, gloomy, or “empty” for more than a few weeks
• Feeling hopeless
• Feeling helpless or worthless
• Insomnia, early-morning wakening, or persistently sleeping too much
• Feeling worn-down, fatigued, or like you’re moving in slow motion
• Loss of appetite: eating because it’s necessary rather than because the food tastes good and satisfies hunger
• Loss of interest in sex
• Restlessness or agitation, pacing the floor
• Difficulty with concentration and with remembering simple things; indecisiveness
• Physical complaints such as headache or pain that don’t get better when treated
• Thoughts of death or suicide to you or someone you care about, seek highly qualified assistance right now! Digging out from a depression should never pull
be a do-it-yourself project. You cannot puyourself up by the bootstraps or tough it out on your own. Chronic depression increases the risk for heart disease, stroke, diabetes, and other serious conditions and must not be ignored. The suggestions we will
widiscuss in this chapter are meant to supplement whatever your health professional may offer you in the way of help.
The Good Old Days
As remarkable as this may sound, some people actually coped surprisingly well with depression 50 to 100 years ago. They intuitively knew that there were some strategies that worked. For one thing, they looked around for someone to talk to. It might have been a pastor, a friend, a neighbor, or a relative. If they could afford it, they went to a psychologist or psychiatrist for counseling. Just talking things out sometimes seemed to help.
People also exercised. It might have been a physically exhausting task like chopping wood, hoeing a field or hiking through the woods. In those days, people spent more time outdoors working hard and walking from here to there. Nowadays we go from the air-conditioned comfort of our house or apartment to the air-conditioned comfort of a car, bus, or train to the air-conditioned comfort of an office or mall. We rarely spend time outside in the sun, and the only “workout” we get is at the gym or health club.
Oh yes, there was one more thing. In the good old days, especially during the winter, mothers made their kids swallow a spoonful of cod liver oil. It was never clear exactly what cod liver oil was good for, but mothers seemed to know that fish oil had beneficial properties. It was just “good for you,” no matter how bad it tasted.
Well, it turns out that virtually all of those quaint old strategies have now been proven helpful against depression. As you will learn shortly, research has shown that fish oil, exercise, light exposure, and cognitive behavioral therapy are surprisingly effective in dealing with depression.
Drug Therapy
Fifty years ago “talking therapy” was considered essential in the treatment of depression. Psychologists and psychiatrists saw lots of patients who suffered from mild to moderate depression. But during the 1970s biological psychiatry took off. The medical profession embraced the theory that depression was primarily caused by an imbalance of chemicals in the brain. Many health professionals adopted the belief that a depressed person only needed antidepressant medication to normalize brain biochemistry. All you had to do was “feed your head” the right chemicals and the depression would disappear.
During those heady days many patients were given tricyclic antidepressants to soothe their troubled psyches. Medications like amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Janimine, Tofranil), and nortriptyline (Aventyl, Pamelor) were prescribed in huge numbers. Never mind that such drugs caused drowsiness, fatigue, constipation, dry mouth, dental problems, weight gain, blurred vision, urinary difficulties, dizziness, disturbed concentration, impaired memory, mental confusion, sexual dysfunction, and impotence.
Although these medications did help many people get out of the depths of despair, the side effects were sometimes as depressing as the depression itself. Imagine what it would be like to put on 30 or 40 pounds, feel mentally cloudy and constipated most of the time, and have no sex life. But insurance companies liked these medications. It seemed far more cost-effective to have an internist or a family practice doctor prescribe an antidepressant than to approve a lengthy series of counseling sessions with a psychologist or psychiatrist.
Then along came Prozac (fluoxetine). In 1987 when it was introduced, this antidepressant hardly made a splash. First-year sales were just barely respectable, but more than doubled in the second year. By the third year, Americans spent more on Prozac than on all other antidepressants combined. Everyone seemed to fall in love with Prozac—physicians, pharmacists, patients, and, most of all, the big payers (insurance companies and HMOs).
Prozac—a selective serotonin reuptake inhibitor, or SSRI—was so successful because it got great PR, and because it seemed to have fewer side effects than traditional tricyclic antidepressants. At least it was less likely to cause sedation, dizziness, constipation, or dry mouth. It also was more effective—or at least that was the impression among physicians and patients. There were never any data to support that belief, but that didn’t stop the media blitz. Prozac even made the cover of Newsweek and Time magazines. Once people decided it was the new wonder drug, other pharmaceutical manufacturers were desperate to get in the game. The race was on.
It wasn’t long before the wannabes started showing up, trying to claim a piece of the Prozac pie. Today the competitors include bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). Almost 190 million prescriptions are written for these antidepressants each year, with sales exceeding $12 billion. 176
Such coeds are being prescribed enthusiastically for a wide range of other health problems, too. The pharmaceutical industry has promoted some of these antidepressants for conditions such as obsessive-compulsive disorder, panic attacks, hot flashes, premenstrual distress, nervousness, and shyness (”social anxiety disorder”).
Almost from the beginning, though, these drugs have been controversial. In the original clinical trial for Prozac, 15 percent of patients in the study dropped out because they felt worse instead of better—a statistic that was not widely publicized. Anxiety, insomnia, restlessness, nausea, and tremors caused distress for some people. There also was a high incidence of sexual dysfunction with the SSRIs. But the real controversy has always swirled around whether Prozac and similar compounds could trigger thoughts of suicide or homicide in some people.
Antidepressants and Suicide
In 1988, we received a letter from a grieving physician. His daughter had been prescribed Prozac for an eating disorder; a month later she took her er life by hanging herself. This oph- thalmologist was convinced that Prozac had contributed to her tragic death. At the time, we discounted this story—which we now regret—and told him that depressed people sometimes take desperate action and may try to harm themselves when they start treatment. Later, he responded that his daughter had never been depressed, nor had she been acting like a person who planned to take her life.
In 1990 an article appeared in the American Journal of Psychiatry describing a half-dozen patients who developed “intense violent suicidal preoccupation after 2 to 7 weeks of fluoxetine treatment.”177 This report stirred up quite a lot of concern, but many psychiatrists downplayed the connection. When we asked the drug company and the FDA about this report, we were told that depressed people sometimes commit suicide and that the drug was not to blame.
Over the last 18 years we have heard of many other instances in which people became preoccupied with harming themselves or others after starting on an antidepressant. A man taking Zoloft awoke in the middle of the night with a strong urge to kill himself. A woman reported wild thoughts on Prozac about ramming her car into other cars and getting a gun to kill an irritating co-worker. Another woman told us that she experienced an overwhelming urge to open her car door and jump-out of the vehicle while it was going at 50 miles an hour down the highway.
My son Mike was prescribed Paxil for depression while he was a graduate teaching assistant at New Mexico State University. Around day 13 he slipped into a mood that I had never seen before. He never came out of it. Four days later he shot himself in the temple with a.2? rifle. He had taken Paxil for 17 days.
I hold the FDA and GlaxoSmithKline (maker of Paxil) responsible for my son’s suicide. No one should ever have to look at a son or daughter’s tombstone!
Whenever we discussed our concerns with psychiatrists, drug companies, or FDA officials, we were told that such events were purely coincidental. Our federal watchdog insisted that the medicines could not have been responsible for such tragic outcomes. But when British drug regulators began warning physicians that SSRI-type medications might trigger suicidal thoughts, agitation, and self-injury in young patients, the whole ball of yarn began to come unraveled.
Eventually, an FDA staffer, Andrew Mosholder, MD, MPH, was given the task of analyzing 22 studies. His conclusion: “Short-term pediatric trials of antidepressant drugs demonstrate an increased rate of suicidal events with active drug compared to placebo.” He also said that there is not adequate information to tell if antidepressants other than Prozac are effective for children.
FDA JULY 1, 2005, PUBLIC HEALTH ADVISORY
• Adults being treated with antidepressant medicines, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.
• Close observation of adults may be especially important when antidepressant medications are started for the first time or when doses for the specific drugs prescribed have been changed.
• Adults whose symptoms worsen while being treated with antidepressants, including an increase in suicidal thinking or behavior, should be evaluated by their health-care professional.
The idea that drugs designed to fight depression and prevent suicide could potentially make things worse for some kids seemed to shock FDA officials to the core. Initially, Dr. Mosholder was muzzled. Eventually, though, the data convinced even the FDA hardliners. Belatedly, the agency issued warnings about suicidal thinking and antidepressants.
These cautions came far too late to prevent many terrible tragedies over nearly 2 decades. As difficult as it has been for psychiatrists and FDA officials to contemplate, people taking SSRI-type antidepressants are sometimes preoccupied with thoughts of suicide or homicide. Harvard psychiatrist Joseph Glenmullen,’ MD, has criticized the makers of SSRI-type antidepressants for delaying adequate warnings.”‘ The maker of Effexor XR added “homicidal ideation” to its label years after the drug was introduced. The company considers this a very rare adverse event and does not believe the drug can be causally linked to actual homicides. But there have been a number of high-profile violent events associated with antidepressants. Causal or not, this controversy continues to simmer.
The entire SSRI-suicide story strikes us as mishandled. Just as with the Vioxx (rofecoxib) scandal, it has seemed to us that FDA officials have been more intent on protecting the pharmaceutical companies’ profits than the public health.
To add even more confusion to this already sordid affair, the reputation these drugs have enjoyed as being highly effective against depression is now suspect. Remember that placebo-controlled trials are the gold standard that everyone is supposed to adhere to. Drug companies are required to show that their expensive antidepressants are significantly superior to a placebo. But an “analysis of 96 antidepressant trials between 1979 and 1996 showed that in 52 percent of them, the effect of the antidepressant could not be distinguished from that of placebo. ,179 In other words, “more than half of all recent clinical trials of commonly used antidepressants failed to show statistical superiority for the drug over placebo.”180
That, dear reader, is almost beyond belief. It suggests that either placebos—sugar pills—are amazingly effective in relieving depression or that current antidepressants are not all that impressive.
Another overview of many clinical trials concludes that the latter is the case. It goes even further and suggests that “recent meta-analyses show selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo…. Antidepressants have not been convincingly shown to affect the long-term outcome of depression or suicide rates.”181 Of course, this kind of analysis relies on the statistical manipulation and combining of many smaller studies. As compelling as the conclusions may be, they do not substitute for really big, well-conducted trials.
The largest and most definitive study of depression and antidepressant medications was a $35 million project, funded by the National Institutes of Health, called the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial. This was no drug company whitewash. This was your tax money at work. What made this research so valuable was that the investigators looked at actual recovery from depression (”remission”), not just some symptom improvement. Recovery is, after all, what depressed patients really care about.
The antidepressants used in the STAR*D trial were bupropion SR (Wellbutrin SR), citalopram (Celexa), sertraline (Zoloft), and venlafaxine XR (Effexor XR). When the long-awaited results were published in the New England Journal of Medicine (March 2006), they were surprisingly disappointing.
About one-fourth of the patients achieved real remission, regardless of the type of antidepressant that was taken.182 What makes this so discouraging is that these patients got optimal treatment. They received intense evaluation and a level of care not usually available to the average patient. If the depressed folks in this study had been treated in a more typical manner, “the remission rate probably would have been significantly lower—perhaps even in the single digits.”183 That’s abysmal.
If there is any good news that came out of the STAR*D research, it is that when a different antidepressant medication was substituted after initial treatment failure, about one in three patients finally did achieve remission. 1114, 181 What this means is that antidepressants actually do what they are supposed to do (cure depression) about half the time. Depending upon your perspective, that means the glass is either half full or half empty.
We are happy to learn that 50 percent of the patients in this trial got better. But even under these ideal conditions, half did not, regardless of the type of medicine used. That means that an awful lot of people are suffering drug side effects without benefit. And since there were no placebo controls in STAR*D, we have no idea how many folks might have improved if they had received sugar pills instead of drugs.
So how can you determine which antidepressant is best for you? In truth, it is extremely difficult for physicians and patients to make clear decisions about safety and effectiveness when it comes to these medications. Despite all the hype from the drug companies, it is hard to prove that one type of antidepressant is better than another one.186
Newer drugs like Cymbalta affect both serotonin and another neurotransmitter called norepinephrine (hence their name serotonin/norepinephrine reuptake inhibitors, or SNRIs). This dual action is supposed to make such drugs more effective. It has certainly driven up the cost. A single Cymbalta pill can cost between $3 and $4. A Wall Street Journal review reported that when Cymbalta was compared head-tohead with venlafaxine (Effexor), an older drug in this class, “Cymbalta wasn’t significantly different from Effexor in treating depression.”187
The bottom line is that there are no “best choices” when it comes to these kinds of antidepressants. All these drugs are roughly similar in effectiveness, and all have the potential to cause serious adverse reactions for some people. Anyone who experiences anxiety, agitation, irritability, and especially thoughts of violence toward himself or others should contact a health professional immediately!
Watch Out for Withdrawal!
There is one other complication associated with these antidepressants that is rarely discussed. Sudden discontinuation of drugs like Effexor, Paxil, Serzone, and Zoloft may cause unexpected symptoms. We have heard from many patients that they experienced dizziness, nausea, insomnia, headaches, nervousness, sweating, shakiness (like a bad hangover), weakness, visual disturbances, and an inability to concentrate. One reader called the problem “Paxil Head,” like having your head stuck in a blender.
I take Zoloft, and have tried to stop taking it several times. Each time I stop I experience a-very strange thing. Doctors, nurses, and pharmacists dismiss me like I’m a nut case, but I swear this is true. I get electrical shocklike sensations in my head and become extremely dizzy. I absolutely know this is associated with not taking Zoloft. Not 2 hours after I resume taking it again the symptoms, which are overwhelming, disappear completely. I would like to get off of this drug but have no idea how to do so, especially when I cannot function without it and no one recognizes I’m having any trouble. They just think I’m crazy.
What is so sad about this particular problem is that no one really knows how common withdrawal symptoms are. There are, as far as we can tell, few good guidelines for helping people overcome this complication. So we do not know how long people will experience dizziness, shocklike sensations, or nausea after they stop a drug like Zoloft. Drug companies are not particularly interested in developing protocols for discontinuing SSRI/SNRI-type medications, since they would then need to admit they have a problem on their hands. That means that patients and physicians are on their own.
Gradual tapering over several weeks may be necessary. We have heard from some doctors that they switch patients over to fluoxetine and then taper it very slowly. That’s because Prozac lingers in the body and may be less likely to trigger withdrawal symptoms *** Fluoxetine (Prozac)
Fluoxetine is a stand-in for all SSRI-type drugs. Although there are subtle variations between medications in this class, there are more similarities than differences.
Side effects: Headache, nausea, dizziness, diarrhea, nervousness, anxiety, and insomnia are relatively common and may affect up to one-fourth of the patients who take SSRI-type medications. Some people may experience drowsiness or dizziness. Delayed ejaculation, inability to achieve orgasm, and decreased sexual desire are common complications of this entire class of drugs. Less frequent problems may include decreased appetite, indigestion, sweating, mania, dry mouth, heart palpitations, tremor, chills, constipation, blurred vision, memory problems, confusion, rash, and joint pains. Blood sugar control or thyroid function may be altered. Seizures, while uncommon, have been reported in roughly 0.1 to 0.2 percent of patients, an incidence comparable to that seen with older antidepressants. Any thoughts of suicide or violence must be reported to a physician immediately)
Downside: SSRI-type medications like Prozac can interact with many other drugs. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant.
Cost: Approximately $130 to $140 for a month’s supply of Prozac. Generic fluoxetine costs $16 to $20 for the same amount.
Despite all the controversy, we still think Prozac is worthy of consideration, especially since it is less likely to precipitate withdrawal symptoms when discontinued. And we are not convinced that other SSRI/SNRIs are more effective. Many people benefit dramatically from this or another SSRI or SNRI. Prozac is now available generically as fluoxetine, so the cost factor is less problematic. We’re not convinced, though, that all generic fluoxetine is created equal. Some patients report therapeutic failures on this generic (see Generic Drug Quandary for details).
Since there is no way to predict whether someone will ben-Bupropion (Wellbutrin)
This antidepressant is less likely to interfere with sexuality and may even be helpful for people who have experienced diminished libido. It is also available generically, so there is a cost savings. People tend to feel energized rather than sluggish when taking bupropion.
Side effects: Common complaints include insomnia, dry mouth, anxiety or agitation, headache, nausea, and dizziness. Less common adverse reactions that we are aware of include mania, seizures, irregular heart rhythms, skin rash, hallucinations, paranoia, high blood pressure, and migraine.
Downside: Bupropion can interact with many other medications. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant. Any thoughts of suicide or violence must be reported to a physician immediately!
Cost: Approximately $130 to $150 for a month’s supply of brand-name Wellbutrin SR; generic bupropion SR runs roughly $60 to $70 for a similar amount.
efit more from one antidepressant than another, this is mostly a process of trial and error. It may take 4 to 6 weeks to begin to see improvement, so it is important to give each medication a fair trial. If no success is achieved after a few drugs in the same class are tried, then it may be time to move on to another category.
Bupropion (Wellbutrin) may offer certain advantages over other SSRI-type drugs. For one thing, it is far less likely to interfere with sexuality. Some have even reported that it restores libido.
Some people do benefit from old-fashioned tricyclic-type antidepressants such as desipramine, imipramine, and nortriptyline. For people who become agitated or anxious on an SSRI/SNRI or find that bupropion keeps them wide awake, tricyclics may offer an acceptable alternative.
There is also a completely different kind of antidepressant that comes as a skin patch (Emsam). We will discuss it at the end of this chapter.
Nondrug Therapy: Back to the Future
At the beginning of this chapter we suggested some old-fashioned approaches to treating depression that might be worth reconsidering. We were referring to seemingly archaic practices such as counseling, exercise, and fish oil. Surprisingly, there is some scientific support for these quaint concepts.
Talking Therapy
In our rush-rush world, people rarely take time to talk anymore. The idea that someone could actually sit down for an hour or so and discuss the issues that are causing distress seems outdated. Insurance companies and “mangled care organizations” may not be thrilled at the prospect of paying a psychologist or psychiatrist $100 to $200 a week to do counseling for several months. The bean counters seem to prefer paying for prescription drugs indefinitely. What is so bizarre about this ass-backwards approach is that psychotherapy can enhance the effectiveness of medications and can be stopped once it has been successful. That seems cost-effective to us.
For those in the know, cognitive behavioral therapy, interpersonal therapy, and problem-solving therapy are surprisingly effective for mild to moderate depression. 188 Cognitive behavioral therapy (CBT) got traction in the 1970s. In a nutshell, this therapy works on the premise that depression arises from dysfunctional thoughts and beliefs. We are all influenced by our early learning experiences. When those thought processes
Cognitive Behavioral Therapy
The results of well-conducted research suggest that cognitive behavioral therapy (CBT) is as effective as antidepressants in treating depression. The benefits are long lasting and we don’t know of any serious side effects to talking therapy.
Downside: Such treatment can be expensive and it requires an experienced psychotherapist. Identifying someone who has the requisite expertise may not be that easy.
Cost: Approximately $1.00 to $200 per session. This is highly variable depending upon the practitioner’s skill. level and are dysfunctional, they can be triggered by situations later in life and produce depression and other psychiatric symptoms. The trick here is to have skilled therapists help patients identify and challenge negative automatic thoughts so that behavior can be changed.”‘
One study found that “cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression but this degree of effectiveness may depend on a high level of therapist experience or expertise.”" Another study found that “cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.”"‘
Exercise
As effective as talking therapy may be for depression, exercise may also be beneficial. Investigators have known for decades that aerobic exercise can improve mood and outlook. Recent research backs this up. A review confirms that exercise can benefit mental health, helpiy to alleviate depression as well as improve physical health.’ According to Canadian reviewers, there is “irrefutable evidence” that physical activity can be effective against depression. 193
One study was dubbed DOSE, for Depression Outcomes Study of Exercise. Men and women between 20 and 45 years of age with mild to moderate depression were asked to exercise for various amounts of time ranging up to 30 minutes of moderate-intensity movement almost every day of the week. That allowed the investigators to compare the “dose response” from exercise. They found that low-intensity exercise was no better than pla- cebo, but high-intensity exercise was an effective treatment
Light
To give your exercise a jump start, go outside and get a little sun on your face. There is growing evidence that light therapy can be beneficial against depression. One eminent psychiatrist reviewed the literature, expecting to find that the research was awful and the therapy didn’t work. Instead, after reviewing the data objectively, he came to the conclusion that phototherapy was “comparable to what has been described in the clinical literature for conventional medications to treat depression. The findings are as strong or as striking.”195,196
Bright light therapy is helpful not only for seasonal af-fective disorder (SAD), which frequently occurs during the winter, but also for depression that occurs at any time of the year. There is evidence that light can enhance the effects of exercise as well as the antidepressant action of medications like citalopram (Celexa).197,’9′
Fish Oil
Grandma might have been right that cod liver oil is good for your mind as well as your body. She may not have had the benefit of randomized, placebo-controlled trials, but we do. Most of them show that fish oil can be helpful against depression. 199 We’re hoping that there will be more studies in the future to determine the best dose of DHA and EPA, the main fatty acids in fish oil. We’re not thrilled with cod liver oil, per se. These days you can obtain pharmaceutical-grade fish oil that does not have the excessive levels of vitamin A you often find in cod liver oil. Too much vitamin A is bad for your bones.
St. John’s Wort
The medical community has had a very hard time grappling with research suggesting that an herb might be as good as an antidepressant like fluoxetine (Prozac) for relieving depression. Nevertheless, there have been dozens of clinical trials demonstrating that St. John’s wort can be effective in treating mild to moderate depression .200 In some studies, St. John’s wort works as well as prescription antidepressants, and it usually has fewer -troublesome side effects.
St. John’s wort has long been prescribed in Europe for treating depression and other mood disorders. Although there are studies showing that the extract is not better than placebo, there are several showing that it works at least as well as prescription antidepressants. Most trials indicate that St. John’s wort appears to be safe and well tolerated, perhaps better tolerated than a pharmaceutical antidepressant.
The way St. John’s wort acts to relieve depression is not known. Scientists don’t even know which of its many constituents might be responsible for the activity. This makes it hard to select an extract appropriately. Only standardized extracts, preferably ones that have been tested and found effective, should be used. Three standardized products that have been tested in Germany are available here. The brand names are Kira, Movana, and Perika.
St. John’s Wort (Hypericum perfornow)
Some people may find that St. John’s wort is an effective antidepressant. As long as it is taken under medical supervision and caution is exercised regarding drug interactions, we think it is worth consideration.
Side effects: Side effects are uncommon and usually mild. Unlike many prescription antidepressants, St. John’s wort does not cause sexual dysfunction. Digestive upset has been reported. Allergic reactions are possible.
Downside: St. John’s wort can cause photosensitization, making the skin and the eyes vulnerable to damage from sunlight. St. John’s wort interacts dangerously with a wide range of prescription medications. Ask your pharmacist or your doctor to check on this possibility if you contemplate taking St. John’s wort together with any other medicine.
Cost: Approximately $15 to $20 a month for Kira brand
The Selegiline (Emsam) Patch
The latest and most interesting chapter in antidepressant therapy involves a prescription skin patch containing the drug selegiline (Emsam). ‘Ibis transdermal medication works in a completely different manner from most current antidepressants. It is called a monoamine oxidase inhibitor (MAGI). Such drugs were among the first antidepressants ever developed. But they lost their luster because of a potentially deadly. interaction with many foods, beverages, and drugs. The “cheese effect,” as it came to be known, could cause extremely high blood pressure when a person taking a medication like Marplan or Parnate ate an aged cheese such as cheddar. This could result in a stroke.
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Q. What can you tell me about selegiline? The vet prescribed it for my elderly dog. She had been very agitated, pacing for hours at a time (sometimes 12 or 15 hours straight!). She would pace until she dropped from exhaustion, sleep for half a day, then get up and start pacing again. She was also drooling excessively, dig-ging compulsively, deliberately knocking things over, and urinating in the house whenever I left.
My vet said these are all symptoms of senile dementia in dogs. I think it was precipitated by the death of my other dog. They had been together for more than 12 years and she just couldn’t handle being alone.
Several days after she started on selegiline all those behaviors stopped completely. It was amazing. She started acting like herself again. After seeing how much it helped my dog, I would definitely take it myself. Do they ever prescribe it for people with memory problems?
A. Our veterinary consultant, Andrea Frost, DVM, says that selegiline can be helpful for dogs with the canine equivalent of senile dementia. When an old dog gets lost in his own house or becomes incontinent because he can’t remember to ask to go out, quality of life for the owner, if not for the dog, has really declined.
Not every dog has as dramatic a response as yours, but selegiline can help buy some old dogs a little more quality time with their human families.
Selegiline is used in human medicine to treat people with Parkinson’s disease and depression. It has been studied against Alzheimer’s disease with mixed results.
0 0 0
The good news is that this new-generation MAGI is far less likely to cause such problems. In the lowest-dose skin patch, there is no food prohibition. When people take higher doses (9 or 12 milligrams), however, they do have to be careful about foods containing tyramine (beef liver, blue cheese, bologna, Brie, broad beans, Camembert, cheddar, Chianti, chicken liver, draft beer, miso soup, Parmesan cheese, pepperoni, salami, sauerkraut, and yeast extract) because their blood pressure could rise dangerously high.
Emsam should not be combined with other antidepressants or St. John’s wort. It is crucial to check with your pharmacist and your physician before combining any other medication when you are using Emsam.
In double-blind trials, scientists determined that Emsam is significantly more effective than placebo. The most common side effects include irritation where the patch is applied to the skin, rash, indigestion, headache, insomnia, diarrhea, dry mouth, and dizziness when standing up suddenly. Sexual side effects appear to be uncommon. Anyone who experiences thoughts of suicide while using this patch should contact the prescribing physician immediately.
Conclusions
If there is one lesson you should learn from this book it is that everyone responds differently to various treatments. That is as true for relieving depression as for lowering cholesterol or controlling diabetes. Some people find that Prozac is an absolute miracle, lifting them from the despair of lifelong depression. Others find it makes them irritable, jittery, and incredibly uncomfortable. There is no good way to predict how any individual will react, so the best advice we can give is to stay vigilant.
If you start to feel better on an antidepressant, that’s great. If you experience no improvement or get worse, contact your health-care professional immediately and seek alternatives. In some cases, combining several approaches such as vigorous exercise, fish oil, and light therapy may be as effective as prescription medicine.
• Depression can take the wind out of your sails. Do not expect that you will be able to pull yourself together on your own. Seek help from friends, family, and qualified professionals.
• Antidepressants can be very helpful for some people. There is no clear evidence that one is superior to another. Trial and error may be the only way to tell which one will produce the best results for you.
• Suicidal thoughts are now recognized as a potential complication of virtually all antidepressant therapy. Family and friends should be especially vigilant during the first few weeks of treatment and whenever your dosage is changed.
Jul
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Enlarged Prostate. TREATMENT OF AN ENLARGED PROSTATE.
July 15, 2009 | Leave a Comment
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If the prostate is enlarged, as detected by a digital rectal examination, but there are no symptoms, there is no need for
treatment seroquel disorders . The size of the gland alone is no indication calling for treatment - still less for surgery allegra famvir myonlinemeds biz . Intervention for
benign enlargement should only be considered when the symptoms become a problem vistaril hydroxyzine .
Secondly, the other thing that may happen is that the bladder can become so stretched that every time a man passes urine
he does not quite empty it actos and heart failure . The bladder expands very gradually, with the result that there is no pain and there may be no
obvious symptoms for a while arimidex hair thinning . Eventually, however, he will pass urine in a dribble, and he may notice that he is
constantly wetting his underpants arrythmia caffeine . He may even find that he is wetting the bed at night (known as enuresis), which is a
distressing and embarrassing symptom ofloxacin ear drops generic name . In extreme cases, the end result of this may be that there is so much back pressure
on the kidneys that they eventually fail price cefpodoxime . This is a very serious condition, known as chronic retention of urine with
renal failure chest pain stops imitrex .
THE RISKS
A benign enlarged prostate is not, in itself, a dangerous condition, but there are three main risks which may arise if
the condition is not treated emerson mirtazapine anxiety .
• Firstly, if the bladder is never completely emptied, there may be a build-up of stagnant urine in it how switch effexor pristiq . This can
become a breeding ground for bacteria and can cause cystitis, which is an inflammation of the inner lining of the
bladder paxil infertility . Treatment is by the administration of antibiotics gloucophage metformin .
• Secondly, the muscular walls of the bladder strengthen in an attempt to force urine through the narrowed urethra benazepril coughing .
As a result, the walls may become thickened and can then pinch the tubes that carry urine from the kidneys to the
bladder, known as the ureters removing caffeine from coffee . Back pressure may cause acute pyelonephritis, which is an inflammation of the kidney,
usually caused by bacterial infection, leading to symptoms such as high fever, chills and back pain quetiapine pharmacokinetic properties . Treatment is usually
by antibiotic drugs, which may need to be given by intravenous infusions doxycycline dog canine fish .
• And finally, the muscles of the bladder may become weakened and no longer able to overcome the resistance to
urine flow metronidazole rectal . They may then cease to function completely, which may be a sudden or a gradual process ultram paroxetine drug interaction . A sudden failure to
function may cause acute retention, which is very painful and requires emergency treatment paroxetine anorgasmia . A gradual failure can lead to
stress THE INTERNATIONAL PROSTATE SYMPTOMS SCORE
The World Health Organization (WHO) recently devised a system, known as the International Prostate Symptoms Score caffeine drink energy in . This
enables you - and your doctor - to judge how severe your prostate symptoms are and how urgently - or if - you need
treatment aleve and red blood cells .
INTERNATIONAL PROSTATE SYMPTOMS SCORE
Less than Less than About More
one time half the half the than half
in live time time the time
Not at all
Almost always
Over the past month:
How often have you had the sensation of not completely emptying your bladder after urinating’?
0 1 2 3 4 5
Needed to urinate
again within two hours 0 1 2 3 4 5 of finishing urinating’?
Stopped and started again several times when urinating’?
0 1 2 3 4 5
Found it difficult to postpone urinating’?
0 1 2 3 4 5
Had to push or strain to start urinating?
0 1 2 3 4 5
Had to get up in the night to urinate’?
0 1 2 3 4 5
How did you score?
• 0-8: your symptoms are very mild cheap wellbutrin xl 150mg 30 count . You may not need any treatment but your symptoms will be closely monitored by
your doctor paxil and sleep apnea . You may benefit from a change in diet or extracts of rye pollen teva generic actonel name .
• 9-17: your symptoms are moderate otc claritin d . Your doctor may prescribe a drug treatment, provided that your rectal
examination and blood tests are normal bactrim and myelosuppression .
• 17 and over: your symptoms are severe where can u sample viagra free . Your doctor will probably refer you to a specialist for further tests and
treatment what is symmetrel used for .
WHAT TO DO
It is not uncommon for a man who is experiencing symptoms of an enlarged prostate to put off going to the doctor tizanidine injected intravenously . He may
do this because he has heard that the doctor will probably give him a rectal examination and he would rather avoid this prilosec prescription strenght .
Or he may do it because he thinks that his symptoms are an inevitable part of growing old and that the doctor will not
take them seriously detrol sideeffects . But he is wrong what are the ingredients in orlistat .
The doctor will take them seriously and, as I have already said, he should not delay is boost plus caffeine free . Treatment nowadays is both
straightforward and effective, and it is sensible to have treatment before your disease progresses and you are at any
risk is remeron safe .
Early screening may help prevent you developing problems in the future with your kidneys dance prints zantac . Even more importantly, it may
ensure that the still more serious but rare problem of prostate cancer is discovered early - and therefore treated early amount of caffeine in starbucks frappuccino .
WHAT YOUR DOCTOR WILL DO
There are several things your doctor and/or a specialist, known as a urologist, may do to investigate an enlarged
prostate, and to decide which treatment would be most appropriate does toprol cause chest discomfort .
These may include any or all of the following:
• Digital rectal examination (DRE) 40 mg zocor .
• Blood tests nonprescription tamoxifen .
• Urine tests neurontin equivlant .
• Ultrasound price of accutane .
• CyStoscopy drug classification for gemfibrozil .
• Intravenous pyelogram (IVP) cephalexin 500mg capsule .
Digital rectal examination (DRE)
The first investigation a doctor will probably do is a digital rectal examination active ingredient in biaxin . To do this, he will gently insert his
gloved index finger into your rectum testosterone propionate injections . He will use a water-based jelly as a lubricant what is venlafaxine hci . A rectal examination does not hurt,
and you should not feel embarrassed - it’s all in a day’s work to a doctor differences between generics of amitriptyline .
The shape and size, as well as the texture and tenderness of the prostate can be felt in this way ibuprofen suicide . If you have an
enlarged prostate, the gland will feel just that - enlarged pravastatin and leg cramps . It will also feel firm and smooth naproxen alcohol .
Blood tests
There are several blood tests that are likely to be done as part of the investigation of an enlarged prostate cialis generics . These may
be done to check for infection, to check how well your kidneys are working, and to eliminate prostate cancer (see Chapter
6) new treatment instead of casodex .
Tests include:
• Full blood count, as a check for infection or anaemia caffeine and conception caremark health resources .
• Urea and electrolytes, to see how well your kidneys are functioning is ibuprofen safe .
• Prostate acid phosphatase (PAP), to check for prostate cancer lasix clarksville tennessee .
• Prostate specific antigen (PSA), to check for prostate cancer chemical formula for caffeine and chocolate .
Urine tests
Similarly, there are a number of urine tests that are likely to be done as part of the investigation of an enlarged
prostate pioglitazone breast cancer . These are done both to determine how badly your stream of urine is affected and to check for infection dont take wellbutrin xl .
Tests include:
• Urinary flow rate, using a urine-flow meter, which determines how badly your ability to urinate normally is
affected is actos a steriod . As you pass urine into a bottle, an electronic device measures both the total amount passed and the speed with
which it is passed sex with levitra . This will reveal the extent of any obstruction to the flow necrotic bone pain zithromax .
• Mid stream urine (MSU), to check for any bacterial infection, which may indicate cystitis, and for any red blood
or pus cells, as well as for any tiny threads of tissue shed from the kidney, known as casts tramadol identifier pt5 .
• Urine dip stick test, to check for sugar and protein buy testosterone now .
Ultrasound
This entails passing high-frequency sound waves through your body, which then bounce back off special tissue plates to
produce an image on a screen kts lithium battery cr2032 . Ultrasound, or sonography, can reveal several things, including:
• The size of your prostate gland itraconazole fluconazole indications .
• Whether there is any residual urine (and, if so, how much), left in your bladder after urinating expiration date of tetracycline .
• The size of your kidneys genital warts and zantac .
Cystoscopy
This entails passing a narrow telescope, known as a cystoscope, through the penis and into the bladder metformin serum creatine . This procedure is
done under general anaesthetic lithium niobate .
It enables the urethra and bladder to be viewed in detail, with the result that the degree of prostate obstruction can be
assessed accurately testosterone vitamins .
Intravenous pyelogram (IVP)
This test entails injecting a radio-opaque form of iodine into a vein herbal equivalent vibramycin . The dye is then concentrated in the kidneys, and
X-rays are taken of the urinary tract ordering ultram delivery flower . These will therefore show any abnormalities diltiazem sustained release . An IVP rules out the possibility that
symptoms are due to urinary tract disease rather than to an enlarged prostate betapace weight gain . It also reveals whether the bladder,
ureters or kidneys have been damaged by back pressure from the enlargement bromocriptine and structure and action .
TREATMENT OF AN ENLARGED PROSTATE
Exactly how the doctors decide to treat your enlarge prostate depends to a large extent on how severe your symptoms are
(this is where the International Prostate Symptoms Score (see page 48) comes in useful and has a practical purpose; on
whether your condition is threatening vital systems such as your kidneys; on how much it is affecting your lifestyle; and
on your general state of health dosage ceroxim cefuroxime axetil oral suspension . Whatever you are offered, it is worth your while checking that you are being offered the
most up-to-date treatment available does amoxicillin affect apri . Treatments are being improved all the time, and it is a good idea to discuss this
with your doctor or specialist will spa white whiten tetracycline stains . You should also voice any particular worries that you have liver caffeine . Don’t worry about wasting
your doctor’s time - that’s what he’s there for and he should be happy to take the time and trouble to talk about your
worries with you and to explain the situation lamictal gum loss .
Is it worth the risk?
You must talk to your doctor in some detail about possible treatments and their risks zelnorm mg . Only you know how much your
symptoms are affecting your life, and only you can decide what risks you are willing to take in order to get rid of them excessive drinking while taking topamax .
Would it be worth a slight risk of impotence, for example, not to have to get up twice in the night to urinate? No one
can answer this on your behalf - it’s got to be your decision motrin advertisement .
If symptoms are mild missed dose of lexapro . zyrtec syrup infant dosage . prevacid non prescription .
In this case, and if tests have ruled out any possibility of prostate cancer, doctors may adopt a `wait-and-see’
approach 26650 lithium . Symptoms may not get any worse, and a modification to diet, along with extracts of rye pollen, may help (see
Naturopathy, Chapter 9) depakote 250 mg .
If symptoms are moderate li-60b lithium ion battery . aciphex nasacort ambien . soma grill in pittsburgh pa .
In this case, a doctor may decide on a drug approach, which may help relieve symptoms med felodipine . Possible drugs include:
• Alpha-blocker drugs, such as indoramin, prazosin and terazosin fluconazole tabletki 150mg . These are the most commonly used form of drug
treatment cetirizine nursing . They relax the nervous system and inhibit contractions in the prostate and urethra singulair swelling due to fluid retention . In this way, they ease
symptoms rather than counteracting the obstruction completely natural alternative for bactrim .
• Antispasmodic drugs, such as flavoxate, oxybutinin and propantheline, which reduce irritation of the bladder viagra houston .
• 5-alpha-reductase inhibitors, such as finasteride, which prevent the hormone testosterone from being converted
into dihydrotestosterone, which is known to cause an enlarged prostate claritin and prostatitis . These drugs shrink the gland and may slightly
improve the flow of urine inventor inventor for penicillin penicillin .
If symptoms are severe caffeine and male health . bupropion sr tab 150mg side effects . discount xenical wholesale stores discount pharmacy .
Symptoms may be so severe that the urethra is blocked off completely, with the result that the sufferer is unable to pass
urine is generic fosamax oral solution available . This is a very painful condition and requires immediate hospitalisation lose weight celexa .
The recommended treatment in this case will probably be catheterisation, which entails inserting a flexible tube, or
catheter, into the bladder under local anaesthetic to drain trapped urine diclofenac in vulture poisoning . This will usually bring instant and welcome
relief and, as such, is a valuable treatment arimidex for males .
It is not, however, considered to be an acceptable long-term solution by most men, who regard it only as a temporary
measure until something permanent can be done sertraline xenadrine . The long-term solution is usually surgery, in the form of a prostatectomy
(see below) digoxin induced gynecomastia .
If, however, surgery is considered to be too dangerous - usually because of ill health or advanced age - a catheter may
be kept in place permanently does toradol react to advil . It will continue to provide drainage into a special bag that is worn attached to the leg jr enterprises ivermectin .
Surgery
For many men, the only acceptable long-term solution is surgery trying to wean off nexium . This entails the removal of either part, or all of, the
prostate gland over the counter prilosec .
Most doctors advise an early operation, because the risk is much increased if the kidneys are already damaged duphaston myoma . If surgery
is performed when symptoms first become a serious nuisance, the results are nearly always very good zithromax for fish .
The removal of part of the prostate is done by a procedure known as transurethral prostatectomy (TURP), in which prostate
tissue is cut away using an electrically-heated wire loop inserted through the urethra testosterone enanthate for bodybuilding . The entire prostate gland is
removed in an operation known as a prostatectomy imitrex sulfa allergy symptoms .
The more common of the two operations is TURP, though an open prostatectomy is sometimes chosen in preference to TURP fellini prozac .
The reasons for this include the following:
• If the prostate is very much enlarged application for plavix .
• If a tumour is suspected, which might be cured through the removal of the entire prostate urologic drugs bactrim .
• If a man also has large bladder stones, which also need to be removed bird ivermectin .
• If a man has bad arthritis in the hips, which cannot therefore be placed up in stirrups, as this is needed for
TURP buy tadalafil count online .
Both transurethral prostatectomy and open prostatectomy are described in detail in Chapter 7 ibuprofen mix with alcohol .
Treatment by stent
A man who is too ill to withstand a major operation may have a stent implant put in place, This is a short, stiff tube
that is placed in the urethra at the point at which it passes through the prostate gland acne caffeine cause does . It holds the urethral walls
open in spite of pressure from an enlarged gland what is zyprexa commonly prescribed for . An advantage of this procedure is that a stent is simple to put in
position and it can be done to a man who is not well enough to have a prostatectomy cipro and c difficile .
There are two types of stent: a permanent mesh type, which is left in position permanently and the skin of the urethra
eventually grows over it, and a temporary spiral type, which can easily be removed but which has the disadvantage that it
is prone to bacterial infection and that it can become dislodged can piroxicam be heated .
Other possibilities
Medical advances have come up with several new procedures, some of which are still at the clinical trial stage ranitidine pill identifier . Research
continues in this field, and the outlook for further advances in the treatment of this debilitating condition is good,
though as yet most of these procedures are still a long way out of mainstream medical practice accutane repeat .
New procedures include:
• TULIP (Transurethral, ultrasound guided, laser-induced prostatectomy), which entails using a laser to cut away
prostate tissue citalopram children .
• Microwave hyperthermia, which involves inserting a microwave coil within a catheter into the urethra and heating
it to a temperature of 45°C (113°F) low testosterone bicycle . The treatment must be done twice a week for three to five weeks vytorin long-term side effects . Each treatment
takes between 30 and 60 minutes lamactil and celexa . There is no need for any anaesthetic and the procedure can be done as an out-patient process in the discovery of ciprofloxacin . As
yet, there have been no large-scale or long-term studies anti aging testosterone .
• Transrectal hyperthermia, which is another heat-shrinking procedure, introducing a probe into the rectum estradiol supplements fertility . This
heats the prostate to a temperature of 43°C (109°F) using microwaves naturally restore testosterone levels .
The procedure is usually repeated six times, and lasts one hour each time wellbutrin full dose . During the treatment period, the patient can
lead a normal life, suffering no more than slight discomfort each time vaseretic physicians update .
• TUNA: Transurethral needle ablation, which means needles are inserted into the prostate, under local anaesthetic,
to allow greater precision and higher temperatures during heat-shrinking procedures ibuprofen dosages wiki .
• Sonoblate, which is another heat-shrinking procedure, this time involving ultrasound waves via the rectum prismatic lithium cells .
• Cryotherapy, which entails inserting a cryoprobe into the penis and freezing the prostate medco lamotrigine 200 mg .
• Dilatation of the prostate with the use of balloons entacapone and levodopa and adverse .