Ezetimibe (eh-HIHI-firri-ibe)
Brand Name Zetia
Combination Product
Generic Ingredients: Ezetimibe + Simvastatin Vytorin
Type of Drug
Cholesterol - lowering agent.
Prescribed For
High cholesterol, high LDL (”bad”) cholesterol, high triglycerides, and low HDL (”good”) cholesterol; also prescribed for two rare genetic disorders called homozygous familial hypercholesterolemia and homozygous sitosterolemia.
General Information
Unlike statin drugs, ezetimibe interferes with the absorption of cholesterol through the intestine and into the bloodstream. Ezetimibe may be helpful for people whose LDL (”bad”) cholesterol remains high despite treatment with a statin drug. Cholesterol-lowering medicines should always be used together with appropriate diet and exercise.
Ezetimibe may be taken alone but is often taken in combination with a statin drug (generally simvastatin). Vytorin is a brand-name combination of these 2 medications. See Stalin Cholesterol-Lowering Agents, page 1052.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
People with liver disease or elevated liver enzyme measurements should not take ezetimibe because its effects on the liver are not known.
Ezetimibe does not slow hardening of the arteries.
There may be a risk of myopathy (skeletal muscle disorder) with ezetimibe; contact your doctor if you experience any unexplained muscle pain, tenderness, or weakness. Ezetimibe + simvastatin has the same effect as simvastatin alone; see Statin Cholesterol-Lowering Agents, page 1052.
Possible Side Effects
Ezetimibe side effects are similar to those reported by people taking a placebo (sugar pill).
V Most common: headache, back pain, joint pain, and abdominal pain.
C,Ibmrnon: muscle ache and respiratory infection.
V Less common: fatigue, chest pain, diarrhea, sore throat, and cough.
For additional information about ezetimibe + simvastatin, see Statin Cholesterol- Lowering Agents, page 1052.
Drug Interactions
•    Cholestyramine reduces the amount of ezetimibe absorbed
in the blood. Separate these drugs by 2 hours or more.
•    Cyclosporine (to prevent organ transplant rejection) may substantially increase the amount of ezetimibe in the blood. This combination must be monitored closely by your doctor.
•    Gemfibrozil (another blood-fat reducer) can increase the amount of ezetimibe in the blood.
•    Fenofibrate may increase the effects of ezetimibe. Fibrates
other than fenofibrate should not be used with ezetimibe due to
the risk of gallbladder complications. For additional informa-
tion about ezetimibe + simvastatin, see Statin Cholesterol-
Lowering Agents, page 1052.
Food Interactions
This drug can be taken without regard to food or meals.
Usual Dose
Ezetimibe
Adult and Child (age 10 and over): 10 mg once a day. Child (age 9 and under): not recommended.
Ezetimibe + Simvastatin
Adult: 10 mg ezetimibe plus 10-80 mg simvastatin once a day in the evening. The simavastatin dose depends on individual need.
Overdosage
Little is known about the effects of ezetimibe overdose. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
If you are taking more than one drug to lower cholesterol or another blood fat, consider the side effects of all of those drugs combined.
,S’D'L’6a)  Populations
Pregnancy/Breast-feeding: Little is known about the effects of ezetimibe during pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks. Statin drugs should never be taken by a pregnant woman or nursing mother.
It is not known if ezetimibe passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use this drug without special precaution.

Generic Name
Famciclovir (fam-SYE-kloe-vere)
Brand Name  Famvir
Type of Drug Antiviral.
Prescribed For
Herpes zoster (shingles), genital herpes, herpes labilalis (cold sores), and herpes simplex in HIV-infected people.
General Information
Famciclovir is absorbed into the body and converted to the antiviral penciclovir, the drug that actually works against shingles by interfering with the reproduction of DNA in the herpes virus. Famciclovir does not affect DNA in uninfected body cells. Famciclovir is broken down by the liver and eliminated from the body through the kidneys.
Cautions and Warnings
Do not take famiciclovir if you are allergic or sensitive to any of its ingredients.
Those with reduced kidney function should have their dosage adjusted accordingly.
Severe liver disease reduces the maximum possible concentration of Famciclovir in the blood and increases the time it takes to reach this maximum level; however, dosage adjustment is not normally required.
Possible Side Effer.%
♦    Most common: headache, nausea, and diarrhea.
♦    Less common: fever, fatigue, pain, vomiting, constipation, appetite loss, dizziness, tingling in the hands or feet, sleepiness, sore throat, sinus irritation, itching, gas, dysmemorrhea, and signs of shingles.
Possible Side Effects (continued)
Rare: chills, abdominal pain, back or joint pain, and upset stomach. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Probenecid, cimetidine, and theophylline interfere with the elimination of famciclovir from the body, possibly leading to higher levels of famciclovir in the blood.
•    People who took famciclovir and digoxin together experienced increased digoxin In their blood.
Food Interactions  None known.
Usual Dose
Shingles
Adult (age 18 and over): 500 mg every 8 hours for 1 week. People with reduced kidney function may require a reduced dose taken as infrequently as once a day.
Genital Herpes
Adult (age 18 and over): 1000 mg twice daily for 1 day; or 250 mg twice a day for up to 1 year for suppression; or 250 mg 3 times a day for 7 days for initial episode. People with reduced kidney function take the same dose but less often, as infrequently as once every 2 days. HIV-infected people should take 500 mg twice a day for 7 days.
Cold Sores
Adult (age 18 and over): 1500 mg as a single dose. Initiate therapy at the earliest sign or symptom of a cold sore (tingling, itching, or burning).
Overdosage
Little is known about the effects of famciclovir ovecdose. Overdose victims should be %Mn to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Famciclovir treatment should be started as soon as shingles is diagnosed. For maximum benefit, be sure to complete the full week of treatment.
Famciclovir is not a cure for genital herpes and it is not known if it will prevent the transmission of the herpes virus to another person. Avoid sexual intercourse when herpes lesions are present even while taking famciclovir for genital herpes.
Begin taking famciclovir at the first sign of a herpes attack (symptoms include pain, tenderness, burning, itching, tingling, ulcers, or scabs). The effectiveness of starting famciclovir 6 hours or more after symptoms or lesions appear has not been established.
Call your doctor if you experience any unusual or intolerable side effects.
If you forget a dose of famciclovir, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot. Do not take a double dose. Call your doctor if you forget more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Famciclovir should only be taken by a pregnant woman if it is absolutely necessary and the possible benefits outweigh the risks to the fetus.
In animal studies, penciclovir (the active form of famciclovir) passed into breast milk in high concentrations but it is not known if this holds true for humans. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors clear famciclovir from the bloodstream more slowly than younger people and should have their dosage adjusted according to their level of kidney function.

Generic Name
Famotidine (fam-OE-tih-dine) 91
Brand Names
Fluxid    Pepcid AC
Pepcid    Pepcid Complete
Type of Drug  Histamine H2 antagonist.
Prescribed For
Ulcers of the stomach and duodenum (upper intestine). This drug is also used to treat gastroesophageal reflux disease (GERD),
stress ulcer, and other conditions characterized by the production of large amounts of gastric fluids; to prevent stress ulcer and stomach and upper intestinal bleeding; and to stop the production of stomach acid during surgery. Pepcid AC is approved for heartburn.
General Information
Histamine H2 antagonists work by turning off the system that produces stomach acid and other secretions. Famotidine is effective in treating the symptoms of ulcer and preventing complications of the disease, although an ulcer that does not respond to another histamine H2 antagonist will probably not respond to famotidine. Histamine H2 antagonists differ only in their potency. Cimetidine is the least potent; 1000 mg are roughly equal to 300 mg of either nizatidine or ranitidine, or 40 mg of famotidine. All these drugs have roughly equivalent success rates in treating ulcer disease and comparable risk of side effects.
Cautions and Warnings
Do not take famotidine if you are allergic or sensitive to any of its ingredients or to any histamine H2 antagonist.
People with kidney or liver disease should take famotidine with caution because 1/3 of each dose is broken down in the liver and the rest passes out of the body through the kidneys.
Do not self-treat with over-the-counter (OTC) forms of famotidine without the advice and supervision of your doctor.
Possible Side Effects
✓    Most common: headache.
✓    Less common: dizziness, mild diarrhea, and constipation.
✓    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
•    T-_Meat-coated tablets should not be taken with famotidine. The change in stomach acidity that famotidine produces causes the tablets to disintegrate prematurely in the stomach.
•    Antacids, anticholinergics, and metoclopramide may slightly reduce the amount of famotidine absorbed into the blood. No special precaution is needed.
Food Interactions
Famotidine may be taken without regard to food or meals.
Usual Dose
Adult 20-40 mg at bedtime, or 20 mg twice a day for 4-8 weeks. Dosage should be reduced in people with severe kidney disease.
Child (age 1-16): 0.23-0.45 mg per lb. of body weight, at bedtime or in 2 divided doses, up to 40 mg a day.
Child (under age 1): Consult your doctor.
Over-the-counter forms of famotidine such as Pepcid AC or Pepcid Complete should only be used for the temporary relief of heartburn, and are not recommended for children under 12 years of age. Do not take more than 2 capsules or chewable tablets in 24 hours.
Overdosage
Little is known about the effects of famotidine overdose, but victims may experience exaggerated side effects. Your local poison control center may advise giving ipecac syrup—available at any pharmacy—to induce vomiting and remove any remaining drug from the stomach. Victims who have definite symptoms should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Take famotidine exactly as directed and follow your doctor’s instructions regarding diet and other treatment in order to get the maximum benefit from the drug. Antacids may be taken together with famotidine if needed.
Do not take the maximum dose continuously for more than 2 weeks without the consent and supervision of your doctor.
Cigarettes worsen stomach ulcers and may reduce famotidine’s effectiveness.
Call your doctor at once if you develop any unusual side eiiecls such as bleeding or bruising,’ iWness, diarrhea, dizziness, or rash. &’A&, tarry stools or vomiting material that resembles coffee grounds may indicate your ulcer is bleeding.
If you forget a dose of famotidine, 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    revealed no Pregnancy/Breast-feeding: Although animal studies
damage to the fetus, famotidine should be avoided by women who are or might be pregnant. When this drug is considered crucial by your doctor, its possible benefits must be carefully weighed against
its risks.
Famotidine may pass into breast milk. Nursing mothers who
must take this drug should use infant formula.
Seniors: Seniors may need lower doses due to loss of kidney function and may be more susceptible to side effects.

Generic Name
Felbamate (FEL-bam-ate)
Brand Name Felbatol
Type of Drug  Anticonvulsant.
Prescribed For
Partial seizures and Lennox-Gastaut syndrome in children.
General Information
Felbamate is related to the older sedative meprobamate. Exactly how felbamate works is not known, but it raises the seizure threshold and prevents the seizure impulse from spreading in the brain, as do other anticonvulsants. Felbamate should only be used when other seizure drugs have failed because of the risks associated with it. About half of each dose passes out of the body through the kidneys; the other half is broken down and eliminated by the liver.
Cautions and Warnings
Do not take felbamate if you am allergic or sensitive to any of its ‘Irigredlents or to any related drugs such as meprobamate.
Felbamate is associated with an increase in the risk of aplastic anemia, a potentially fatal condition.
Possibly fatal liver failure occurs in people taking felbamate much more often than normal. Regular liver function tests are recommended. People with liver disease should not take felbamate.
Felbamate is not recommended as first-line epilepsy treatment. Felbamate should be used only by those with severe epilepsy for whom the benefits outweigh the risks. Doctors prescribing felbamate should be thoroughly familiar with the drug and must obtain written, informed consent from patients before prescribing.
Felbamate should never be suddenly stopped or seizures may become more frequent. Dosage should be gradually reduced or replaced by another anticonvulsant.
Felbamate may cause increased sensitivity to the sun. Wear protective clothing and use sunscreen while taking this drug. People with kidney disease may require lower doses.
Possible Side Effects
Adult
♦    Most common: sleeplessness, sleepiness, fatigue, headache, dizziness, nervousness, upset stomach, vomiting, constipation, nausea, and appetite loss.
V Common: anxiety, tremors, walking unusually, depression, tingling in the hands or feet, diarrhea, liver inflammation, abdominal pains, respiratory infections, abnormal vision, and taste changes.
✓    Less common: weakness, dry mouth, stupor, abnormal thinking, rash, sinus irritation, sore throat, muscle aches, fever, and chest pain.
♦    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.
Child
✓    Most common: abdominal pain, fever, respiratory infections, sleeplessness, sleepiness, nervousness, vomiting, constipation, and black-and-blue marks.
✓    Common: headache, appetite loss, hiccups, sore throat, coughing, middle ear infections, fatigue, weight loss, temporary loss of urine control, qak”,,NbNW)ng unusually, weak-))855, abnormal thinking, emotional instability, pinpoint pupils, rash, upset stomach, and low white-blood-cell count.
✓    Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if your child experiences any side effect not listed above.
Drug Interactions
•    Combining felbamate and other antiseizure drugs usually requires dosage adjustments due to the risk of drug interaction. Dosage of felbamate should be reduced by 20-33% to reduce the risks of associated side effects.
•    Combining felbamate and carbamazepine reduces blood levels of both drugs by roughly half. Dosage adjustments are necessary.
•    Combining phenobarbital and felbamate increases the amount of phenobarbital in the blood and decreases felbamate levels. Dosage adjustments are necessary.
•    If you combine felbamate and phenytoin, your phenytoin dosage may have to be reduced by as much as 40%. This combination also decreases felbamate blood levels by almost 50%.
•    Felbamate increases blood levels of valproic acid and methsuximide.
Food Interactions
Felbamate is best taken on an empty stomach but may be taken with food if it causes upset stomach.
Usual Dose
Adult and Child (age 14 and over): 1200-3600 mg a day, divided into 3-4 doses.
Child (age 2-13): 6.8-20.5 mg per lb. a day, divided into 3-4 doses.
Overdosage
Overdose symptoms may include upset stomach, increased heart rate, and felbamate side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Do not take more felbamate than your doctor has prescribed. Felbamate can cause drowsiness; be careful when, driving  perfQ(ft g
Avoid prolonged exposure to the sun while taking felbamate. Call your doctor if you develop any bothersome or persistent side effect.
Maintain good dental hygiene while taking felbamate and use extra care when brushing or flossing because this drug can cause swollen gums. See your dentist regularly.
km ,s %2& nq6re concentration.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and another in 3 or 4 hours, then go back to your regular schedule. Do not take
a double dose.
Special Populations
Pregnancy/Breast-feeding: This drug may cross into fetal circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Felbamate passes into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors, especially those with liver, kidney, or heart disease, may be more sensitive to the effects of this drug and should receive lower doses.

Generic Name
Felodipine (feh-LOE-dih-pene) 91
Brand Name Plendil
Combination Product
Generic Ingredients: Enalapril + Felodipine Lexxel
Type of Drug
Calcium channel blocker.
Prescribed For  High blood pressure.
General Information
Felodipine is one of many calcium channel blockers available in the U.S. Its once-daily dosage schedule makes it particularly stilted to treating high blood Felodipine blocks the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage interferes with the contraction of these muscles, which in turn dilates (widens) the veins and vessels that supply blood to them. This dilating effect reduces blood pressure, the amount of oxygen used by the heart muscle, and the risk of blood vessel spasm. Felodipine is therefore useful in
treating not only high blood pressure but also angina pectoris (brief attacks of chest pain), a condition related to poor oxygen supply
to the heart muscles.
Felodipine only affects the movement of calcium into muscle cells-, it has no effect on calcium in the blood.
Lexxel is a combination of felodipine and enalapril, an angiotensin converting enzyme (ACE) inhibitor.
Cautions and Warnings
Do not take felodipine if you are allergic or sensitive to any of its ingredients.
On rare occasions, felodipine may cause very low blood pressure that may lead to stimulation of the heart and rapid heartbeat and can worsen angina. This reaction may happen when treatment is first started, when dosage is increased, or if the drug is rapidly withdrawn; it may be avoided by reducing dosage gradually.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken only once daily—have a greater chance of having a heart attack than do people taking beta blockers or other medications for the same purpose. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Patients taking a beta-blocking drug who begin taking felodipine may develop heart failure or increased angina.
People with severe liver disease may require dosage adjustments.
People taking felodipine who have had a heart attack and have lung congestion may experience worsened heart failure, since this drug can actually reduce the force of each heartbeat.
Possible Side Effects
Side effects produced by calcium channel blockers are generally mild and rarely cause people to stop taking them. Side effects are more common with higher doses and in older patients.
I Most common: swelling in the ankles, feet, or legs; dizziness; lightheadedness; muscle weakness or cramps; facial flushing; and headache.
V Less common: respiratory infections, cough, tingling in the hands or feet, upset stomach, abdominal pains, chest pains,
stomach, , heart palpitations,
Drug Interactions
•    Felodipine may increase the amount of beta-blocking drugs in the bloodstream. This can lead to heart failure, very low blood pressure, or an increased incidence of angina. However, in many cases these drugs have been taken together with no problem.
•    Felodipine increases the effects of other blood-pressurelowering drugs. Such drug combinations are often used to treat hypertension.
•    Cimetidine, ranitidine, and azole antifungals such as ketoconazole and itraconazole increase the amount of felodipine in the blood and may account for a slight increase in the drug’s effect.
•    Phenytoin and other hydantoin antiseizure medicines, carbamazepine, and barbiturate sleeping pills and sedatives may decrease the amount of felodipine in the blood, reducing its effect on the body.
•    Erythromycin and cyclosporine may increase the side effects of felodipine.
•    Felodipine may increase the effects of digoxin, theophylline (prescribed for asthma and other respiratory problems), and oral anticoagulant (blood-thinning) drugs.
•    Felodipine may also interact with quinidine (prescribed for abnormal heart rhythm) to produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.
•    Qd(Gii= Channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
You may take felodipine with food if it upsets your stomach. Avoid taking felodipine with grapefruit juice—it doubles the amount of drug absorbed.
Possible Side Effects (continued) nausea, constipation, diarrhea
throat, runny nose, back pain,    rash.
and
♦ Rare: Rare side effects can affect the heart,
blood, and joints. It can affect    and
your mood, sex drive,
urinary tract. Contact your do    you experience side effect not listed above.
ctor if    any Usual Dose
2.5-10 mg a day. No patient should take more than 20 mg a day. Do not stop taking felodipine abruptly. The dosage should be reduced gradually over a period of time.
Overdosage
Felodipine overdose can cause low blood pressure. If you think you have taken an overdose of felodipine, call your doctor or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop constipation, nausea, very low blood pressure, breathing difficulties, increased heart pain, dizziness, or lightheadedness, or if other side effects are bothersome or persistent.
Swelling of the hands or feet may develop within 2 or 3 weeks of starting felodipine. The chances of this happening depend on age and dosage. It occurs in less than 10% of people under age 50 taking 5 mg a day and in more than 30% of those over age 60 taking 20 mg a day.
Be sure to continue taking your medication even if you feel well, and follow any instructions for diet restriction or other treatments to help maintain lower blood pressure.
Do not break or crush felodipine tablets.
It is important to maintain good dental hygiene while taking felodipine and to use extra care when using your toothbrush or dental floss because of the chance that the drug will make you more susceptible to certain infections.
If you forget to take a dose of felodipine, 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
Pregnancy1filreast-feeding. Animal studies of felodipk”e have shown that it crosses RAW the Zeta) circulation and causes birth iNlfEcls. Women who are or who might become pregnant while taking this drug should not take it without their doctor’s approval. The potential benefit of taking felodipine must be carefully weighed against its risks.
It is not known if felodipine passes into breast milk. Nursing mothers who take felodipine should use infant formula.
Seniors: Seniors, especially those with liver disease, are more sensitive to the effects of this drug.

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Ciclopirox

August 1, 2009 | Leave a Comment

Generic Name
Ciclopirox (sye-kloe-PERE-ox) &
Brand Names
Loprox    Penlac
Type of Drug Antifungal,
Prescribed For
Fungus and yeast infections of the nails and skin, including athlete’s foot, candida, and dandruff.
General Information
Ciclopirox slows the growth of a variety of fungus organisms and yeasts and kills many others. The drug penetrates the skin, hair, hair follicles, and sweat glands. Ciclopirox nail lacquer is used for toenail and fingernail fungus infections. Ciclopirox shampoo is used for dandruff.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
Possible Side Effects
Common: burning, itching, stinging, or oozing at the application site.
Drug Interactions None known.
Usual Dose
Cream/Lotion
Adult and Child (age 10 and over): Massage into cleansed affected skin and surrounding area twice a day.
Nail Lacquer
Adult: Apply to infected nails once a day. Use in conjunction with monthly visits to a health care professional.
Child (under age 10): not recommended.
Shampoo
Adult: Wet hair and apply 1-2 tsp to the scalp. Lather and leave on hair and scalp for 3 minutes, then rinse. Avoid contact with eyes. Repeat twice weekly for 4 weeks.
Child (under age 16): not recommended.
Overdosage
Accidental ingestion may cause nausea and upset stomach. Call your local poison control center or hospital for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
This product can be expected to relieve symptoms within the first week of use. Follow your doctor’s directions for the complete 2-4 week course of treatment with the cream or lotion to gain maximum benefit. The nail lacquer may be used for up to 48 weeks. Stopping the medication too soon can lead to a relapse.
When using ciclopirox nail lacquer, do not apply it to any skin other than that which surrounds the infected nails, because of possible irritation. Do not apply nail polish or any other nail lacquer to infected nails while you are using this product.
Avoid using ciclopirox nail lacquer near an open flame, since the product is flammable.
Do not cover cream or lotion with a bandage.
Call your doctor if the affected area burns, stings, or becomes red after you use this product, 13y i1 your symptoms do not clear Up aher 4 weeks of treatment; by then it is unlikely that this product will be effective.
If you forget a dose of ciclopirox, apply it as soon as you remember. Do not apply more than the amount prescribed to make up for the missed dose.
Special Populations
PregnancylBreast-feeding., ciclopirox may pass to the fetus in very small amounts. In animal studies, high doses of ciclopirox given by mouth did not harm the fetus. Caution should be exercised when using ciclopirox during pregnancy.
It is unknown if ciclopirox passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use this drug without special restriction.

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Chlorzoxazone

August 1, 2009 | Leave a Comment

Generic Name
Chlorzoxazone (klor-M-uh-zone)
Brand Names
Parafon Forte DSC    Strifon Forte DSC
Type of Drug
Skeletal muscle relaxant.
Prescribed For
Pain and spasm of muscular conditions, including strain, sprain, bruising, and lower back problems.
General Information
Chlorzoxazone works primarily on the spinal cord level and on the brain, acting as a mild sedative. This results in fewer spasms, less pain, and greater mobility. Chlorzoxazone provides only temporary relief and is not a substitute for other types of therapy, such as rest, surgery, and physical therapy.
Cautions and Warnings
Do not take chlorzoxazone if you are allergic or sensitive to any of its ingredients, or if you have a condition known as porphyria.
People with poor liver or kidney function should take this drug with caution because serious liver toxicity has rarely occurred in people using chlorzoxazone.
Chlorzoxazone may interact with other drugs that cause nervous system depression (see “Drug Interactions”).
Because it is possible to become dependent on this drug, people with a history of substance abuse should take chlorzoxazone with caution.
Possible Side Effects
♦    Most common: dizziness, drowsiness, lightheadedness, malaise, and aveTStimulation,
♦    Less common: headache, stomach cramps or pain, diar-
rhea, constipation, heartburn, nausea, and vomiting.
•    Rare: internal bleeding, liver problems, severe allergic-type skin reactions, and breathing problems. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• The depressive effects of chlorzoxazone may be enhanced by taking it with alcohol, sedatives, sleeping pills, or other nervous system depressants. Avoid these combinations.
Food Interactions
Take this drug with food if it upsets your stomach. The tablets may be crushed and mixed with food.
Usual Dose
Adult: 250-750 mg 3-4 times a day. Child: 125-500 mg 3-4 times a day.
Do not take more medication than is prescribed.
Overdosage
Early signs of chlorzoxazone overdose may include nausea, vomiting, diarrhea, drowsiness, dizziness, lightheadedness, and headache. Victims may also feel sluggish or sickly and lose the ability to move their muscles. Breathing may become slow or irregular, and blood pressure may drop. Contact a doctor immediately or go to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Chlorzoxazone may make you drowsy or reduce your ability to concentrate. Be extremely careful while driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorzoxazone may turn your urine orange to purple-red; this is not dangerous.
Call your doctor if you develop drowsiness, weakness, an allergic reaction, skin rash or itching, breathing difficulties, black or tarry stools, vomiting of material that resembles coffee grounds, liver problems, or any other severe or bothersome side effect.
4f you miss a dose of chlorzoxazone by more than an hour, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of chlorzoxazone in pregnant women has not been established. Pregnant women should only take chlorzoxazone after carefully weighing its potential benefits against its risks.
It is not known if chlorzoxazone passes into breast milk. Nursing mothers should consider using infant formula.
Seniors: Seniors, especially those with severe liver disease, are more sensitive to the effects of chlorzoxazone.

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Cevimeline

August 1, 2009 | Leave a Comment

Generic Name
Cevimeline (seh-VIM-ih-lene) 9
Brand Name  Evoxac
Type of Drug  Cholinergic.
Prescribed For
Dry mouth in people with syndrome.
General Information
Sj6gren’s syndrome jS a group 0j symptoms related to a lack of bodily secretions. People with this condition have very dry eyes and mucous membranes, facial lesions, and neck swelling. It often occurs in menopausal woman and is often associated with rheumatoid arthritis, poor blood circulation in the legs, and tooth decay. Cevimeline increases secretions in the mouth by binding to specific nervous system receptors and causing the release of more saliva.
Cautions and Warnings
Do not take cevimeline if you are allergic or sensitive to any of its
ingredients.
This drug may make breathing more difficult and worsen lung conditions such as asthma, chronic bronchitis, or chronic obstructive pulmonary disease (COPD).
Eye conditions like glaucoma or inflammation of the iris may be worsened by cevimeline.
Cevimeline may affect the heart, and some people with severe heart disease, including those with a history of severe angina or heart attack, may not be able to compensate for this effect.
Cevimeline may worsen gallstones and kidney stones and should be avoided by people with a history of these conditions.
Cevimeline may cause visual blurring, especially at night.
Possible Side Effects
✓    Most common: excessive sweating, headache, nausea, sinus irritation, respiratory infection, runny nose, and diarrhea.
✓    Common: upset stomach, abdominal pains, urinary infection, coughing, and sore throat.
✓    Less common: vomiting, back pain, injury, rash, conjunctivitis (pinkeye), dizziness, bronchitis, severe joint pain, fatigue, bone pain, sleeplessness, hot flushes, excess salivation, chills, and anxiety.
✓    Rare: frequent urination, weakness, and flushing. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Combining cevimeline with a beta blocker can lead to heart rhythm disturbances.
•    Cevimeline may interfere with the effects of anticholinergics, found in Some medications for abdominal or stomach spasms or cramps.
•    Cholinergics such as bethanechol, donepezil, physostigmine, pilocarpine, and pyridostigmine can add to the effects of cevimeline.
•    Some drugs may interfere with the breakdown of cevimeline in the liver, increasing the chance of drug side effects. These include amiodarone, celecoxib, chlorpheniramine, cimetidine, ciprofloxacin, clarithromycin, clomipramine, cocaine, diltiazem, erythromycin, fluconazole, fluoxetine, halofantrine, indinavir, itraconazole, ketoconazole, methadone, mibefradil, nelfinavir, paroxetine, quinidine, ranitidine, ritonavir, saquinavir, and terbinafine.
Food Interactions
Grapefruit juice may interfere with the breakdown of cevimeline in the liver, increasing the chance of drug side effects. Food interferes with the absorption of cevimeline into the bloodstream. Take this drug on an empty stomach.
Usual Dose
Adult: 30 mg 3 times a day. Child: not recommended.
Overdosage
Overdose symptoms can include exaggerated drug side effects including headache, visual impairment, excess tearing and/or sweating, difficulty breathing, stomach or intestinal spasms, nausea, vomiting, diarrhea, changes in heart rhythm, blood pressure changes, shock, mental confusion, and tremors. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
cevimeline may cause blurred vision, possibly interfering with driving or performing tasks that require reliable vision, especially at night or in low light.
If you sweat excessively while taking cevimeline, be sure to drink a lot of water. Excessive sweating can lead to dehydration.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Pregnant women should take cevimeline only if it is considered crucial by your doctor, since its effect on the developing fetus is not known.
It is not known if cevimeline passes into breast milk, but nursing mothers who must take this drug should consider using infant formula.
Seniors: Older adults should be cautious about using this drug because of its possible effects on the kidney, liver, and heart, and on other diseases or medications.

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Cetirizine

August 1, 2009 | Leave a Comment

Generic Name
Cetirizine (seh-TERE-ih-zene)
Brand Name  Zyrtec
The information in this profile also applies to the following drugs:
Generic Ingredient: Azelastine
Generic Ingredient: Fexofenadine 91 Allegra
Generic Ingredient: Levocetirizine 91 Xyzal
Type of Drug  Antihistamine.
Prescribed For
Azelastine: runny nose, sneezing, nasal itching, and post-nasal drip. Cetirizine: stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal and year-round allergy, and for other symptoms of allergy such as rash, itching, and hives; also prescribed for chronic itching and for asthma. Fexofenadine: sneezing, stuffy and runny nose; scratchy throat and mouth; and itchy, watery, and red eyes caused by seasonal allergies. Levocetirizine: stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal and year-round allergy, and for other symptoms of allergy such as rash, itching, and hives; also prescribed for chronic itching.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from the cell at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes. Cetirizine causes less sedation than older antihistamines and appears to be just as effective. Levocetirizine is the active portion of the cetirizine molecule and is as effective as cetirizine with a similar side effect profile.
Cautions and Warnings
Do not take cetirizine if you are allergic or sensitive to any of its ingredients.
People with kidney disease should receive reduced dosages of cetirizine and levocetirizine. Do not take these drugs if kidney disease is severe. Children with kidney disease should not receive levocetirizine.
Possible Side Effects
✓    Common: headache, drowsiness, fatigue, dry mouth, bitter taste in the mouth, dizziness, runny nose, and sore throat.
✓    Less common: nosebleeds, stuffy nose, sneezing, cough, nausea, upset stomach, changes in bowel habits, nervousness, and fever (children).
♦    Rare: fainting and weight gain. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Cimetidine may increase the level of azelastine in the blood.
•    Cetirizine is less likely than other antihistamines to interact with drugs.
•    Ritonavir increases the amount of levocetirizine and slows its breakdown in the body. This may result in increased levocetirizine side effects.
Food Interactions
•    Ceterizine and levocetirizine may be taken without regard to food or meals.
Usual Dose
Azelastine Nasal Spray
Adult and Child (age 12 and over): 1-2 sprays in each nostril twice a day.
Child (age 5-11): 1 spray in each nostril twice a day.
Cetirizine
Adult and Child (age 6 and over): 5-10 mg once a day depending on symptoms. Reduce dosage in people with kidney disease. Child (age 1-5): 2.5-5 mg a day.
Child (age 6 months-1 year): 2.5 mg a day.
Fexofenadine
Adult (age 12 and over): 60 mg twice a day or 180 mg once a day. People with kidney disease should take 60 mg a day.
Child (age 6-11): 30 mg twice a day.
Levocetirizine
Adult and Child (age 12 and over): 5 mg every evening.
Child (age 6-11): 2.5 mg (1h tablet) every evening. Dosage for children should not exceed 2.5 mg a day. Child (under age 6): not recommended.
Overdosage
Drug overdose is likely to cause severe side effects. Overdose victims should be Oven ipecac syrup—available at any pharmacy—to make them vomit and be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Use extra caution while doing anything that requires concentration, such as driving a car or operating hazardous machinery.
Report sore throat, unusual bleeding, bruising, tiredness, weakness, or any other unusual side effect to your doctor. Do not combine these drugs with alcohol or other nervous system depressants. Do not put azelastine nasal solution into your eyes.
If you forget to take a dose of cetirizine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Oral antihistamines are generally considered safe for use during pregnancy. But do not take any antihistamine without your doctor’s knowledge if you are or might become pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of antihistamine pass into breast milk. Nursing mothers who must take cetirizine should use infant formula.
Seniors: Antihistamines are more likely to cause dizziness, sleepiness, and confusion in seniors. Dosage reduction may be recommended depending on kidney function.

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Alitretinoin

July 16, 2009 | Leave a Comment

Generic Name
Alitretinoin (al-ih-TRET-in-oin)
Brand Name
Panretin
Type of Drug Retinoid.
Prescribed For
Skin lesions of Kaposi’s sarcoma (KS).
General Information
Alitretinoin binds to and activates retinoid receptors in human cells. Once activated, these receptors help stimulate the body’s natural mechanisms for limiting tissue growth—in this case, the growth of KS cells. KS lesions, which are primarily associated with human immunodeficiency virus (HIV), can respond to alitretinoin in as little as 2 weeks, but most people do not start to see results for 48 weeks or, in some cases, 14 weeks or more.
Cautions and Warnings
Do not use alitretinoin if you are allergic or sensitive to retinoids or to any of its ingredients.
Alitretinoin is applied to individual KS lesions. It does not treat systemic KS or prevent new KS lesions from forming.
People requiring systemic KS treatment (those who have developed more than 10 new KS lesions within a month) should not use alitretinoin.
People with swollen lymph glands, KS that affects the lungs or other major organ involvement should not use alitretinoin.
Possible Side Effects .
✓    Most common: rash and burning pain at application site.
♦    Common: itchy, flaking, peeling, cracking, oozing, swelling, and inflammation at application site.
Drug Interactions
•    Do not use insect repellant products that contain DEET, a widely used chemical repellant. Alitretinoin increases DEET toxicity.

Usual Dose
Adult: Apply 2-4 times a day to KS skin lesions. Seniors should use this drug with caution.
Child: not recommended.
Overdosage
Little is known about the effects of accidental ingestion. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Apply enough alitretinoin gel to cover the entire skin lesion. Allow the gel to dry for 3-5 minutes before covering the area with clothing. Avoid showering, bathing, or swimming for at least 3 hours.
If you use a bandage or dressing, be sure it is not tight and that air can circulate freely over the area.
Avoid applying alitretinoin to unaffected skin because it may be irritated by the drug. Avoid applying near the nose, eyes, or mouth.
Alitretinoin contains alcohol. Always keep it away from any open flame.
Retinoids can cause unusual sensitivity to the sun. While this has not been seen with alitretinoin, you should avoid prolonged exposure to the sun or use sunscreen while taking this drug.
If you forget a dose, apply it as soon as you remember. If it is almost time for your next dose, apply the forgotten dose and then space the rest of your doses throughout the day. Continue with your regular schedule the next day.
Special Populations
PregnancylBreast-feeding., Alitretinoin can harm the fetus when sufficient levels of the drug are present in the mother’s bloodstream, but it is not known if these levels are achieved during routine use of alitretinoin. Women who are or might be pregnant should only use this drug after discussing its potential benefits and risks with their doctors.
It is not known if alitretinoin passes into breast milk. Nursing mothers who must use alitretinoin should use infant formula.
Seniors: There is no information on use of alitretinoin by seniors. Seniors should use it with caution.

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Adefovir

July 16, 2009 | Leave a Comment

Generic Name
Adefovir (ah-deh-FOE-veer)
Brand Name  Hepsera
Type of Drug  Antiviral.
Prescribed For
Chronic active hepatitis B in adults.
General Information
Hepatitis B is one of several different types of hepatitis, a viral infection of the liver. Adefovir is an antiviral drug that can reduce the amount of hepatitis B virus in the bloodstream and slow its spread to healthy liver tissue, however, it cannot cure chronic hepatitis B. People with chronic hepatitis B may develop liver cirrhosis or liver cancer and it is not known if adefovir can prevent these conditions from occurring. Like other viruses and bacteria, the hepatitis B virus can become resistant to the effects of adefovir.
Adefovir works against the hepatitis C virus in a way similar to that of certain human immunodeficiency virus (HIV) drugs. It interferes with an enzyme called reverse transcriptase, which is an essential component of the viral reproduction process. Almost half of each dose is eliminated via the urine within 24 hours of taking it.
Cautions and Warnings
Do not take adefovir if you are allergic or sensitive to any of its ingredients.
Adefovir can be toxic to the kidneys, especially in people who already have some kidney problems. Since it is eliminated from the body through the kidneys, people with kidney disease are often given lower doses of adefovir.
In some cases, hepatitis can become severely aggravated upon discontinuation of adefovir. Your doctor should check your liver for’ 2 weeks after the drug is stopped. it is possible that antiviral therapy may have to be re-started.
Adefovir has some activity against the human immunodeficiency virus (HIV). An HIV blood test is recommended before starting adefovir treatment. If you are HIV positive, adefovir could make the HIV virus resistant to future antiviral drugs.

People taking adefovir can develop liver disease, liver enlargement, fat degeneration, and lactic acidosis (potentially fatal metabolic imbalance). This may be a reason for your doctor to stop your adefovir treatment. This occurs most frequently in obese women.
Possible Side Effects
In studies, side effects reported in the treated group were similar in frequency to placebo.
✓    Most common: weakness, headache, stomach pain, and nausea.
✓    Less common: intestinal gas, diarrhea, and upset stomach.
Drug Interactions
This drug was studied extensively in an attempt to predict possible drug interactions. No major interaction problems have been revealed.
•    Taking drugs that can be toxic to the kidneys (such as amino-glycosides, cyclosporine, nonsteroidal anti-inflammatory drugs (NSAIDs), tacrolimus, and vancomycin) together with adefovir can lead to the more rapid appearance of kidney damage.
•    Ibuprofen, when taken in dosages of 800 mg 3 times a day, will increase adefovir blood levels by about 20 %, however the importance of this finding is unknown.
Food Interactions
Adefovir may be taken without regard to food or meals.
Usual Dose
Adults: 10 mg once a day. People with kidney disease requiring dialysis may take only 10 mg a week. The exact dosage is based on the severity of kidney disease.
Child: not recommended.
Overdosage
Gastrointestinal symptoms are the most likely outcome of an adefovir overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.

Special Information
Practice safe sex and safe needle use. People taking adefovir may still spread hepatitis B through sexual contact or by sharing needles. Practice safe sex using condoms and dental dams.
Do not share personal items that can have blood or body fluids on them, such as toothbrushes or razor blades.
Try to take adefovir at the same time every day.
Adefovir must be taken continuously to maintain its effectiveness. Be sure to keep enough adefovir on hand so that you do not run out of medicine.
If you take adefovir on a regular schedule and forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose of this medicine. Call your doctor if you forget 2 or more doses in a row. Skipping or forgetting too many doses can make the hepatitis C virus resistant to adefovir.
Call your doctor at once if you feel very weak or tired, cold (especially in your arms and legs), dizzy or lightheaded, have unusual muscle pain, trouble breathing, stomach pain with nausea and vomiting, or have a fast or irregular heartbeat. These could be signs of lactic acidosis.
Call your doctor if you experience jaundice (symptoms include yellowing of the skin or whites of the eyes), appetite loss for a few days or more, lower stomach pain, nausea, dark urine, or bowel movements that are light in color. These could be signs of liver toxicity.
Special Populations
Pregnancy/Breast-feeding: Animal studies with adefovir have revealed a tendency for some birth defects when the dosage administered was more than 20 times the average human dose. There is no information on the effect of adefovir during pregnancy. The company that produces adefovir has established a registry to collect information on pregnant women who take this drug. When this drug is considered crucial by your doctor, its potential benefits may be carefully weighed against its risks.
It is not known if adefovir passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may be more sensitive to adefovir’s side effects because of the natural loss of kidney function that occurs with advancing age.

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Adderall

July 16, 2009 | Leave a Comment

Brand Name
Adderall
Generic Ingredients
Dextroamphetamine Sulfate + Dextroamphetamine Saccharate + Amphetamine Aspartate + Amphetamine Sulfate
Other Brand Names Adderall XR
The information in this profile also applies to the following drugs:
Generic Ingredient.* Dextroamphetamine Sulfate RE Dexedrine    Dextrostat
Generic Ingredient., Lisdexamfetamine Dimesylate Vyvanse
Type of Drug
Central-nervous-system (CNS) stimulant.
Prescribed For
Attention-deficit hyperactivity disorder (ADHD) and narcolepsy (uncontrollable desire to sleep).
General Information
Amphetamines are stimulants that work on the brain’s feeding center. Adderall, which is a mixture of two forms of amphetamine, may be used as a short-term aid in weight reduction. It should not be taken for longer than a few months for this purpose.
Amphetamines may also be prescribed for childhood ADHD, a condition characterized by distractibility, short attention span, hyperactive behavior, emotional instability, and difficulty controlling impulses. They should be used only after a complete evaluation of the child has been done. Frequency and severity of symptoms and their appropriateness for the age of the child determine whether drug therapy is required. Many experts believe that amphetamines offer only a temporary solution because they do not permanently change behavioral patterns. Psychological, educational, and social measures must also be taken to ensure successful treatment in the long term.

Cautions and Warnings
Do not take Adderall if you are allergic or sensitive to any amphetamine or have heart disease, a heart defect, high blood pressure, hardening of the arteries, liver or kidney disease, tics or Tourette’s syndrome, seizures or abnormal brain wave tests, thyroid disease, glaucoma, or a history of drug abuse.
Amphetamines should be used with extreme caution because they are highly addictive and easily abused.
New or worsening thought patterns, bipolar illness, aggressive or hostile behavior, psychotic behavior, and new manic symptoms can develop during treatment with amphetamines.
Stimulants like amphetamines are not effective and may be dangerous for children whose symptoms are related to environmental factors or primary psychiatric conditions, including psychosis.
Stimulants can cause weight loss and stunted growth in children under age 10. Blurred vision and difficulty focusing can occur.
Possible Side Effects
✓    Common: heart palpitations, restlessness, overstimulation, dizziness, sleeplessness, increased blood pressure, rapid heartbeat, upper abdominal pain, and weight loss.
✓    Less common: euphoria (feeling “high”), hallucinations, muscle spasms and tremors, headache, dry mouth, unpleasant taste in the mouth, diarrhea, constipation, upset stomach, nausea, vomiting, rash, itching, changes in sex drive, and impotence.
✓    Rare: psychotic drug reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Combining an amphetamine and a monoamine oxidase inhibitor (MA01) antidepressant may cause a severe increase in blood pressure as well as bleeding inside the skull. Wait at least 2 weeks after stopping an MAGI before taking an amphetamine.
•    Amphetamines may reduce the effectiveness of high blood pressure medicines.
•    Gastrointestinal and urinary acidifying agents such as methenamine reduce the effectiveness of amphetamines.

•    Gastroinstestinal alkalizing agents, such as sodium bicarbonate, and urinary alkalizing agents (acetazolamide, some thiazides) may increase and prolong the effects of amphetamines.
•    Antipsychotic medications such as chlorpromazine, haloperidol, and lithium carbonate inhibit the stimulatory effects of amphetamines and can cause amphetamine poisoning.
•    Amphetamines may enhance the effects of tricyclic antidepressants, norepinephrine, phenobarbital, phenytoin, and meperidine.
•    Amphetamines may decrease the effectiveness of beta blockers.
•    Amphetamines may counteract the sedative effect of antihistamines.
•    Amphetamines can delay the absorption of ethosuximide into the bloodstream.
•    Propoxyphene increases the CNS-stimulating effect of amphetamines. Fatal convulsions have occurred in propoxyphene overdose with amphetamines.
Food Interactions
These drugs may be taken without regard to food or meals.
Usual Dose
Dextroamphetamine and Adderall
ADHD
Child (age 6 and older): 5-40 mg once or twice a day.
Child (age 3-5): 2-5 mg a day. Dose may be increased weekly until maximum response is achieved.
Narcolepsy: 5-60 mg a day.
Weight Control: 5-30 mg a day in divided doses 30-60 minutes before meals; alternately, a single, long-acting dose may be taken in the morning.
Adderall XR
Adults: 20 mg a day.
Child (age 13-17): 10-20 mg every morning. Child (age 6-12): 10-30 mg every morning. Child (under age 6): not recommended.
Lisdexamfetamine
Child (age 6-12): 30 mg every morning. Daily dose may be increased up to 70 mg.
Child (under age 6): not recommended.

Overdosage
Symptoms include tremors, muscle spasms, restlessness, exaggerated reflexes, rapid breathing, dry mouth, constipation, hallucinations, confusion, panic, and overaggressive behavior. These may be followed by depression, exhaustion, abnormal heart rhythms, blood pressure changes, nausea, vomiting, diarrhea, convulsions, and coma. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Amphetamines should be used very cautiously and only when considered absolutely necessary.
When taken for weight control, this drug should be used only when other methods have failed, and will gradually lose its effectiveness as the body starts breaking it down faster. Do NOT increase your dosage when this occurs. The drug must be discontinued.
Amphetamines are addictive and commonly abused. If you feel you have developed a tolerance or dependence to Adderall, contact your doctor. Do not increase your dosage without your doctor’s approval.
Amphetamines may impair your ability to drive or operate heavy machinery. Use with caution. To prevent this drug from interfering with sleep, take it at least 6-8 hours before bedtime.
Do not crush or chew the sustained-release form.
If you forget your once-daily dose, skip it and go -back to your regular schedule the next day. If you take the drug 2-3 times a day and miss a dose, take it as soon as you remember. If it is within 3 hours of your next dose, skip the one you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Use of amphetamines during the early stages of pregnancy may cause birth defects. Amphetamines also increase the risk of premature delivery and low-birth-weight infants and may cause drug withdrawal symptoms in newborns. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Amphetamines pass into breast milk. Nursing mothers who must take them should use infant formula.
Seniors: Seniors are more sensitive to this drug’s effects.

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Adapalene

July 16, 2009 | Leave a Comment

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

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

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

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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.
0 0 *
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.

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