Aug
12
Dimenhydrinate - Diphenhydramine Hydrochloride - Disopyramide - Dofetilide
August 12, 2009 | Leave a Comment
Generic Name
Dimenhydrinate (dye-men-HYE-drih-nate) A
Brand Names
Calm-X Dramamine
Dimetabs Triptone
The information in this profile also applies to the following drugs: Generic Ingredient: Meclizine 91
Antivert Bonine
An tOmA 2S Meni-D
Antivert 50 Ru-Vert-M Antrizine
Type of Drug
Antihistamine and antiemetic (an agent that prevents or relieves nausea and vomiting).
Prescribed For
Nausea, vomiting, vertigo, and dizziness associated with motion
sickness.
General Information
Dimenhydrinate, which depresses middle ear function, is a mixture of diphenhydramine—an antihistamine believed to be the active ingredient—and another ingredient. Meclizine is an antihistamine. It takes a little longer to start working than dimenhydrinate, but its effects last much longer. Meclizine does a better job of preventing motion sickness than treating its symptoms. It takes 30 minutes to 1 hour to work and lasts for 12-24 hours.
Cautions and Warnings
Do not take dimenhydrinate if you are allergic or sensitive to any of its ingredients. Newborn babies should not be given this drug.
People with a prostate condition, stomach ulcer, intestinal obstruction, bladder problems, difficulty urinating, glaucoma, asthma, or abnormal heart rhythms should use dimenhydrinate only while under a doctor’s care.
Because it controls nausea and vomiting, dimenhydrinate may hide the symptoms of appendicitis or overdoses of other drugs.
Possible Side Effects
✓ Most common: drowsiness.
♦ Less common: confusion; nervousness; excitation; restlessness; headache; sleeplessness, especially in children; tingling; heavy or weak hands; fainting; dizziness; tiredness; rapid heartbeat; low blood pressure; heart palpitations; blurred or double vision; difficult or painful urination; increased sensitivity to the sun; appetite loss; nausea; vomiting; diarrhea; upset stomach; constipation; nightmares; rash; drug reaction (symptoms include rash, itching, hives, and breathing difficulties); ringing or buzzing in the ears-, dry mouth, nose, or throat; stuffy nose-, wheezing: and increased chest phlegm OT chest tightness.
Drug Interactions
• This drug should not be taken with a monoamine oxidase inhibitor antidepressant.
• Taking dimenhydrinate with an alcoholic beverage, other antihistamine, sedative, or other central-nervous-system (CNS)
depressant may cause excessive dizziness, drowsiness, or other signs of depression.
• Side effects of anticholinergics may be increased when taken with dimenhydrinate.
• Combining dimenhydrinate and certain antibiotics that cause dizziness or other ear-related side effects may mask early signs of these side effects, especially in infants and children.
Food Interactions
Take dimenhydrinate with food or milk if it upsets your stomach.
Usual Dose
Dimenhydrinate
Adult and Child (age 13 and over): 50-100 mg-1 or 2 tablets or 4-8 tsp.-30 minutes prior to travel; then every 4-6 hours; do not take more than 400 mg a day.
Child (age 6-12): 25-50 mg-1/2 or 1 tablet or 2-4 tsp.—every 6-43 hours; do not take more than 150 mg a day.
Child (age 2-5): up to 25 mg-1/2 or 1 tablet or 2 tsp.-every 6-8 hours; do not take more than 75 mg a day.
Child (under age 2): Consult your doctor.
Meclizine
Adult and Child (age 13 and over): 25-50 mg 1 hour before travel; repeat every 24 hours for duration of journey. Up to 100 mg a day in divided doses may be needed to control dizziness from other causes.
Child: not recommended.
Overdosage
Symptoms of overdose include drowsiness, clumsiness, unsteadiness, feeling faint, facial flushing, and dry mouth, nose, or throat. Convulsions, coma, and breathing difficulties may also develop. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
N1 Maximum effectiveness against motion sickness, take dimenhydrinate 1-2 hours before traveling; it may still be effective if taken 30 minutes before traveling.
This drug may cause drowsiness: Be extremely cautious when driving, operating hazardous machinery, or doing anything that requires concentration.
Dimenhydrinate may cause dry mouth, nose, or throat. Sugarless candy, gum, or ice chips can usually relieve these symptoms. Constant dry mouth may increase the likelihood of developing tooth decay or gum disease. Pay special attention to oral hygiene while you are taking dimenhydrinate, and contact your doctor if dry mouth lasts more than 2 weeks.
If you forget to take a dose of dimenhydrinate, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that meclizine may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant —especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of dimenhydrinate may pass into breast milk. Dimenhydrinate may also slow milk production. Nursing mothers who must take dimenhydrinate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects and should take the lowest effective dose.
Generic Name
Diphenhydramine Hydrochloride
(dye-fen-HYE-druh-mene hye-droe-KLOR-ide) 91
Brand Names
40 Winks
AllerM,ly,
AllerMax Maximum Strength Altaryl Children’s Allergy Banophen
Banophen Allergy
Benadryl Allergy
Benadryl Children’s Allergy* Benadryl Children’s Dye Free Benadryl Dye Free Allergy
Liquid Gels
Children’s Pediacare Nighttime Cough’
Compoz Gel Caps
Compoz Nighttime Sleep Aid Diphen AF
Diphenhist
Dormin
Dytuss
Genahist
Midol PM
Miles Nervine
Nytol Quick Caps
Nytol Quick Gels Maximum Strength
Scot-Tussin Allergy*
Siladryl
Simply Sleep
Sleep-Eze 3
Sleepinol Maximum Strength Sleepwell 2-Nice
Snoozefast
Sominex Original Formula Sylphen Cough
TheraFlu Thin Strips Multi Symptom
Triaminic Thin Strips Cough and Runny Nose
Tusstat
Unisom
‘Some products in this brand-name group are alcohol- or sugar-free.
Type of Drug Antihistamine.
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy and for other symptoms of allergy such as itching, rash, and hives; also prescribed for motion sickness, insomnia, and Parkinson’s disease.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction), drying the nose, throat, and eye secretions. Diphenhydramine is the most common active ingredient found in nonprescription sleep aids.
Cautions and Warnings
This drug should not be used if you are allergic or sensitive to any of its ingredients. It should be avoided or used wilt extreme care if you have narrow-angle glaucoma, stomach ulcer, intestinal abslmcfion, other stomach problems, difficulty urinating, or enlarged prostate. It should not be used by people who have sleep apnea or deep-breathing problems such as asthma. Use with care if you have a history of thyroid disease, heart disease, emphysema, chronic bronchitis, or high blood pressure.
Drug Interactions
• This drug should not be taken with a monoamine oxidase inhibitor antidepressant.
• The effects of sedatives, sleeping medications, and other central-nervous-system (CNS) depressants will be intensified when combined with diphenhydramine hydrochloride; it is extremely important that doses of these drugs are properly adjusted.
• This drug increases the intoxicating and sedating effects of alcohol.
Food Interactions
Take this drug with food if it upsets your stomach.
Usual Dose
Allergy
Adult: 25-50 mg 3-4 times a day.
Child (over 20 tbs.): 12.5-25 mg 3-4 times a day.
Nighttime Sedation
Adult and Child (age 12 and over): 25-50 mg at bedtime.
couqh. SIN%
Adult and Child (age 12 and over): 25 mg every 4 hours; do not take more than 150 mg in 24 hours.
Child (age 6-12): 12.5 mg every 4 hours; do not take more than 75 mg in 24 hours.
mouth, and weakness.
g, rash, sensitivity to bright light, per-
s, lowering of blood pressure, head-
t, sleeplessness, dizziness, disturbed sion, restlessness, nervousness, irri- eling “high”), tingling and weakness of lurred or double vision, ringing in the , appetite loss, nausea, vomiting, con- urinary difficulties, thickening of lung s of the chest, wheezing, nasal stuffi-
h, nose, or throat.
Possible Side Effects
✓ Common: drowsiness
✓ Less common: itching
• fever, chills
• rapid heartbeat
confusion
euphoria (feelin
hands or feet, blurre
• upset stomach
• diarrhea, secretions, tightnes
• and dry
Child (age 2-6): 6.25 mg every 4 hours; do not take more than
25 mg in 24 hours.
Child (under age 2): not recommended.
Thin Strips
TheraFlu
Adult and Child (age 12 and over): 1 strip every 4 hours; do not take more than 6 strips in 24 hours.
Triaminic
Child (age 6-12): 1 strip every 4 hours; do not take more than 6 strips in 24 hours.
Overdosage
Symptoms of overdose include depression or stimulation—especially in children; dry mouth; fixed or dilated pupils; flushing; and upset stomach. Overdose victims should be made to vomit with ipecac syrup—available at any pharmacy. Take the overdose victim to a hospital emergency room immediately if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be extremely cautious when driving or operating hazardous equipment.
If you are taking this medication for motion sickness, take the first dose at least 30 minutes prior to exposure.
If you forget to take a dose of diphenhydramine hydrochloride, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 miDMIns of pregnancy—because newborns may have severe reactions to antihistamines.
SMM) amounts of antihistamine pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects and may require lower dosages.
Generic Name
Disopyramide (die-soe-PIE-rah-mide) 92
Brand Names Norpace
Type of Drug Antiarrhythmic.
Prescribed For Abnormal heart rhythms.
General Information
Disopyramide phosphate slows the rate at which nerve impulses are carried through heart muscle, reducing the response of heart muscle to those impulses. It acts on the heart similarly to the more widely used antiarrhythmic medications procainamide hydrochloride and quinidine sulfate. Disopyramide is often prescribed for people who do not respond to other antiarrhythmic drugs.
Cautions and Warnings
Do not take disopyramide if you are allergic or sensitive to any of its ingredients or if you have heart block, unless you have a cardiac pacemaker.
This drug can worsen heart failure or trigger severely low blood pressure. It should be used in combination with another antiarrhythmic agent or beta blocker with caution.
In rare instances, disopyramide has caused a reduction in blood-sugar levels. Therefore, the drug should be used with caution by diabetics, older adults—who are more susceptible to this effect—and people with poor kidney or liver function. Ask your doctor if you should have your blood-sugar levels checked while taking this drug.
Because of its anticholinergic effects, men with a severe prostate condition and people who have glaucoma, myasthenia gravis, or severe difficulty uritx;aA:jng should use disopyramide with caution.
People with liver or kidney disease must take a reduced dose of disopyramide.
Potassium levels affect the action of disopyramide. People with blood potassium levels that are out of the normal range must correct this imbalance before starting disopyramide.
Norpace CR
Possible Side Effects
♦ Most common: dry mouth, urinary difficulty, and constipation.
♦ Common: blurred vision; dry eyes, nose, and throat; frequent urination; nausea; stomach pain or bloating; gas; dizziness; fatigue; headache; and nervousness.
♦ Less common: itching, rashes, muscle weakness, generalized aches and pains, not feeling well, low blood-potassium levels, increases in blood-cholesterol and triglyceride levels, heart failure, and low blood pressure.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Phenytoin and rifarnpin may increase the rate at which the body removes disopyramide from the blood. Your disopyramide dose may need alteration if this combination is used. Other drugs known to increase drug breakdown by the liver, such as barbiturates and primidone, may also have this effect.
• Other antiarrhythmic drugs, such as procainamide and quinidine, may increase the effect of disopyramide, making dosage reduction necessary. At the same time, disopyramide may reduce the effectiveness of quinidine.
• When disopyramide is combined with a beta-blocking drug, increased disopyramide effects, additive effects, or depression of heart function may result.
• Azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, telithromycin, and verapamil may increase the amount of disopyramide in your blood, causing abnormal heart rhythms or other cardiac effects.
• Disopyramide may reduce the effectiveness of oral anticoagulant (blood-thinning) drugs. Your doctor should check your anticoagulant dosage to be sure you are getting the right amount.
• Hydantoins may cause a decrease in the effectiveness of disopyramide.• Disopyramide may increase the amount of digoxin in your blood, though the amount of the increase is not likely to af-
fect your heart.
• St. John’s wort may decrease disopyramide levels.
Food Interactions
Disopyramide should be taken on an empty stomach at least 1
hour before or 2 hours after meals. Usual Dose
Adult: 400-800 mg a day (divided into 2 or 4 doses for the immediate-release form). In severe cases, 400 mg every 6 hours may be required. This level of dosage should be monitored in the hospital. The sustained-release preparation is taken every 12 hours. People with reduced kidney function should receive a lower dosage, depending on the degree of kidney function present. People with liver failure should take 400 mg a day.
Child (age 13-18): 2.5-7 mg a day per lb. of body weight. Child (age 5-12): 4.5-7 mg a day per lb. of body weight. Child (age 1-4): 4.5-9 mg a day per lb. of body weight.
Child (under age 1): 4.5-13.5 mg a day per lb. of body weight.
Overdosage
Overdose symptoms are breathing difficulties, abnormal heart rhythms, and unconsciousness. In severe cases, overdosage can lead to death. Overdose victims should be made to vomit with ipecac syrup—available at any pharmacy—to remove any remaining drug from the stomach. Call your doctor or poison control center before doing this. If you must go to a hospital emergency room, ALWAYS bring the prescription bottle or container. Prompt and vigorous treatment can mean the difference between life and death in severe overdosage.
Special Information
Disopyramide may cause symptoms of low blood sugar: anxiety, chills, cold sweats, drowsiness, excessive hunger, nausea, nervousness, rapid pulse, shakiness, uaus~M% weakness, tiredness, or cool, pale skim If kNSN)appens to you, eat some chocolate, candy, U rilher high-sugar food, and call your doctor at once.
Disopyramide can cause dry mouth, urinary difficulty, constipation, or blurred vision. Call your doctor if these symptoms become severe or intolerable, but do not stop taking the medication without your doctor’s approval.
If disopyramide is required for a child and capsules are not appropriate, your pharmacist can make a liquid product. Do not do this at home: This medication requires special preparation. The liquid should be refrigerated and protected from light and should be thrown away after 30 days.
Do not crush, chew, or open sustained-release capsules.
If you forget to take a dose of disopyramide, take it as soon as possible. However, if it is within 4 hours of your next dose, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feeding: Do not take this drug if you are pregnant or planning to become pregnant while using it, because it will pass into the fetus and may affect its development. When disopyramide is considered crucial by your doctor, its potential benefits must carefully be weighed against its risks.
Disopyramide passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of this drug.
Generic Name
Dofetilide (DOH-fet-a-lyed)
Brand Name Tikosyn
Type of Drug Antiarrhythmic.
Prescribed For
Specific abnormal heart rhythms.
General Information
Dofetilide is used to establish and maintain normal sinus rhythm in the heart. Dofetilide is available only to hospitals and doctors who receive specific training and education on how to use this drug because of the risks associated with using it.
Cautions and Warnings
Do not take dofetilide if you are allergic or sensitive to any of its ingredients.
Dofetilide is reserved for people whose abnormal heart rhythms have not responded to other drugs. People taking dofetilide must be in a hospital or other facility for at least 3 days where appropriate blood tests can be performed to monitor kidney and heart function.
This drug is cleared through the kidneys. Poor kidney function increases the amount of dofetilide in the body. Liver disease has no effect on dofetilide blood levels.
Dofetilide, like other antiarrhythmic drugs, can cause severe and sometimes fatal abnormal rhythms of its own.
Do not take dofetilide without first talking to your doctor if you have a low blood level of potassium or magnesium.
Women may be at a greater risk for some arrhythmias caused by dofetilide.
Possible Side Effects
Serious heart arrhythmias can develop in up to 31b% of patients taking up to 1000 mcg a day of dofetilide. People taking daily doses above 1000 mcg a day are at up to 5 times greater risk for arrhythmias.
• Most common: headache, chest pain, and respiratory infection.
♦ Common: difficulty breathing, nausea, and dizziness.
♦ Less common: flu; sleeplessness; accidental injury; back pain; diarrhea; abdominal pain; angina; anxiety: joint pain; weakness; atrial and ventricular arrhythmia; high blood pressure; pain; heart palpitations; swollen legs, ankles, or arms; sweating; and urinary infections.
♦ Rare: some arrhythmias, heart attack, hives, slow heartbeat, stroke, facial or other paralysis, tingling in the hands or feet, cough, liver damage, migraine, fainting, and sudden death. Contact your doctor if you experience any side effect not listed above.
‘D?Ug Interactions
Dofetilide should not be given with drugs that are known to interact with it. Dofetilide must be stopped at least 2 days before any potentially interacting drug is taken.
• Do not mix dofetilide with any product containing verapamil, a calcium channel blocker, or trimethoprim, used for urinary infections. These combinations can substantially raise the amount of dofetilide in the blood.
• Some drugs may increase the amount of dofetilide in the blood by inhibiting enzymes that break it down in the liver. They include delavirdine, indinavir, btonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, clarithromycin, cannabis, diltiazem, erythromycin, fluconazole, fluvoxamine, itraconazole, ketoconazole, mifepristone, nefazodone, norfloxacin, mibefradil, selective serotonin reuptake inhibitors (SSRIS), troleandomycin, and zatirlukast.
• Some drugs may reduce the amount of dofetilide in the blood by stimulating enzymes that break it down in the liver, including efavirenz, nevirapine, carbamazepine, corticosteroids, modafanil, phenobarbital and other barbiturates, phenytoin, pioglitazone, and rifampin. Amiloride, metformin, megestrol, and triamterene can interfere with the elimination of dofetilide via the kidney, raising blood levels of the drug.
• Other drugs that can increase the effects of dofetilide are Other antiarrhythmic drugs, bepridil, phenothiazines, and tricyclic antidepressants.
• Mixing dofetilide with digoxin may lead to a ventricular arrhythmia called torsade de pointes. Thiazides, furosemide, and other potassium-depleting diuretics can also increase the risk of this arrhythmia.
Food Interactions
Grapefruit juice may increase dofetilide blood levels.
Usual Dose
Adult: 125-500 mcg twice a day.
Child (under 18 years): not recommended.
Overdosage
Dofetilide overdose is likely to cause significant heart rhythm problems. Overdose victims must be treated symptomatically by their cardiologist.
Special Information
Read all information supplied to you before you begin taking this medication and read it again if anything in your treatment program changes.
Tell your doctor about any changes in your prescription or nonprescription drug use or in your use of vitamins, minerals, and other dietary supplement products.
Be sure that any other doctor or hospital that treats you and might prescribe another drug knows you are taking dofetilide.
Call your doctor at once if you develop any signs of altered electrolyte balance including excessive or prolonged diarrhea, sweating, vomiting, appetite changes, or excessive thirst.
If you forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Dofetilide causes birth defects in animal studies. Pregnant women should take this drug only after discussing with their doctors its potential benefits and risks.
It is unknown whether dofetilide passes into breast milk. Nursing mothers who take it should consider using infant formula.
Seniors: Older adults may take this drug without special restriction.
Aug
1
Chlorpromazine
August 1, 2009 | Leave a Comment
Generic Name
Chlorpromazine (klor-PROE-muh-zene) Al
Brand Names
Sonazine Thorazine*
The information in this profile also applies to the following drugs: Generic Ingredient: Fluphenazine Hydrochloride RE Generic Ingredient: Thioridazine Hydrochloride 0 Generic Ingredient: Trifluoperazine Hydrochloride
‘Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Phenothiazine antipsychotic.
Prescribed For
Psychotic disorders; moderate to severe depression with anxiety; agitation or aggressiveness in disturbed children; intractable pain; and senility. May also be used to relieve nausea, vomiting, hiccups, restlessness, acute intermittant porphyria, and apprehension before surgery or other procedures.
General Information
Chlorpromazine and other phenothiazines act upon a portion of the brain called the hypothalamus. Phenothiazines affect parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Chlorpromazine is available in suppositories and as liquid for those who have trouble swallowing tablets.
Cautions and Warnings
Do not take chlorpromazine if you are AeTgic or sensitive to any oVilsingredients or to any phenothiazine drug. Do not take it if you have very low blood pressure, Parkinson’s disease, or blood, liver, kidney, or heart disease.
Chlorpromazine may depress the cough reflex. People have accidentally choked to death because the cough reflex failed to protect them. Because of its effect in reducing vomiting, chlorpro-mazine may obscure symptoms of disease or toxicity due to over-
dose of another drug.
Use chlorpromazine under your doctor’s strict supervision if you have glaucoma, epilepsy, ulcers, or urinary difficulties.
Avoid exposure to extreme heat, because this drug may upset your body’s temperature-control mechanism. Do not allow the liquid forms of this drug to come in contact with your skin because they are highly irritating.
Chlorpromazine may cause unusually high or low levels of cholesterol.
Possible Side Effects
♦ Most common: drowsiness, especially during the first or second week of therapy. If drowsiness becomes troublesome, contact your doctor.
V Less common: changes in blood components, including anemias, raised or lowered blood pressure, abnormal heart rate, heart attack, sensitivity to light, and faintness or dizziness.
V Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Jaundice (symptoms include yellowing of the whites of the eyes or skin) may appear; when it does, it is usually within the first 2-4 weeks of treatment. Normally the jaundice goes away when the drug is discontinued, but there have been cases when it has not.
Phenothiazines may produce extrapyramidal side effects, including spasm of the neck muscles, rolling back of the eyes, convulsions, difficulty swallowing, and symptoms associated with Parkinson’s disease. These side effects seem very serious but usually disappear after the drug has been withdrawn; however, symptoms affecting the face, tongue, or jaw may persist for as long as several years, especially in older adults with a history of brain damage.
Chlorpromazine may cause an unusual increase in psychotic symptoms or may cause paranoid reactions, tiredness, lethargy, restlessness, hyperactivity, confusion at night, bizarre dreams, sleeplessness, depression, decreased sex drive, increased appetite, or euphoria (feeling “high”).
Drug Interactions
• Be cautious about taking chlorpromazine with over-the-
counter cough, cold, or allergy medications, barbiturates, al-
cohol, sleeping pills, narcotics or other sedatives, or any other
drug that may produce a depressive effect.
• Aluminum antacids may reduce the effectiveness of phenothiazine drugs.
• Chlorpromazine may reduce the effectiveness of bromocriptine and appetite suppressants.
• Anticholinergic drugs may reduce the effectiveness of chlorpromazine and increase the chance of side effects.
• Phenothiazine drugs may counter the blood-pressurelowering effect of guanethidine.
• Taking lithium together with a phenothiazine drug may lead to disorientation, loss of consciousness, or uncontrolled muscle movements.
• Combining propranolol and a phenothiazine drug may lead to unusually low blood pressure.
• Combining tricyclic antidepressants with a phenothiazine drug can lead to antidepressant side effects.
• Chlorpromazine may reduce the effectiveness of epinephrine and norepinephrine.
• Cigarette smoking reduces the amount of chlorpromazine in your blood. Smokers may need larger doses.
Food Interactions
Take liquid chlorpromazine with fruit juice or other liquids. You may also take it with food if it upsets your stomach.
Usual Dose
Adult: 30-1000 mg or more a day, individualized according to your disease and response.
Child (age 6 months and over): 0.25 mg per lb. of body weight every 4-6 hours, up to 200 mg or more a day, depending on disease, age, and response.
Chitty (under 6 months): not recommended.
Overdosage
Overdose symptoms include depression, extreme weakness, tiredness, lowered blood pressure, agitation, restlessness, uncontrolled muscle spasms, convulsions, fever, dry mouth, abnormal heart rhythms, and coma. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or
container.
Special Information
Call your doctor at once if you develop sore throat, fever, rash, weakness, visual problems, tremors, muscle movements or twitching, yellowing of the skin or whites of the eyes, or darkening of the urine.
Do not stop taking chlorpromazine without your doctor’s knowledge. It may take several weeks before this drug takes effect.
This drug may cause drowsiness. Use caution when driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorpromazine may cause unusual sensitivity to the sun and may turn your urine reddish brown to pink.
If dizziness occurs, avoid rising quickly from a sitting or lying position and avoid climbing stairs. Use caution in hot weather, because this drug may make you more prone to heat stroke.
If you are using sustained-release capsules, do not chew them or break them—swallow them whole. Liquid forms of phenothiazines must be protected from light. Do not take them out of their opaque bottles.
If you take chlorpromazine more than once a day and forget to take a dose, take it right away if you remember within an hour. If you do not remember within an hour, skip the dose you forgot and continue with your regular schedule. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue your regular schedule the next day. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Infants born to women taking this drug have experienced side effects—including jaundice and nervous system effects. Check with your doctor about taking chlorpromazine if you are or might be pregnant.
This drug may pass i”W breast milk. Nursing mothers who must take chlorpromazine should use infant formula .
Seniors: Seniors are more sensitive to the effects of this drug and usually achieve desired results with lower dosages. Some experts feel that seniors should receive ‘/,-1/4 the usual adult dose.
Jul
16
Aldosterone Blockers
July 16, 2009 | Leave a Comment
Type of Drug
Aldosterone Blockers (al-DOH-stir-own)
Brand Names
Generic Ingredient: Eplerenone Inspra
Generic Ingredient. Spironolactone Aldactone
Combination Product
Generic Ingredients: Hydrochlorothiazide + Spironolactone Aldactazide
Prescribed For
High blood pressure, cirrhosis, and congestive heart failure (CHF); also used for people with low blood potassium who require a diuretic.
General Information
Aldosterone blockers limit the access of aldosterone—a hormone that helps to regulate several different body functions—from its receptor. Too much aldosterone results in high sodium levels, which can lead to water retention and potassium loss; it can also affect the size, shape, and function of the heart. Aldosterone blockers are generally combined with other medicines in the management of disease. These drugs are useful in removing excess body fluids in conditions associated with high aldosterone levels.
One in every ten people with high blood pressure has excess aldosterone in their systems. In people with congestive heart failure (CHF), aldosterone levels can be 20 times higher than normal, which can worsen their condition, making the use of aldosterone blockers an important part of their treatment. Aldosterone block-ers also help the heart return to normal size, shape, and function in people with heart failure. Eplerenone is broken down in the liver, primarily by an enzyme system known as CYP3A4.
Cautions and Warnings
Do not take aldosterone blockers if you are allergic or sensitive to any of their ingredients.
Do not use aldosterone blockers if you have kidney failure or high blood potassium.
People with liver disease should be cautious about using a!- dosterone blockers.
People taking an aldosterone blocker should have their potassium levels checked periodically.
People with diabetes who have albumin in their urine should not take aldosterone blockers.
Possible Side Effects
Eplerenone
✓ Less common: dizziness, diarrhea, fatigue, flu-like symptoms, coughing, abdominal pain, elevation of blood cholesterol and/or triglyceride levels, elevation of blood potassium levels, and albumin in the urine.
✓ Rare: enlargement of the breasts in males, irregular menstrual cycles in women, and painful breasts. Contact your doctor if you experience any side effect not listed above.
Spironolactone
✓ Less common: drowsiness, lethargy, headache, gastrointestinal upset, cramps and diarrhea, rash, mental confusion, fever, feeling unwell, enlargement of the breasts in males, impotence, and irregular menstrual cycles or deepening of the voice in women.
Drug Interactions
• Do not combine eplerenone with itraconazole or ketoconazole. These drugs can cause the amount of eplerenone in the blood to increase by up to 500% and may cause fatal increases in blood potassium.
• Mixing eplerenone with erythromycin, fluconazole, saquinavir, or verapamil increases the amount of eplerenone in the blood. People taking this combination must watch for signs of high blood potassium (see “Special Information”) and have their blood potassium levels checked regularly.
• Combining a potassium supplement and an aldosterone blocker can lead to dangerously high blood levels of potassium. Do not use a salt-substitute or take any extra potassium unless prescribed by your doctor.
• Combining an aldosterone blocker with an ACE inhibitor or an angiotensin H receptor blocker (ARB) may significantly raise blood potassium. Be sure your doctor monitors your potassium levels if you combine these drugs.
• Spironolactone may interfere with anticoagulant (blood-thinning) drugs and mitotane (an anticancer drug).
• Aspirin can interfere with the diuretic effect of spironolactone but does not alter its effect on high blood pressure or CHF.
• Combining spironolactone with alcohol, barbiturates, or narcotics can lead to dizziness or fainting when rising suddenly from a sitting or lying position.
• Combining spironolactone and a corticosteroid can lead to very low blood potassium.
• Spironolactone may alter your response to drugs used during general anesthesia.
• Lithium generally should not be combined with any diuretic.
• Combining nonsteroidal anti-inflammatory drugs (NSAIDs) with aldosterone blockers can lead to severe elevations of blood potassium and reduce the blood-pressure-lowering effect of the diuretic.
• Spironolactone may raise digoxin blood levels and increase the risk of severe digoxin side effects. Your doctor may have to adjust your digoxin dosage.
• St. John’s wort (a CYP3A4 inducer) may decrease eplerenone levels by about 30%.
Food Interactions
Food appears to increase the amount of spironolactone absorbed into the blood. Take this drug with food at the same time every day. Eplerenone may be taken without regard to food or meals. Taking this drug with grapefruit juice increases the amount of drug absorbed into your body.
Usual Dose
Eplerenone
Adult 50-100 mg a day. Child: not recommended.
Spironolactone
Adult: Starting dosage is 50-100 mg a day in divided doses for high blood pressure; 25-200 mg a day in divided doses for high fluid levels related to other diseases; and 25-100 mg a day for low potassium levels related to diuretic use.
Child: 1-2 mg per lb. of body weight a day.
Spironolactone + Hydrochlorothiazide Adult: 1-4 tablets daily.
Overdosage
Eplerencne overdose may lead to low blood pressure and high blood potassium. Spironolactone overdose may lead to drowsiness. confusion, rash, nausea, vomiting, dizziness, and diarrhea. Rarely. coma may occur in people with severe liver disease. High blood potassium may also occur, especially in people with kidney zsease. Call your local poison control center or a hospital emercency room for more information. If you seek treatment, ALWAYS oring the prescription bottle or container.
Special Information
<e a c!osterone blockers exactly as they are prescribed.
High blood levels of potassium associated with aldosterone blockers may cause weakness, lethargy, drowsiness, muscle pain or cramps, and muscular fatigue. Use caution while doing anything that requires intense concentration, like driving or operating machinery.
Do not use a salt substitute or take anything else that is a source of extra potassium, including many multivitamin or supplement products.
People with high blood pressure should not self-medicate with over-the-counter cough, cold, or allergy remedies containing stimulants. These drugs can raise blood pressure effectiveness and have an adverse effect on the heart.
!f you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies with eplerenone showed no effects on a developing fetus. Spironolactone crosses into the fetal circulation. When your doctor considers either of these drugs crucial, their potential benefits must be carefully weighed against their risks.
Jul
16
Acebutolol
July 16, 2009 | Leave a Comment
Generic Name
Acebutolol (ah-seh-BUTE-uh-lol) 91
Brand Name Sectral
Type of Drug
Beta-adrenergic blocking agent. Prescribed For
High blood pressure and abnormal heart rhythms.
General Information
Acebutolol hydrochloride is one of many beta-adrenergic blocking drugs, or beta blockers. These drugs interfere with the action of adrenaline and other chemicals in the body that affect many body functions. Individual beta blockers have different characteristics that can make them more suitable for certain conditions or people.
Cautions and Warnings
Do not take acebutolol if you are allergic or sensitive to any of its ingredients or to beta blockers.
You should be cautious about taking acebutolol if you have asthma, severe heart failure, a very slow heart rate, or heart block (disruption of the electrical impulses that control heart rate) because the drug may worsen these conditions.
People with angina taking acebutolol for high blood pressure risk aggravating their angina if they suddenly stop taking the drug. These patients should have their acebutolol dosage reduced gradually over 1-2 weeks.
Acebutolol should be used with caution if you have liver or kidney disease because your ability to eliminate this drug from your body may be impaired.
Acebutolol reduces the amount of blood pumped by the heart with each beat. This reduction in blood flow may aggravate the condition of people with poor circulation or circulatory disease.
If you are undergoing major surgery, your doctor may want you to stop taking acebutolol at least 2 days before surgery.
People with a history of severe anaphylactic reaction to alergens may be unresponsive to usual doses of epinephrine while taking beta blockers.
Possible Side Effects
Side effects are relatively uncommon and usually mild; normally they develop early in the course of treatment and are rarely a reason to stop taking acebutolol.
✓ Most common: fatigue.
✓ Common: dizziness and headache.
✓ Less common: chest pain, swelling in the legs or arms, depression, sleeplessness, abnormal dreams, rashes, constipation, diarrhea, upset stomach, stomach gas, nausea, frequent urination, back pain, joint and muscle pain, difficulty breathing, stuffy nose, and vision changes.
♦ Rare: cough, low blood pressure, slow heart beat, anxiety, impotence, changes in response to touch stimulation, itching, vomiting, abdominal pain, painful urination, nighttime urination, liver changes, sore throat, wheezing, eye irritation, pain or dry eye, and lupus erythematosus (extremely rare). Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Acebutolol may interact with surgical anesthetics to increase the risk of heart problems during surgery. Some anesthesiologists recommend gradually stopping the drug by 2 days before surgery.
• Acebutolol may interfere with the normal signs of low blood sugar and with the action of oral antidiabetes drugs.
• Acebutolol increases the blood-pressure-lowering effects of other blood-pressure-reducing agents, including clonidine, guanabenz, and reserpine, and calcium channel blockers such as nifedipine.
• Aspirin-containing drugs, nonsteroidal anti-inflammatory drugs (NSAIDS), and sulfinpyrazone may interfere with the blood-pressure-lowering effect of acebutolol.
• Cocaine may reduce the effectiveness of all beta blockers.
• Acebutolol may worsen the problem of cold hands and feet associated with ergot alkaloids, used to treat migraine. Gangrene is a possibility in people taking both an ergot and acebutolol.
• Acebutolol will counteract thyroid hormone replacements.
• Calcium channel blockers, flecainide, hydralazine, contraceptive drugs, cimetidine, propafenone, haloperidol, phenothiazine sedatives (molindone and others), quinolone antibacterials, and quinidine may increase the amount of acebutolol in the bloodstream and lead to increased acebutolol effects.
• Acebutolol should not be taken within 2 weeks of taking a monoamine oxidase inhibitor (MAGI) antidepressant.
• Acebutolol may interfere with the effects of some antiasthma drugs, including theophylline and aminophylline.
• Combining acebutolol with digitalis drugs may result in excessive slowing of the heart, possibly causing heart block.
• If you stop smoking while taking acebutolol, your dose may have to be reduced because your liver will break down the drug more slowly afterward.
• Aluminum salts, barbiturates, calcium salts, cholestyramine, colestipol, ampicillin, and rifampin may reduce the effectiveness of acebutolol.
• Beta blockers may block the effects of epinephrine.
Food Interactions
None known.
Usual Dose
High Blood Pressure
Adult: starting dose-100 mg a day, taken all at once or in 2 divided doses. The daily dose may be gradually increased. Maintenance dose-400-800 mg a day.
Senior: Older adults may respond to lower doses and should be treated more cautiously, beginning with 100 mg a day, increasing gradually to a maximum of 400 mg a day.
Child: not recommended.
Abnormal Heart Rhythms
Adult: starting dose-200 mg a day. Maintenance dose-200600 mg a day in 2 divided doses.
Senior: Older adults may respond to lower doses and should be treated more cautiously, beginning with 100 mg a day, increasing gradually to a maximum of 400 mg a day.
Child: not recommended.
Overdosage
Symptoms of overdose include extremely slow or irregular heartbeat, very low blood pressure, breathing difficulties, and seizures. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Acebutolol is meant to be taken continuously. When ending acebutolol treatment, dosage should be reduced gradually over a period of about 2 weeks. Do not stop taking this drug unless directed to do so by your doctor.
Do not take other medications, including over-the-counter medications, without consulting with your doctor. The use of some nasal decongestants with acebutolol may result in severely high blood pressure.
Acebutolol may cause drowsiness or dizziness. Be careful when driving or performing complex tasks.
It is best to take acebutolol at the same time each day. If you forget a dose, take it as soon as you remember. If you take acebutolol once a day and it is within 8 hours of your next dose, skip the dose you forgot and continue with your regular schedule. If you take acebutolol twice a day and it is within 4 hours of your next dose, skip the missed dose and continue with your regular schedule. Never take a double dose.
Special Populations
PregnancylBreast-feeding. Acebutolol crosses into the placenta. Infants born to women who took a beta blocker while pregnant had lower birth weights, low blood pressure, and slow heart rates. Acebutolol should be taken during pregnancy only if the potential benefit outweighs the risk.
Large amounts of acebutolol pass into breast milk. Nursing mothers taking acebutolol should use infant formula.
Seniors: Seniors taking acebutolol may need a reduced dosage.
Jul
16
Depression. Diagnosis, Treatment and FAQ.
July 16, 2009 | Leave a Comment
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.
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.” 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 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. 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.”
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.” 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. 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.”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. 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.
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.”
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.
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.
Jul
2
Prescription Pills for Acne
July 2, 2009 | Leave a Comment
Prescription Pills for Acne
When topical antibiotics don’t do the job, dermatologists may prescribe oral medication to get the antibiotic into the bloodstream rather than just on the surface of the skin. Tetracycline and clindamycin have been widely prescribed, but some acne-causing bacteria have developed resistance to them. Now, dermatologists may be more likely to prescribe minocycline. Although this antibiotic works against acne, it is not clear that it is either more effective than other oral antibiotics or less likely to cause undesirable reactions. Anyone who is prescribed oral antibiotics needs to know This topical treatment has been flying under the radar for years. Some dermatologists tell us that it should have anti-inflammatory action and may be better tolerated than benzoyl peroxide.
Side effects: Redness, dryness, and burning.
Downside: Hard to find, although it is available from many online pharmacies. May take several weeks to work. Physicians and pharmacists seem unaware of its effectiveness, and studies are few.
Cost: Approximately $30 for a 30-gram tube.
Patients should discuss all the pros and cons of oral (systemic) antibiotic therapy with the doctor prescribing it. Certain drugs may cause rare but potentially serious side effects, such as the pseudomembranous colitis that is sometimes seen with clindamycin. One study found that people using antibiotics (oral or topical) to treat their acne were about twice as likely to come down with an upper respiratory tract infection. Colds, flus, and similar upper respiratory tract infections are usually self-limited and rarely a serious threat to health, but it makes sense to evaluate whether the acne is in fact affecting your life so much that you’d be willing to trade it for a cold. It might not make sense to take an antibiotic for mild acne that is not too bothersome. After completing a course of antibiotic treatment, acne patients may be able to keep their skin clear by using tretinoin gel or a similar product.” Adapalene or tazarotene gel may also be useful.” Using such a topical medicine as follow-up therapy can reduce the amount of antibiotic exposure. Mostly prescribed pills for acne are Cipro and Accutane.
Jul
2
Acne: Prescription Lotions and Gels
July 2, 2009 | Leave a Comment
Prescription Lotions and Gels for Acne Treatment
If treatment with benzoyl peroxide doesn’t get your pimples under control within a couple of months, check with a physician. Dermatologists often prescribe topical antibiotic gels or lotions in addition to or instead of benzoyl peroxide. Erythromycin and clindamycin are old standbys. Because they have been so widely used however, bacteria have begun to develop resistance to them. As a result, dermatologists have been restricting their use and instead turning to other approaches.
One other medication that is being prescribed is azelaic acid (Azelex, Finevin). Like benzoyl peroxide, this topical treatment seems to keep pores from clogging and to discour-age the multiplication and spread of bacteria. It too may result in burning, stinging, redness, or dryness of the skin. In rare instances, dark skin exposed to azelaic acid may develop lighter patches. If you have a cold sore or fever blister that gets worse while you are using an azelaic acid product, notify the prescribing physician immediately.
Isotretinoin or a similar compound in the vitamin A family can be very effective in treating acne and reducing the inflammation associated with severe acne. Using topical vitamin A–like compounds (retinoids) early in the course of acne lessens the likelihood of scarring, a complication of the condition. Some doctors prescribe tretinoin together with benzoyl peroxide or with an oral antibiotic such as doxycycline to clear the skin faster.
Clindamycin Gel (Cleocin T, Clinda-Derm, Evoclin Topical Foam
Clindamycin is an antibiotic that can be applied to the skin to fight acne-causing bacteria. It may take 2 months to see significant improvement, but generally this treatment is effective. Other topical antibiotics such as erythromycin gel are also effective. Some prescription products combine an antibiotic with benzoyl peroxide for greater effectiveness. These include BenzaClin and Duac Gel (clindamycin plus benzoyl peroxide) and Benzamycin (erythromycin plus benzoyl peroxide). These are effective but expensive because no generic equivalents are available.
Side effects: Itching, burning, dryness, and peeling. A rare but very serious and dangerous side effect of clindamycin that is extremely unlikely to occur but still possible with the topical form is pseudomembranous colitis. Notify your doctor immediately if you develop persistent or bloody diarrhea.
Downside: Skin bacteria (P. aches) are beginning to develop resistance to topical clindamycin.
Cost: Approximately $50 for a 60-gram tube Tretinoin Gel (Retin-A).
Retin-A speeds up cell turnover and normalizes the lower levels of the skin. With 6 weeks or more of treatment, it is frequently very helpful against acne.
Side effects: Stinging, dryness, redness, flaking, and irritation.
Downside: Retin-A makes skin more sensitive to sunburn and sun damage, so stay out of the sun and use effective protection against ultraviolet rays.
Cost: $35 to $50 for 15 grams.
There is another prescription gel or cream that is based on a vitamin. Nicomide-T gel or cream contains nicotinamide, a form of niacin. Like Retin-A, it is topical but not an antibiotic, so theoretically bacteria should not develop resistance to it. A preliminary study showed that Nicomide-T gel is as effective as clindamycin gel in reducing blemishes.” Other research confirmed that it can protect the skin and is less likely to dry it than a number of other acne treatments. It is not clear whether Nicomide-T is as effective as Retin-A, though some studies conducted by the manufacturer, Sirius Laboratories, suggest that adding it to other treatments boosts the effectiveness of both.
Jul
2
Acne: Over-the-Counter Treatment
Benzoyl peroxide is the primary ingredient in most OTC acne treatments. This compound has antimicrobial activity and is usually quite effective for mild acne.
Q. My teenage son has a mild case of acne, but to him it is huge. He washes with strong cleansers and uses a variety of acne medicines. Can you recommend something that will clear up his skin so he doesn’t scrub so much? His face is bright red after all the washing, and I don’t think that is good.
A. You’re right! Acne is not caused by dirt, so vigorous washing won’t help. It may even make things worse.
OTC benzoyl peroxide (Benzac, Clearasil Acne Treatment, Oxy 5, etc.) should do the job. If not, your son should see a dermatologist. Retin-A (tretinoin) and/or antibiotics can work wonders.
Benzoyl peroxide is found in a number of different products, from cleansing bars and liquid cleansers to lotions and even shaving creams. Read the instructions on the label and follow them; the procedure varies a little for the different forms. Benzoyl peroxide can dry the skin and cause irritation. If that happens, use it a little less frequently or look for a product with a lower concentration of the ingredient.
Benzoyl peroxide unplugs pores and discourages thegrowth of skin bacteria. It is not, however, an antibiotic, and skin bacteria don’t seem to develop resistance to it.. Follow the instructions on the product label for application and use.
Side effects: Skin irritation, dryness, redness, scaling, and rash.
Downside: Acne may worsen initially before improving. Use the product for 6 weeks to 2 months to evaluate its effectiveness..
Cost: Varies, depending on - the product; approximately $20 to $30 for a month’s worth of gel .
individuals are allergic to benzoyl peroxide and break out in hives or swelling, so try it out on your forearm first to make sure you will not react badly. If you do, you will have to forgo benzoyl peroxide treatment and look for another way to manage your acne.
A few nonprescription acne products contain active ingredients other than benzoyl peroxide. Resorcinol is generally used in combination with sulfur (Clearasil Adult Care contains them both). Salicylic acid is also found in some OTC acne products. None of these should be used in combination with benzoyl peroxide. All may irritate and dry the skin, and they should not be combined with other products that might irritate the skin. Prescription acne treatment drugs are Cipro and Accutane which are commercial names for generic Ciprofloxacin and Isotretion.