Aug
1
Cimetidine
August 1, 2009 | Leave a Comment
Generic Name
Cimetidine (sih-MET-ih-dene)
Brand
Tagamet Tagamet HB 91
Type of Drug Histamine H2 antagonist.
Prescribed For
Ulcers of the stomach and duodenum (upper intestine); also used for upset stomach, gastroesophageal reflux disease (GERD), benign stomach ulcer, bleeding in the stomach and duodenum, colorectal cancer, prevention of stress ulcer, hyperparathyroidism, fungal infections of the hair and scalp, herpes virus infection, excessive hairiness in women, chronic itching of unknown cause, skin reactions, warts, acetaminophen overdose, and other conditions characterized by the production of large amounts of gastric fluids. Cimetidine may be prescribed to stop the production of stomach acid during surgery.
General Information
Histamine H2 antagonists work by turning off the system that produces stomach acid and other secretions. Cimetidine 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 cimetidine. 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. These drugs are roughly equal in their ability to treat ulcer disease and their risk of side effects.
Cautions and Warnings
Do not take cimetidine if you are allergic or sensitive to any of its ingredients or any histamine H2 antagonist. Cimetidine has a mild antiandrogen effect, which probably causes the painful, swollen breasts that some people experience after taking this drug for a month or more.
People with kidney or liver disease should take cimetidine with caution because 1/3 of each dose is broken down in the liver and passes out of the body through the kidneys.
Do not self-treat with over-the-counter forms of cimetidine without the advice and supervision of your doctor.
The fact that symptalleviated by cimetidine does not dude the possibility of stomach cancer, which can have symptoms similar to other gastrointestinal (GI) disorders. Make sure your doctor screens for possible malignancy.
these symptoms stop 3-4 days after discontinuing the drug. Call your doctor if this happens to you.
Possible Side Effects
Serious side effects are uncommon.
♦ Most common: mild diarrhea, dizziness, rash, painful breast swelling, nausea and vomiting, headache, confusion, drowsiness, hallucinations, and impotence.
♦ Less common: liver inflammation, peeling or red and swollen rash, breathing difficulties, tingling in the hands or feet, delirious feelings, and oozing from the nipples.
✓ Rare: Cimetidine may affect white blood cells or blood platelets. Some symptoms of these effects are unusual bleeding or bruising, unusual tiredness, and weakness. Other rare side effects are inflammation of the pancreas, hair loss (reversible), abnormal heart rhythms, heart attack, muscle or joint pains, and drug reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Separate cimetidine from antacid doses by about 3 hours to avoid reducing cimetidine’s effectiveness. Other drugs that may reduce the absorption of cimetidine are metoclopramide and anticholinergic drugs, including trihexyphenidyl hydrochloride, oxybutynin, and benztropine mesylate.
• Cigarette smoking reverses the healing effect cimetidine has on ulcers.
• Cimetidine may increase the side effects of a variety of drugs, possibly leading to drug toxicity. These drugs include alcohol; aminophylline; oral antidiabetes drugs; benzodiazepine sedatives, except lorazepam, oxazepam, and temazepam; caffeine; calcium channel blockers; carbamweoine; carmustine; chloroquine; tkeCaiTAe; fluorouracil; labetalol; lidoQa« , Tneloprolol; metronidazole; moricizine; mexiletine; narcotic pain relievers; nifedipine; ondansetron; pentoxifylline; phenytoin; procainamide; propafenone; propranolol; quinine; quinidine; tacrine; theophylline drugs, except clyphylline: triamterene; tricyclic antidepressants; valproic acid; and warfarin (a blood-thinner).
• Drugs whose absorption may be decreased by cimetidine are iron, indomethacin, fluconazole, ketoconazole, and tetra-
cycline antibiotics.
• Enteric-coated tablets should not be taken with cimetidine. The change in stomach acidity causes the tablets to disin-
tegrate prematurely in the stomach.
• cimetidine may decrease the effects of digoxin and tocainide.
Food Interactions
None known.
Usual Dose
Adult: 400-800 mg at bedtime; 300 mg 4 times a day with meals and at bedtime; or 400 mg twice a day. To treat GERD-400 mg 4 times a day. Do not exceed 2400 mg a day. Users of Tagamet HB should not take more than 400 mg a day. Smaller doses may be as effective for seniors or those with impaired kidney function.
Overdosage
Little is known about the effects of cimetidine overdose, but victims may experience exaggerated side effects. Two deaths have occurred. Your local poison control center may advise giving ipecac syrup—available at any pharmacy—to induce vomiting and remove any drug remaining in 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 cimetidine exactly as directed and follow your doctor’s instructions regarding diet and other treatment in order to get the maximum benefit from the drug.
Do not take the maximum dose continuously for more than 2 weeks without the consent and supervision of your doctor.
Cigarette smoking is associated with stomach ulcers and reduces cimetidine’s effectiveness.
Call your doctor at once if you develop any unusual side effects such as bleeding or bruisiiAg, tiredness, diarrhea, dizziness, rash, 131 NMbdinations. Black, tarry stools or vomiting material that resembles coffee grounds may indicate your ulcer is bleeding.
If you miss a dose of cimetidine, take it as soon as possible. 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: Animal studies reveal no damage to the fetus, although cimetidine does pass into the fetal blood. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Large amounts of cimetidine pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may need less medication due to loss of kidney function and be more susceptible to side effects, especially confusion and other nervous system effects (see “Cautions and Warnings”).
Aug
1
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.
Jul
16
Adapalene
July 16, 2009 | Leave a Comment
Generic Name
Adapalene (uh-DAP-uh-lene)
Brand Name Differin
Type of Drug Anti-acne.
Prescribed For Acne.
General Information
Adapalene is similar to a retinoid. Retinoids are compounds related to vitamin A and are used in acne treatment. When adapalene is applied to an acne lesion, it modifies several of the processes involved in skin cell function. It reduces inflammation in the acne lesion and slows the formation of the material that fills the lesion. Very little adapalene is absorbed through the skin.
Cautions and Warnings
Do not use adapalene if you are allergic or sensitive to any of its ingredients. If you are sunburned, wait until your sunburn clears before applying adapalene to your skin. Avoid sun or sunlamp exposure while using adapalene. If you must be in the sun, be sure to apply sunscreen or wear protective clothing over areas where you have applied adapalene. Extreme wind or cold can also be irritating to skin where adapalene has been applied.
Adapalene can irritate the skin if used in combination with products such as medicated or abrasive soaps or cleansers, astringents, or soaps and cosmetics with a strong drying effect. Avoid products containing sulfur, resorcinol, or salicylic acid.
Adapalene can be highly irritating if it gets into your eyes or if it is applied to your lips, the angles of your nose, mucous membranes, cuts, abrasions, or sunburned or damaged skin. Avoid using depilatories or waxing while using adapalene.
Possible Side Effects
V Most common: redness, irritation, dryness, scaling, itching, and burning are common after applying adapalene to your skin. These effects usually occur during the first 24 weeks of adapalene use and subside as treatment continues. Symptoms may be severe enough to cause you to stop using adapalene; call your doctor if this happens to you.
V Rare: skin irritation, stinging sunburn, and worsening acne. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
None known.
Usual Dose
Adult and Child (age 12 and over): Wash affected areas with a mild or soapless cleanser and apply a thin layer of adapalene at bedtime.
Child (under age 12): not recommended.
Overdosage
Chronic ingestion of adapalene can cause liver toxicity and other side effects associated with swallowing large amounts of vitamin A. Swallowing adapalene gel is extremely dangerous for pregnant women, who should not take more vitamin A than is contained in their prenatal vitamins. Infants who swallow adapalene should be taken to a hospital emergency room for treatment.
Special Information
Stop using adapalene and call your doctor if you develop a severe skin reaction or any sign of drug allergy or reaction (symptoms include rash, hives, itching, changes in complexion, and breathing difficulties or irregularities).
Adapalene may exacerbate your acne at first, but you should see improvement within 2 weeks.
If you must be in the sun, be sure to apply sunscreen or wear protective clothing over areas to which you have applied adapalene.
Using more than a thin film of adapalene does not produce better results and may be more irritating to the skin.
If you forget to apply a dose of adapalene, apply it as soon as you remember. If it is almost time for your next application of adapalene, skip the dose you forgot and continue with your regular schedule.
Special Populations
PregnancylBreast-feeding., Animal studies of adapalene have shown no effects on the fetus. Since the effect of adapalene on pregnant women is not known, the drug should be used only when the possible benefits outweigh the risks.
It is not known if adapalene passes into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors may use this drug without special precautions.
Jul
16
Acetaminophen
July 16, 2009 | Leave a Comment
Generic Name
Acetaminophen (uh-SEE-tuh-MIN-uh-fen) RE
Brand Names
Acephen Mapap-
Aceta Mapap Children’s
Acetaminophen Uniserts Mapap Extra Strength
Apacet Mapap Infant Drops
Aspirin Free Anacin Maximum Maranox
Strength Neopap
Aspirin Free Pain Relief Oraphen-PD
Dynafed, Children’s JR Panadol*
Dynafed EX Redutemp
Dynafed Extra Strength Silapap
Feverall Silapap Children’s
Feverall, Infants Silapap Infants
Genapap” Tapanol
Genebs Tempra*
Liquiprin Tylenol*
*Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug
Antipyretic and analgesic.
Prescribed For
Relief of pain and fever for people who cannot or do not want to take aspirin or a nonsteroidal anti-inflammatory drug (NSAID). Acetaminophen may be given to children about to receive a
DTP vaccination to reduce the fever and pain that commonly follow the vaccination.
General Information
Acetaminophen is generally used to relieve pain and fever associated with the common cold, flu, viral infections, or other disorders where pain or fever may occur. It is also used to relieve pain in people who are allergic to aspirin, or those who cannot take aspirin because of potential interactions with other drugs such as oral anticoagulants. It can be used to relieve pain from a variety of sources, including arthritis, headache, muscle ache, menstrual cramping, and tooth and periodontic pain, although it does not reduce inflammation.
Cautions and Warnings
Do not take acetaminophen if you are allergic or sensitive to any of its ingredients. Do not take acetaminophen for more than 10 days in a row (5 days for children) unless directed by your doctor. Do not take more than is prescribed or recommended on the package.
Use this drug with extreme caution if you have kidney or liver disease or viral infections of the liver. Large amounts of alcohol increase the liver toxicity of large doses or overdoses of acetaminophen. Avoid alcohol if you regularly take acetaminophen. Some people are more sensitive to this effect than others.
Possible Side Effects
This drug is relatively free from side effects when taken in recommended doses. For this reason it has become extremely popular, especially among those who cannot take aspirin. V Rare: large doses or long-term use may cause liver dam-
age, rash, itching, fever, lowered blood sugar, stimulation,
yellowing of the skin or whites of the eyes, and/or a change
in the composition of your blood. Contact your doctor if
you experience any side effect not listed above.
Drug Interactions
o Large doses of barbiturate drugs, carbamazepine, phenytoin and similar drugs, izoniazid, rifampin, and sulfinpyrazone may increase the chances of liver toxicity if taken with acetaminophen.
• Alcoholic beverages increase the chances for liver toxicity
and possible liver failure associated with acetaminophen.
Food Interactions
None known.
Usual Dose
Adult and Child (age 12 and over): 325-650 mg 4-6 times a day,
or 1000 mg 3-4 times a day. Avoid taking more than 4 g (twelve
325-mg tablets) a day for long periods of time. Child (age 11): 480 mg 4-5 times a day. Child (age 9-10): 400 mg 4-5 times a day. Child (age 6-8): 320 mg 4-5 times a day. Child (age 4-5): 240 mg 4-5 times a day. Child (age 3): 160 mg 4-5 times a day. Child (age 1-2): 120 mg 4-5 times a day.
Child (age 4-11 months): 80 mg 4-5 times a day. Child (under age 4 months): 40 mg 4-5 times a day.
Overdosage
Acetaminophen is a commonly used ingredient in many over-the-counter (OTC) medications. Always check the list of ingredients when using more than one OTC medication to ensure that the combined dosage is within guidelines and to avoid accidental overdose.
Acute acetaminophen overdose may cause nausea, vomiting, sweating, appetite loss, drowsiness, confusion, abdominal tenderness, low blood pressure, abnormal heart rhythms, yellowing of the skin and whites of the eyes, and liver and kidney failure. Liver damage has occurred with 12 extra-strength tablets or 18 regular-strength tablets, but most people need larger doses-20 extra-strength or 30 regular-strength tablets—to damage their livers. Regular use of large doses for long periods-30004000 mg a day for a year—can also cause liver damage, especially if alcohol is involved. In case of overdose, induce vomiting as soon as possible with ipecac syrup—available at any pharmacy —and take the victim to a hospital emergency room. ALWAYS bring the acetaminophen bottle or container.
Special Information
Unless abused, acetaminophen is a beneficial, effective, and relatively nontoxic drug. Follow package directions and call your doctor if acetaminophen does not relieve pain in 10 days for adults or 5 days for children. Call your doctor if fever gets worse or persists longer than 3 days.
Alcoholic beverages will worsen the liver damage that acetaminophen can cause. People who take this drug on a regular basis should limit their alcohol intake.
If you forget to take a dose, take it as soon as you remember. If it is within an hour of 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: Acetaminophen ‘is considered safe during pregnancy when taken in usual doses. Taking continuous high doses of the drug may cause birth defects or interfere with fetal development. Three cases of congenital hip dislocation appear to have been associated with acetaminophen. Check with your doctor before taking this drug if you are or might be pregnant.
Small amounts of acetaminophen may pass into breast milk, but the drug is considered harmless to nursing infants.
Seniors: Seniors may take acetaminophen as directed by a doctor.
Jul
15
Recovery from Prostate Surgery.
July 15, 2009 | Leave a Comment
Recovery from
Prostate Surgery
Whatever anyone tells you, a prostatectomy is a major opera-tion and you need to allow yourself sufficient time to
recover from it bupropion and synthroid . Men are notoriously impatient, especially if they have to go back to work, but you must accept that you
will probably have to slow down for a while cost of bromocriptine .
Don’t expect miracles, and don’t be too hard on yourself flomax tamsulosin florida . You may not have had a leg amputated, but you have nevertheless
had a major operation and you must make allowances for this lancet avandia . You must not expect too much of yourself during your
recovery period in order to give yourself the best chance to get better as quickly as possible prilosec otc cheapest prices . Any impatience may, in
the long run, only make matters worse and set you back on your road to recovery aggrenox and plavix efficacy .
Exactly how long it takes you to get yourself back to a state of good health depends to a large extent on how fit you
were before you had the operation lithium ion hammer drill driver . It also depends on how large your prostate gland was, and on whether or not there were
any complications as a result of surgery lexapro comments .
Remember that old cliche about time being the great healef? It may not be very original but, like a lot of cliches, it’s
true recreational use of methocarbamol . So grit your teeth and take things easy for a while dangers of prozac and phentermine . It may take as long as three months before you feel completely
well again, but once you do, you’ll be utterly convinced that it was worth every minute!
Your bladder
In the first few weeks after your operation, don’t be surprised if your symptoms do not seem any better than before how to use clomiphene . They
may even seem worse tetracycline regime ngu dosage . This doesn’t mean that the operation hasn’t been a success - only that you haven’t healed yet clomid triplets quadruplets .
It can take anything up to about six weeks for the cut surface inside the prostate to heal over completely viagra levitra studies . Expecting
everything to work perfectly before this happens is unrealistic hydrocodene ibuprofen . Until then, you will have to be prepared to make
allowances active ingrediant in nexium .
Even when your urinary system returns to a state of good health, do not be surprised if you have problems getting used to
this overdoeses on anafranil . You’ve probably spent a long time - years maybe - getting used to having to empty your bladder all too frequently,
and it may take a long time -several weeks, probably, or even months - before you succeed in unlearning those habits methotrexate headaches . Be
patient and you will gradually build up confidence in your bladder again until you are able to forget about it
completely singular montelukast .
Medication
You will probably still be taking a course of antibiotics when you leave hospital caffeine and adrenal gland . You must be disciplined about taking
these viagra exposed . Remember to finish the course, and don’t just stop taking the pills as soon as you feel better herb comparable to metronidazole . This could set you
back a long way and allow any leftover bacteria to multiply and mount another attack just when you’re least expecting it
and you’re congratulating yourself on getting better erythromycin compatibility with doxycycline .
AFTER AN OPEN PROSTATECTOMY
If you’ve had an open prostatectomy, you will have stitches in your abdomen and you will have been given strict
instructions on what you can and can’t do imdur contraindications . You will be tired after your general anaesthetic and you will need to look
after your wound cheapest ultram overnight . A district nurse will probably come to your house every other day to change the dressing, and she will
take the stitches out when necessary zantac 300 tablets .
You will have been told what movements you can make to avoid putting too great a strain on both the scar and the
surrounding muscles testosterone propionate takes affect . You should also:
• Avoid carrying anything at all heavy - even a full kettle may be too heavy, so fill it only half full va paying for valtrex medication .
• Get out of your chair cautiously and gently by wriggling your way to the edge of the chair before getting up paxil news .
• Build up slowly to normal activities children’s loratadine .
• Use your common sense at all times and don’t attempt to do too much hyperkalemia with augmentin .
• STOP immediately if you suspect you are doing too much duricef therapy . Once you’ve had the stitches removed
Even when you’ve had the stitches removed, you will still need to be careful cardiolite persantine . It takes a good six weeks for the wound to
heal itself, and several months before the abdominal muscles get back to their full strength drug reactions skin nexium .
AFTER A TRANSURETHRAL PROSTATECTOMY (TURP)
If, on the other hand, you’ve had the more common transurethral prostatectomy (TURP), you won’t have any visible signs of
your operation, like a scar, and it’s all too easy to forget that you’ve actually had an operation at all vytorin side affests . But you have,
and you mustn’t forget it wellbutrin 150xl .
Any operation puts a great physical strain on the body and, as a result, takes a surprisingly long time for you to get
over clindamycin pharmacophore . In hospital, you will have spent most of your time sitting or lying in bed clozapine food . You probably won’t have done anything
more strenuous than reading or watching television weight loss and seroquel . As soon as you get home, the temptation will be to resume all your
favourite occupations - going for a walk in the park, perhaps, or doing a bit of gardening vibramycin 200 mg . But it is not a good idea to
get back into the swing of things too soon vicoden and ibuprofen . This should be a slow and gradual process, and you must be careful not to
push yourself too far, or to do more than you can genuinely cope with hypertension medications inspra norvasc propyl .
In the meantime, make sure that you get plenty of rest buy cardizem . Get up late, have a rest whenever you feel you need one, and go
to bed early levitra viagr cialis . Whenever you are sitting, remember that a firm seat is more comfortable than a soft one that can press
upwards between the buttocks olanzapine .
The problem is obviously greater for people who live alone and who are looking after themselves alternatives to lasix . But even where this is
the case -perhaps even more so, in fact, because you can’t risk driving yourself so hard that you make yourself ill - you
must restrict yourself at First to doing the essentials who makes plavix . You’ll obviously need to do the cooking and washing, but most
other things can wait prednisone alternatives .
There is absolutely no shame in spoiling yourself at a time like this misoprostol en valdivia . Your priority is to get well, and everything else
comes second to that average testosterone in a young male .
HAVING PLENTY TO DRINK
Whatever type of prostatectomy you’ve just had, it is a good idea to keep up your intake of fluids - preferably as much
as 3 rituxan and cellcept .4 litres/6 pints a day lamivudine brand name . This may sound a lot, particularly if you’ve been used to limiting your fluid intake because
of your need to urinate so frequently, but it is important because it helps your bladder to build up its strength and to
return to normal pseudo ephedrine loratadine .
Drinking plenty of liquid also helps to ward off infection and to soothe any bladder irritation celebrex lawyers tx . It helps, too, to wash
out any little pieces of scab and blood from the cut surface inside the prostate, which is likely to happen for the first
six to eight weeks after the operation allegra information page . Although you may notice signs of blood in your urine at first, you should not
feel any pain lovastatin pravastatin conversion .
Contact your doctor if:
• You feel pain fluoxetine causes eps .
• You notice any large amounts of deep red blood in your urine headache morning caffeine .
• You see any blood clots eldepryl cheap no rx .
• You are still passing large bits of scab after the first few days following the operation determination ivermectin in fat .
BLADDER CONTROL
The great majority of prostatectomies are successful, and recovery is usually straightforward prednisone methotrexate arthritis dosages . Having said that, though,
recovery can sometimes be slow, and efficient urination is something you may have to work at will clomid upset normal cycles .
Just after the operation, the urethra may be swollen, which may in turn be painful augmentin dose children . This pain can make the urethral
muscles contract from time to time, which can mean that the flow of urine is either slow or intermittent what are the dossages of lexapro . Bruising of the
tissues around the urethra can also prevent the muscles surrounding the urethra working properly, which can mean that the
urethra neither opens nor closes completely tylenol motrin alternating chart . This can result in a low stream of urine, of continual leakage of urine paste ivermectin dogs .
Such problems are, of course, unpleasant and debilitating, but they should disappear as soon as the swelling and bruising
get better, which should take only a fortnight or so body surface area prednisone .
Another problem following the operation may be that you suffer from just as bad - if not worse - a degree of frequency
and urgency of urination as you did before the operation information about amiodarone . This is likely to be brought about by inflammation of the
prostate and urethra, and may continue until the cut surface of the prostate is completely healed, which can take as long
as six to eight weeks plavix nose bleeds . It can last even longer 11′ you develop a urinary tract infection, which is a good reason to have
your urine tested at your six-week check-up pied piper of prozac acolyte .
It may surprise you to know that the opposite problem of an absence of urgency can, contrary to what you might expect, be
even more worrying than its presence zantac 15 . This is because if you suffered from chronic retention of urine before your
operation, your bladder may have become so accustomed to holding a large amount of urine that it does not send the right
signal when it is full plavix about . The danger, in this case, is that the bladder may become so full that it will be unable to
contract properly and empty itself efficiently lithium batteries rechargeable . You will have to empty it by the clock - say every hour or so - until you
begin to feel the natural urge to urinate caffeine content in chocolate vs coffee . This should happen spontaneously, if gradually caffeine capsules .
In short, you can expect your bladder to behaving abnormally for up to six weeks or so after the operation how is metformin excreted .
Bladder training
You will probably benefit from training - or retraining - your bladder to hold more urine and to last comfortably for
longer periods of time levothroid price . This should help reduce increased frequency and urgency of urination, as well as night-time
urination zanaflex and food .
Start by making a urination chart, or frequency/volume chart, detailing the time and amount of urine each time you go to
the toilet pharmacy purchasing cyclosporine microemulsion . Equip yourself with a measuring jug, of the type you can buy in hardware or kitchen equipment shops, so as to
measure the volume of urine premarin topical . Continue keeping this chart while you are bladder training zoloft morphine interaction .
You will probably be used to emptying your bladder each time you feel the slightest urge to do so, or even each time you
pass a toilet ‘just in case’ orlistat substitute . Stop doing this and gradually increase the time between visits to the toilet acyclovir online prescription . Start by
holding on for another two minutes after you feel the need to go to the toilet, then increase this to five minutes, then
another five minutes, and so on pletal side effects .
All this is easier said than done, but there are a few ‘tricks’ that should make it easier for you to hold on between
visits furosemide 500mg .
• Sit rather than stand when you feel the desire to urinate makita 10.8 lithium .
• Keep still rather than moving around zyprexa mdl orders .
• Pull up your pelvic floor muscles (see below) lipitor itchy skin .
• Cross your legs reglan side efffects .
• Hold your penis, if you can do this discreetly allegra cause does indigestion .
• Take regular, slow, deep breaths azithromycin impurity a .
• Think about something else to keep your mind off your bladder 50mg clomid .
• Try to do something else to take your mind off your bladder,
such as making a telephone call, or reading the newspaper shbg anastrozole .
You will find that you can gradually manage to hold on for longer and longer intervals enalapril side effects in dogs . Aim, ultimately, for an interval
of three to four hours serum sickness clinical signs amoxicillin .
Bladder training can achieve a lot for most people in just four weeks methotrexate sulfa drug allergy . Try to keep it up for three months or, even
better, six months probecid penicillin powder . Don’t expect to have dealt with all your problems even after six months clomid and metformin twin . Symptoms can continue to
improve for as long as a year -or even longer clomid without insurance .
PELVIC FLOOR EXERCISES
Most women are familiar with their pelvic floor muscles, particularly if they have had a baby high estradiol concerns . A lot of men, on the other
hand, may not even know that they have any pelvic floor muscles, let alone what or where they are chemical composition of lithium .
Pelvic floor exercises strengthen the pelvic floor muscles, which support and help to close the urethra provera rx . Strengthening
these muscles will help increase your ability to hold on before you go to the toilet sideeffects of avelox .
Try tensing up the muscles between your scrotum and anus, in much the same way as you would to prevent the flow of urine,
or to hold back the urge to break wind fexofenadine de . If you are not sure if you are doing this right, put a finger there and you will
feel a ring of muscle around the anus become firmer spironolactone hair loss . Another way of doing it is to try stopping the flow ofurine while
you are actually urinating home recipe dog ivermectin comfortis . If the muscles are very weak, you may only be able to weaken the flow of urine and not
actually to stop it cheap vardenafil . Try this once a day until you can stop the stream of urine efficiently and completely adhd treatment caffeine . When you are
able to tense up the muscles, you can continue practising in other positions and while doing other things - on the bus,
doing the washing-up, waiting for a bus, whatever is most convenient cholesterol caffeine . Hold the muscles tense for five seconds, then relax
for five seconds discount generic viagra soft tabs . Repeat the whole cycle of tensing and relaxing five times, which will take about a minute articles on manufacturers of lithium batteries . Ideally, you
should do this for a total of 15 minutes (at least) a day exelon rivastigmine .
You have to stick at it to obtain results, because it takes time for weakened muscles to build up strength renal scan with lasix washout . Stick to
between three and six months of diligent exercise, and you are bound to notice results seroquel cause numb .
RESUMING SEXUAL ACTIVITY
You can resume sexual activity as soon as you feel up to it mefenamic acid its indication . Some doctors are wary of advising patients to do this, in
case of disturbing clots and scabs, others say that the passage of semen cannot do any more harm than the passage of
urine list of herbs that contain caffeine . Be alert to how you feel, and follow your natural inclinations find cheapest tramadol ambien .
You may, however, not feel like sex for some time after the operation tegretol once a day . If this happens to you, you shouldn’t worry about veterinary drugs famotidine .
It does not mean that you have lost your sex drive or your potency as a result of the operation - it simply means that
you have a natural degree of fatigue after what is, after all, a major operation side affects altace 25mg . This is even more likely if you have
had a general anaesthetic sildenafil 50mg kamagra tablets .
Retrograde ejaculation
You are unlikely to ejaculate in quite the same way as you did before the operation and may experience retrograde
ejaculation (see Chapter 7) celexa phentermine gt . This means that semen goes backwards up the urethra into the bladder, rather than forwards
and down into the urethra cozaar and drug interactions . This often has the effect of making you sterile, and a lot of men find this a very difficult
hurdle to deal with, even if they do not actually want to father any more children prevacid non prescription . In their eyes, the fact that they are
now sterile seems to emasculate them in some way, to make them less of a man foods that have theophylline . It is important that a man is told that
this is a likely side-effect of a prostatectomy before the operation, as this seems to help them deal with it better olanzapine dangers . If
a man is not told until afterwards, when it is aAit accompli in which lie had no say, he may be very angry drug information prescription ultram .
Even if you do have retrograde ejaculation, this cannot guarantee that your partner won’t become pregnant and you should
still use some form of contraception if this is an issue cardizem norvasc . You cannot rely on a prostatectomy to give you a reliable form
of contraception medicare warfarin genetic test policy . It is estimated that between 5 and 10 per cent of men are still fertile afterwards metronidazole neurotoxicosis in cats . If you want a
reliable and permanent method of contraception, you may want to discuss the possibility of having a vasectomy with your
surgeon, as this can easily be done at the same time as a prostatectomy information about depo provera .
Your urine will probably look a little cloudy after intercourse, as the semen that went into the bladder is washed out nexium patient assistance .
You may also find that you bleed slightly after intercourse during the first six weeks or so after the operation - just
as you notice a little blood in your urine - but as long as this is not a large amount of blood, you should not have
anything to worry about boniva infusions .
YOUR SIX-WEEK CHECK-UP
By six weeks after the operation, most of your symptoms should have cleared up, though you may still be suffering from
frequency and urgency of urination altace and garlic .
You will probably have a check-up after six weeks, which is your opportunity to discuss anything that is worrying you celebrex 200 mg 30 .
It is particularly important to have a test done on a urine sample, just to check that you are free of any urine
infection risperdal blood sugar . Some hospital clinics also like to repeat the urine flow test, which will indicate that the operation has been
successful actos drugs glipizide .
Jul
5
Topical NSAIDs
Americans have been deprived of an arthritis treatment that is widely available all over the world. Topical NSAIDs (gels, creams, and sprays) are very popular with patients and physicians in Europe, Australia, Canada, New Zealand, and dozens of other countries, but they are virtually ignored in the United States. The very same drugs (diclofenac, ibuprofen, ketoprofen, ketorolac, piroxicam, etc.) that cause so much mischief
PPI CAUTION
“Although there seems to be a general agreement among gastroenterologists that proton pump inhibitors should be prescribed to high-risk patients taking low-dose aspirin, 91 such a strategy has not been widely adopted because of a lack of definitive evidence to support it.”92
—Carlo Patrono et al., The New England Journal of Medicine, 2005
when taken orally can be applied to the skin with little, if any, risk of stomach ulcers, kidney problems, heart attacks, strokes, or other systemic complications. Except for aspirin-like compounds (salicylates) found in OTC products like Aspercreme, BenGay, Myoflex creme, and Sportscreme, you will not find topical NSAIDs on pharmacy shelves in the United States. That’s because the FDA has never approved these formulations for topical use.
How effective are topical NSAIDs for relieving the pain and inflammation of arthritis? Over the years there have been dozens of clinical trials of such products for both temporary (acute) discomfort and longer-term (chronic) treatment. 3 One review of 26 double-blind, placebo-controlled trials involving 2,853 patients concluded that “topical NSAIDs were effective and safe in treating acute painful conditions for 1 week.”94
Okay, okay! We hear you: “One week, big deal.” Another review examined 14 double-blind, placebo-controlled trials including almost 1,500 patients. The conclusion: “Topical NSAIDs were effective and safe in treating chronic musculoskeletal conditions for 2 weeks.”" That’s a little better, but still not a long-term solution. One sour note comes from the thorough and objective Cochrane Library. The reviewers for this organization analyze all available evidence, published and unpublished, and provide their assessment of various treatments. This 2004 review looked at studies of use of topical NSAIDs for longer than 2 weeks and determined that “after 2 weeks there was no evidence of efficacy superior to placebo. No trial data support the long-term use of topical NSAIDs in osteoarthritis.”96
Based on this summary we would be inclined to suggest that topical NSAIDs be used for 2 weeks or less to relieve an acute arthritis flare-up. On the brighter side, there are now four newer clinical trials of use for 3 to 12 weeks. 97,98 Investigators specifically looked at osteoarthritis of the knee. In each study, diclofenac (Pennsaid or Voltaren Emugel) was superior to placebo in providing relief, with only “minor local irritation and no significant systemic adverse events.”99, 100 In a 12-week head-to-head comparison of oral diclofenac with topical diclofenac (Pennsaid Lotion), their effectiveness was comparable. But side effects like nausea, indigestion, stomach pain, and liver damage were much more likely to occur with the oral NSAID.101
Pennsaid Lotion is interesting because the formulation relies on DMSO (dimethyl sulfoxide) to help get the drug through the skin and into the area of the joint where pain relief is desired. DMSO is a solvent that is uniquely able to penetrate the skin and carry medications with it. We have long wondered why drug companies were not using DMSO to facilitate absorption. Now the makers of Pennsaid have done just that.
So, how can you get topical NSAIDs? If you were in Australia you could purchase products like piroxicam (Feldene Gel), ibuprofen (Nurofen Gel), ketoprofen (Orudis Gel), and diclofenac (Voltaren Emulgel) over the counter without a prescription. At this time that is impossible in the United States. Nevertheless, it is possible to purchase oral ibuprofen and ketoprofen over the counter. That means a compounding pharmacist (one who mixes raw ingredients into finished products) can legally purchase ibuprofen or ketoprofen powder, make a cream or a gel,
sell
and it to you without a prescription.
An alternative would be to shop online for one of the brands mentioned above. Since they are nonprescription in many countries, you may be able to purchase them and not have US Customs give you any problems. One final option, and our number one recommendation, is to have a US physician write a prescription for Pennsaid. This topical form of diclofenac has been tested in several clinical trials and found to produce long-lasting relief from osteoarthritis. You would then need to contact a Canadian pharmacy online or by phone to have the prescription filled. Since this drug is not available.
**** Pennsaid Lotion (diclotenat)
This topical NSAID has been shown to provide lasting relief from the pain and inflammation of osteoarthritis. It may produce some skin irritation, but does not appear to cause significant systemic toxicity, as oral diclofenac does.
Side effects: Skin dryness, flakiness, and rash
Downside: Not available in the United States. Available by prescription in Canada, Finland, Iceland, Italy, Greece, Portugal, the United Kingdom, and elsewhere.
Cost: Approximately $60 to $120 per month
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs) side-effects and downsides
July 5, 2009 | Leave a Comment
NSAID Nastiness
The biggest recognized drawback to NSAIDs has always been their tendency to cause digestive tract distress. That’s because of how they work in the body. These drugs block the manufacture of a class of chemicals called prostaglandins. These hormonelike compounds have a profound impact on cells throughout the body.
f you sprain your ankle, have a tooth extracted, or develop arthritis, you will experience pain, redness, warmth, and inflammation. This is in large measure due to prostaglandins made by a protein called cyclooxygenase-2 (COX-2). Blocking their formation with NSAIDs like ibuprofen or naproxen means there is less inflammation and pain.
But some prostaglandins made by another protein, COX-1, are beneficial. They protect the stomach lining from damage. If you disrupt their production by blocking COX-1 with NSAIDs, many people complain of symptoms such as nausea, indigestion, abdominal pain, constipation, and diarrhea. It is estimated that more than half of the people taking NSAIDs experience unpleasant gastrointestinal (GI) symptoms.68
Far more worrisome are ulcers, which can bleed or, in the worst case, perforate. A bleeding ulcer or a hole in the stomach wall can very quickly turn into a life-threatening crisis. All too often there are no early warning symptoms that someone is on the verge of disaster.
Although it is hard to know exactly how many people are affected each year, experts estimate that more than 100,000 are hospitalized because of complications caused by NSAIDs and more than 16,000 die.’ The researchers admit these numbers are probably conservative.
Although most physicians have known for a long time that NSAIDs can be hard on the stomach, they didn’t realize that the same drugs can be disastrous for the small intestine. That’s because until recently the small intestine could not be examined directly. Now a small video camera the size of a capsule can be swallowed and the image it transmits can be monitored on a television as the capsule passes into the small intestine.
“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain largely a ’silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem. 70 Furthermore, the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDs “7l
—Michael M. Wolfe et al., The New England Journal of Medicine, 1999
Investigators discovered in a preliminary study that 71 percent of the patients taking NSAIDs had erosions or ulcers in their small intestine, compared to only 10 percent of those not taking these drugs.72 This unexpected finding suggests that NSAID damage to the intestinal tract is even more common and serious than previously suspected.
Frequently, aspirin is sold with an enteric coating that protects the stomach from harm. The coating is designed to dissolve in the small intestine instead, releasing the aspirin there. When we asked gastroenterologist Waqar Qureshi, MD, chief of endoscopy at Baylor University and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, about such formulations, he said, “Enteric-coated drugs might, in fact, cause more damage than regular medications.”" This is because the damage occurs in the small intestine, where the tissue is less resistant to irritating chemicals than the stomach is and where the damage may go undetected.
The COX-2 Catastrophe
With such GI toxicity associated with_ NSAIDs, it’s hardly any wonder that doctors and patients were excited to learn about COX-2 inhibitors. Vioxx, Bextra, and Celebrex were introduced with the idea that they would be gentler on the stomach than other NSAIDs. That’s because these newfangled members of the class were supposed to be “selective.” They would block only the COX-2 enzyme, relieving inflammation as well as aspirin or other NSAIDs do. By sparing the COX-1 enzyme, prostaglandins would be created to protect the stomach from irritation. The promise: pain relief with much less risk of digestive upset or stomach ulcers.
As soon as COX-2 inhibitors were introduced in 1999, they took off like rocket ships. Aggressive advertising directed at consumers and enthusiastic prescribing by physicians turned Celebrex and Vioxx into overnight sensations. Tens of millions of people started popping these pills in the hope that they would relieve pain without the usual problems.
There was just one big oops. By selectively blocking the COX-2 enzyme to relieve inflammation, a crucial prostaglandin called prostacyclin was also reduced. This compound is our friend. It dilates blood vessels and keeps the sticky part of blood, called platelets, from clumping together to form clots. Without adequate amounts of prostacyclin circulating throughout the body, there is an increased risk of blood clots that can trigger heart attacks and strokes.
Early in the development of COX-2 inhibitors some researchers worried that there could be cardiovascular dangers. In 2000, a large Vioxx study suggested that the pain reliever could cause an increased risk of heart attacks and other vascular complications. 74
Neither the FDA nor the manufacturer acted on those early warning flags. In one of the darkest hours in the history of American medicine, millions were allowed to continue taking COX-2 inhibitors until the fall of 2004. By then the handwriting was on the wall. First Vioxx and then Bextra were pulled off the market. In the interim, it is estimated that more than 100,000 people who had been taking COX-2 inhibitors suffered heart attacks and strokes.75 According to FDA safety officer David Graham, MD, as many as 40,000 people may have died .71
The Broken Promise
If COX-2 inhibitors like Vioxx, Bextra, and Celebrex had truly protected the digestive tract from damage, it might have been easier to justify their approval, aggressive marketing tactics, and high prices. But an editorial in the Journal of the American Medical Association described the science behind COX-2 inhibitors as a “house of cards” based on wishful thinking. They were marketed “with unrealistic expectations about pain relief, marked gastrointestinal protection, and safety.”77
Canadian researchers tracked hospital admissions caused by gastrointestinal bleeding before and after the introduction of COX-2 inhibitors (Vioxx, Celebrex, and Mobic). Instead of dropping when the new drugs became available, as investigators had expected, the rate of hemorrhage and hospitalization for older people paradoxically rose by 10 percent .78 British researchers asked a similar question: Would COX-2 inhibitors be easier on the stomach than traditional NSAIDs? The an-
FDA NSAID WARNING
“NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, m ocardial infarction [heart attack], and stroke, which can be fatal.-71 rt
—FDA Public Health Advisory, April 7, 2005
saver: There was no evidence to suggest that the newer drugs were less harmful to the digestive tract.” In hindsight, it looks as if we were all sold an expensive bill of goods.
Other NSAID Troubles
No sooner did the FDA wake up to the risk of heart attacks and strokes associated with COX-2 inhibitors than the agency had to deal with the possibility that other NSAIDs might pose a similar problem. Decades after these drugs began to be marketed, the FDA reviewed the data and decided that all such prescription pain relievers should carry a stronger black-box warning.
The FDA goes on to warn that people with risk factors for cardiovascular disease are especially vulnerable to these life-threatening problems. That includes almost everyone with arthritis. If you accumulate enough birthdays to develop osteoarthritis, you are bound to have some hardening of the ar-
OTHER NSAID ADVERSE EFFECTS
• High blood pressure
• Fluid retention, edema
• Congestive heart failure
• Stomach ulcer (bleeding)
• Perforation of the stomach
• Perforation of the small intestine
• Perforation of the large intestine
• Kidney damage
• Severe allergic reaction
• Skin rash (toxic)
• Itching
• Stevens-Johnson syndrome
• Liver damage
• Blood disorders (anemia)
• Asthma worsening
teries. But that’s not all. The FDA has gone on to emphasize other problems with NSAIDs as well.
It is easy for your eyes to glaze over when looking at such a list. You may also assume that some of these potential side effects are rare events, but that could be a dangerous assumption. A study of older and potentially sicker patients revealed a startling incidence of kidney damage associated with Celebrex. More than 20 percent of the people taking this COX-2 inhibitor experienced kidney toxicity (fluid retention, high blood pressure, and kidney failure).81 If patients had some kidney impairment before the study started (a common situation in older people), the likelihood of kidney toxicity jumped to more than 50 percent! We assume other NSAIDs are likely to have a similar effect on kidney function.
NSAID Survival Strategy
By now it should be clear that nonsteroidal anti-inflammatory drugs, including the COX-2 inhibitors, can be trouble with a capital T! They aren’t all that effective for arthritis, especially of the knee. Some NSAIDs may actually contribute to joint deterioration if they are taken for years. Then there’s the risk of serious side effects like bleeding ulcers, hypertension, heart
Aspirin
Aspirin prevents blood clots and lowers the risk of heart attacks and strokes. Unlike other NSAlDsJt does not raise blood pressure.
Aspirin remains the best buy for pain relief. At pennies a day, it reduces the inflammation that is at the root of so many chronic ailments, including arthritis, diabetes, and Alzheimer’s disease. Regular aspirin users seem to develop fewer cancers of the colon, rectum, prostate, pancreas, ovary, skin, lung, and breast.
Downside: Damage to the stomach lining. The potential for indigestion, gastritis, and ulcers makes this drug inappropriate for many. Bleeding or perforated ulcers can be life threatening. Anyone on long-term aspirin therapy must be under medical supervision.
Cost: Approximately $2 to 5 per month
ASPIRIN AND BAKING SODA
Although it will not be identical to Alka-Seltzer, you can create your own buffered, soluble aspirin. In a glass, combine:
• 2 uncoated aspirins
• 8 ounces club soda or sparkling water
•’/p teaspoon baking soda
• Juice from 1/4 wedge lemon
Wait till the aspirins dissolve and then drink. This formula is not appropriate for people on a sodium-restricted diet.
attacks, strokes, and kidney or liver damage. Why would anyone in his or her right mind take such medicine?
The most obvious answer is that there aren’t very many pharmaceutical alternatives. Doctors have relatively little to offer beyond NSAIDs when it comes to pain and inflammation. And sometimes you hurt so much that you need something to help you move your bones around. When used in the short-term and with appropriate safeguards, it may be possible to take an NSAID. But which one should you consider?
Aspirin remains our first choice by far. No other NSAID or OTC pain reliever has ever been proven more effective. In addition, aspirin reduces the risk of heart attacks and thrombotic (clotting) strokes. As a bonus, there is growing evidence that aspirin may diminish the likelihood of developing many common cancers. We discourage the use of enteric-coated aspirin because this merely moves the aspirin to the small intestine, where it can do serious damage.
Our preferred method for taking aspirin is as a liquid. In Europe, Australia, Canada, New Zealand, and dozens of other countries you can find several soluble, effervescent aspirin products. Brands like Aspro and Disprin are very popular because all you do is drop the aspirin tablets into a glass of water, where they fizzle and dissolve within seconds. This makes them a little faster acting and possibly a little less irritating to the stomach (though there is no guarantee of protection).
Soluble aspirin never really caught on in the United States, except in the form of Alka-Seltzer. It is a combination of as-pirin, sodium bicarbonate, and citric acid advertised for relief of “acid indigestion, sour stomach, heartburn with headache, body aches and pains.” The trouble with Alka-Seltzer is that it’s way more expensive than plain aspirin and there’s too much sodium for folks who have congestive heart failure or salt-sensitive hypertension.
If you would prefer not to pay an arm and a leg for fizzy aspirin, you could make your own soluble aspirin for a fraction of the cost. All you have to do is buy some club soda or sparkling water. Drop two regular-strength aspirin tablets in the fizzy water and let them dissolve. It will take a couple of minutes.
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs)
July 5, 2009 | Leave a Comment
NSAIDs
After the roller-coaster ride with cortisone, you would think that the medical establishment would have been more careful about the next big thing. Maybe doctors were so anxious to find something safer for arthritis that they didn’t appreciate that they might be jumping from the frying pan into the fire.
Aspirin was the first nonsteroidal anti-inflammatory drug (NSAID). It was introduced in 1899 and was a mainstay of arthritis treatment for most of a century. Aspirin works a little differently from other drugs in this class and has advantages that make it unique. For almost 100 years aspirin was the Rodney Dangerfield of the drugstore. It got relatively little respect. Because aspirin was available over the counter, it took physicians a long time to appreciate how valuable it could be against heart attacks, strokes, and even cancer. Because it has been around for so many years, doctors have often assumed that newer medicines would provide better pain relief. And they (and their patients) have often been disappointed.
The launch of prescription indomethacin (Indocin) in 1965 really put NSAIDs on the map. These drugs became some of the most successful pharmaceuticals of their time. Whenever a new anti-inflammatory drug came along, it generated tremen-
NON-ASPIRIN NSAIDS
• Celecoxib (Celebrex)
• Diclofenac (Cataflam, Voltaren)
• Etodolac (Lodine)
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid)
• Ibuprofen (Advil, Motrin, etc.)
• Indomethacin (Indocin)
• Ketoprofen (Orudis, Oruvail)
• Ketorolac (Toradol)
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Anaprox, Naprosyn)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Sulindac (Clinoril►
• Tolmetin (Tolectin)
dons excitement. Drugs like sulindac (Clinoril), piroxicam (Feldene), ibuprofen (Motrin), and naproxen (Naprosyn) had their time in the limelight. Then along would come something newer and doctors would switch their allegiance.
Those of us who have observed this game of medicinal musical chairs for more than 40 years have become somewhat cynical about this class of pain relievers. The fickle switching from one drug to another suggests to us that no particular NSAID really stands out. There have not been really great head-to-head clinical trials that prove one drug is superior to another or significantly safer than others in the class.
If truth be told, these drugs really don’t work all that well when it comes to relieving the pain and inflammation of arthritis, especially of the knee. Despite the fact that tens of millions of people have spent countless billions of dollars on these medications, there are surprisingly few data demonstrating long-term benefit with their use. A scientific analysis of 23 different studies was published in the British Medical Journal in 2004. This meta-analysis involved more than 10,000 patients and revealed a shocking discovery: “NSAIDs can reduce short-term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support prolonged use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.”‘
What a bombshell! This review of the world’s medical literature on NSAIDs concluded that such drugs are reasonable only for short-term use. But arthritis is a long-term affair. The only conclusion we can draw: Regular use of such drugs is inappropriate for a chronic condition like arthritis.
Even more alarming, some evidence suggests that these medications may actually be harmful to arthritic joints. 61,62,63 Researchers in the Netherlands followed more than 1,600 patients for several years. Patients who had been taking the NSAID diclofenac (Arthrotec, Cataflam, Voltaren) experienced greater joint deterioration as determined by x-ray evidence. The authors concluded, “Our data suggest that diclofenac may not be harmless and may induce accelerated progression of hip and knee OA [osteoarthritis].”64
OTC Mistake?
When NSAIDs like ibuprofen (Advil, Cap-Profen, Excedrin 113, Genpril, Haltran, lbuprin, Ibuprohm, Ibu-Tab, Medipren, “OTC analgesics including NSAIDs are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects. -,65
—C. Mel Wilcox et al., Journal of Rhouniatology, 2005
Midol IB, Motrin IB, Nuprin, Pamprin IB, Profen, etc.) and naproxen (Aleve) were approved for over-the-counter (OTC) sale, millions of people were delighted to have access to these powerful anti-inflammatory drugs. An Rx-to-OTC switch was a radical concept back in 1984. Even though the FDA assured consumers that such drugs were so safe that they did not require medical supervision, many physicians opposed the plan. They feared that side effects such as rash, fluid retention, high blood pressure, gastritis, and ulcers might make these drugs too dangerous for casual use. The FDA ignored the worriers.
Dear reader, we cannot tell you whether the decision to make NSAIDs available OTC was a blessing or a curse. The FDA has been incredibly inept at keeping track of adverse reactions to prescription medications. The agency’s track record on nonprescription pills is even worse. So, we really do not know how many ulcers, heart attacks, or other serious complications have occurred because of easy access to NSAIDs.
What we do know is that people are gobbling down these drugs almost like candy. Based on scientific surveys (Roper and the National Consumers League), it is estimated that 23 million Americans use a nonprescription NSAID (ibuprofen or naproxen) every day.” Only about one in five consumers bothers to read the directions on the label and fewer than one in three checks out dosing instructions. Perhaps that’s why one-fourth of them take more than the recommended dose. Scarier still, roughly half of the people surveyed were unaware of the potential for NSAID toxicity or just plain didn’t care.
Jul
3
Allergy: Quercetin and Bromelain
July 3, 2009 | Leave a Comment
Quercetin and Bromelain
Two other natural products that may be worth consideration against allergies are quercetin and bromelain. Quercetin is an antioxidant flavonoid that is found in many fruits, vegetables, and herbs. The anti-inflammatory effect of quercetin helps stabilize mast cells. These are the cells in your eyes, nose, and lungs (and other places in your body) that are highly sensitive to allergens.
Think of mast cells as floating mines. When they come into contact with allergens like ragweed pollen or dust mite poop, a switch gets thrown on these cellular “mines” and all hell breaks loose. Mast cells start releasing histamine and other chemicals called kinins (pronounced KYE-nins), which then turn on a cascade of other nasty things like leukotrienes and prostaglandins. The end result is sneezing, itching, inflammation, and congestion.
Quercetin, especially when combined with bromelain (an enzyme derived from pineapple), seems to stabilize mast cells and make them less likely to trigger the release of such chemicals.44 45,46
We think such an approach may be more logical than trying to block the effect of histamine with antihistamines.
Think of it this way. If your mast cells are like a barn holding in a bunch of wild horses (histamine molecules), then what would be more efficient—reinforcing the door and walls of the barn to keep those wild histamines inside or trying to protect all the grass in your pasture from having those histamine “horses” nibbling away at it? Antihistamines are like a chemical barrier that tries to protect your grass once the horses are out of the barn. But they are not 100 percent efficient, and some histamine will always find a target and wreak havoc. Keeping the barn closed tightly (or the mast cells stabilized) seems to us to be a more effective approach.
Jul
2
Isotretinoin in Acne Treatment
July 2, 2009 | Leave a Comment
Isotretinoin
Dermatologists have one last big gun, a powerful medicine to use in desperate cases when nothing else has worked. Isotretinoin has stirred a lot of emotions—from excitement to fear—because it is so effective but also has some extremely serious side effects. This drug is approved for severe cystic acne, and it really should be reserved for acne that is not responding to other treatments.
From the time of its introduction, the maker of Accutane strove to get across the point that this drug can cause birth defects. Women who take this medication must. not get pregnant while they are on the drug or for several months after stopping it. (The compound stays in the body for a while.) Nonetheless, the manufacturer’s warnings have not been enough. Every year some women on isotretinoin do conceive, despite all the precautions. As a result, the FDA and the manufacturer have limited the access to this medicine. To prescribe it, a dermatologist must have enrolled in the iPLEDGE program, which educates physicians about the drug. Patients are also required to enroll in the iPLEDGE program and view the educational DVD before taking the first dose. The program uses telephone- and computer-based tracking to verify that female patients are get-** Isotretinoin (Accutane, Amnesteem, Cla r a v i s, S o t r e t.
Isotretinoin is chemically related to vitamin A, so it controls cell division. Four to 5 months of treatment usually results in significant clearing of acne, sometimes lasting years.
Common side effects: Dry lips and mouth; dry, crusty skin; upset stomach; hair loss; nosebleed; sun sensitivity; elevated cholesterol; and reduced night vision
Serious side effects: Birth defects; depression, potentially leading to suicidal thoughts or behaviors; inflammation of the pancreas; pressure on the brain (pseudotumor cerebri) causing severe headache
Downside: Despite efforts to keep this drug away from pregnant women, each year some babies are exposed in utero and born with birth defects. Women must use two different and effective means of contraception throughout the time they are taking Isotretinoin.
Cost: Varies widely from about $100 to $400 for 1 month of treatment
ting regular pregnancy tests to ensure that they do not take this medication during pregnancy. Patients who do not enroll in the program cannot get their prescriptions filled. More information is available online at www.ipledgeprogram.com.
Q. I have been on Accutane to treat bad acne for almost a month. I have taken 26 tablets, but stopped taking it when I thought I might be pregnant.
I found out yesterday that I am indeed pregnant, and I am scared. I want to have this baby, but after reading about the drug causing birth defects, I am not sure. What should I do?
A. We were shocked to learn that you have become pregnant while taking Accutane. This acne medicine can cause very serious birth defects in a fetus.
That is why the manufacturer recommends every woman have a pregnancy test before she starts on this drug and use effective contraception throughout therapy. Every time a pill is removed from its packaging, a symbol reminds the patient not to take this drug during pregnancy.
Please discuss this serious matter with your physician and your partner. The drug company can provide further information about your odds of having a baby with severe health problems.