Aug
12
Dicyclomine - Digoxin - Diltiazem
August 12, 2009 | Leave a Comment
Generic Name
Dicyclomine (dih-SYE-kloe-meen) 10j
Brand Names
Bemote Dilomine
Bentyl Di-Spaz
Bycloft),e Or-Tyl Dibent
Type of Drug
Antispasmodic and anticholinergic.
Prescribed For
Irritable bowel, spastic colon, and similar digestive problems; also prescribed for colic in children over age 6 months.
General Information
Dicyclomine hydrochloride has been used for many years to calm “nervous stomach.” It and other anticholinergics work by blocking the effects of the neurohormone acetylcholine in the gastrointestinal (GI) tract. This reduces the mobility of the GI tract and slows the production of enzymes and other secretions.
Cautions and Warnings
Do not take dicyclomine if you are allergic or sensitive to any of its ingredients.
Dicyclomine should not be used by those with obstructive disease of the GI or urinary tract, severe ulcerative colitis, reflux esophagitis, acute bleeding with unstable heart function, myasthenia gravis, or glaucoma.
Dicyclomine should not be used in infants less than age 6 months or by breastfeeding mothers.
This drug should be used with caution if you have heart disease, Down’s syndrome, spastic paralysis, reduced mobility of the stomach and lower esophagus, fever, urinary difficulties, enlarged prostate, hiatal hernia, intestinal paralysis, kidney or liver disease, rapid heartbeat, hyperthyroidism (overactive thyroid gland), high blood pressure, or ulcerative colitis.
Dicyclomine reduces your ability to sweat and may lead to heat exhaustion and heatstroke, which can be life-threatening. Avoid extended heavy exercise and limit your exposure to high temperatures.
Anticholinergenic psychosis has been reported by those taking anticholinergenics, but it usually resolves within 24 hours after discontinuation of the drug.
Possible Side EfferkS
♦ Common: dry mouth, dizziness, blurred vision, nausea, and lightheadedness.
V Less common: drowsiness, weakness, nervousness, constipation, and decreased sweating.
Possible Side Effects (continued)
♦ Rare: drug allergy (symptoms include rash, itching, lives,
and breathing difficulties), confusion, eye pain, dizziness
when rising quickly from a sitting or lying position, a bloated
feeling, difficult or painful urination, headache, memory
loss, and vomiting. Contact your doctor if you experience
any side effect not listed above.
Drug Interactions
• Antacids containing calcium or magnesium, citrates, sodium bicarbonate, and carbonic anhydrase inhibitor drugs may increase dicyclomine’s therapeutic effect and side effects.
• Combining dicyclomine with other anticholinergic drugs including atropine, belladonna, clidinium, glycopyrrolate, hyoscyamine, isopropamide, propantheline, and scopolamine may intensify side effects.
• Dicyclomine may reduce stomach acidity and blood levels of oral ketoconazole (an antifungal).
• Dicyclomine may decrease the therapeutic effects of anti-glaucoma medications. Taking dicyclomine with corticosteroids used to treat glaucoma may be hazardous.
• Dicyclomine may counteract the effect of metoclopramide in reducing nausea and vomiting.
• Taking dicyclomine with a narcotic pain reliever may cause severe constipation.
• Taking this or any drug that slows the movement of stomach and intestinal muscles with a potassium chloride supplement –especially one in wax-matrix tablet form—may lead to excessive irritation of the stomach.
• Combining dicyclomine with amantadine, certain drugs to control heart rhythm, antihistamines, nitrates or nitrites, may increase dicyclomine side effects.
• Dicyclomine may increase the effects of atenolol and digoxin.
• Pftn0hiazine drugs, monoamine oxidase inhibitor antidepressants, benzodiazepines, and tricyclic antidepressants may increase side effects of dicyclomine. The effectiveness of phenothiazines to control psychotic symptoms may be decreased.
Food Interactions
Take dicyclomine on an empty stomach, a half hour before or 2 hours after a meal.
Usual Dose
Adult: 80-160 mg a day in 4 divided doses. Seniors should receive the lowest possible dosage and increase only as needed. Child (age 2 and over): 5-10 mg 3-4 times a day.
Child (age 6 months-2 years): 5-10 mg of syrup 3-4 times a day. Child (under 6 months): not recommended.
Overdosage
Symptoms include blurred vision; clumsiness; confusion; breathing difficulties; dizziness; drowsiness; dry mouth, nose, or throat; rapid heartbeat; fever; hallucinations; weakness; slurred speech; excitement, restlessness, or irritability; warmth; and dry or flushed skin. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Children taking dicyclomine may be more likely to develop high body temperature in hot weather and other side effects and should be carefully watched for side effects. Dicyclomine should not be given to infants or children unless the doctor decides that its use is absolutely necessary.
Call your doctor if you develop diarrhea, rash, flushing, eye pain, dry mouth, urinary difficulties, constipation, increased sensitivity to light, or any bothersome or persistent side effect.
Brush and floss your teeth regularly while taking this drug. Because dicyclomine may cause dry mouth, you may be more likely to develop cavities or other dental problems. Ice or hard candy may relieve dry mouth.
Constipation may be treated by using a laxative.
Dicyclomine may make you drowsy or tired and cause blurred vision. Be careful when driving or doing any task that requires concentration.
If you forget take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: A few cases of human malformation were linked to dicyclomine, but studies have shown that the drug has no effect on the fetus. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Dicyclomine can reduce the amount of milk produced. Infants given dicyclomine may faint, go limp, and develop breathing problems and seizures. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more susceptible to side effects, especially memory loss, changes in mental state, and glaucoma. Seniors may obtain maximum benefit with smaller dosages.
Generic Name
Digoxin (dih-JOX-in) A
Brand Names Digitek
Lanoxicaps
Lanoxin
Type of Drug Cardiac glycoside.
Prescribed For
Congestive heart failure (CHF) and other heart conditions involving a very rapid heartbeat.
General Information
Digoxin works directly on heart muscle. It improves the heart’s pumping ability or helps to control its beating rhythm. People with heart failure often develop swelling of the lower legs, feet, and ankles; digoxin improves these symptoms by improving blood cir-
Digoxin is generally used as part of the lifelong treatment of CHF.
Cautions and Warnings
Do not use digoxin if you are allergic or sensitive to it. Digoxin allergies are rare.
Digoxin should not be used in people with ventricular fibril-
lation.
Digoxin should be used with caution in people with sick sinus
syndrome or incomplete AV block, as it may cause a worsening of these conditions.
Digoxin has been used to treat obesity. The risk of fatal heart rhythms associated with such treatment makes it extremely dangerous as weight-loss medication. Many heart disease symptoms may be associated with digoxin. Report any unusual side effects to your doctor at once.
Kidney disease may increase blood levels of digoxin. Your dosage may need adjustment.
Long-term use of digoxin may cause the body to lose potassium, especially since it is generally used in combination with diuretics (agents that increase urination). For this reason, be sure to eat a balanced diet and high-potassium foods—bananas, citrus fruits, melons, and tomatoes.
Digoxin should be used with caution in people with electrolyte disorders.
Digoxin requirements vary with thyroid status. If you are taking digoxin and your thyroid status changes, your doctor will have to alter your digoxin dosage.
Possible Side Effects
Adult and Senior
♦ Common: dizziness, headache, nausea, and diarrhea.
✓ Less common: appetite loss, vomiting, weakness, apathy, drowsiness, blurred or yellow-tinted vision, seeing halos around bright lights, depression, psychoses, confusion or disorientation, restlessness, hallucinations, delirium, seizure, nerve pain, abnormal heart rhythms, and slow pulse.
✓ Rare: Enlargement of the breasts has been reported after long-term use of digoxin. Contact your doctor if you experience any side effect not listed above.
Child
T Children are more likely to develop abnormal heart rhythms before they see yellow or green halos or spots and before they develop nausea, vomiting, diarrhea, or stomach pain. Any abnormal heart rhythms that develop while a child is taking digoxin should be assumed to be a side effect.
Drug Interactions
• Drugs that may increase the effect of digoxin are alprazolam, amiloride aminoglycoside antibiotics, amiodarone, anticholinergic drugs, benzodiazepines, captopril, clarithromycin, diltiazem, diphenoxylate, dipyridamole, erythromycin, esmolol, felodipine, flecainide, hydroxychloroquine, ibuprofen, indomethacin, itraconazole, nifedipine, nitrendipine, omeprazole, propafenone, propantheline, quinidine, quinine, spironolactone, tetracycline, tolbutamide, triamterene, and verapamil.
• Drugs that may decrease blood levels of digoxin include aminoglutethimide, aminoglycosides, aminosalicylic acid, antacids, anti-cancer combinations, antidiabetes medication, antihistamines, barbiturates, cholestyramine, colestipol, cyclosporine, kaolin-pectin mixtures, metoclopramide, oral kanamycin, oral neomycin, oral sulfonylureas, phenylbutazone, phenytoin and related anti-seizure drugs, rifampin, St. John’s wort, sucralfate, and sulfasalazine.
• Disopyramide may alter the effects of digoxin, although the exact interaction is not well understood.
• Thiazide and loop diuretics, furosemide, ethacrynic acid, and bumetanide increase digoxin’s effect and increase the risk of side effects.
• Spironolactone may increase or decrease the side effects of digoxin; amiloride may reduce the effect of digoxin on the force of heart contraction.
• The effects of digoxin on the heart may be additive to those of ephedrine, epinephrine and other stimulants, beta blockers, calcium salts, procainamide, and rauwolfia drugs.
• Digoxin dosage must be adjusted when it is combined with a thyroid drug.
Food Interactions
These drugs may generally be taken without regard to meals. Taking your medication after a high-fiber meal reduces the amourxtcil drug absorbed into your blood.
Usual OQSS
Adult and Child (age 10 and over): starting dosage—known as the digitalizing or loading dose—is about 4-7 mcg per lb. of body weight. Digitalization may also be accomplished with a lower dosage over 7 days. Maintenance dosage 0.125-0.5 mg; it must be corrected for kidney function. For seniors, a lower dosage is required.
Child (under age 1o): starting dosage-5-30 mcg per lb. of body weight. Maintenance dosage-20-35% of the starting dosage. Careful measurement of your child’s digoxin dosage is crucial to safe and effective treatment.
Overdosage
Adult: Symptoms include appetite loss, nausea, vomiting, diarrhea, headache, weakness, apathy, blurred vision, yellow or green spots or halos before the eyes, yellowing of the skin or whites of the eyes, and changes in heartbeat.
Senior: Vomiting, diarrhea, and eye trouble are frequently seen. Child: An early sign is a change in heart rhythms.
Call your doctor immediately if any of these symptoms appear. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Take each day’s dose at the same time of day.
Do not stop taking digoxin without your doctor’s knowledge.
Lanoxicaps are better absorbed than tablet forms of digoxin. For this reason, each dose of Lanoxicaps is slightly lower than the corresponding digoxin tablet.
Avoid over-the-counter diet and cold medications containing stimulants.
Call your doctor at once if you develop side effects.
There may by some variation between digoxin tablets from different manufacturers. Do not change drug brands without telling your doctor.
Check your pulse every day—your doctor will teach you how—and call your doctor if it drops below 60 beats per minute.
If you forget a dose and remember at least 12 hours before your next dose, take it right away. If you do not remember until it is less than 12 hours before your next dose, skip the one you forgot and continue with your regular schedule. Do “lot take a double dose. Call your doctor if you M1 a dose for 2 or more days.
Special Populations
Pregnancy/Breast-feeding: Digoxin crosses into the fetal circulation. While digoxin is sometimes used during pregnancy to treat fetal heart disease, women who are or might be pregnant should not take digoxin without their doctor’s approval. When your doc-tor considers this drug crucial, its potential benefits must be care-
fully weighed against its risks.
Small amounts of digoxin pass into breast milk. Nursing mothers who take digoxin should use infant formula.
Seniors: Seniors are more sensitive to digoxin’s effects, especially appetite loss. Seniors with impaired renal function may need lower
dosages.
Generic Name
Diltiazem (dil-TYE-uh-zem) 92
Brand Names
Cardizem Dilt-CD
Cardizem CD Diltia XT
Cardizem LA Diltzac
Cartia XT Taztia XT
Dilator XR Tiazac
Type of Drug
Calcium channel blocker.
Prescribed For
Angina pectoris, chronic stable angina, Raynaud’s disease, prevention of second heart attacks, tardive dyskinesia (severe side effects associated with antipsychotic and other drugs), and hypertension (high blood pressure).
General Information
Diltiazem hydrochloride is one of many calcium channel blockers available in the U.S. These drugs block the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage of calcium interferes with the contraction of these muscles, which in turn dilates (widens) the veins and ves sels that supply blood to them. This ditatk”q effect reduces blood pressure, the amount 0 Oxygen used by the heart muscle, and the ~1A 0 blood vessel spasm. Diltiazem is therefore useful in treating not only hypertension but also angina pectoris, a condition related to poor oxygen supply to the heart muscle and characterized by brief attacks of chest pain.
Diltiazem affects the movement of calcium only into muscle cells; it has no effect on calcium in the blood.
Cautions and Warnings
Do not take d,1taz&m1f you are allergic or sensitive to any of its
ingredients.
Diltiazem can slow your heart and interfere with normal electrical conduction. For people with a condition called sick sinus syndrome, this can result in temporary heart stoppage.
Diltiazem should not be taken if you are having a heart attack or if you have lung congestion. Diltiazem should be taken with caution by people with heart failure because it can worsen that condition.
Low blood pressure may occur, especially in people also taking a beta blocker.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken once daily—have a greater chance of having a heart attack than people taking beta blockers or another medicine for the same purposes. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Diltiazem can cause severe liver damage and should be taken with caution if you have had hepatitis or any other liver condition.
Caution should also be exercised if you have a history of kidney problems, although no clear tendency toward causing kidney damage is seen with this drug.
Possible Side Effects
♦ Common: dizziness, lightheadedness, weakness, head-
ache, and fluid accumulation in the hands, legs, or feet.
✓ Less common: low blood pressure, fainting, increase or decrease in heart rate, abnormal heart rhythm, heart failure, nervousness, fatigue, nausea, rash, tingling in the hands or feet, hallucinations, temporary memory loss, difficulty sleeping, diarrhea, vomiting, constipation, upset stomach, itching, unusual sensitivity to sunlight, paxnlu) or stiff joints, liver inflammation, and increased urination, especially at night.
Drug Interactions
• Diltiazem taken with a beta-blocking drug for hypertension is usually well tolerated, but may lead to heart failure in people with already weakened hearts.
• Calcium channel blockers, including diltiazem, may add to
the effects of digoxin. This effect is not observed with any
consistency, however, and only affects people with a large
amount of digoxin already in their systems.
• Cimetidine and ranitidine increase the amount of diltiazem in the bloodstream and may account for a slight increase in the drug’s effect.
• Diltiazem may increase blood levels of cyclosporine, carbamazepine, encainide, and theophylline, and thus increase the chance of side effects from these drugs.
• Diltiazem may cause a decrease in blood lithium levels, possibly undermining lithium’s antimanic effect.
• Calcium channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
Diltiazem is best taken on an empty stomach, at least 1 hour before or 2 hours after meals.
Usual Dose
Immediate-Release Products 30-60 mg 4 times a day.
Sustained-Release/Extended-Release Products Cardizem CD: 120-480 mg once a day. Cardizem LA: 120-540 mg once a day. Cartia XT: 120-300 mg once a day. Dilacor XR: 180-480 mg once a day. Dilt-CD: 120-360 mg once a day. Diltia XT: 180-480 mg once a day. Diltzac: 120-360 mg once a day. Taztia XT: 120-150 mg once a day. Tiazac: 120-360 mg once a day.
Overdosage
Symptoms of diltiazem overdose are very low blood pressure and reduced heart rate. Overdose victims must be made to vomit with 1J)8C2c syrup—available at any pharmacy—within 30 minutes of taking the overdose. Do not induce vomiting if the victim has fainted or is convulsing. If overdose symptoms have developed or more than 30 minutes have passed, vomiting is of little value. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special information
Call your doctor if you develop any of the following symptoms! swelling of the hands, legs, or feet-, severe dizziness; constipation or nausea; or very low blood pressure.
Do not open, chew, or crush sustained-release capsules of
diltiazem.
If you take your diltiazem 3 or 4 times a day and forget a dose, take it as soon as you remember. Space the remaining doses throughout the rest of the day. If you take diltiazem 1 or 2 times a day and forget to take a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: In animal studies. high doses of diltiazem interfered with the development of the fetus. Diltiazem should not be taken by women who are or might be pregnant. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks.
Because diltiazem passes into breast milk, nursing mothers taking this drug should use infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug because it takes longer to pass out of their bodies.
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
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
CONSTIPATION. COMPLETE INFORMATION.
July 16, 2009 | Leave a Comment
CONSTIPATION
• Get enough fluid and fiber
• Eat prunes, apples, or apricots
• Sprinkle ground flaxseed on cereal *****
• Chew sugarless gum ****
• Use psyllium powder ****
•Try docusate for less straining **
• Use milk of magnesia for quick relief (occasional use)
• Ask your doctor about a prescription for Mira Lax **
Many people feel that regularity is the key to good health. Is this true or is it a myth? Grandmothers around the world have promoted daily bowel movements for generations, but there is no evidence that a trip to the bathroom each morning is necessary. People vary in the frequency that suits them best. Some do well on a schedule of no more than three times a week. Others feel good on a schedule as frequent as a few times a day.
Constipation is defined as unsatisfactory defecation, 155 but doctors and patients don’t always agree on what is most important. Physicians may prefer objective measures like the number of days between bowel movements. But people may be as concerned about consistency as frequency. They complain about the effort of passing hard “golf balls” or “bricks.”
Sometimes physicians dismiss constipation as a minor complaint. While it is not usually life threatening, constipation can be serious. Almost 100,000 people are hospitalized each year for constipation-related problems. Many more suffer considerable distress and reduced quality of life as a result of this common condition.
Fluids and fiber are the cornerstones of constipation prevention. Those who are constipated are often urged to drink more water. Adequate fluid (at least 6 glasses of water a day) is essential, but unless someone is actually dehydrated, drinking extra water does not solve the problem of hard stools. To-SOME DRUGS THAT MAY LEAD TO CONSTIPATION
• Abilify (aripiprazole)
• Actonel (risedronate)
• Anaprox (naproxen)
• Arimidex (anastrozole)
• Asacol (mesalamine)
• Casodex (bicalutamide)
• Cataflam (diclofenac)
• Catapres (clonidine)
• Cenestin (synthetic conjugated estrogens)
• Clinoril (sulindac)
• Clorpres (clonidine and chlorthalidone)
• Clozaril (clozapine)
• Cognex (tacrine)
• C6rdarone (amiodarone)
• Covers-HS (verapamil)
• Creon (pancreatin)
• Cymbalta (duloxetine)
• Detrol (tolterodine)
• Ditropan XL (oxybutyn n)
• Duragesic (fentanyl►
• EC-Naprosyn (naproxen)
• Effexor (venlafaxine)
• Ferrara (letrozole)
• Geodon (ziprasidone)
• Gleevec (imatinib)
• Imdur (isosorbide
mononitrate)
• Kadian (morphine sulfate)
• Kytril (granisetron)
• Lexapro (escitalopram)
• Lotronex (alosetron)
• Lyrics (pregabalin)
• Meridia (sibutramine)
• Mirapex (pramipexole)
• Myfortic (mycophenolic acid)
• Nalfon (fenoprofen)
• Naprosyn (naproxen)
• Orap (pimozide)
• OxyContin (oxycodone)
• Pacerone (amiodarone)
• Pancrease MT (pancrelipase)
• Paxil (paroxetine)
• Permax (pergolide)
• Rapamune (sirolimus)
• Relafen (nabumetone)
• Remeron (mirtazapine)
• Requip (ropinirole)
• Retrovir (zidovudine)
• Risperdal (risperidone)
• Rythmol (propafenone)
• Thalomid (thalidomide)
• Topamax (topiramate)
• Vicodin (hydrocodone and acetaminophen)
• Zofran (ondansetron)
• Zoloft (sertraline)
• Zyprexa (olanzapine)
gether with fiber, though, the fluids may help. The first step, of course, is to make sure that the diet contains at least 25 grams of fiber a day. That may take some doing, but it can be accomplished with 5 to 10 servings of vegetables and fruits a day, along with whole grains rather than refined bread, pasta, crackers, and the like. For some people, though, even that may not be enough to conquer constipation completely.
If constipation arises suddenly or if it starts to interfere with everyday activities, it makes sense to check in with your doctor. There are some conditions, such as an underactive thyroid gland or Parkinson’s disease, that can lead to constipation. In those cases the underlying disease needs to be treated.
Warning signs that should trigger a doctor’s visit include blood in the stool or bleeding from the rectum; dark, tarry stool; weight loss of 10 pounds or more; a family history of colon cancer; or a positive Hemoccult test, a way of identifying invisible blood in the Stoo1.156 Be sure to tell the doctor about any of these issues, so the proper workup can be done.
People taking medications or even supplements should also check with their doctor to see whether one of these might be responsible. A surprising number of prescription drugs can trigger constipation as a side effect. Because of the impact that constipation can have on their sense of well-being, patients sometimes become upset if doctors don’t warn them that a prescribed medication may interfere with bowel function. Narcotics are among the most notorious offenders, but there are many others. Sometimes, switching to a different medicine can ease the problem. The physician should always be involved in such a decision, because some of these drugs may be essential treatment for a serious condition such as cancer or AIDS.
Dietary Approaches
For uncomplicated constipation, focus on increasing the high-fiber foods in the diet. Sometimes, people buy a loaf of softand-squishy “wheat” bread and figure that’s all they need to do to get extra fiber. Wrong! Unfortunately, the “wheat” label may just be a marketing ploy. Consumers need to read the ingredient list to see if the first ingredient is whole-wheat flour. That’s a good start.
Even better is to actually consume the whole grains in pi-FOODS THAT ARE HIGH IN FIBER
• Apples 0 Lima beans
• Barley 0 Oat bran
• Beans 0 Oats (steel-cut)
• Blackberries 0 Pears
• Bran a Popcorn
• Bran cereal 0 Prunes
• Broccoli 0 Raisins
• Bulgur wheat 0 Split peas
• Chickpeas 0 Uncle Sam Cereal
• Fiber One cereal 6 Wheat berries
• Figs • Winter squash
• Lentils
lafs or porridges, which is one reason we are so fond of steel-cut oats. (Also, they taste wonderful.) One of our favorite high-fiber breakfasts is steel-cut oats with extras: blackberries or pieces of apple, together with walnuts or almonds, topped with a sprinkling of freshly ground flaxseed. To boost the protein content of this breakfast, we stir in some egg white while the oats are cooking.
0 0 0
O. My wife is bedridden with emphysema and osteoporosis. Her fractured vertebrae are due to the steroids she takes for emphysema.
The doctor suggested calcium to strengthen her brittle bones. Then she had a problem with bowel movements because of not getting any exercise.
This caused her great distress until she tried eating a quarter of an apple every evening. The apple has made her regular again.
A. Thanks so much for reminding us all of the importance of fiber in the diet. This may help explain the wis-dom behind Grandmother’s recommendation of an apple a day.
O 0 *
Prunes
Why are the marketers changing the name of prunes to “dried plums”? While it is an accurate designation, it’s not particularly catchy. Instead, it is an attempt to get away from the image of self-treatment for constipation that “prune” or “prune juice” conjures up.
O 0 0
Q. A year ago I had a serious problem with constipation (over 2 weeks!). I tried everything I could, including Metamucil, Ex-Lax, milk of magnesia, and a Fleet enema with no results. A visit to the doctor resulted in a prescription but still no relief.
Then I remembered. Prunes are laxatives. I bought some prune juice with pulp and drank 4 ounces a day with plenty of water. Within a few days I was back to normal.
For a few months I drank some every other morning to keep me regular. Now I only need it once a week. Prune juice with pulp is my salvation.
A. Prunes are a time-honored home remedy for constipation. Researchers have confirmed what grandmothers always knew: Prunes stimulate the digestive tract.
In 1951 scientists discovered an ingredient in prunes that is closely related to the chemical laxative oxyphenisatin. This product was taken off the market when it was linked to liver damage.
Experts for the Harvard Health Letter suggest, “it is unlikely that moderate consumption [of prune juice] would cause any problems, but prune use, like everything else, should be prudent.”
Prunes are said to be loaded with antioxidant phytonutrients, so they are a healthy choice if consumed in moderation. They are not the only dried fruit that can be helpful in an attempt to overcome constipation. Dried figs and even apricots provide a little variety. They may not have any specifically laxative components, but they certainly are good sources of fiber, and some people find them quite helpful.
Dried apricots (two a day) and plenty of water can relieve constipation. It helps me and has helped my friends.
Flaxseed
Another source of fiber is not nearly as well known as prunes. Flaxseed has long been used as a source of soluble fiber. It is one of the ingredients in an old-fashioned cold cereal, Uncle Sam Cereal. Once marketed as a “natural laxative,” it is now being touted as a low-glycemic-index or low-carb food. The primary ingredients are wheat berries and flaxseed. Both should help to keep things moving in the right direction.
Constipation has been my problem for more years than I want to count Psyllium seed barely works.
My solution is flaxseeds ground in my coffee grinder I keep it in small batches in the refrigerator and take’/ teaspoon with a glass of juice or water daily. Sometimes I sprinkle it on my cereal or put it in a fruit smoothie. I like the nutty taste and it has been like. a miracle forme.
***** Flaxseed
Ground flaxseed is a good source of soluble. fiber. Not only is it helpful against constipation, it can aid in lowering cholesterol and may help reduce the hot flashes of menopause. Flaxseed is an excellent plant source of omega-3 fatty acids.
Downside: Keeps well until ground, then is susceptible to going rancid. Keep ground flaxseed in the refrigerator for no more than 10 days to 2 weeks.
Cost: Approximately $4 to $5 per month (around 130 a dose)
Besides combating constipation, flaxseed is an excellent source of omega-3 fatty acids and has the added advantage of lowering cholesterol at least modestly. The seeds keep well, but once they are ground (a blender or a coffee grinder works well), they go rancid quickly. Ground flaxseed meal should be kept in the refrigerator or even in the freezer. Someone with a tendency to constipation might well want to get in the habit of incorporating ground flaxseed into meals.
Another way to get the benefits of flax is to make a solution. Simmer 2 tablespoons of flaxseed in 3 quarts of water for 15 minutes. Cool the liquid and strain it. It should be kept in the refrigerator. Add 2 ounces a day to fruit juice.
Sugarless Gum
It might be surprising to learn that something as simple and inexpensive as sugarless gum could counter constipation quite effectively. By the way, the converse is also true. People sometimes have problems with chronic diarrhea because of their gum-chewing habits. Sugarless candy has the same impact.
* 0 0
Q. I read with interest and sympathy a letter about problems with constipation. I wanted to share something that has helped me.
After hearing some people complain that sugar-free jelly beans gave them diarrhea if eaten in quantity, I
sl%priess Gum
Pick a flavor that you like and experiment.to find the right dose. The “sugar alcohols” used to sweeten sugarless gummaltitol, sorbitol, mannitol, and xylitol—are not absorbed from the digestive tract. They act as “osmotic laxatives.” Chewing sugarless gum does not contribute to tooth decay. A gum containing xylitol might even help fight ear infections.
Side effect: Diarrhea
Downside: Many sugarless gums contain aspartame, which some people prefer to avoid.
Cost: Approximately 70 to 150 a dose
decided to see if they would help my frequent constipation. I have found that if I eat 30 sugar-free jelly beans with a glass of water half an hour before bedtime, I stay regular. I hope this idea might help others with the same problem.
A. Thanks for the tip. Many people find that the sweeteners in sugar-free candy can cause diarrhea. How clever of you to turn that side effect to your advantage! Each person will have to experiment to find the right “dose.”
0 * *
Over-the-Counter Remedies
Laxatives are among the most popular products in the pharmacy. Hundreds of millions of dollars are spent each year on these over-the-counter remedies. But overuse of such products can be a serious problem.
Q. My 19-year-old daughter and her girlfriend have been taking laxatives for weight control for several months. They also take over-the-counter diet pills.
My main concern is about the abuse of laxatives. Would you please print the harmful effects laxatives can cause? She won’t listen to me!
A. Chronic laxative abuse can undermine the body’s ability to eliminate waste on its own. We have heard from many elderly people who started using laxatives in their youth and became dependent upon them.
We are more concerned, however, about the potential interactions these young women might experience. Strong laxatives can deplete the body of potassium.
Laxatives are not an effective tool for lasting weight loss. Dietary counseling and exercise may be more helpful in the long run.
We generally suggest that people avoid stimulant chemicals like aloe, cascara sagrada, senna, and castor oil. These can be irritating to the digestive tract. Some of these compounds can interfere with proper nutrition, and chronic use might make a person more susceptible to weakened bones.
Bulk-Forming Laxatives
The first step in treating constipation is to increase your intake of fiber. Since dietary fiber may not be enough, there are several possible sources of fiber sold as “bulking agents” in the pharmacy. Psyllium is a naturally derived fiber from blond ispaghula seed (Plantago ovata). It can usually be bought quite inexpensively. There are also some alternative types of fiber.
Adequate fluid intake is crucial when taking fiber. Swallowing fiber such as psyllium without enough water could lead to choking as a result of the product clumping and swelling in the esophagus. Other digestive tract blockage is also possible if fluid intake is inadequate. 157
If psyllium is not satisfactory, other possible fiber sources are available. Polycarbophil (Equalactin, FiberCon, Fiber-Lax, Konsyl Fiber) may be the next step.
Sold under a number of brand names, including Metamucil, Fiberall, Konsyl, Perdiem Fiber Therapy, Reguloid, and Serutan. Store brands, available in most drugstore chains, are more economical. Psyllium (I tablespoon in 8 ounces of water three times a day) is approved both for constipation and for lowering. cholesterol. It may take a few days to observe the effects. Psyllium is considered safe for daily use. Sugar-free brands may be more economical, but most contain aspartame, which some people would rather avoid.
‘Side effects: Flatulence, bloating, or diarrhea; severe allergic reactions
Downside: May interfere with the absorption of other drugs taken at the same time. Many people object to the gloppy or gritty texture of dissolved psyllium fiber.
Cost: Approximately 8t. to 300 per dose
dude methylcellulose (Citrucel) and powdered cellulose (UniFiber). There’s no good evidence to suggest that any one of these is superior to the others overall, but people do have their favorites.
No bulk-forming laxative should be taken if the person is nauseated, vomiting, running a fever, or suffering abdominal pain. Such symptoms deserve prompt medical attention.
I’ve had such frustration with constipation over the years. I’ve tried a lot of remedies, but the ones that worked were too harsh. Then a friend told me about UniFiber. It is a very fine powder, and I combine it with canned peaches or homemade oat bran muffins. It really regulates my system with no diarrhea or cramping.
Stool Softeners
When the main problem is that the stool is hard, the best remedy may be a stool softener. These are also recommended for people who have had abdominal or colorectal surgery or an episiotomy during labor and delivery and must avoid straining.
Old-fashioned mineral oil is the best-known product in this category. It should be used for only a short time, though. Mineral oil is petroleum-based and is not absorbed into the body. But it can interfere with the absorption of important fat-soluble nutrients, such as vitamin A, vitamin D, vitamin E, and vitamin K. Over weeks or months, this could be detrimental to health.
The doctors’ choice in stool softeners is usually docusate sodium or docusate calcium. Although the evidence of their effectiveness is not strong, 118 they are widely used. They might work better in a postsurgical situation than they do for chronic constipation.
Dacusate Sodium
Available as Colace and Ex-Lax Stool Softener, and generically under various store brand names. Acts as a wetting agent to help stool absorb more water and thus become softer. Expect this product to take up to 3 or 4 days to work.
Side effects: Rash, throat irritation, nausea Cost: Approximately 250 to 500 per dose
This usually works fairly rapidly, within several hours. Each dose should be taken with 8 ounces of water. It is intended for occasional use only.
Side effects: Diarrhea, nausea, weakness
Downside: This laxative contains magnesium, so it should not be used by people with kidney disease. It may disrupt the balance of minerals and fluid in the body.
Cost: Approximately 600 to 750 per dose
Osmotic Laxatives
Compounds that attract water into the digestive tract add moisture to the stool. This softens it and may even help hurry it along. Such agents are called osmotic laxatives. We’ve already discussed sugarless gum, which works in this manner. It also exemplifies the downside of these laxatives: Getting the balance just right can be difficult. It’s not rare for a person to experience diarrhea as a side effect if the dose is too high. Some old familiar remedies fall into this category. Both Epsom salts and milk of magnesia are osmotic laxatives.
Prescription Laxatives
Chronic constipation can be extremely frustrating. If lifestyle changes and over-the-counter approaches are unsuccessful, people turn to their doctors hoping for a miracle. In this situation, miracles are few and far between. Physicians do have a few drugs they can prescribe that may be helpful. One is a type of osmotic laxative called lactulose (Chronulac, Duphalac, Kristalose) that has been around quite a long time. This is a type of sugar that is not absorbed well, so it pulls water into the intestines. It may take a day or 2 to produce results, and it can result in cramping, gas, or diarrhea.
There is another option as well. A prescription laxative containing polyethylene glycol, an ingredient quite similar to those used for cleansing the colon prior to a colonoscopy, can be used for desperate cases. MiraLax is not supposed to be used for more than 2 weeks at a time, however. MiraLax is an osmotic laxative.
The doctors’ big gun in prescription products is Zelnorm
Contains polyethylene glycol, or PEG. It comes as a powder to be dissolved in juice, water, coffee, or tea. Expect results in 2 to 4 days. Do not use for more than 2 weeks.
Side effects: Diarrhea, abdominal cramping, nausea, gas Downside: Prolonged or excessive use may upset the balance of fluids * and minerals in the body or result in laxative dependence.
Cost: Approximately $1.40 to $2 per dose; one dose per day
(tegaserod). It was developed for people who have irritable bowel syndrome with h constipation as the predominant symp- tom. It has also been approved for chronic constipation in adults under the age of 65. Your doctor will be able to evaluate if this last resort is appropriate for you. There have been instances of serious, dehydrating diarrhea that required hospitalization. Another dangerous side effect that worries us is ischemic colitis, a condition in which blood supply to part of the intestine shuts down. It has not been established whether Zelnorm was responsible for this frightening complication. Nevertheless, this drug is probably appropriate only when everything else has failed.
10 Tips for Combating Constipation
1. Pay attention to your diet. Getting plenty of fiber and fluid is essential. In addition, though, some foods tend to be constipating. Cheese has a reputation in this regard, but coconut, which can help ease diarrhea, may be constipating if too much is eaten. Other people have warned of the effects of pomegranate, mango, or peanut butter. The tannins in tea may also contribute to constipation.
2. Sip warm water with a tablespoon of blackstrap molasses. This sweetener contains a number of minerals. Some people find it a tasty way to cope with constipation. Another old-fashioned home remedy for constipation is drinking lemon juice in a cup of hot water first thing in the morning. Afterward, rinse your mouth with plain water, to protect your teeth.
3. Simmer 2 tablespoons of flaxseed in 3 quarts of water for 15 minutes. Cool, strain, and add 2 ounces of the liquid to orange juice every day. An alternative is to use freshly ground flaxseed on cereal or other foods.
4. Chew sugar-free gum. Experiment to find the appropriate dose. Or, if you prefer, eat sugar-free candy. Either may ease constipation; don’t overdo it.
5. Take psyllium powder in 8 ounces of water. For when you’re traveling, Metamucil makes psyllium cookies that are easier to carry, but they’re also more expensive and higher in calories.
6. Stay away from traditional laxative herbs such as aloe, cascara sagrada, and senna. They are harsh and overstimulate the digestive tract. Very occasional use may be acceptable, but overuse can lead to dependence. Instead, try dong quaff, ginger, or milk thistle.
7. Load up on vitamin C. Some people find that about 2,000 milligrams a day is enough to trigger diarrhea. Finding the dose that works for you and backing off just slightly is one approach that may work. Do not try this if you have ever had kidney stones, because excess vitamin C raises oxalate excretion and might increase the risk of a recurrence.159
8. Stir a couple teaspoons of Swedish bitters into a cup of water. Hot water or herb tea may work best. It also comes in capsules that are convenient when traveling.
9. Experiment with a bulk-forming laxative. Some people find that UniFiber or Citrucel works better for them than psyllium.
10. Make sure you get enough magnesium, especially if you are taking calcium supplements. Calcium carbonate can be constipating, but magnesium can help offset this tendency. We generally advise people that a dose above 300 milligrams of magnesium per day may cause diarrhea. The maximum short-term dose of magnesium advised on the label of Phillips’ Milk of Magnesia is 2,000 milligrams for adults. Do not take magnesium or milk of magnesia if you have kidney disease.
Conclusions
Constipation accompanied by pain, nausea, vomiting, or fever should not be ignored. It deserves medical attention. Even without such symptoms, persistent constipation should also be brought to a physician’s attention. Uncomplicated constipation may respond to home treatment.
• Begin with diet. Make sure you get six to eight 8-ounce glasses of water or other fluids daily. Concentrate on increasing fiber, and make sure you get 25 to 35 grams daily.
• Ask your doctor to check whether a medical condition or medication may be causing your constipation.
• Eat fruit. Apples, dried apricots, and (in moderation) dried plums, aka prunes, are a wonderful way to establish regularity when needed.
• Sprinkle ground flaxseed on your food, or take a solution of simmered flaxseed in juice.
• Chew sugarless gum or enjoy sugar-free candy for its laxative effect.
• Take psyllium as directed, with an 8-ounce glass of water.
• Docusate may soften stools and ease straining.
• Milk of magnesia may give relatively quick relief, but should not be overused. It’s off-limits for anyone with kidney trouble.
• Drugs such as MiraLax are intended for short-term use of less than 2 weeks.
Jul
15
Cancer of the Prostate. SYMPTOMS.
July 15, 2009 | Leave a Comment
Cancer of the Prostate
Cancer of the prostate, or adenocarcinoma of the prostate, as it is technically called, is a malignant growth occurring
in the prostate gland ford motor co lithium vehicles . It is an alarmingly common problem, though most men would probably be surprised to learn this on about citalopram 20mg .
They will have heard of it - famous sufferers have included Frank Zappa, Roger Moore, macho Gulf War hero ‘Stormin”
Norman Schwartzkopf and President Fran4ols Mitterand - but they are unlikely to realise just how common it is clomid and progesterone cream .
This is surprising because it is, in fact, the most common type of cancer in men in Britain celebrex and percocet . It is also the second most
common cause of death from cancer in men, after lung cancer generic to viagra . According to the Imperial Cancer Research Fund, it kills
nearly 10,000 men a year in Britain, which is four times as many men as women who die from cervical cancer taking luvox and paxil . Some 14,000
new cases of prostate cancer are diagnosed each year in Britain effexor xr no pres . But ask the average man in the street where his prostate
gland is, and the chances are he won’t be able to tell you fetal exposure to dilantin .
A DISEASE OF OLD AGE
Prostate cancer most often occurs in the elderly, though it does sometimes develop in middle age bupropion tab 300mg xl . More precisely, it is
most common in men over the age of 55, and becomes increasingly common as a man gets older raman caffeine . Nearly all deaths caused by
prostate cancer occur in men over the age of 65, while half of all cases occur in men over the age of 75 medication digoxin . Peak age is
between 70 and 80 clotrimazole betamethasone dermatitis ear .
People worry that cancer of the prostate seems to be on the increase, but this is not necessarily as sinister a prospect
as may at first appear blood clots developed while on warfarin . More screening is being done, which is bound to reveal an increase in figures dyspepsia effexor xr 300 . And it is, in any
case, more characteristically a disease of old age than any other cancer wellbutrin stimulant effects . As there are more and more elderly people in
the population today, it is not surprising that prostate cancer has become correspondingly more common too ibuprofen and tylox .
SURVIVAL RATES
The question in the mind of any man who is reading this will probably be: If I get prostate cancer, what are my chances
of survival?
The answer to this vexed question is not a simple or an obvious one caffeine breastfeeding coke . This is because it depends on so many things:
• How old you are warfarin testing kits .
• The state of your overall health, prostate apart first try sucess stories using clomid .
• At what stage the cancer was discovered singulair aerator 780 .
In a man over the age of 70, the survival rate is about 50 per cent prilosec infant . It is higher in a younger man - the younger he is,
the greater his chances of survival paxil lawyers san diego . His chances are also higher if the cancer was detected early on in its growth duracell lithium manganese batteries rc .
WHAT CAUSES IT?
The exact cause of prostate cancer remains a mystery, though the male hormone testosterone appears to have some
involvement lithium polymer battery pv use . Quite what that is, though, is not certain testosterone shot women .
Certain risk factors have, however, been identified breast cancer risperdal . Firstly, and like a great many cancers, cancer of the prostate is
known to run in families mobic 15 mg infomation . If a close relative - say, a brother or father - has cancer of the prostate, a man’s risk of’
developing the disease seems to be nearly three times greater than that of a man who does not have any family history of
the disease phenergan black box warning . If a man has more than one relative with prostate cancer - say, a grandfather or uncle as well as a brother
or father - his chances of developing the disease are as many as six times greater than that of a man who does not have
any family history of the disease evista buy online .
There do, however, seem to be other factors involved brain shiver symptoms from withdrawal effexor . Diet is one of these mrsa osteomyelitis vacomycin efficacy zyvox efficacy . The typical UK diet, for example - which is
usually low in green vegetables, fruit and pulses and high in animal fats in the form of meat and dairy products - may
well be a contributing factor lithium manganese battery charging .
According to the Cancer Research Campaign, black American men have the highest incidence of prostate cancer, with some 50
per cent more cases than in the US white male population soma muscle relax . This is probably because they have a higher than usual level of
testosterone prednisone how fast does it work .
The number of sexual partners a man has had may have a link with the development of prostate cancer, though this has not
been proved prevacid how long . In particular, the wart virus (human papilloma virus), which is usually sexually transmitted, may increase a
man’s chances of developing cancer of the prostate, in much the same way as it predisposes a woman to developing cancer
of the cervix maker of zoloft .
SYMPTOMS
Very often there are, unfortunately, no early signs of prostate cancer casodex pharmacy . which makes its early detection very difficult overnight generic viagra american express .
The great majority - up to 90 per cent - of cancers begin on the outside of the prostate, which means that they do not
usually obstruct urinary flow in the early stages of the disease, and can therefore go unnoticed for some time effects of metoprolol succ er .
And they can remain undetected for some time because prostate cancer is very slow in spreading amoxicillin trying to conceive . It may be as long as four
years before the cancer has doubled in size, and this, too, makes its early diagnosis very difficult unless people have
routine screening for the disease soft drink caffeine amounts .
In its later stages, however, prostate cancer has similar symptoms to those of an enlarged prostate clindamycin pharmacophore . It is not unusual,
in fact, for a man who is being investigated for an enlarged prostate to have cancer diagnosed wikipedia metronidazole . That is not intended to
be alarmist, however, and any man who is being investigated for an enlarged prostate should not panic fluticasone propionate high blood pressure . An enlarged
prostate is ten times more common than prostate cancer, so the odds are greatly in your favour - it’s just that the two
conditions do have similar symptoms allegra breedlove harry potter . As has already been discussed (see Chapter 5), the symptoms of an enlarged prostate
are:
• A weak, sluggish urinary stream, which may be particularly noticeable first thing in the morning; you may notice
this as a thin stream, or you may not be able to urinate as high or as far as you used to tetracycline uti mg achromycin .
• Difficulty in starting the flow of urine, known as hesitancy date cialis was released by fda .
• A tendency to stop and start urinating, known as an intermittent flow testosterone propionate or cypionate .
• The feeling that you haven’t quite emptied your bladder and that there is more to come tetracycline hydrochloride cas .
• Straining to pass water baclofen uses .
• Incontinence - this is not an inevitable part of old age, it is a sign that there is something wrong zovirax 5 .
• Dribbling of urine coin lithium batteries .
• Urinary retention cipro 500 mg .
• Pain or discomfort on passing water, known as dysuria what does flagyl do .
• Blood in the urine, known as haematuria diltia xt 240mg sode effects stoping .
• The need to rush urgently to the toilet to pass water relieve cymbalta withdrawal symptoms .
• Increasingly frequent need to pass water - perhaps as often as every two hours who use zyrtec .
• Having to get up in the night to pass water fexofenadine hcl 180 mg tab .
• The need to push or strain to pass water photograph of omeprazole 20mg .
• Blood in the semen, known as haemospermia terbinafine 250mg tablet .
There may, however, be no urinary symptoms at all prazosin maximum dosage . The first sign of the disease may be from secondary growths, or
metastases, of the cancer, which are most commonly in the bones side effects of cardizem cd . Prostate cancer has a tendency to spread to the bones,
and this happens in a high proportion of cases risks of coumadin .
Symptoms of cancer of the bone:
• Pain in the bone, which is often worse at night celecoxib poland .
• Bone tenderness no perscription buy for azithromycin .
• Brittle bones, which may suddenly break without any injury medications oxytrol dis 3.9 mg 24 .
• Fatigue generic didronel .
• Loss of appetite nursing standing orders for coumadin .
• Weight loss levothyroxine nausea dizziness .
• Anaemia apris birth control .
Bone cancer
A malignant growth in the bone can be primary, in which case it originates in the bone itself: or secondary, in which
case it has spread from cancer elsewhere in the body avandia and congestive heart failure . Secondary bone cancer, or metastatic cancer, is more common than
primary bone cancer, and prostate cancer is one of the cancers that spreads readily to the bone codeine allergy tramadol .
Bone metastases occur most commonly in:
• The spine diet for coumadin patient .
• The ribs neurontin withdrawal .
• The hips lexapro help to purchase medicine .
• The pelvis dose gabapentin pain .
• The upper legs promethazine routes of administration .
• The skull is bactrim effective for diverticulitis .
Secondary bone cancers from the prostate often respond well to hormonal treatment, including oestrogen or hypothalamic
hormones premarin price . Sometimes the most effective treatment may be by removal of the testes, or adrenal glands drink alcohol with fluoxetine capsules . The administration
of a radioactive isotope such as Metastron is used to relieve pain from bone cancer isosorbide dinitrate cream .
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
5
Arthritis General Information
July 5, 2009 | Leave a Comment
ARTHRITIS
• Eat a diet rich in selenium
• Get 1,000 lU of vitamin D daily *****
• Follow a Mediterranean diet
•Take aspirin to relieve pain and control inflammation ****
• Try naproxen for pain relief **
• Ask your doctor about a prescription for Pennsaid
(diclofenic)
• Experiment with fish oil and green-lipped mussels ** *Try gin-drenched raisins
• Consider Certo and grape juice *****
• Drink pomegranate juice ****
• Sip vinegar with apple and grape juices
• Drink cherry juice
*Take turmeric **** *Try boswellia
• Consider acupuncture ***
No one really knows how many people suffer from arthritis and related inflammatory conditions. The folks at the CDC (Centers for Disease Control and Prevention), who are in charge of tracking such things, put the number at close to 70 million. That includes more than 43 million adults diagnosed by doctors and another 23 million who have symptoms but have not been officially diagnosed .57,58 That means one in three adults is afflicted with some form of arthritis.
If you think that’s a lot of folks, you ain’t seen nothin’ yet. Aging baby boomers are about to discover up close and personal what it’s like to suffer from chronic inflammation. The CDC estimates that by 2030 we will add another 22 million to the list of people in pain. 59 Arthritis will become the biggest obstacle to enjoyable retirement for the boomer generation.
With so many suffering, it’s hardly any wonder we’re all desperate for relief. Shaking hands, buttoning a shirt, or typing on a computer keyboard can be difficult if your fingers hurt. But who can give up e-mail? We communicate with the world through our fingers.
Everyone tells us that exercise is the most important thing we can do for our overall health. Yet it’s hard to walk, jog, or play tennis or golf if your knees, hips, and shoulders are sore.
No wonder we turn to drugs to relieve our inflammation and ease the pain. A friend who hiked the Appalachian Trail dubbed ibuprofen “vitamin I.” Weekend warriors frequently rely on Advil (ibuprofen) or Aleve (naproxen) before, during, and after tennis matches, basketball games, or karate competitions. We now know that most of the medications used for arthritis can have potentially serious side effects.
We’re caught in a classic double bind. Without something to control inflammation, pain limits our activities, which is not good for our health. Take the medicine, however, and we risk all sorts of complications, from high blood pressure and kidney problems to heart attacks and strokes. Some popular anti-inflammatory drugs may even make our arthritis worse.
Jul
3
Allergy: Corticosteroid Nasal Sprays
July 3, 2009 | Leave a Comment
Corticosteroid Nasal Sprays
The big revolution in allergy treatment involves the use of steroid nasal sprays. Allergists have known for decades that cortisone-like drugs (prednisone, for example) can dampen the reactions of an overactive immune system and calm allergy symptoms amazingly well. The trouble is that relief comes at a stiff price. So many side effects are associated with oral corticosteroids that few physicians would ever consider prescribing such medications for nasal allergy symptoms except as a last resort. Even then, cautious doctors prescribe medications like prednisone for the shortest period of time necessary. Adverse reactions can include irritability, insomnia, anxiety, high blood pressure, potassium depletion, headache, nausea, and dizziness.
Not surprisingly, people wanted the benefits of steroids without the risks. That’s where nasal sprays come in. There are about a half- dozen different intranasal corticosteroids available by prescription. Most experts would say that these formulations are the most effective allergy treatment available. Although it may take a week for the benefits to reach peak effect, these sprays should relieve allergy symptoms such as itching, sneezing, and congestion quite well. They are pricey, however. A small bottle can run $85 to $95. At the time of this writing, generic flunisolide costs around $40. We cannot say whether one spray is better or safer than another.
The general consensus is that there are few, if any, systemic
GENERIC
BRAND NAME
Beclomethasone
Beconase AQ
Budesonide
Rhinocort Aqua
Flunisolide
Nasarel
Fluticasone
Flonase
Mometasone
Nasonex
Nasacort AQ
Triamcinolone
INTRANASAL
CORTICOSTEROIDS
side effects associated with topical steroids. In other words, the experts do not believe people absorb enough of the drugs into the system to cause much, if any, concern.55 One study did report growth suppression in children, but other research has not confirmed this complication. There have been rare reports of nasal perforation (creating a hole between the nostrils) and increased pressure within the eyes. More common are local reactions such as irritation and burning in the nose, sore throat, nasal dryness, nosebleed, and headache.
Tags: accutane before and after photos, air thunder lithium, all about tramadol overdose, allergists, Allergy, allergy treatment, atenolol and acute anxiety, atom of hydrogen helium and lithium, baclofen withdrawl, beclomethasone, beconase aq, benefits of steroids, benzoyl peroxide topical gel 10, can penicillin affect my menstrual cycle, carvedilol pavk, cheapest price for cialis, consensus, Corticosteroid, corticosteroids side effects, coumadin purple face and brusing, crixivan epivir azt, cyp3a4 and erythromycin breath test, demadex mites dog, dosage testosterone injection, doxepin for insomnia, effect combine take drink alcohol prozac, estradiol of 30, evista beschreibung, flagyl sulfa, flomax competition, flunisolide, fluticasone, GENERIC, growth suppression, high blood pressure, ibuprofen and your heart, indocin information, intranasal corticosteroids, irritability, kamagra reviews, lawsuit prozac, lek norvasc, lexapro and rash, lexapro sideeffects, light sensitivity of fexofenadine, long term side affects of prozac, mayo clinic atenolol, Medications, medicine inderal la, metoclopramide hcl tab 5mg, Nasacort, nasacort aq, nasal allergy symptoms, nasarel, nausea and dizziness, oral corticosteroids, overactive immune system, paxil herbal alternative, peak effect, potassium depletion, pradeepan soma cayman, prednisone, prednisone for ear infection, rare reports, Rhinocort, rhinocort aqua, risperdal injection quick acting, side affects of zocor, side effects of cymbalta withdrawal, singulair hfa, steroid, steroid nasal sprays, stiff price, suicidale thoughts on lexapro, tamoxifen uterine biopsy, testosterone lowerd naturaly with supplements, topical steroids, Treatment, treatment of amoxicillin and hydrocodone, uses of amitriptyline, vytorin mood, what are three properties of lithium, will ultram ruin a drug test, withdrawl recovery effexor, zoloft drug screen