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, 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.
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)
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.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. 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 pilafs 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.
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
Q. 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.
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.
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 for me.
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. 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
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 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.”
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.
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. 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
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 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.
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.
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. 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.
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 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. If 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. 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 ”
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. 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.
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 .
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.” 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?
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 arteries. 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.
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
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.
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
• 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 tremendons 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.
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)
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. 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].
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.
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
• Consider Certo and grape juice
• Drink pomegranate juice
• Sip vinegar with apple and grape juices
• Drink cherry juice
• 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. 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. 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 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.
GENERIC/BRAND NAME
Beclomethasone
Beconase AQ
Budesonide
Rhinocort Aqua
Flunisolide
Nasarel
Fluticasone
Flonase
Mometasone
Nasonex
Nasacort AQ
Triamcinolone
Still generic Singulair is widely prescribed to ease the breathing problems because of asthma.
Jul
3
Allergy Medications - Nasalcrom (Cromolyn)
July 3, 2009 | Leave a Comment
Allergy Medications Nasalcrom (Cromolyn)
Speaking of stabilizing mast cells, another way to do this is with a nasal spray. Cromolyn (NasalCrom) was first introduced as a prescription product in 1983. NasalCrom went over the counter in 1997. Cromolyn, the active ingredient in Nasalcrom.
This nonprescription nasal spray. is often ignored by doctors; but it is a valuable tool in the fight against nasal allergies. By stabilizing mast cells in the nose, NasalCrom makes it harder for histamine and other inflammatory chemicals to be released and do their dirty work.
Side effects: Cromolyn is very safe and does not cause drowsiness or rebound nasal congestion the way OTC nasal decongestants can. Some people may experience temporary sneezing, nasal burning, or a bad taste in their mouth.
Downside: You must use NasalCrom at least four times a day to really benefit. Some experts believe it is much less effective than intranasal corticosteroids.
Cost: Approximately $17 to $20 for a 1- to 2-month supply finally derived from an herb, the fruit of bishop’s weed (Ammi visnaga), which was traditionally used to treat asthma.
The compound cromolyn stabilizes highly sensitive mast cells in the lining of the nose and lungs so they can better resist the onslaught of pollen. It won’t cause drowsiness or cognitive impairment and, if used regularly, it is quite effective. Unlike decongestant nose sprays, there is no need to fear developing dependency.
cromolyn is available in eyedrops (Crolom) for itchy, red eyes due to allergies. There is also an aerosol inhaler (Intal) for treating asthma. Both products require a prescription, whereas NasalCrom does not require your physician’s assistance.
Q. I’m going to visit my daughter in a few weeks and she has two cats that have the run of the house. When I’m there, I suffer runny nose, watery eyes, and sneezing from the cat hairs that are all over the house and furniture.
Can you recommend something over-the-counter for me to take during the visit?
A. NasalCrom is a nasal spray that can be quite effective if taken preventively. You will need to start spritzing several days before arriving so you can stabilize the cells in your nose and protect them against cat allergens.
If you also took the oral antihistamine Claritin (loratadine), you might be able to minimize the sneezing and allergic reactions.