Archive for the ‘medicine safety’ Category

How To Take Your Thyroid Medicine

Q: My husband takes a thyroid medicine called levothyroxine. He went to his doctor last week because he’d been feeling tired and the doctor told him it’s because he’s taking his thyroid pills wrong. All these years he’s taken it with his other morning pills at breakfast, but now he’s supposed to take it 30 minutes BEFORE his breakfast instead. He’s tried to make the switch but it’s really hard for him to remember to take it first thing in the morning. Is there anything we can do?

Levothyroxine is a very potent medicine; even small changes in the dose can create big differences in how much energy you have. How much levothyroxine you need can depend not only on how much medicine is prescribed by your doctor, but also on HOW you take those pills. Your husband may not be getting the entire dose of his thyroid medicine because food can interfere with the ability of levothyroxine to get into your body.

Like most medicines, in order to do its job levothyroxine must first get into your body. It needs to jump from a pill sitting in an amber prescription bottle all the way into your thyroid gland, where it works to support your metabolism and give you energy.

When you swallow a pill it doesn’t magically dissolve in your stomach and do its thing right then and there. Most medicines need to get into your bloodstream first before they can get to where they need to go and do what they are supposed to do. Although your pills dissolve in your stomach they can’t jump into your body from there. Instead, medicines and nutrients have to leave your stomach and move into your small intestine before they can be launched into your body.

Your small intestine is a busy place. Its walls are covered with blood vessels and specialized cells designed to transport nutrients and medicines into your bloodstream, where they get carried on throughout your body and delivered to where they need to be, like levothyroxine going to your thyroid gland.

The process of medicine going from a pill you swallow to entering your bloodstream is called absorption. Some medicines are better at being absorbed than others. While many medicines are completely absorbed after you take them, other medicines like levothyroxine can run into trouble along the way, resulting in less of it getting into your body and doing its job.

Your husband will get more consistent results from taking his levothyroxine on an empty stomach because food and certain minerals can attach themselves to it and prevent it from making the trip through the wall of his small intestine into his bloodstream and on to his thyroid gland.

But the most important thing of all is taking it consistently, every day, the same way. His doctor will use blood tests to adjust his levothyroxine dose if he needs more.

Here Are 5 Tips For Best Results When Taking Levothyroxine:

  1. Levothyroxine is absorbed best on an empty stomach, either AT LEAST 30 minutes before a meal OR 3-4 hours after you’ve finished eating.
  2. If you have trouble remembering to take your levothyroxine first thing in the morning, try taking it at bedtime instead, as long as it’s been at least 3 hours since your evening meal. Taking it at bedtime may be easier to remember than taking it all by itself in the morning, especially if you take other medicines at the same time.
  3. If you forget to take your levothyroxine before breakfast, go ahead and take it anyway. Don’t worry, your stomach is not going to blow up, your intestines are not going to fall apart and your thyroid is not going to die. If you take levothyroxine with your meal you may not absorb the whole dose but if you skip entirely it you won’t get ANY of it absorbed! And that’s worse.
  4. If trying to take levothyroxine on an empty stomach is too complicated to do, don’t panic. It’s perfectly okay to take levothyroxine with your breakfast or other meal, as long as you take it that way all the time. Many patients are perfectly successful taking levothyroxine because they ALWAYS take it with their breakfast and don’t skip any doses.
  5. If you take calcium or iron supplements, don’t take them at the same time as levothyroxine. These minerals can significantly reduce the amount of levothyroxine that you absorb, so it’s best to separate them by at least 3-4 hours.

 

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The Best Non-Prescription Pain Relievers

Q:             Which non-prescription pain medicine is the best to use?

There are 4 pain medicines you can buy without a prescription: Tylenol®, Aleve® Advil®, and Motrin-IB®. Which would be best for you to use depends on what type of pain you need it for and whether you have certain kinds of medical conditions.

Tylenol® is oldest of the pain medicines available over-the-counter (OTC). Also known by its generic name acetaminophen, Tylenol® is very safe to use as long you avoid taking too much of it. Taking more than 8 Extra-Strength tablets of 500mg acetaminophen or 12 tablets of regular strength or 325mg Tylenol® in one day can permanently damage your liver, especially if you do it frequently.

The other 3 pain medicines you can buy without a prescription are closely related to each other and all work in the same way. The active ingredient in Aleve® is naproxen and the active ingredient in both Advil and Motrin-IB is ibuprofen. Ibuprofen and naproxen are called non-steroidal anti-inflammatory drugs or NSAIDs for short. NSAIDs are powerful painkillers that are quite effective for certain types of pain associated with inflammation: muscle aches, sprains or strains, tension headache, and dental pain.

Pain medicines with anti-inflammatory action like ibuprofen or naproxen are much better than Tylenol® or acetaminophen for menstrual cramps and especially to prevent swelling and pain after a tooth extraction, but it comes with a price. NSAIDs can cause stomach pain and bleeding, interfere with how your kidneys work, or trigger heart failure from retaining excess water.

I recommend naproxen (Aleve®) over ibuprofen because it lasts longer. Naproxen lasts 8-10 hours while ibuprofen wears off in 6 hours. Years ago I tore a ligament in my right wrist while chopping wood in weather 20 degrees below zero. Some people should NOT be allowed to swing an axe, and I’m one of them! Even taking the most potent prescription strength of ibuprofen three times a day I’d wake up in excruciating pain night after night at exactly 3:25 am. After switching to the OTC strength of naproxen I slept blissfully through the night.

Always take an NSAID with a full glass of water or right after a meal to reduce your risk of stomach problems like burning, cramps, heartburn or bleeding ulcers. The extra water or food will dilute the medicine as it dissolves in your stomach, decreasing your chances of developing pain or bleeding.

When taking naproxen or ibuprofen it’s extremely important to drink plenty of water and avoid them if you are having vomiting or diarrhea. NSAIDs can cause problems with your kidneys, especially if you become dehydrated.

If you have a certain type of heart condition called congestive heart failure (CHF), you should avoid NSAIDs completely. Just ONE DOSE of ibuprofen or naproxen can trigger a deadly build up of fluid in your lungs.

If you have stomach or kidney problems, Tylenol® will be the safest medicine for you to treat mild to moderate pain… unless you take too much of it.

Unfortunately, taking more acetaminophen than you should is MUCH easier than you’d think. Following the dosing recommendations on your bottle of Tylenol® is not enough to prevent problems because acetaminophen is already in many commonly prescribed prescription pain medicines like Vicodin® and Percocet®.

You can also end up taking too much NSAID medicine without realizing it. In addition to OTC formulations, higher strengths of ibuprofen and naproxen along with several other prescription-only NSAIDs are widely prescribed as anti-inflammatory medicines. Taking an OTC and prescription NSAID at the same time increases your chances of having side effects like stomach pain, kidney problems or bleeding ulcers.

 

To choose the best OTC pain medicine for you, follow these guidelines:

  1. For muscle aches, sprains and strains, dental pain or menstrual cramps taking an NSAID like ibuprofen or naproxen will usually work much better for you than Tylenol® or acetaminophen. I recommend naproxen because it lasts 8-10 hours, but either naproxen or ibuprofen should help.
  1. If you have a stomach ulcer, kidney problems, congestive heart failure (CHF), or are taking a blood thinner, you should stick with Tylenol® or acetaminophen regardless of the type of pain you have, because it’s is a safer choice.

 

  1. Don’t double up on painkillers. Although it’s safe to take an NSAID anti-inflammatory medicine at the same time as Tylenol®, you should NEVER take more than one NSAID at a time or more than one medicine with acetaminophen in it at a time. Ask your pharmacist if you’re not sure if your prescription pain medicine has either acetaminophen or an NSAID in it.

 

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Safe Medicine Disposal

Q:        How should I get rid of my old and expired medicines? I don’t want to just flush them down the toilet into our water supply.

You are not alone in having leftover medicines. In fact, nearly one-third of medicines sold to Washington State households go unused every year, according to a report by Take Back Your Meds, a group of over 270 health organizations, law enforcement, local governments and environmental groups. That’s about 33 million containers of unused pills just in the state of Washington. When you think about the rest of the country…Yikes!

Disposing of your unused medicines is a good idea. Keeping unwanted and outdated prescription medicines around your house invites abuse and theft. Removing medicines you no longer need helps keep habit-forming drugs from entering the lives of your children, grandchildren or their friends and keeps you from contributing to the rapidly growing problem of prescription drug abuse.

It’s not just the people you know who are checking out your medicine cabinet. In addition to friends of your children and grandchildren looking for your leftover pain pills, today’s home intruders look for prescription bottles of pain medicines sitting on countertops or stacked up in medicine cabinets, not just for flat screen televisions and laptop computers.

One of the safest ways to dispose of your expired, unused or unwanted medicines is to take them to a site participating in a take-back program. While it seems natural to return your unused medicines to your pharmacy, under federal law, pharmacies, doctor’s offices and hospitals can’t accept any outdated or unwanted prescriptions of controlled substances, such as narcotic painkillers like Vicodin® or medicines for anxiety such as Ativan® (lorazepam).

The Drug Enforcement Administration (DEA) began hosting national prescription drug take back events beginning in September 2010. Twice a year the DEA partners with local law enforcement agencies to give the public another alternative to disposing of their medicines besides putting them in the trash or flushing them down the toilet.

The 12th Annual National Prescription Drug Take Back Day will be Saturday, October 22, 2016, and as with previous national Take Back events you can bring your medicines to participating sites for safe, free disposal, no questions asked.

But now there’s no need to wait for the next Take Back Day. The DEA has encouraged communities to provide local drop box sites authorized by the DEA for year-round safe medication disposal. You can search by zip code, city or county to find the authorized sites closest to you on the DEA website: https://www.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1.

If you can’t get to a take-back site near you, the Food and Drug Administration (FDA) recommends disposing of any potent pain medicines by removing them from their original containers and flushing them down a sink or toilet. This includes pain pills containing drugs like Vicodin® or hydrocodone, oxycodone, and patches containing fentanyl, also called Duragesic®. Although it seems harmful to the environment to flush them, it’s even more dangerous to leave them in your trash container. Just part of a pill or a used patch of these powerful pain relievers can be lethal to a pet or small child sucking or chewing on it.

Other prescription medicines can be safely disposed of by first removing them from their bottles and boxes and mixing the pills or capsules with something unappealing like kitty litter, coffee grounds, sawdust or even dirt, then placing them in a leak-proof container like a sturdy zip-lock bag before adding them to your trash bin.

Before putting empty prescription bottles into the trash, protect your privacy by marking out any identifying information such as your name, prescription number and drug name with a permanent marker, like a Sharpie®. Sometimes you can just peel the label off and crumple it up.

4 Tips to Safely Dispose of Your Unwanted or Expired Medicines:

  1. The best way to dispose of your medicines is to take them to a Take-Back location or event in your community. Many communities hold their own Take-Back events during the year in addition to National Prescription Take Back events held in the spring and fall.
  2. If you can’t get to a take-back location or event, remove any potent pain medicines such as hydrocodone, oxycodone, OxyContin®, or fentanyl patches and flush them down the toilet or sink. Don’t leave them in your trash to be found by a child or pet.
  3. Mix any non-narcotic prescription pills in with kitty litter, used coffee grounds, or even dirt before placing them into your trash. Using a plastic container with a secure lid or a heavy plastic zip-lock bag helps prevent leakage.
  4. Remember to remove or mark out any personal information and drug names before tossing used prescription bottles or boxes into your trash.

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Caffeine as Our Drug of Choice

Every morning at 6am Pacific Standard Time you’ll find me in my kitchen in front of a silver machine concocting a cup of jump-start for my day. My well-used Gaggia Classic espresso machine relieves my caffeine deprivation every morning with an aromatic, high-octane blend of caffeine, water and milk. As I write this my 16-ounce unflavored latte steams by my right elbow.

I’m not alone when performing this ritual of drinking coffee before engaging my brain. 100 million Americans are also daily coffee drinkers and 60% of us consider coffee a mandatory part of our morning routine. There’s even a National Coffee Month each August to celebrate our addiction.

Although Americans purchase a large proportion of the world’s supply of coffee beans and are the home of Starbucks®, Seattle’s Best® and Dunkin’ Donuts®, we aren’t the world’s most dedicated coffee drinkers. In fact, we only rank 25th in per capita coffee consumption, out-caffeinated by the Top 5: Finland, Norway, Iceland, Denmark and the Netherlands.

Coffee is a definitely a worldwide beverage. Green, or unroasted coffee beans are the second most traded and valued commodity in the world, behind only crude oil. We call coffee “Java” because when coffee as a beverage first became popular in the 19th century the highest quality of beans came from the Philippine island of Java.

Why do we love coffee so much? Probably because it naturally contains caffeine, the most widely consumed stimulant in the world. Found in over 60 different plants, caffeine’s effect on the brain can be detected in amounts as low as 10mg, a fraction of the 100mg dose found in an average 8-ounce cup of brewed coffee.

As the most common psychoactive compound ingested in the world, caffeine is found in beverages all around the globe: coffee, tea, a South American drink called mate, and kola nut. Kola nut extract was originally added to carbonated beverages to flavor them, although today soda manufacturers use synthetic sources of flavoring and caffeine in their cola flavored products.

Enterprising entrepreneurs have added caffeine to other things besides soda. Need the pick-me-up quality of caffeine but don’t want coffee breath? Try one of the popular energy drinks like Red Bull® or 5-Hour Energy®. There’s even Stay Alert® chewing gum with 100mg of caffeine per stick, about the same amount found in a good ol’ cup of java. Not interested in drinking a beverage to get your day going? Wired Waffles® brings you 200mg of caffeine per waffle to jump-start your day or you can use their caffeinated pancake syrup.

If the thought of putting caffeine into foods bothers you, welcome to the club. The Food and Drug Administration (FDA) has concerns about the amount of caffeine in foods, particularly since waffles, pancake syrup, gum and candy are attractive to children.

As I sip my morning coffee, I wonder, “Should caffeine be allowed to be added to foods that don’t naturally contain it? Should we let other products besides our traditional beverages provide us with caffeine?”

One consideration is the fact that we vary in our sensitivity to caffeine’s side effects. Some of us can drink a pot of coffee and go right to sleep while others experience side effects like heart palpitations, tremor, anxiety and insomnia after only one cup. Some heart patients are advised to avoid caffeine completely because of the risk of increased blood pressure and heart rate.

The currently recommended limits of caffeine intake are 300-400mg per day in adults and 100mg daily in teens and young adults. The FDA is concerned about whether to approve food products containing caffeine as an additive because little is known about the effects of caffeine in small children, young adults, or in pregnancy.

In 2010 the FDA forced the withdrawal of caffeinated alcoholic beverages like Joose® and Four Loko® because of studies indicating that combined ingestion of caffeine and alcohol could lead to life-threatening situations. The FDA determined that caffeine consumption masks the sensory cues people use to track their level of alcohol intoxication. Young adults drinking the alcohol/caffeine combinations found in products like Four Loko® continued drinking well beyond what they usually drank with blood alcohol levels 2-3 times higher than those drinking beverages containing only alcohol.

You can find more information about caffeine in foods and other interesting topics on the FDA website under Consumer Updates: www.fda.gov/ForConsumers. Just don’t ask me any tough questions before I have my morning cup of Joe…

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Choosing a Medicine for Your Aches and Pains

Q: There are so many choices out there for aches and pains. Which medicine is best for me?

When you have mild to moderate pain like a headache, sore muscles or aching joints there are 4 pain medicines you can buy without a prescription: aspirin, acetaminophen (Tylenol®), ibuprofen (Advil®), and naproxen (Aleve®). Which one should pick?

Aspirin is the oldest of these four options and is available in two strengths: low dose or “baby” aspirin which are 81mg each and the adult dose of 325mg, which is exactly 4 times the 81mg dose. Many Americans take one aspirin a day to prevent heart problems because of how it works as a blood thinner. If you take any prescription blood thinner medicine like Plavix®, warfarin (Coumadin®), or one of the newer ones advertised on the television, don’t take more aspirin for relief of your headache pain. Since aspirin can upset your stomach it’s best to take it with food or a full glass of water.

Whether sold as Tylenol® or by its generic name acetaminophen, Tylenol® is the most popular and common painkiller sold in America. Although it is safe enough for kids to take, Tylenol® has a dark side: taking too much acetaminophen is deadly to your liver. Being available in over 200 different non-prescription products the popularity of acetaminophen makes it dangerous because its so easy to get too much.

If you take a prescription pain medicine you may already be getting acetaminophen. Look for the abbreviations APAP or ACET on the prescription label, or ask your pharmacist. If you have liver disease, don’t take Tylenol® until you talk to your doctor about whether taking it is safe for you and how much you can safely take for pain.

The other two pain relievers available without a prescription are closely related to each other and also to aspirin. Ibuprofen and naproxen were originally only given as prescription medicines, but now they are available in non-prescription products in addition to their stronger prescription doses. Aspirin, naproxen and ibuprofen relieve muscle aches and swelling better than acetaminophen and belong to a group of medicines called NSAIDs, or non-steroidal anti-inflammatory drugs.

When taking ibuprofen, also known as Advil® or Motrin-IB®, or its close cousin, naproxen, sold as Aleve® be careful to take it with food to avoid stomach pain and bleeding. NSAID medicines can also damage your kidneys, especially if you have kidney problems or take it when you are dehydrated.

Taking too much of an NSAID is particularly dangerous because it can cause stomach bleeding and kidney failure. In addition to the non-prescription NSAID remedies there are several prescription NSAIDs commonly prescribed. Ask your pharmacist if you are already taking a prescription-strength NSAID and if you are, avoid taking the non-prescription versions.

7 Tips for Taking OTC (over-the-counter) Pain Relievers Safely:

  1. For aching muscles and swelling, ibuprofen or naproxen usually works better than acetaminophen. Some people get more relief with one or the other. Ask your pharmacist before taking ibuprofen or naproxen to make sure that you’re not already getting a prescription product doing the same thing.
  2. Avoid taking an NSAID if you already take a blood thinner. Taking 81mg of aspirin daily is ok, though. Ask your pharmacist if you aren’t sure if you are on a blood thinner medicine.
  3. Watch out for taking too much Tylenol®. Healthy adults can take up to 4 grams per day, or the equivalent of 8 tablets of extra-strength acetaminophen. Older adults are should limit their Tylenol® use to 3.1 grams daily, or 6 tablets of extra-strength Tylenol®. If you take a prescription pain reliever ask your pharmacist to find out if it has acetaminophen in it, and how much.
  4. If you take aspirin daily for your heart, talk to your doctor o pharmacist before taking it for pain relief. It’s safer to take Tylenol® or another NSAID like naproxen instead.
  5. You can take both acetaminophen and an NSAID for pain at the same time, as long as you don’t take more than is safe for you. Your pharmacist is a medication expert and can advise you as to which one is best for you.
  6. If you have kidney disease avoid taking ibuprofen or naproxen for mild to moderate pain, and make sure that you stay well hydrated when taking either one.
  7. If you have liver disease, ALWAYS check with your doctor before taking Tylenol® or acetaminophen.

 

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How To Get Better Pharmacy Care

Being a patient in a hospital is a dangerous place to be because it puts you at risk of being harmed by a medication error. That’s because more doses of medicine and more powerful medicines are given to people who are sick enough to need hospital care.

No matter how much we try, we are all human, and mistakes will be made. Our best hope is to catch these medication errors before they get to the patient by training staff to be alert, building in safeguards that flag potential problems, and by clear communication between the pharmacy staff who fill each medication order and the nursing staff administering it to the patient.

There are two main systems hospitals use to provide medicines to patients: centralized and decentralized distribution systems. In a centralized system the pharmacy is in the basement and pharmacists work inside its walls. Nursing sends new medication orders down to pharmacy and receives them without ever seeing or talking to a pharmacist.
A decentralized system puts pharmacists on the floors or units, usually right next to nursing stations. Pharmacists and nurses work side-by-side to interpret orders that are sent along to the central pharmacy for filling.

In my 12 years as a hospital pharmacist I’ve worked in both decentralized and centralized pharmacy systems and there is a significant difference between them. In a centralized system, nursing and pharmacy have an adversarial relationship, where in a decentralized pharmacy system pharmacy and nursing respect and value each other. My observation is that in centralized pharmacy systems the only time nurses communicate with the pharmacy is by phone when things go wrong, like when they can’t find the next dose of their antibiotic or have run out of pain medicine. The nurse calls the pharmacy in frustration, complaining about how she doesn’t have the medicine and the pharmacy learns to dread getting called by nurses.

Decentralized pharmacies put pharmacists and nurses side-by-side, and the face-to-face contact fosters less blame and more cooperation. Pharmacy helps nurses find missing doses of medicines clarify orders and in general are seen as heroes instead of the problem.

The most striking difference between the two systems is in detecting and resolving potential medication errors. Nursing is the last link between a medication order and the patient. The nurse administering a medicine is the last opportunity to find a mistake or error before it gets to the patient. Let’s be honest here. Because we are human it’s not possible to completely eliminate medication errors. The best we can do is to recognize an error and correct things that aren’t right before they harm an innocent patient.

In a centralized system if a nurse notices something that “doesn’t seem quite right” they will tend to avoid calling the pharmacy, as the pharmacy already thinks they call too much and complain. Instead, they will let it go. In a decentralized system a nurse facing the same “not quite right” feeling will call over the pharmacist, saying, “Hey, could you take a look at this? What do you think?”

There’s a similar situation faced by older Americans when it comes to getting their prescriptions. Centralized pharmacy services are provided by mail-order pharmacies and decentralized services by local pharmacies.

Outside of a hospital, the last link in the chain of a medication error is YOU. Like hospital nurses in a decentralized pharmacy system, using a local pharmacy gives you the opportunity to develop a relationship with a pharmacist or pharmacists. When you see things that don’t make sense to you, you are more likely to ask the pharmacist for help than if you get your medicines through the mail.

Here are 5 tips on getting the safest pharmacy care:

1.    Look for non-mail order options in your benefit plan and choose local whenever you can.

2.     Keep a complete list of all of your medications, and share it with all of your providers, not just your doctors. Take it to your dentist, chiropractor, and each pharmacy that you use. Keep everyone in the loop avoids dangerous duplication or risky combinations of medicines.

3.    Establish a relationship with at least one pharmacist so that you feel comfortable asking them questions. This is an absolutely critical skill as our medications become more complex and more powerful and more dangerous.

4.    If you see something you don’t understand about the medicine please SPEAK UP. ASK! Mail-order pharmacies tend to discourage people questioning things. By not asking questions you are passing up an opportunity to discover a mistake before it gets to you.

5.    Insist on 90-day supplies from your doctor for your regular medicines. This limits the number of times a pharmacy is filling your prescriptions and reduces the possibility of an error,as you get only 4 or 5 refills a year instead of 11 or 12..

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Which is the Best Antihistamine For You?

Q: Every summer my nose runs and my eyes itch from my allergies. Claritin® has worked for me in the past but for some reason this year is different. I tried Allegra®, but it’s not helping, either. What other antihistamines could I try?

Antihistamines work by keeping histamine locked away inside your body. Histamine is a compound that triggers inflammation and is stored in special cells in your body called mast cells. When you come in contact with something you’re allergic to, your mast cells open up, spilling out histamine and triggering the symptoms we associate with an allergic reaction: stuffy or runny nose, itchy eyes and sinus pressure.

Because they work by preventing histamine from escaping from your mast cells, antihistamines work best if you take them at least 1 hour BEFORE being exposed to what sets your allergies off.
Which antihistamine you should try depends on which one will work best for you and how drowsy it makes you. There are 2 main categories of antihistamine medicines to choose from: sedating ones and non-sedating ones. The sedating antihistamines are older drugs that often cause drowsiness and dry you out. This drying action can actually help relieve your runny nose and watery eyes. Newer antihistamines don’t drowsiness but may not be as effective at drying up a runny nose.

Some antihistamines relieve allergy symptoms better with some people than with others. Many people have to try more than one before they find the one that works best for their allergy symptoms while causing the least drowsiness.

How important to you is avoiding drowsiness? Older antihistamines cause at least some drowsiness in most people. If this is a concern for you, start with the newer antihistamines because they cost little to no drowsiness.

One of the best antihistamines to try first is loratadine, also known as Claritin® and Alavert®. It’s taken only once a day, and rarely causes drowsiness. If loratadine isn’t helping you, another newer non-sedating antihistamine is Allegra®, or fexofenadine, available in either twice a day or once a day versions.

If either of those is not working for you, try cetirizine (Zyrtec®). It’s more likely to cause you some drowsiness compared to Claritin® or Allegra® but because it’s more drying than either of them it can help dry up your runny nose. You only have to take it once a day and it causes minimal drowsiness.

If Claritin®, Allegra® or Zyrtec® aren’t giving you enough relief, you can try one of the older sedating antihistamines. The most powerful is Benadryl® also known as diphenhydramine. It helps with serious allergic symptoms but will cause drowsiness in most people. In fact, you can buy diphenhydramine as a sleeping pill without a prescription as Tylenol PM® or Sominex II. Benadryl® needs to be taken 3 to 4 times a day for best results. Some people take it just at night and substitute another antihistamine during the day.

There are other older antihistamines still available, including chlorpheniramine, brompheniramine, and triprolidine. Triprolidine causes less drowsiness than the other older antihistamines and seems to have the most drying action as well. Surgeons used to avoid having their nose drip while doing surgery. Its main drawback is that it’s only available as Actifed®, a combination with the original formulation of Sudafed®. I really like how effective it is for runny nose, watery eyes and nasal congestion.

4 Tips on how to choose an antihistamine:

1. Take a dose of your antihistamine BEFORE you come in contact with what you are allergic to, if possible. That way you’ll get better results than if you wait until your nose stuffs up and your eyes start itching.

2.  If you have to drive or use machinery, choose one of the newer non-sedating antihistmines like loratidine (Claritin®), fexofenadine (Allegra®) or cetirazine (Zyrtec®) first.  Everyone is a little different in how they react to a medicine.

3. If your first antihistamine choice doesn’t help you, try another one. It’s not unusual to get good results with one yet very little relief from another.

4. An antihistamine can be purchased as a single agent or combined with other medicines, like a decongestant. I recommend you avoid the Sudafed PE® that is sold on the shelf which contains phenylephrine because it is not as effective as the original formula of Sudafed® containing pseudoephedrine. If you need a decongestant for a stuffy nose I recommend the original version of Sudafed®, available from your pharmacist.  You will need to bring photo identification to purchase it. Triprolidine/pseudoephedrine (Actifed®) is a good choice for runny and stuffy nose symptoms.

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Your Medicine and the Sun

It was a beautiful sunny midsummer afternoon, perfect for feeding the ducks. My seven year-old niece Crystal was staying with me, and after finishing our lunch of grilled cheese sandwiches and tomato soup, I loaded my backpack with water and a bag of old bread scraps before setting out for the duck pond at a local park.

Crystal tossed the first bread bits as far as she could. Soon the ducks swam over to gobble up the floating treats, creating squawking competition for each bit of bread. Laughing, she continued pitching the rest of the bread piece by piece into the quacking crowd. Once the bread was gone we headed for the swings, pumping our legs to carry us higher and higher into the cloudless sky.

“Aunt Louise, I feel hot. ”

“Let’s head for that big tree over there, and I’ll get you some water.”

Opening my pack, I fished out a water bottle and turned around to offer it to Crystal, nearly dropping it in shock when I saw her flaming red cheeks and arms. Heading back home, I kept thinking, “She had sunscreen on, so how could she have burned so quickly?”

Once we got home, I zipped into the kitchen to get a damp towel for Crystal’s face. Sitting right next to the sink was her prescription bottle of antibiotic. I’d given Crystal her morning dose right after breakfast and then left it out on the counter to remind me to give her next dose at dinner. Could her medicine have caused her to burn even through her sunscreen?

When my brother had dropped Crystal off the day before I had focused on the dosing instructions printed on the label of her bottle but overlooked the small yellow sticker over on the side that warned about exposure to sunlight. Luckily, her “burn” faded by dinnertime, but I’ve never forgotten how scared I felt.

Exposing our skin to sunshine causes our skin to react, either by “tanning” or “burning”. Sunlight contains ultraviolet radiation; there are wavelengths called UVA and UVB that can trigger skin reactions like rash, itching and even exaggerated sunburn. These effects are called photosensitivity reactions.

Sunburn, skin cancer and accelerated skin changes such as wrinkles and spots called photo aging are caused mostly from exposure to UVB radiation. UVB rays are most intense between 10 in the morning and 4 pm, and help our skin produce Vitamin D. UVA radiation triggers photosensitivity reactions in people taking certain medicines, like Crystal. Normal sunlight has approximately 20 times as much UVA radiation as UVB. Because UVB radiation causes more sunburn, 96% of the rays from tanning beds are UVA wavelengths.

Crystal’s antibiotic increased the sensitivity of her skin to the UVA wavelengths in the sunshine we played in that July afternoon. Back then; the sunscreen she wore protected her against UVB rays, which can cause sunburn, but not against UVA wavelengths, which can trigger photosensitivity skin reactions. Today’s sunscreen products are formulated to protect against BOTH UVA and UVB radiation.

The measure of how much protection a sunscreen product gives is called its SPF (Sun Protection Factor). The bigger the SPF number, the better the protection. For example, if you properly apply a sunscreen with an SPF of 15, you could stay out in the sun 15 times as long without burning as you could without it.

Sunscreens come in two main types: chemical and physical. Chemical sunscreens work by absorbing specific wavelengths of UV radiation before they penetrate your skin, while physical sunscreens reflect and scatter UVA and UVB radiation. The lighter your skin, the more quickly it can burn and the more protection you need.

4 Tips for Taking Medicines That Can Cause Sun Sensitivity:

  1. AVOID tanning beds or going outside into direct sunlight until you finish the medicine. When going outside during the day, cover up with long sleeves and a hat with a brim at least 4 inches wide, or apply sunscreen with UVA and UVB protection.
  2. Apply sunscreen at least 15 minutes before you expect to be outside in the sun. To be most effective, sunscreens need time to bind to your skin.
  3. Don’t skimp when applying sunscreen. The FDA estimates an adult in a swimsuit should use about 4 and 1/2 teaspoonfuls when applying sunscreen to their whole body.
  4. Reapply your sunscreen frequently, especially after swimming, playing in the water or sweating. And don’t forget to reapply sunscreen after drying yourself off with a towel.

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New Options For Your Allergies

Allergies can be an occasional annoyance or a source of ongoing misery. They can even change your life. One guy I knew, Steve, after finally reaching his lifelong dream of becoming a veterinarian developed a very serious allergy to dogs and cats while in his very first year of practice.

After trying every antihistamine and desensitizing treatment available at the time, Steve’s allergies were still so severe that he faced a tough choice: to completely change his veterinary practice to taking care of other animals instead of dogs and cats, completely give up his lifelong dream of being a veterinarian, or risk dying from an anaphylactic reaction to one of his patients. He eventually left the veterinary world behind to become a pharmacist, graduating a couple of years after me.

Many years ago I had a customer called Connie, who came in frequently seeking help for her allergies. After years of sniffling and sneezing she was told she was allergic to cats. The trouble with that was she had 2 Siamese cats that she refused to part with. Sasha and Lucy were her best buddies: they slept with her every night and she dressed them up in cute outfits every Halloween and Christmas.

Back then I only had a few antihistamines and a couple of nose sprays to offer to Connie, but today I can show her many more options. Claritin®, Zyrtec® and Allegra® are newer antihistamine pills now available without a prescription. Claritin® (loratadine), Zyrtec® (cetirizine) and Allegra® (fexofenadine) each had great success as prescription antihistamines and are widely available today without a prescription.

In addition to those pills I can also suggest 2 new nose sprays that can really change Connie’s life. These nasal sprays contain anti-inflammatory medicine that works similar to prednisone and are very effective for allergy symptoms of the nose, called allergic rhinitis. Now she doesn’t need to go to a doctor to benefit from them. Nasacort AQ 24 Hr® was the first nose spray with triamcinolone, a prednisone-like ingredient. Available without a prescription, Nasacort AQ 24 Hr® has been joined by Flonase Allergy Relief® which contains a different cortisone-like ingredient, fluticasone. These nose sprays are one of the most effective ways to treat allergic symptoms, especially those that involve the nose like sneezing, sniffling and stuffiness.

Up until now, the only nose sprays we had available for allergies that didn’t need a prescription could not be used for more than a few days at a time. Afrin® (naphazoline) and Neo-Synephrine® (phenylephrine) sprays work by causing the blood vessels in your nose to shrink, relieving your stuffy nose. Trouble is, your relief only lasts a short while; if you continue using them they eventually stop working and your congestion comes back even while you are still using them. This is called rebound. Some people can use these intermittently for months and manage to avoid getting rebound stuffiness, while others find their nose spray only works for about 3 days before it quits. If you have high blood pressure or a heart condition, you should avoid this type of nose sprays completely, as they increase blood pressure.

Nasalcrom® is a nose spray for allergies that works by blocking your allergic symptoms. It only works if you start using it several weeks BEFORE you are around whatever you’re allergic to, and has to be used 3-4 times daily for best effect. Unlike Afrin® or Neo-Synephrine®, Nasalcrom® can be used safely in children 2 years and older and can be continually used for years without losing its effectiveness.

Nasacort AQ® 24 Hr® and Flonase Allergy Relief® contain a cortisone-like medicine that can effectively relieve nasal congestion, runny nose and sneezing with just one or two sprays a day. Kids as young as 2 years old can safely use Nasacort AQ 24 Hr® and Flonase Allergy Relief® can be used safely in children 4 years old and older. Another great thing is being able to add any antihistamine pill to either Nasacort AQ®24 Hr or Flonase Allergy Relief® for even more relief.

If Connie walked into my pharmacy today, she would have 3 new antihistamine tablets and 3 more nose sprays to choose from for relieving her stuffy nose, and Lucy and Sasha could continue sleeping with her every night. My 3 Scottish Terriers would be SO jealous!

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Medication Safety: Question Everything

One of my favorite videos is of a backyard July 4th fireworks display gone wrong: a little dachshund runs up to a lighted Roman Candle, grabs it in its mouth and runs around as fireworks shoot out sideways from the burning tube, scattering the watching crowd. Sometimes getting a new medicine can go sideways on you…

Jane is an 86-year-old just home from the hospital after not being able to catch her breath. At the hospital the doctor diagnosed her with congestive heart failure and changed her water pill to a stronger one to help keep the fluid out of her lungs. She was given a list of her medicines when she was discharged back home and the new medicine was on it, but when I saw her the next day she was starting to have trouble breathing again. Checking her pill bottles, I noticed that she had a new prescription for her old water pill instead of her new one.

“This isn’t the medicine that your hospital paperwork shows you should be taking.”
“I know, but when I asked the pharmacist about it he said that they filled the prescription with exactly what was called in for me. I thought maybe the doctor changed her mind.”
“Maybe. Let me check.”

Calling the pharmacy, I spoke to the pharmacist and discovered that her prescription wasn’t faxed to them but instead was called in.

“Was it called in by the doctor?”
“No, by a nurse at the hospital.”

I then called the doctor who’d prescribed Jane’s new medicine and asked, “Did Jane’s water pill get changed from torsemide back to furosemide?”

“No! I want her taking torsemide, not furosemide. Why?”
“Well, the nurse on the floor called in the new prescription as furosemide. Do you want me to send a new prescription for the torsemide?”
“Yes, please!”

If Jane had taken her paperwork to the pharmacy and showed it to the pharmacist, they wouldn’t have assumed that the doctor changed her mind but instead contacted the doctor to clarify the prescription. Instead, Jane almost ended up back in the hospital with the wrong medicine. She questioned it, but without having the paperwork with her to show the pharmacist, she just assumed the doctor changed it back and accepted the wrong medicine.

Then yesterday, 56 year-old Marjorie came in a for a blood thinner check. She’d gone to the emergency room the previous day with one side of her mouth drooping and trouble talking. Luckily, she got better and the doctors diagnosed a TIA, or transient ischemic attack, due to her blood thinner level being way too low.

“Marjorie, your chart shows that I increased your warfarin dose last week, and changed the tablet size, too. But you’re taking the same dose you were on before.”
“I thought we had changed my dose, but when I picked up my new bottle at the pharmacy the label and tablets inside were different than what you’d told me. I thought you’d changed your mind, so I took it the way the label said.”

When I called Marjorie’s pharmacy they insisted they’d never received any new prescriptions for her, so they refilled her current prescription, which was now the old tablet size and old directions.

“Marjorie, let’s fix this before you really DO have a stroke.”

These days, doctor’s offices send most prescriptions by electronic fax, which records it directly into the patient’s medical chart. Most of these faxes arrive, but when they don’t, it STILL looks like they arrived just fine. With an electronic fax there’s no way to tell the difference between one that arrived at its destination and one that didn’t. I sincerely believe that there’s a black hole in our universe, randomly sucking innocent electronic faxes traveling between doctor’s offices and pharmacies, causing medication mishaps and mayhem.

Here are 3 ways you can protect yourself against your medications going sideways:

1. Make a list of your medicines and update it with any additions and changes. Take it with you whenever you go to the doctor, the hospital, or your pharmacy.

2. If a doctor or other medical provider changes your medicine, get it in writing. Keep this with your current list of medicines and take it to the pharmacy when you pick your prescriptions in case there’s a discrepancy.

3. PLEASE ASK QUESTIONS! Question anything that doesn’t look right to you. With so many people involved and a fax-sucking black hole loose in the universe, omissions and misunderstandings can easily affect your medications. Speak up and question anything that doesn’t look right. Your health and safety may well depend on it.

And watch out for wiener dogs running with fireworks…

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