Posts Tagged ‘Zantac®’

Magnesium: An Amazing Mineral

Magnesium is an amazing mineral and micronutrient. Essential for making bone tissue, it’s also a key ingredient in the action of nerves and muscles and a critical component in many enzyme reactions in your body.

A good source of magnesium is unprocessed foods that have lots of fiber, especially dark green leafy green vegetables, whole grains, legumes, and nuts. Magnesium is also found in tofu, avocado, bananas and raisins. Although whole wheat has abundant magnesium, when processed into white flour 80% of the magnesium is lost.

Some common medicines and remedies that use also contain magnesium. When you buy a box or bag of Epsom salts, you are taking home powdered magnesium sulfate, my favorite for soaking sore feet and puncture wounds.

Many laxatives also contain some type of magnesium. If you need a little help to “move things along”, you can choose a fizzy solution of clear magnesium citrate or a milky white liquid called magnesium hydroxide, also called milk of magnesia. Magnesium is also used as antacid to neutralize excess acid in the stomach in both tablets and liquid as Maalox®, Mylanta®, and Rolaids®.

Sometimes magnesium can interfere with important prescription medicines. Coming in contact with magnesium can cripple the effectiveness of powerful antibiotics. Magnesium can attach itself to the molecules of doxycycline, ciprofloxacin and levofloxacin preventing nearly 50% of their dose from getting absorbed into your body. You should avoid taking any vitamin and mineral supplement or any laxative or and acid containing magnesium for at least two hours before and four hours after taking any of these antibiotics.

Several years ago while working as a hospital pharmacist one of our patients had severe pneumonia. Once he got better he was transferred out of the intensive care unit and onto a nursing floor but within a couple of days he relapsed, ending up back in intensive care fighting for his life. The culprit was Maalox®, a liquid antacid containing magnesium. On the nursing floor he was receiving doses of Maalox® every 2 hours along with his oral tablets of ciprofloxacin, blocking half of his antibiotic from being absorbed, which nearly killed him. Once we realized this and stopped the Maalox®, he recovered quickly.

If your magnesium is too low it may affect your ability to keep your bones strong, putting you at risk for osteoporosis. Low magnesium levels in your body can also aggravate high blood pressure and contribute to migraine headache. Magnesium deficiency magnifies the effects of calcium or potassium deficiency. That’s because you can’t fix or correct low calcium or low potassium without first correcting low levels of magnesium.

Older adults are more likely to have a low magnesium level. As we age we are less able to absorb magnesium though our stomach and our kidneys tend to increase the amount of magnesium we lose through our urine. Older adults also tend to eat less magnesium in their diet and are more likely to have chronic diseases and take medicines that interfere with magnesium absorption.

Nearly all of the magnesium in our bodies is found inside cells and tissues and over 50% is found in bone. Because less than 1% of our body’s magnesium is in our blood, it may be hard to detect not having enough magnesium.

Here are some tips to help you maintain adequate magnesium:

1. Eat foods that are high in magnesium.
The best foods for magnesium are dark green and leafy vegetables, whole grains such as whole wheat and oats, nuts, and legumes.

2. Reduce or avoid taking potent acid blocker medicines called proton pump inhibitors.
These medicines interfere with your ability to absorb magnesium. If you take a medicine like Prilosec®, Prevacid®, Nexium®, or Protonix®, you may want to taper off of them or consider changing to a less potent stomach acid remedy like ranitidine (Zantac®) or cimetidine (Tagamet®).

3. If you take magnesium as a supplement, choose a form that is most easily absorbed.
There is evidence that magnesium from magnesium oxide or magnesium sulfate is less easily absorbed than magnesium from other sources like citrate, lactate, chloride, or aspartate.

A REMINDER: If you take an antibiotic such as doxycycline, ciprofloxacin or levofloxacin be careful to take any magnesium supplements or vitamins with magnesium either one hour before or 3-4 hours after taking your antibiotic. There’s usually a small sticker on the side of the bottle to alert you to this issue.

More information about magnesium is available at http://ods.od.nih.gov/factsheets/Magnesium-Consumer/.

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The Heat of Heartburn

Q: I take a prescription strength stomach acid medicine called Prevacid® which has helped my heartburn a lot. Now my insurance company is refusing to cover it. When I stop it, all my heartburn symptoms come back. What can I do?

Prevacid® is an acid blocking medicine called a proton pump inhibitor, or PPI. Every time you eat or drink something, a miniature pump called a proton pump shoots gastric acid into your stomach to start digesting that piece of yummy apple pie ala mode you just ate. Prevacid® and other PPIs reduce heartburn and help heal stomach ulcers by reducing the amount of gastric acid in your stomach.
PPIs are our most effective medicines for treating excessive stomach acid and are very good at helping heal ulcers. PPIs can even help prevent ulcers. People taking blood thinners like warfarin or Coumadin® together with pain medicines like ibuprofen or naproxen have less problems with bleeding ulcers if they are also taking a PPI.
Twenty-two years ago while taking the very last capsule of an antibiotic called doxycycline, it got stuck. Extra water didn’t help. I could feel a pressure beneath my breastbone right where that darn pill had stuck. Soon it felt like I was swallowing fire every time I ate or drank anything. The pain kept increasing until I ended up in the Emergency Department diagnosed with an ulcer in my esophagus, all because of a pill dissolving in the wrong place!
The ER doctor started me on a prescription medicine called Prilosec®, the very first PPI available and for the next 6 weeks spicy food was off-limits. I glumly ate yogurt while my family enjoyed the Tex-Mex food at my youngest sister Margaret’s wedding in Austin, Texas.
Is it okay to take a PPI year after year?
It seems to be safe to take a PPI for years instead of just months, but there is a price. Absorbing Vitamin B12, iron, calcium and magnesium depends on having a certain amount of stomach acid. Those who take PPIs longer than a few months risk becoming deficient in these critical nutrients. Long-term use of PPIs is also associated with an increase in bone fractures both in men and women, possibly related to absorbing less calcium.
Stomach acid is one of the most important defenses our body has against foreign organisms. Taking a PPI long-term can lead to increased infections such as pneumonia or a particular organism called Clostridium difficile that causes antibiotic-associated diarrhea.
If you’ve suffered from heartburn when stopping your PPI you are not alone. Between 60-90% of folks taking a PPI for at least 3 months notice symptoms of stomach burning when they stop taking it.
Having heartburn symptoms come back when you stop your Prevacid® doesn’t mean you’re stuck on it for the rest of your life.

Here are 3 approaches to reducing your dependence on a PPI medicine:
1.     If your doctor has no objections, slowly taper the dose down over several months before stopping it. If you take your PPI twice a day, start the taper by decreasing or stopping the evening dose. If you take the PPI once a day, taper by cutting the dose in half or taking it every other day. Stay on the reduced dose for several weeks before trying another decrease.
Taper the PPI dose every few weeks until you are off it completely. If your symptoms come back, start with the last dose you were symptom-free and stay on it another few weeks before trying to taper it. For some people this may take up to 9 months.
2.     Switch to an older stomach medicine like Zantac® or ranitidine to help control your symptoms. Called an H2-blocker, medicines like Zantac® work best when taken at night. Taking a PPI in the morning and rantidine (Zantac®) at night can help keep your symptoms under control while tapering your PPI.
3.    If your prescription PPI taper isn’t feasible or successful, you can switch to a PPI available without a prescription such as Prilosec® OTC or Prevacid® 24HR®. Another PPI has just become available over-the-counter (OTC): Nexium® 24HR.
For occasional fast-acting relief of heartburn, antacids like Tums®, Mylanta® and Maalox® are available in liquid form or chewable tablets. These older antacid products often contain calcium or magnesium, which can interfere with absorbing some prescription medicines. Please check with your pharmacist before taking them.

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The Importance of Vitamin B12

One of my patients is a retired Marine. A few months ago he told me that he had been suffering from pains in his legs and feet for a couple of years. His doctor had tried several different pain medicines, but none of them really did much so he quit them all and just put up with it. Then he started taking a B vitamin with a lot of B12 in it, and to his amazement, within 3 days his feet and legs stopped hurting. It’s been over 6 months and the pain hasn’t come back. He’s decided to continue the vitamin, just to make sure.

Vitamin B12 is a water-soluble B vitamin that helps your body make new red blood cells , helps your nerves work, and prevents certain kinds of anemia. A deficiency in Vitamin B12 can show up as fatigue, weakness, depression or pain in your feet or hands.

According to the National Institutes of Health (NIH), Vitamin B12 is found mostly in animal proteins, such as fish, meat, poultry, eggs, milk, and milk products. Most healthy adults get enough Vitamin B12 in their diet; those who don’t either don’t get much animal protein in their diet or aren’t able to absorb Vitamin B12 very well.
Strict vegetarians may not get enough animal protein in their diet to satisfy the recommendation of 1 to 2 mcg daily of Vitamin B12. Others become deficient because they cannot absorb it very well, like the elderly, those who have had gastric bypass surgery and people who take certain medicines.

The most common cause of Vitamin B12 deficiency is not being able to absorb it. This can be due to a condition called atrophic gastritis, which affects 10-30% of the elderly. Atrophic gastritis interferes with the ability to absorb Vitamin B12 from your food because it decreases secretion of digestive juices such as gastric acid.
Our bodies only absorb about half the Vitamin B12 we get in our diet, which is usually attached to animal based protein like ground beef or chicken. Without enough stomach acid, your body can’t break down proteins and Vitamin B12 stays stuck to the protein.

Those who don’t absorb Vitamin B12 well may notice benefit from higher amounts of supplementation.
Medicines that can contribute to poor absorption and deficiency of Vitamin B12 include acid-reducing medicines such as Prilosec® (also known as omeprazole), Prevacid® (also known as lansoprazole), Protonix® or Nexium®. Older acid-blocking medicines which also impair absorption of Vitamin B12 include Zantac® (ranitidine), Pepcid® or Axid®. Metformin, a common pill for diabetes can also interfere with absorption of Vitamin B12.
Vitamin B12 contains cobalt and is available in several forms. The Vitamin B12 that is given as a shot is cyanocobalamin. Oral supplements are available as either cyanocobalamin, or methylcobalamin, and can be purchased without a prescription.

Most people who can absorb Vitamin B12 well only require 1 or 2 mcg daily. If you are over 70, take medicine for heartburn or an ulcer or have had gastric bypass surgery, you may need more than that. 1000-2000mcg daily of Vitamin B12 as an oral or a sublingual tablet can overcome poor absorption. Be sure to avoid the timed-release or long-acting products, because they may not be as well absorbed as the immediate release forms.
Since Vitamin B12 isn’t found in plant foods, if you are vegetarian the National Institutes of Heath suggests fortified breakfast cereals as an alternative source.

Vitamin B12 deficiency can be detected with a blood test. There are several ways to get more of the vitamin: monthly injections from your medical provider, tablets that you swallow and tablets that dissolve under your tongue. Your doctor or medical provider can advise you which would be best for you to take, and how much. There’s more information about Vitamin B12 at http://ods.od.nih.gov/factsheets/VitaminB12-QuickFacts/.

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