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Type of Drug
corticosteroids, Oral (kor-tih-koe-STER-oids)
Brand Names
Betamethasone Celestone
Gerzq(t St D?Pdient: Budesonide Entocort EC
Cortisone Acetate &I
Dexamethasone EQ Mymethasone
Fludrocortisone
Hydrocortisone Cortef
Methylprednisolone 19 Medrol
Prednisolone 10
Orapred    Pediapred
Orapred ODT    Prelone
Prednisone 0 Prednisone Intensol    Sterapred
Prescribed For
A wide variety of disorders from rash to cancer, including adrenal disease, adrenal hormone replacement, bursitis, arthritis, severe skin diseases including psoriasis and other rashes, severe or disabling allergies, asthma, drug or serum sickness, attacks of multiple sclerosis, severe respiratory diseases including pneumonitis, blood disorders, gastrointestinal (GI) disease including ulcerative colitis and Crohn’s disease, and inflammation of the nerves, heart, or other organs. Dexamethasone is also used to treat mountain sickness, vomiting, bronchial disease in premature babies, excessive hairiness, and hearing loss associated with bacterial meningitis. Fludrocortisone is used to treat Addison’s disease and for symptomatic orthostatic hypotension. Prednisone is used to improve strength and function of some muscular dystrophy patients. Methylprednisolone is used to decrease mortality in some patients suffering from severe alcoholism and chronic active hepatitis.
General Information
Produced by the adrenal gland, natural corticosteroids are hormones that affect almost every body system. The major dMeyences among corticosteroid drugs are potency and variation in secondary effects, 0OZ10r preference and past experience with a Mftosferoid usually determine which drug to prescribe for a specific disease.
Cautions and Warnings
Do not use an oral corticosteroid if you are allergic or sensitive to any of its ingredients.
Corticosteroids may mask symptoms of an infection. Because these drugs compromise the immune system, new infections may occur during corticosteroid treatment; when this happens, a relatively minor infection that would respond to ordinary treatment can turn serious. Corticosteroids may impair immune response to hepatitis B, prolonging recovery. They may reactivate dormant amebiasis (a parasitic infection). Corticosteroids should not be taken if you have a fungal blood infection, because they can allow the infection to spread more easily. They should be used with caution by people with herpes eye infection, tuberculosis or in any other bacterial, fungal, or viral infections.
Long-term use of any corticosteroid may increase the risk of developing cataracts, glaucoma, or eye infections, especially viral or fungal.
When stopping a corticosteroid, dosage must be reduced gradually under a doctor’s supervision—otherwise you may experience adrenal gland failure.
If you are taking large corticosteroid doses. you should not receive any live virus vaccine because corticosteroids interfere with the body’s reaction to the vaccine.
Hydrocortisone and cortisone may lead to high blood pressure. Other corticosteroids are less likely to affect blood pressure.
Corticosteroids should be used with caution if you have severe kidney disease.
High-dose or long-term corticosteroid therapy may aggravate or worsen stomach ulcers. This may occur when total dosage reaches 1000 mg of prednisone, 150 mg of betamethasone or dexamethasone, 5000 mg of cortisone. 4000 mg of hydrocortisone, 1000 mg of prednisolone, or 800 mg of methylprednisolone.
People who have recently stopped taking a corticosteroid and are going through a period of stress may need small doses of a rapid-acting corticosteroid, such as hydrocortisone, to get them through this period. Call your doctor if you think you might be experiencing this kind of stress reaction.
Use corticosteroids with caution if you have had a recent heart attack or have, Colitis, heart failure, high blood pressure, blood-clotting tendencies, thrombophlebitis, osteoporosis, antibiotic-resistant infections, Cushing’s disease, myasthenia gravis, metastatic cancer, diabetes, underactive thyroid disease, cirrhosis of the liver, or seizure disorders.
corticosteroid psychosis (symptoms include euphoria or feeling “high,” delirium, sleeplessness, mood swings, personality changes, and severe depression) may develop in people taking dosages greater than 40 mg a day of prednisone. These symptoms may also develop with other corticosteroids taken in equivalent doses (see “Usual Dose” for relative equivalencies). Symptoms of corticosteroid psychosis usually develop within 15-30 days of beginning treatment. These symptoms may also be linked to other factors—women and those with a family history of psychosis are more at risk.
Corticosteroids can cause loss of calcium, which may result in bone fractures and aseptic necrosis of the femoral and humorai heads (a condition in which the large bones in the hip degenerate from loss of calcium).
Prednisone may aggravate emotional instability.
Corticosteroids do not cure multiple sclerosis (MS) or slow its progression, though they may speed recovery from attacks of the disease.
. Corticosteroid products often contain tartrazine dyes and sulfite preservatives. Many people are allergic to these chemicals.
Possible Side Effects
✓    Most common: headache, respiratory infections, acne, and bruising.
✓    Common: water retention (swollen ankles), back pain, heart failure, upset stomach (possibly leading to stomach or duodenal ulcer), potassium loss, dizziness, fatigue, insomnia, weight gain, increased appetite, nausea, stomach gas, abdominal pain, general pain, muscle weakness, loss of muscle mass, slowed healing of wounds, increased sweating, allergic rash, itching, convulsions, excess hair growth, and worsening of a pre-existing psychiatric condition.
✓    Less common: irregular menstruation; slowed growth in children, particularly after lengthy periods of corticosteroid treatment; adrenal or pituitary gland suppression; diabetes; drug sensitivity or allergic reactions; blood clots; moon face; feeling unwell; euphoria; mood swings; personality Changes; and severe depression.
♦    Rare: Rare side effects can appear in any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Tell your doctor if you are taking any oral anticoagulant (blood-thinning) drug. If you begin taking a corticosteroid, your anticoagulant dosage may have to be adjusted.
•    Combining a corticosteroid and a diuretic such as hydrochlorothiazide may cause loss of blood potassium. Low blood potassium may increase the side effects of digitalis drugs.
•    Contraceptive drugs, estrogen, erythromycin, azithromycin, clarithromycin, and ketoconazole may increase the risk of corticosteroid side effects.
•    Barbiturates, aminoglutethimide, phenytoin and other hydantoin anticonvulsants, rifampin, ephedrine, colestipol, and cholestyramine may reduce the effectiveness of corticosteroids.
•    Corticosteroids may decrease the effects of aspirin and other salicylates, growth hormones, and isoniazid.
•    Combining a corticosteroid and a theophylline drug may require a dosage adjustment of either or both drugs.
•    Corticosteroids may interfere with laboratory tests. Tell your doctor if you are taking any of these drugs so that tests are properly analyzed.
•    Limit your intake of alcohol while on oral corticosteroids.
Food Interactions
Take corticosteroids with food or a small amount of antacid to avoid stomach upset. If stomach upset continues, notify your doctor. Grapefruit juice doubles the amount of some oral corticosteroids absorbed into the blood.
Usual Dose
Once-daily doses should be taken in the morning. Dosages vary greatly and depend upon the specific disease being treated. Dosages for infants and children should be individualized according to severity of disease and response to treatment.
Betamethasone: starting dosage-0.6-7.2 mg a day. Maintenance 1609age-0.6-7.2 mg a day.
Budesonide: 9 mg a day.
Cortisone: starting dosage-25-300 mg a day. Maintenance dosage-25-300 mg a day.
Dexamethasone: 0.75-9 mg a day. Daily dosage sometimes exceeds 9 mg. A temporary dosage increase may be necessary it you are experiencing emotional stress. In alternate-day therapy, twice the usual daily dose is taken every other day.
Hydrocortisone: 20-240 mg a day.
Methylprednisolone: starting dosage-4-48 mg or more a day. Maintenance dosage varies. A temporary dosage increase may be necessary if you are experiencing emotional stress. in alternate-day therapy, twice the usual daily dose is taken every other day.
Prednisone and Prednisoione: 5-60 mg a day. Daily dosage sometimes exceeds 60 mg. A temporary dosage increase may be necessary if you are experiencing emotional stress. In alternate-day therapy, twice the usual daily dose is taken every other day.
Equivalent doses: Using 5 mg of prednisone as the basis for comparison, equivalent doses of other corticosteroids are 0.6 mg-0.75 mg of betamethasone, 25 mg of cortisone, 0.75 mg of dexamethasone, 20 mg of hydrocortisone, 4 mg of methylprednisolone, and 5 mg of prednisolone.
Overdosage
Symptoms of overdose are anxiety, depression or stimulation, joint or muscle pain, blurred vision, stomach bleeding, increased blood sugar, high blood pressure, and water retention. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Do not stop taking this medication without your doctor’s knowledge. Suddenly stopping any corticosteroid drug may have severe consequences; the dosage must be gradually reduced by your doctor.
G& your doctor if you develop unusual weight gain, black or tarry stools, swelling of the feet or legs, muscle weakness, vomiting of blood, menstrual irregularity, prolonged sore throat, fever, cold or infection, appetite loss, nausea and vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar.
If you take several doses a day and forget a dose, take the dose you forgot as soon as possible. It it is almost time for your next dose, skip the one you forgot and double the next dose. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
If you take a corticosteroid every other day and forget a dose, take it immediately if you remember it in the morning of your regularly scheduled day. If it is much later in the day, skip the dose you forgot and take it the following morning, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Studies have shown that long-term corticosteroid therapy at high dosages may cause birth defects, as may chronic corticosteroid use during the first 3 months of pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Corticosteroids taken by mouth may pass into breast milk. Most nursing mothers who must take a corticosteroid should use infant formula, though low dosages of some of these drugs may be taken for short periods while breast-feeding. Consult your doctor.
Seniors: Seniors are more likely to develop high blood pressure while taking an oral corticosteroid. Older women are more susceptible to osteoporosis (a condition characterized by loss of bone mass due to depletion of minerals, especially calcium) associated with high dosages of oral corticosteriods. Lower dosages are just as effective in seniors and cause fewer side effects.

Type of Drug
Corticosteroids, Topical
(kor-tih-koe-STER-oids)
Brand NameS
CLASS 1–Super-potent topical products
Betamethasone Dipropionate gel, ointment 0.05% 91
Diprolene gel/ointment
C/obetasol Propionate 0.05% cream, foam, gel, lotion, shampoo, ointment 19
Clobex    Olux
Cormax    Olux E
Embeline    Temovate Embeline E
Difforasone Diacetate ointment 0.05% RE Olux-E Foam    Psorcon E
Fluocinonide cream 0.1 % 0 Vanos
Flurandrenolide tape 4 MCgICM2 Rfl Cordran Tape
Halobetasol Propionate cream/ ointment 0.05%
Ultravate
CLASS 2—High-potency topical products  Amcinonide ointment 0.1 % (0
Betamethasone Dipropionate cream 0.05%
Diprolene AF
Generic Ingredients: Betamethasone Dipropionate (0.064%) + Calcipotriene (0.005%) ointment
Taclonex
Desoximetasone Cream, ointment 0.25% and 0.05%; 0.05% gel DG
Topicort    Topicort LP
Generic 10gVEOUnt.- Diflorasone Diacetate cream, ointment 0.05% 91
Apexicon    Florone E
Apexicon E    Maxiflor
Florone    Psorcon
Fluocinonide cream, gel, ointment,
solution 0.05% 9
Lidex    Lidex E
Halcinonide cream, ointment, solution 0.1 % Halog
Mometasone Furoate ointment 0.1 % 91 Elocon
Triamcinolone Acetonide ointment 0.5% RE
CLASS 3—Upper mid-strength topical products  Amcinonide lotion 0.1 % 0
Betamethasone Dipropionate cream 0.05% (a
Diprolene    Teladar
Maxivate
Generic Ingredient.- Betamethasone Valerate ointment 0.1 %
Fluocinofone Acetonide [’61 Capex Shampoo
Fluticasone Propionate cream 0.05% 9 Cutivate
Triamcinolone Acetonide cream 0.5%
Delta-Tritex    Kenonel
Flutex    Triacet
Kenalog Cream    Triderm Kenalog-H
CLASS 4—Mid-strength topical products  Amcftnide cream 0.1% D3
Betamethasone Dipropionate lotion 0.05% and foam 0.12%®
Diprosone    Maxivate Lotion
Luxiq Foam
Desoximetasone cream 0.05% 19 Topicort
Fluocinolone Acetonide
Synalar Ointment 0.025%    Synalar-HP Cream 0.2%
Flurandrenolide ointment 0.05% Cordran
Fluticasone Propionate lotion 0.05% Cutivate
Hydrocortisone Valerate ointment 0.2% ED Westcort
Mometasone Furoate cream, lotion, solution 0.1
Elocon
Prednicarbate ointment 0.1 % 10 Dermatop E
Triamcinolone Acetonide 0.1 %
Aristocort A    Delta-Tritex Cream
Aristocort Cream and    Kenalog
Ointment    Triderm
CLASS 5—Lower mid-strength topical products  Betamethasone Valerate cream, lotion 0.1
Beta-Val    Dermabet
Betatrex    Valnac
Clocortolone Pivalate cream 0.1 % Cloderm
Desonide ointment 0.0511/0
Desonate    Tridesilon
UnOwen    Verdeso Foam Lokara
Fluocinolone Acetonide cream 0.025% 91 Synalar
Flurandrenolide cream, lotion M Cordran Lotion 0.05% Cordran SP 0.05% Cordran Ointment 0.25%
Fluticasone Propionate ointment 0.005% Cutivate
Hydrocortisone Butyrate Cream, ointment, solution 0.1 0
Locoid
Hydrocortisone Probutate 0.1% Pandel
Hydrocortisone Valerate cream 0.2% RE Westcort
Prednicarbate Cream 0.1 % RE Dermatop E
CLASS 6—Mild topical products
Alclometasone Dipropionate cream, ointment 0.05% 91
Aclovate
Desonide cream, lotion 0.05% DesOwen    Tridesilon Lokara
Fluocinolone Acetonide cream, shampoo, solution 0.01%
Derma-Smoothe/FS Oil    FS Shampoo
Flurosyn    Synalar
Flurandrenolide cream DG Cordran SP 0.025%
Generic Ingredient., Triamcinoione Acetonide cream 0.1 % MS10cort
Triamcinolone Acetonide cream 0.025% Flutex    Triacet
Kenalog
CLASS 7—Least potent topical products  Hydrocortisone A
1% HC    HydroSkin
Ala-Cort    HydroTex
Ala-Scalp    Hytone
Alcortin    Ivy Soothe
Analpram-HC    Maximum Strength Bactine
Anusol-HC    Maximum Strength Cortaid
Cetacort    Maximum Strength Cortaid
Cortaid Intensive Therapy    Faststick
Cortizone-5    Maximum Strength
Cortizone-10    KeriCort-1 0
Cortizone-10 Plus    Nutracort
Cortizone-10 Quickshot    Procort
Cortizone for Kids    Proctocream-HC
Delcort    Proctofoam-HC
Extra Strength CortaGel    Stie-cort
Hemril    Synacort
Hi-Cor 1.0    Tegrin HC
Hi-Cor 2.5    Texacort Hycort
Hydrocortisone Acetate cream, ointment 0.5% and 1%G
Cortef Feminine Itch    Lanacort
Corticaine    Maximum Strength Caldecort
Cortifoam    Micort-HC
Dricort    U-Cort Gynecort Female Creme
Prescribed For
Inflammation, itching, eczema, dermatitis, vitiligo (patchy loss of skin color), blistering skin diseases, lupus and other connective tissue diseases, psoriasis, and many other specialized skin problems; may also be used to Weal severe diaper rash.
General Information
Topical corticosteroids do not cure the underlying cause of skin problems, but they can relieve symptoms of rash, itching, or inflammation by interfering with the body mechanisms that produce them. You should never use a topical corticosteroid without your doctor’s knowledge because it could mask a symptom important in diagnosing your condition. Also, improper use of a topical corticosteroid could lead to unwanted and sometimes permanent side effects. In general, ointment forms of topical steroids are more potent and usually more effective than cream or lotion forms. Ointments are also less likely to cause allergic reactions because they contain fewer inactive ingredients.
Generic products in this group can vary in potency and produce different results from their brand-name counterparts, even though they contain the identical quantity of active ingredient. Topical steroids are rated from 1 (most potent) to 7 (least potent). Generally, products within a potency class are interchangeable. Ask your doctor or pharmacist which products are interchangeable. The lowest potency products are available without a prescription. Ointments tend to be more potent than creams and solutions and different product concentrations affect their classification.
Super-potent topical corticosteroids (class 1) should not be used on the face, neck, under the arms, or in the groin area. These products are generally reserved for situations in which less potent products have not worked. They should be used with caution, and should only be applied to the areas that are affected with the rash. Using a product in this category for longer than 2 weeks at a time increases the risk of permanent skin damage.
High-potency topical corticosteroids (classes 2 and 3) are best for the trunk, arms, and legs, but should not be used on the face, neck, under the arms, or in the groin area. Using a product in this category for longer than 2 weeks at a time increases the risk of permanent skin damage.
Intermediate-potency topical corticosteroids (classes 4 and 5) can be used in children for up to 1-2 weeks at a time. This type of medication is best for the trunk and extremities. It is safer for use on thin skin, and less effective on thicker skin.
Low-potency topical corticosteroids (classes 6 and 7) can be used on any part of the body, and can be used in children. They are the best choice for the face, uadera~m area, groin, neck, and i ftl Occluded areas such as skin folds.
Cautions and Warnings
Do not use a topical corticosteroid if you are allergic or sensitive to corticosteroids or to any ingredients of the aerosol, cream, gel, lotion, ointment, or solution. Do not use a topical corticosteroid as the sole treatment for bacterial skin infections such as impetigo, viral skin diseases such as herpes, fungal skin infections such as athlete’s foot, or known tuberculosis of the skin. These drugs should not be used in the ear if the eardrum is perforated. Do not use a topical corticosteroid on ulcerated skin, or to treat acne.
Skin problems can become less responsive with time if a product is applied continuously over a long period of time. This can re-
sult in a flare-up of the problem when the medication is stopped.
Using a less potent product may avoid this problem.
Rectal corticosteroid products should not be used if you have any serious bowel condition, including bowel perforation, obstruction, abscess, and systemic fungal infection.
The rectal foam is not expelled after it has been applied and may result in higher drug blood levels than those associated with rectal enema products. The risk of systemic (whole-body) side effects is greater when more of the drug enters the blood. If there is no improvement after 2 or 3 weeks of using a rectal corticosteroid, contact your doctor.
Using a topical corticosteroid around the eyes for prolonged periods may cause cataracts, glaucoma and/or permanent thinning and fragility of skin around the eyes where the corticosteroid is being applied.
Children may be more susceptible to serious systemic side effects from topical corticosteroids, including growth retardation, Cushing’s syndrome, and suppression of natural corticosteroid production, requiring a tapering of the medication, especially if the medications are applied to large areas over long periods. Super-potent topical corticosteroids are not recommended for children.
Possible Side Effects
♦ Most common: burning; itching; irritation; “steroid” acne; skin thinning, tightening, or discoloration; stretch marks; dry cracked skin; bruising; and secondary i0ection. These effects are more likely when the treated area is covered Stith al) occlusive bandage (one that prevents contact with water and air). Side effects are more likely with extended use of high-potency topical corticosteroid products and when the treated area is covered with a bandage that completely prevents skin contact with water and air.
Possible Side Effects (continued)
V Significant amounts of corticosteroids may be absorbed into the bloodstream if large amounts are used for long periods. This can result in systemic effects and may cause serious problems, particularly in people with liver disease. Systemic side effects include lightheadedness, hives, growth suppression, and adrenal suppression.
Drug Interactions None known.
Usual Dose
Adult
Cream, Ointment, Solution, Foam, and Aerosol: Apply a thin film to the skin 2-3 times a day. High- and super-potent products should be applied no more than twice a day, and should be used for short-term treatment, usually 2-3 weeks at a time. Some may have to be applied only once a day.
Rectal Enema: 100 mg nightly for 21 days.
Rectal Foam: 1 applicator’s worth, 1-2 times a day for 2-3 weeks.
Child: Dosages for children should be limited to the lowest possible potency.
Overdosage
Serious adverse effects are unlikely after accidental ingestion. Excessive use of large amounts of topical corticosteroids may cause overdose symptoms and require gradual discontinuation of the drug. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the prescription bottle or container.
Special Information
To prevent secondary infection, clean the skin before applying the drug. Apply a very thin film and rub in gently—effectiveness depends m contact area, not the thickness of the layer applied.
Do not wash, rub, or put clothing on the area until the medication has dried.
Topical corticosteroids have an additive effect: with continuous use, 1 or 2 applications a day may be as effective as 3 or more. Once the drug begins to take effect, your doctor may recommend reducing the dose to the minimum level needed to control the
condition.
Flurandrenolide tape comes with specific directions for use-, fol-
low them carefully.
If your doctor instructs you to apply plastic wrap or any other occlusive dressing, follow directions carefully. These dressings can increase the penetration of the drug into your skin by as much as 10 times, which may be a crucial element in the medication’s effectiveness. Occlusive dressings should not be used with any of the super-potent topical products.
If you are using one of these products for diaper rash, do not use tight-fitting diapers or plastic pants, which can cause too much drug to be absorbed into the blood.
Your doctor may prescribe a specific form of the product with good reason. Do not change forms without your doctor’s knowledge: a different form may not be as effective.
If you forget to administer a dose, do so as Soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not administer a double dose.
Special Populations
Pregnancy/Breast-feeding: Large amounts of corticosteroids applied to the skin for long periods of time may increase the risk of birth defects. When your doctor considers any of these drugs crucial, its potential benefits must be carefully weighed against its risks. Do not use any over-the-counter hydrocortisone product for more than a few days without your doctor’s knowledge.
Nursing mothers who must use a topical corticosteroid should consider using infant formula. If you apply a corticosteroid to the nipple area, be sure to completely clean the area prior to nursing. Nursing mothers should never use the highest potency corticosteroids (classes 1, 2 or 3) because of the risk of absorbing large amounts of drug into the system that could find its way into breast milk. Nursing mothers should discuss toqkoa1 corticosteroid use with their doctor befQ(e,applying any product.
Seniors: Seniors are more susceptible to high blood pressure and osteoporosis (a condition characterized by loss of bone mass due to depletion of minerals, especially calcium) associated with large dosages. These effects are unlikely with topical corticosteroids unless a high-potency medication is used over a large area for an extended period.

Brand Name
Cortisporin Otic
Generic Ingredients
Hydrocortisone + Neomycin Sulfate + Polymyxin B Sulfate RE
Other Brand Names
AK-Spore H.C. Otic    Octicair
Antibiotic    Otic-Care
Cortatrigen Ear Drops    Otocort
Drotic    Pediotic
Ear-Eze    UAD LazerSporin-C
Type of Drug
Antibiotic and corticosteroid combination.
Prescribed For
Superficial ear infection, ear inflammation or itching, and other outer ear problems.
General Information
Cortisporin Otic contains a corticosteroid to reduce inflammation and 2 antibiotics to treat local ear infections. This combination can be quite useful for local ear problems because of its dual method of action and its relatively broad applicability.
Cautions and Warnings
Do not use Cortisporin Otic if you are allergic or sensitive to any of its ingredients.
Cortisporin Otic is designed for use in the ear. It can be very damaging if placed into the eye.
Cortisporin should not be used if you have herpes simplex, vaccinia, or chickenpox. It also should not be used by patients sensitive to sulfite.
Cortisporin Otic should not be used iAyou have a perforated eardrum,
Possible Side Effects
V Local irritation, such as itching or burning, may occur as a drug sensitivity or allergic reaction.
Drug Interactions None known.
Usual Dose
3-4 drops in the affected ear 3-4 times a day. Treatment should not last beyond 10 days.
Overdosage
The amount of drug contained in each bottle is too small to cause serious problems. Call a hospital emergency room or your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Use only when prescribed by a physician. Overuse of this or similar products can result in the growth of new organisms, such as fungi. If new infections or problems appear, stop using the drug and contact your doctor.
Before administering drops, wash your hands, then hold the Closed bottle in your hand for a few minutes to warm it to body temperature. Shake well for 10 seconds. For best results, drops should not be self-administered, but given by another person. The person receiving the drops should lie on his or her side with the affected ear facing upward. Fill the dropper and instill the required number of drops directly in the ear canal.
If the drops are being given to an infant, hold the earlobe down and back to allow the drops to run in. If the drops are being given to an older child or adult, hold the earlobe up and back to allow them to run in. Do not put the dropper into the ear or allow it to touch any part of the ear or bottle. Keep the ear tilted for about 5 minutes after the drops have been put in or insert a soft cotton plug, whichever is recommended by your doctor.
If you forget to administer a dose of Cortisporin Otic, do so as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedQ%e. Do not apply a double dose.
Special Populations
Pregnancy/Breast-feeding: There are no studies of Cortisporin Otic in pregnant women but it does contain a corticosteroid, which when used over long periods of time in other formulations may increase the risk of birth defects. This drug should only be used during pregnancy after carefully weighing it potential benefits against its risks. Nursing mothers who must take this drug should use in-Pant formula.
Seniors: Seniors may use this product without special restriction.

Brand Name
Cosopt
Generic Ingredients  Dorzolamide + Timolol
Type of Drug
Carbonic anhydrase inhibitor and beta blocker combination.
Prescribed For
Open-angle glaucoma and ocular hypertension.
General Information
Cosopt contains 2 glaucoma drugs that work in different ways. It is intended for people whose glaucoma does not respond to either drug used alone. Small amounts of dorzolamide and timololthe active ingredients in Cosopt–enter the bloodstream.
Cautions and Warnings
Do not use Cosopt if you are allergic or sensitive to any of its ingredients or cannot take sulfa drugs or beta blockers. Cosopt should not be used by people with bronchial asthma, severe chronic obstructive pulmonary disease, slow heart rate or heart block, heart failure, or who are in shock.
People with diabetes or an overactive thyroid should use Cosopt with caution since beta blockers can mask the signs of low blood sugar or hyperthyroidism.
Small amounts of both ingredients enter the bloodstream and can produce the same kinds of systemic (whole-body) reactions associated with larger dosages of either a sulfa drug or beta blocker. Stop using the drug at once and call your doctor if a serious reaction develops.
4lt?18b)ockers may have to be discontinued prior to major surgery because they can affect the heart’s ability to respond normally. Some people taking a beta blocker experience severe reductions in blood flow while undergoing general anesthesia.
Dorzolamide should not be used by people with kidney disease and has not been studied in people with liver disease.
People with a history of severe allergic reactions who take a beta blocker may be at increased risk of experiencing a reaction because the drug blocks part of the body’s natural allergic
response.
Timolol can worsen the muscle weakness that accompanies myasthenia gravis.
Possible Side Effects
♦    Most common: changes in sense of taste, especially bitterness or sourness; increased sensitivity to light; and a burning or stinging sensation in the eye.
♦    Common: eye redness, irritation, or itching, and blurred vision.
♦    Less common: abdominal pain, back pain, eyelid inflammation, bronchitis, cloudy vision, eye discharge or swelling, conjunctivitis (pinkeye), corneal erosion, corneal staining, lens cloudiness, cough, dizziness, dry eye, upset stomach, drug particles in the eye, eye pain, tearing, eyelid scaling, eyelid pain or discomfort, sensation of something in the eye, headache, high blood pressure, influenza, lens discoloration, nausea, sore throat, cataracts, sinus irritation, respiratory infection, urinary infection, visual problems, and retinal detachment.
•    Rare: slow heartbeat, heart block or failure, chest pain, stroke, depression, diarrhea, dry mouth, breathing difficulties, low blood pressure, stuffy nose, rash, tingling in the hands or feet, kidney stones, and vomiting. Contact your doctor if you experience any side effect not listed above.
See Dorzolamide, page 200, and Timolol, page 1129, for fur-
ther side effect information.
Drug Interactions
•    If you use more than 1 eyedrop medkc;a~mn, separate doses of these drugs tai z& Y@ast 10 minutes.
•    COSOpt can increase the effect of other carbonic anhydrase inhibitors.
•    Combining Cosopt with an oral beta blocker or another calcium antagonist may increase the risk of side effects, especially changes in heart rhythm and low blood pressure.
•    Do not combine Cosopt and another beta-blocking eyedrop.
•    Combining Cosopt and reserpine can lead to low blood pressure, slowing of heartbeat, and dizziness or fainting.
•    Combining Cosopt with digitalis and a calcium antagonist, or with quinidine, can slow heartbeat.
See Dorzolamide, page 200, and Timolol, page 1129, for further drug interactions.
Usual Dose
Adult: 1 drop in the affected eye twice a day. Child: not recommended.
Overdosage
Little is known about the effects of Cosopt overdose or accidental ingestion. Possible overdose symptoms include dizziness, headache, shortness of breath, slow heartbeat, breathing difficulties, heart attack, and nervous system effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Conjunctivitis (pinkeye) and eyelid reactions can occur due to an allergic reaction or as the result of local irritation. If you experience either of these problems, stop using the drug and call your doctor so that your condition can be evaluated.
To prevent infection, do not allow the eyedropper to touch your fingers, eyelids, or any surface. Wait at least 10 minutes before using any other eyedrops.
Cosopt contains benzalkonium chloride (a preservative), which may be absorbed by soft contact lenses. Remove your soft contact lenses before using the eyedrops; you may put them back in 15 minutes after a dose.
If you forget a dose of Cosopt, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Store Cosopt away from sunlight.
Special Populations
Pregnancy/Breast-feeding: The safety of using Cosopt is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if dorMlamidle passes into breast milk, though timolol does. Nursing mothers who must use Cosopt should use
infant formula.
Seniors: Seniors may use Cosopt without precaution.

Generic Name
Clemastine (KLEH-mas-tene) A
Brand Names
DayHist-1    Tavist-1
Tavist    Tavist Allergy
Combination Pr(3dUtj
Generic Ingredients: Acetaminophen + Clemastine + Pseudoephedrine
Tavist Allergy/Sinus/Headache
Type of Drug  Antihistamine.
Prescribed For
Sneezing, stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergies and for other symptoms of allergies such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of naturally occuring histamine (a chemical released by body tissue during an allergic reaction) from cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes. Clemastine fumarate is less sedating than most antihistamines, but not less sedating than astemizole, cetirizine, or loratadine.
Cautions and Warnings
Clemastine should not be taken if you are allergic or sensitive to any of its ingredients.
People with asthma or other deep-breathing problems, heart disease, high blood pressure, diabetes, enlarged prostate, glaucoma, stomach ulcers or other stomach problems, and hyperthyroidism should use clemastine with caution because its side effects can aggravate these problems.
Possible Side Effects
✓    Most common: drowsiness; headache; weakness; nervousness; stomach upset; nausea; vomiting; cough; stuffy nose; diarrhea; constipation; sore throat; nosebleeds; and dry mouth, nose, or throat.
✓    Less common: allergic reaction (symptoms include rash, itching, hives, and breathing difficulties), sleeplessness, menstrual irregularities, muscle aches, sweating, tingling in the hands or feet, frequent urination, visual disturbances, and ringing or buzzing in the ears.
Drug Interactions
•    Cbrnbining clemastine with alcohol, sedatives, sleeping pills, or other nervous system depressants may increase the depressant effects of clemastine. Do not combine these drugs.
•    The effects of oral anticoagulant (blood-thinning) drugs may be decreased by clemastine. Do not take this combination without your doctor’s knowledge.
Monoamine oxidase inhibitor antidepressants may increase the drying and other effects of clemastine. This combination can also worsen urinary difficulties.
e When taking antihistamines on a regular basis, notify your doctor if you are taking large amounts of aspirin. Effects of too much aspirin may be masked by the antihistamine.
Food Interactions
Clemastine is best taken on an empty stomach at least 1 hour before or 2 hours after eating; it may be taken with food if it upsets your stomach.
Usual Dose
Adult and Child (age 12 and over): 1.34 mg twice a day up to 8.04 mg of the syrup or 2.68 mg of the tablets in 24 hours.
Child (age 6-12) (syrup only): 0.67 mg twice a day or up to 4.02 mg a day.
Overdosage
Overdose is likely to cause severe side effects. Overdose victims should be given ipecac syrup—available at any pharmacy—to induce vomiting and should then be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Clemastine may make it difficult for you to concentrate or perform complex tasks such as driving a car. Be sure to report any unusual side effects to your doctor
Antihistamines may occasionally produce excitability, particularly in children.
If you forget to take a dose of clemastine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feedj(IV. DO not take any antihistamines without WU ‘Obtlor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of clemastine pass into breast milk. Nursing mothers who must take clemastine should use infant formula.
Seniors: Seniors are more sensitive to side effects.

Generic Name
Clindamycin (klin-duh-MYE-sin)
Brand Names
Cleocin    Clindesse
Cleocin T    Clindets
Clinda-Derm    Evoclin Clindagel
Type of Drug  Antibiotic.
Prescribed For
Serious bacterial infections. The vaginal cream is used to treat bacterial vaginosis. Topical clindamycin is used to treat acne and rosacea.
General Information
Clindamycin is one of the few oral drugs that is effective against anaerobic bacteria, which grow only in the absence of oxygen and are often found in infected wounds, lung abscesses, abdominal infections, and infections of the female genital tract. It also works against bacteria usually treated with penicillin or erythromycin, including serious respiratory tract infections. Clindamycin may be useful for treating certain skin or soft tissue infections. It kills the bacteria that frequently cause acne.
Clindamycin is not used to treat vaginal fungus or yeast infections.
Cautions and Warnings
Do not take clindamycin if you are allergic or sensitive to any of its ingredients or to lincomycin, another antibiotic.
People with asthma or a history of allergies should use clindamycin capsules with caution.
Clindamycin can cause a severe intestina(kmkation called colitis, which can be fatal. Signs of colitis are diarrhea, blood in the Stool, and abdominal cramps. Any form of this drug, including products applied to the skin and the vaginal cream, can provoke colitis. Because of this, clindamycin should be reserved for serious infections or those that cannot be treated with other drugs.
Clindamycin should be used with caution if you have gastrointestinal disease or kidney or liver disease.
Possible Side Effects
Capsules
✓    Most common: stomach pain; nausea-, vomiting-, diarrhea,
in up to 20% of people; and pain when swallowing.
♦    Less common: itching; rash; signs of serious drug sensitivity, such as difficulties breathing and yellowing of the skin or the whites of the eyes; colitis, (see “Cautions and Warnings”); effects on blood components; and joint pain.
Topical Lotion
♦    Most common: dry skin, redness, burning, peeling, oily skin, and itching.
♦    Less common: diarrhea, abdominal pain, upset stomach, and colitis (see “Cautions and Warnings”).
Vaginal Cream
♦    Most common: vaginal itching or irritation; thick, white vaginal discharge; and pain during intercourse.
♦    Less common: nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache, vertigo, and colitis (see “Cautions and Warnings”).
Drug Interactions
•    Do not combine clindamycin and erythromycin.
•    The absorption of clindamycin capsules into the bloodstream is delayed by Kaolin-Pectin Suspension (prescribed for diarrhea). Separate these drugs by at least 1 hour.
•    clindamycin should be used with caution by people also using neuromuscular agents.
Food Interactions
Take the oral medication with a full glass of water or with food to prevent irritation of the stomach and intestine.
Usual Dose
Capsules
MUIV ) 50-450 mg every 6 hours.
Child (under age 16): 3.5-11 mg per lb. of body weight a day, in 3-4 doses. For severe infections, at least 37.5 mg 3 times a day, regardless of weight.
Foam: Dispense enough to cover the affected area(s) onto a cool surface (the foam will melt on contact with warm skin). Use fin-gertips to massage small amounts into the affected area(s) until the foam disappears.
Suppositories: Insert 1 suppository a day for 3 consecutive days.
Topical Lotion: Wash the skin and pat dry before application. Apply enough to cover the affected area(s) with a thin coat twice a day.
Vaginal Cream: Insert 1 applicator’s worth at bedtime for 7 consecutive days, except for Clindesse, which requires one applicator’s worth once at any time of day.
Overdosage
clindamycin overdose may lead to severe diarrhea and other drug side effects. Do not treat this diarrhea on your own. Discontinue use of this drug and call your local poison center for information. If you go to an emergency room for treatment, ALWAYS bring the prescription bottle or container.
Special Information
Prolonged or unsupervised use of clindamycin may lead to secondary infections from susceptible organisms. such as fungi. Take this drug for the full course of therapy as indicated by your physician.
If you develop severe diarrhea or abdominal pain, call your doctor at once. Call your doctor immediately if you experience breathing difficulties or jaundice (yellowing of the skin or whites of the eyes).
Women using the vaginal cream should not have vaginal intercourse or use other vaginal products such as tampons or douches until treatment is complete.
Use of latex condoms or diaphragms within 72 hours following treatment with the vaginal creams or suppositories is not recommended. These products may decrease the efficacy of condoms or diaphragms.
The topical lotion is for external use only. Avoid contact with your eyes or mucous membranes.
If you miss a dose of oral clindamycin, take it as soon as you rememlae~. SSW19 almost time for your next dose of clindamycin, double that dose and go back to your regular dosage schedule.
Special Populations
Pregnancy/Breast-feeding: This drug crosses into fetal blood circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
clindamycin passes into breast milk. Nursing mothers who must take oral clindamycin should use infant formula.
Seniors: Seniors with other illnesses may be unable to tolerate diarrhea and other clindamycin side effects.

Generic Name
Clonazepam (klon-A-zeh-pam)
Brand Name  Klonopin
Type of Drug  Anticonvulsant.
Prescribed For
Petit mal and other seizures and panic attacks; also prescribed for periodic leg movements during sleep, speaking difficulty associated with Parkinson’s disease, acute manic episodes, nerve pain, and schizophrenia.
General Information
Clonazepam is a benzodiazepine drug. Clonazepam is not used as a sedative or hypnotic. It is used only for the uses described above in people who have not responded to other drug treatments. Tolerance to the effects of clonazepam commonly develops within about 3 months of use. Your doctor may raise your clonazepam dosage periodically to maintain the drug’s effect.
Cautions and Warnings
Do not take clonazepam if you are allergic or sensitive to any of its ingredients or any other benzodiazepine.
When stopping clonazepam treatments, the drug must be discontinued gradually. Abrupt discontinuance of clonazepam may lead to drug withdrawal symptoms including severe seizures, tremors, abdominal or muscle cramps, vomiting, whet increased sweating.
IJSIF,l OfMazeparn with caution if you have a chronic respiratory illness, since the drug tends to increase salivation and other respiratory secretions and can make breathing more labored.
Avoid using clonazepam if you have severe depression, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, alcoholism, or kidney disease. These conditions may exacerbate the depressive effects of benzodiazepines, and such effects may be detrimental to your overall
condition.
Clonazepam can aggravate narrow-angle glaucoma, but if you have open-angle glaucoma, you may take it.
Possible Side Effects
♦    Most common: drowsiness, poor muscle control, and behavioral changes.
✓    Rare: Rare side effects can occur in almost any part of the body but are most likely to affect mental function, stomach and intestines, urinary function, blood, and liver. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    The depressant effects of clonazepam are increased by sedatives, sleeping pills, narcotic pain relievers, antihistamines, alcohol, monoamine oxidase inhibitor antidepressants, tricyclic antidepressants, and other anticonvulsants.
•    Mixing valproic acid and clonazepam may produce severe petit mal seizures.
•    Smoking, phenobarbital, phenytoin, carbamazapine, and rifampin may reduce clonazepam’s effectiveness.
•    Clonazepam may increase the requirement for other anticonvulsant drugs in people who suffer from multiple types of seizures.
•    The effects of clonazepam may be prolonged when it is taken with cimetidine, contraceptive drugs, disulfiram, fluvoxamine, isoniazid, oral antifungal medications (e.g. ketoconazole), metoprolol, probenecid, propoxyphene, or propranolol.
•    Theophylline may reduce clonazepam’s sedative effects.
•    Separate antacids from y<3kwc_%1Dnazepam dose by at least 1 bZldi %prevent them from interfering with clonazepam being absorbed into the bloodstream.
•    Clonazepam may increase blood levels of digoxin and the risk of digoxin toxicity.
•    Clonazepam may decrease the effect of levodopa + carbidopa.
Food Interactions
Clonazepam is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Clonazepam is available in either tablets or orally disintegrating tablets, called wafers. Wafers should not be opened until immediately before the dose is to be taken. Do not push the wafer through the foil. Use dry hands to remove the wafer. The wafer will disintegrate quickly in saliva.
Seizures
Adult and Child (age 10 and over): starting dose    0.5 mg 3 times a day. The dose is increased by 0.5-1 mg every 3 days until seizures are controlled or side effects develop. The maximum daily dose is 20 mg.
Panic attacks
Adult and Child (age 10 and over): starting dose-0.25 mg twice daily. The dose is increased to 1 mg a day after 3 days. Most people do not require a higher dose.
Child (under age 10 or below 66 Ms.): starting dose-0.0220.066 mg per lb. of body weight a day in divided doses. Dosage can be increased gradually to a daily dose of 0.22-0.44 mg per lb. of body weight.
Other uses for clonazepam involve doses from 0.5-16 mg a day, depending on the condition and its severity. Clonazepam dosage must be reduced in people with impaired kidney function.
Overdosage
Overdose may cause confusion, coma, poor reflexes, sleepiness, low blood pressure, labored breathing, and other depressive effects. If the overdose is discovered within a few minutes and the victim is still conscious, it may be helpful to induce vomiting with ipecac syrup—available at any pharmacy. Overdose victims must be taken to a hospital emergency room. ALWAYS bring the prescription bottle or contai”iaT.
Special Information
Clonazepam may interfere with your ability to drive or perform other complex tasks because it can cause drowsiness and difficulty in concentrating.
Your doctor should perform periodic blood counts and liver function tests while you are taking this drug to check for possible
side effects.
Do not suddenly stop taking clonazepam—severe seizures may result. The dosage must be discontinued gradually by your doctor.
If you miss a dose by 1 hour or less, take it right away. Otherwise, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Carry identification or wear a bracelet indicating that you have a seizure disorder for which you take clonazepam.
Special Populations
Pregnancy/Breast-feeding: Clonazepam crosses into the fetal circulation and can affect the fetus. Women who are or might be pregnant should avoid it. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Some reports suggest a strong link between anticonvulsant drugs and birth defects, though most of the information pertains to phenytoin and phenobarbital, not clonazepam. It is also possible that the epileptic condition itself or genetic factors common to people with seizure disorders may figure in the higher incidence of birth defects.
Clonazepam may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of this drug—especially dizziness and drowsiness—and may require smaller doses.

Generic Name
Captopril (KAP-toe-pril)
Brand Name  Capoten
Combination Products
Generic Ingredients: Captopril + Hydrochlorothiazide [M Capozide
Type of Drug
Angiotensin-converting enzyme (ACE) inhibitor.
Prescribed For
High blood pressure and heart failure; diabetic kidney damage and post-heart attack management; also used for kidney hyperten-Sion, the management of people with a high risk of heart disease, chronic kidney disease, the prevention of a second stroke, and high blood pressure associated with other medical conditions, such as scleroderma and Takayasu’s disease.
General Information
Captopril and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin 11, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, helps to reduce blood pressure, and relieves the symptoms of heart failure. Captopril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation. Captopril usually begins working about 1 hour after it is taken.
In addition to its labeled uses, captopril has been studied in the diagnosis of certain kidney diseases and of primary aldosteronism; in the treatment of rheumatoid arthritis; in swelling and fluid accumulation; in Bartter’s syndrome; in Raynaud’s disease; and in post–heart attack treatment when the function of the left ventricle is affected.
Cautions and Warnings
Do not take captopril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients or in those undergoing venom immunization.
People with impaired kidney function should not take captopril unless other anti hypertensives have not worked or have had unacceptable side effects.
Swelling of the face, extremities, or throat has been known to occur with captopril, which can be dangerous (see “Special Information”).
Although not common, captopril may cause very low blood pressure. It may also affect your kidneys, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of captopril treatment. Captopril may cause a decline in kidney function.
Captopril may affect white-blood-cell counts, possibly increaSlN I)Ur susceptibility to infection. Your doctor should monitor your blood counts periodically.
Captopril can cause serious injury or death to the fetus if taken during pregnancy. Pregnant women should not take captopril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
♦    Most common: rash, itching, and cough that usually goes away a few days after you stop taking the drug.
✓    Less common: dizziness, tiredness, sleep disturbances, headache, tingling in hands or feet, chest pain, heart palpitations, feeling unwell, abdominal pain, nausea, vomiting, diarrhea, constipation, appetite loss, dry mouth, breathing difficulties, and hair loss.
♦    Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    The blood-pressure-lowering effect of captopril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid blood-pressure drop should be used with caution if you are taking captopril.
•    Combining 325 mg of aspirin a day with captopril carries a higher risk of death than taking lower doses (less than 160 mg a day). People taking aspirin to prevent a heart attack should use the lower dose.
•    Captopril may increase the effects of lithium; this combination should be used with caution.
•    Mixing any ACE inhibitor with an NSAID pain reliever can increase the chances of kidney failure.
•    Severe sensitivity reactions can occur in those taking allopurinol.
•    Captopril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
•    Antacids and captbe taken at least 2 hours apart. 1 tapsaicin may trigger or aggravate the cough associated with captopril.
•    Inclomethacin may reduce the blood-pressure-lowering effect of captopril.
•    Phenothiazine sedatives and antivomiting agents may increase the effects of captopril.
•Probenecid increases captopril’s effect as well as the chance of side effects.
•    The combination of allopurinol and captopril increases the chance of an adverse drug reaction.
•    Captopril may affect blood levels of digoxin. More digoxin in
the blood increases the chance of digoxin-related side ef-
fects, while less digoxin in the blood can compromise its
effectiveness.
Food Interactions
Captopril should be taken 1 hour before a meal.
Usual Dose
Adult: 25 mg 2 or 3 times a day to start. Dosage may be increased to 450 mg a day in divided doses, if needed. Dosage must be tailored to your needs. People with poor kidney function must take lower doses.
Child: 0.14-0.28 mg per lb. of body weight, 3 times a day. Infant: 0.07-0.14 mg per 1b. of body weight.
Overdosage
The principal effect of captopril overdose is a rapid drop in blood pressure, which may lead to dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Captopril may cause swelling of the face, lips, hands, and feet. This swelling may also affect the larynx (throat) and tongue and interfere with breathing. If this happens, go to a hospital emergency room at once. Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, a persistent rash, or losses in the sense of taste.
People who are already taking a diuretic (an agent that increases urination) may experience a rapid blood-pressure drop after their first dose of captopril or when their captopril dose k!Z,iTlr_Teased. To prevent this, your doctor may tell ‘you to stop taking your diuretic or to OYtM8 _’ your salt intake 2 or 3 days before starting captopril. The diuretic may then be restarted gradually.
You may get dizzy if you rise to your feet too quickly from a sitting or lying position when taking captopril.
Avoid strenuous exercise or very hot weather because heavy sweating or dehydration may lead to a rapid drop in blood pressure.
Avoid over-the-counter stimulants that can raise blood pressure while taking captopril, including diet pills and decongestants. Also, do not use potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you forget to take a dose of captopril, take it as soon as you remember. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might be pregnant should not take ACE inhibitors. If you become pregnant, stop taking captopril and call your doctor immediately.
Small amounts of captopril pass into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors may be more sensitive to the effects of captopril due to age-related declines in kidney or liver function.

Alka-Seltzer
We used to think that Alka-Seltzer was one of the more irrational remedies in the drugstore trileptal peidatric . That is because it contains both aspirin and bicarbonate of soda requip corporation . In the original edition of The People’s Pharmacy, published more than 30 years ago, we-said, “If you have indigestion or upset stomach, the last thing you want is aspirin included in the tablet percentage caffeine content in tea . That is like trying to put out a fire with gasoline too much testosterone .”
We may have been wrong effexor and alcohol . It’s not just that millions of people have used this product successfully for decades natural alternative for spironolactone . This tablet of aspirin (325 milligrams), bicarbonate of soda (1,916 milligrams), and citric acid (1,000 milligrams) is converted into sodium citrate when it fizzes in a glass of water clindamycin dosage for feline toxoplasmosis . This antacid seems to provide fast and effective relief of “acid indi-gestion, upset stomach, and heartburn syrup ranitidine .” What we don’t know is whether Alka-Seltzer is any more effective than a half-teaspoon of baking soda in 4 ounces of water when it comes to
heartburn symptoms lexapro high snorting .
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G orgasm dj caffeine . Allow me to tell you about my experience with heartburn, which I have had for a very long time what is digoxin poison arrows . Last year I started using a toothpaste which contains baking soda clomid and breast tenderness . Since then my heartburn is gone medication and tramadol hcl and information . If I change toothpaste the heartburn comes back, so it’s not a coincidence tablet viagra .
I brush my teeth three times a day online steroids nolvadex . Even though I don’t swallow the toothpaste I think a little of it gets into my stomach and the baking soda neutralizes the stomach acid loratadine condition . Could that be true?
A lithium breast feeding . Baking soda (half a teaspoon in 4 ounces of water) is a tried and true remedy for heartburn lithium overdose . Alka-Seltzer, long used for stomach upset, contains sodium bicarbonate, the compound in baking soda accutane and pearly penile papules . Whether you’d get enough baking soda from your toothpaste to actually neutralize stomach acid is hard to tell, but thanks for sharing your success clarisa nora doctorovich viagra .
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Antacids
For the occasional bout of heartburn, antacids work surprisingly well jeff johnson viagra . In fact, they may be better than pricey acid suppressors digitek 0.25 mg . That’s because it takes hours to shut down acid production zoloft duration of side effects . If you go to the ballpark and gobble down two chili dogs, chase them with beer, and have Cracker Jack for dessert, you don’t want to wait hours for your acid suppressor to go to work insulin resistance glucophage diet . Popping a Turns E-X, Maalox Quick Dissolve, or Rolaids Extra Strength can be safe and effective lexapro message board side effects . That’s because they all contain calcium carbonate, which neutralizes stomach acid lithium polymer batter prices . There are lots of such products to choose from, so pick something that tastes tolerable and isn’t too pricey lithium metal mining .
Calcium Carbonate
Calcium carbonate is inexpensive, fast-acting, and effective addiction and wellbutrin . In addition, you get extra calcium allera with augmentin 875 mg .
Downside: Constipation is fairly common if used regularly beneficial facts about lithium . Cost: A bottle containing 160 tablets of Turns Ultra (1,000 mg calcium carbonate per pill) costs $8 to $10 chloroquin chloroquine . That should be enough to last 2 to 3 months or much longer if used occasionally viagra and heart medicines .
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0 better for gps lithium or nimh .1 have never seen you recommend calcium carbonate for heartburn order avapro . Why? You keep suggesting sodium bicarbonate, even though it introduces too much sodium into the body kamagra in berlin . Calcium carbonate, on the other hand, provides much-needed calcium depakote for headaches . What is your problem?
A propecia cost . We agree that calcium carbonate (Caltrate, Titralac, Turns, etc generic equivalent of lipitor 10mg .) is an excellent, inexpensive antacid that can quickly ease heartburn and supply extra calcium adverse side effects of premarin . We’ve recommended it for decades demeclocycline .
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Don’t forget Pepto-Bismol kroger pharmacy price cialis . We think the familiar pink liquid also has some benefit caffeine free unsweetened tea . The active ingredient, bismuth subsalicylate, can be found generically in store brands and in Maalox Total Stomach Relief Liquid butalbital apap caffeine tabs drug . While not a very powerful antacid, Pepto does seem to calm the fire of heartburn through mechanisms we may not understand very welt dosage of amoxil for young child . Perhaps it coats the esophagus and helps reduce the irritating effects of nid reflux will help the prozac work quicker . There are even decent data to suggest that bismuth subsalicylate can help against traveler’s diarrhea topamax eating . When it is combined with antibiotics, Pepto-Bismol can help fight infection by the bacterium Helicobacter pylori, which leads to gastritis and stomach ulcers tetracycline antibiotcs .
Acid Suppressors
The mainstays for treating indigestion or heartburn are acid suppressors celexa patient ratings . That’s because pharmaceutical companies have become extremely adept at creating such drugs ibuprofen side effects on liver . In the 1960s a team of scientists led by an extraordinary researcher (Sir James Black) hypothesized that if they could block specialized histamine receptors (H2 receptors) in the stomach, they could reduce acid production toprol vs metoprolol .
Histamine2 Antagonists
When drug companies thought about antihistamines, they focused on relieving allergy symptoms in the nose cialis cheapest price . But Sir James thought he could come up with a new kind of antihistamine that would work primarily in the stomach tetracycline and antacids studies . In 1972 the breakthrough was announced, and in 1977 cimetidine (Tagamet) became the first H, antagonist launched in the United States dosing amounts before surgery promethazine . It went on to become one of the most successful drugs in history caffeine drink energy in . Like its successor ranitidine (Zantac) new zealand pharma amitriptyline . Tagamet was one of the first billion-dollar babies (with annual sales of greater than $1 billion) antiobiotics for people allergic to penicillin .
Although these acid suppressors were initially prescribed to help heal stomach ulcers, they rapidly became popular as super antacids xenical online pharmacy phentermine meridia . Any amorphous abdominal pain was treated with an H, antagonist clomid and ovulation test kits . Their success was noted by other drug companies, and “me-too” drugs like famotidine (Pepcid) and nizatidine (Axid) soon appeared benzoyl peroxide tinted acne lotion . Such drugs were perceived as so safe that once they lost their patent protection, the FDA approved them for over-the-counter sale ultram online prescriptions . Although these drugs can relieve heartburn by making stomach contents less acidic, they are not as fast-acting as antacids advantages of wellbutrin .
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Q zyrtec swelling feet . 1 had two hip replacement surgeries in my mid-forties ramipril dosage color . I was given cimetidine (Tagamet) to prevent stress ulcers post-op for the first one and it gave me very nasty hallucinations what is the drug carvedilol . I had already withdrawn myself from the pain medications, and the staff assured me nothing I was taking could induce these things generic alternitive for vytorin . When the surgeon stopped the Tagamet, the nasties went away abilify prescribing .
For the second operation, I listed cimetidine as a drug problem, but they gave it to me anyway boniva alert . I knew within an hour something was seriously wrong and fortunately didn’t have to take any more wellbutrin generic names .
I was assured that the incidence of problems is low, but I’d hate for others to go through what I experienced danger zocor .
A eli lilly cialis tadafil . Cimetidine (Tagamet) has been linked to hallucinations, depression, confusion, and disorientation ciprofloxacin and the oral mucosa . Such psychological side effects are relatively rare, but people need to know that they can occur nitrix interaction with cialis .
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There are not enough data to recommend one H2 antagonist over another chloramphenicol 1 equine eye medication . They are all roughly comparable in effectiveness building muscle testosterone . Side effects are generally uncommon pregnant on paxil . Cimetidine may cause a slightly higher incidence of headache, sexual difficulties, and mental confusion or disorientation than some of the other drugs in this class maxalt info . This usually only happens at high doses or in older or sicker patients trane lithium bromide chillers . Other possible side effects associated with HZ antagonists may include dizziness, fatigue, diarrhea, and constipation asprin and pregnancy .
Interactions are a bigger issue with medications like Cimetidine norethindrone acetate pregnancy test . This acid suppressor can cause mischief when combined with many other drugs, including alcohol atrovent arachides . It is crucial that anyone using such acid suppressors check with both a physician and a pharmacist for any incompatibilities claritin million .
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Q zoloft reaction fatigue . I have been on either Tagamet or Zantac for years warfarin effects mood . I have a hiatal hernia that causes severe heartburn does omeprazole help in stopping rebleeding .
Over the last 2 years I find that ( start to feel “tight” after a single beer prozac overnight no prescription . I used to drink two or even three beers on a hot day after 18 holes of golf with no problem penicillin and without prescription . Now with just one beer I feel too impaired to drive fortamet glucophage lawsuit .
Could these heartburn medicines have that effect? I used to be able to hold my booze with the best of them dystonic reaction to geodon . Because of this I am loath to even take a drink at a party medication warfarin .A using expired asprin . You have raised a fascinating issue tetracycline neomycin bacitracin and prednisolone infusion . More than a decade ago, alcohol expert Charles Lieber, MD, reported that cimetidine (Tagamet) and ranitidine (Zantac) could increase blood alcohol concentrations in susceptible people singulair cramps . He told his colleagues that such interactions “may result in unexpected impairment to perform complex tasks, such as driving maggi santarlasci vitro desloratadine . Thus, patients treated with these drugs should be warned of this possible side effect nortriptyline withdrawal symptoms .”403
More recently Dr treatment for amoxicillin rash . Lieber warned, “Under conditions mimicking social drinking, ranitidine increases blood alcohol to levels known to impair psychomotor skills needed for driving high blood pressure wellbutrin .”404
0 0 0
If we had to pick one over-the-counter (OTC) acid suppressor to relieve heartburn, we would probably opt for Pepcid Complete allegra d xr .The reason is that this medication combines the H, antagonist famotidine (10 milligrams) with calcium carbonate (800 milligrams) and magnesium hydroxide (165 milligrams) astrazeneca atacand . Putting these three ingredients together means that you get the immediate benefit of fast-acting antacids (calcium carbonate and magnesium hydroxide) plus longer-acting acid suppression with famotidine antihistamines claritin .
Proton Pump Inhibitors (PPIs)
The most powerful acid suppressors available are called proton pump inhibitors (PPIs) diflucan and amoxicillin 500 .This class of medications has been
*** Pepcid Complete
Pepcid Complete combines immediate action with longer-lasting acid cQMv6 is feldene an nsaid .
Downside: Side effects are uncommon but nevertheless, be vigilant for allergy, jaundice, headache, constipation, dizziness, or diarrhea seroquel withdrawals weakness .
Cost: $17 to $20 for 50 pills sinemet crushing tablet with applesauce . Should last several months using motrin and tylenol for kids . Short-term use should be safe apri bondurant . Long-term use should be approved and monitored by a physician mining of lithium .
incredibly successful for the pharmaceutical industry, which has done well with graphic commercials featuring a cartoon stomach or “The Purple Pill chlorpromazine hcl .” Over 70 million prescriptions are written annually for these drugs at a cost of almost $10 bil lion high testosterone test in women . 40
Starting with omeprazole (Prilosec), drug companies have created a series of compounds that are capable of dramatically changing the acid environment of the stomach viagra medi tabs . Such action is extremely helpful for curing ulcers depo provera injection weight gain . It can also help relieve reflux has anyone tried smoking prozac . But there is growing concern that long-term acid suppression may have some unexpected and potentially unpleasant consequences is prednisone acidic .
Acid is important in the stomach does fosamax cause dementia . For one thing, it creates an inhospitable environment autoimmune hepatitis azathioprine . Germs have a hard time surviving in acid metronidazole cat conditions . Studies published in the Journal of the American Medical Association have suggested that constantly suppressing stomach acid may increase the risk of pneumonia and severe infectious diarrhea generic allegra .”-407 Presumably, this is because bacteria not killed by stomach acid can work their way up through the esophagus and get into the lungs or work their way down and infect the lower digestive tract dilantin alcohol . Such serious infections can be life threatening lithium manganese battery charging high temperature .
PPIS AND CANCER
The really big elephant in the room with the PPIS is a fear of cancer atenolol hydrochlorot interactions . For years there has been a quiet controversy brewing regarding a possible relationship between acid suppression and the risk of cancer amiodarone hcl . In 1985 we wrote: “Scientists fear that if bacteria set up housekeeping in your stomach, they can go to work converting nitrate to nitrite prednisone two parent dose . drug side effects ultram er . what is nifedipine er . effexor and wiehgt loss . Nitrate is a chemical which can come from food, water, or even saliva; by itself it
PROTON PUMP INHIBITORS
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)
probably does little harm amoxicillin dosage treatment course for pneumonia . But if nitrate is turned into nitrite by bacteria, all hell can break loose, because the end product can be something very bad indeed—nitrosamines vytorin muscle cramps . Nitrosamines are among the most potent cancer-causing chemicals
known musc nexium protocol .
Over the last several decades there has been an alarming increase in what was once a rare kind of esophageal cancer atrovent nasal . Adenocarcinoma of the esophagus has turned into an epidemic cheap order prescription ultram .’ Gastroenterologists are mystified about the causes of this deadly condition lithium battery rechargers . Some have told us that it’s brought on by the American diet buy discount buy flomax online . Others blame it on reflux and insist that PPIs can solve the problem by reducing acid exposure to delicate tissues apcalis erectalis kamagra plus . Has reflux really increased that much in the last couple of decades, and if so, why’?
A provocative editorial that appeared in the American Journal of Gastroenterology entitled “Acid Suppression and Adenocarcinoma of the Esophagus: Cause or Cure?” lays out the confusion and the contradictionS interaction of amiodarone and zorcor .410 Thomas Schell, MD, points out that “decreasing acid reflux by the use of PPIs
*** Prilosec OTC (omeprazole)
For years Prilosec was the most prescribed drug in the country clindamycin medication 25mg . The active ingredient, omeprazole, did not lose its effectiveness when it went over the counter synthesis of paroxetine .
Downside: Side effects are uncommon, but headache, diarrhea, rash, cough, and upper respiratory tract infections have been noted chemical make-up of augmentin . Rare but very serious side effects may include blood disorders, inflammation of the pancreas, liver problems, and severe skin reactions warfarin and vitamin d .
Special Cautions: Use Prilosec OTC for only 2 weeks at a time loratadine breastfeeding . According to the information on the label, you can repeat another 14-day course alter 4 months have elapsed u 2899 viagra . Prolonged use of prescription proton pump inhibitors may require vitamin 8,2 supplementation (up to 1 milligram daily) canada health advisory prozac . Extra vitamin C (500 milligrams) and vitamin E (200 IU) may reduce the possible formation of carcinogens (nitrosamines) simvastatin oral gavage .
Cost: $30 to $40 for 42 pills (1 year’s supply)
might help to slow or halt this deadly progression zoloft and buspar free .” But he also reminds his colleagues that lack of acid in the stomach (achlorhydria) “is a known risk factor for adenocarcinoma of the stomach claritin health alternative .” Dr caffeine in youth . Schell notes that nitrosamines formed by bacteria in the stomach “would also expose the esophagus to these carcinogens andriol for low testosterone in women .”
There are three other disconcerting problems linked to long-term use of PPIs tablissement services sp cialis s . When the stomach ceases to produce acid, it senses that something has gone terribly awry and it tries desperately to get acid-producing cells working again taking flagyl and consuming alcohol . It does so by making a compound called gastrin, which aids in digestion and also triggers the production of stomach acid dizziness after taking cymbalta . When acid levels do not rise, gastrin production continues indefinitely, often at very high levels chemical properties of asprin .
Imagine that the float device in your toilet was stuck in the “on” position ovral l vietnam . The water would keep running forever, which is what happens with gastrin in your stomach lasix intramuscular . There is no acid “float” to turn off the gastrin supply breast paint after getting off effexor .
Too much gastrin is not a good thing buspar sexual dysfunction . In fact, there is increasing concern that gastrin may stimulate abnormal cell growth throughout the digestive tract, increasing the risk of cancer-, of the stomach, pancreas, and colon, as well as the esophagus cipro thompson ct .411,412
Another concern about long-term treatment with PPIs has to do with nutrient absorption digoxin toxcicity . It is harder to absorb vitamin BQI iron, and calcium when there is not enough acid in the stomach what is telmisartan . Older people may have some trouble getting enough vitamin B12 2 or iron under normal conditions antimicrobial properties of ampicillin . With a PPI on board, this may be an even greater challenge levofloxacin renal impairment . 413 A vitamin B12 deficiency can lead to some very serious consequences fosamax and contraindications . Symptoms may include anemia, fatigue, nerve damage (burning, tingling, weakness, or numbness in the hands and feet), difficulty in sensing vibration, unsteadiness, shortness of breath, and psychological side effect’S, Depression, confusion, and poor memory may be mistaken for early-onset Alzheimer’s disease definition hydroxyurea .
* 0 0
Q valtrex and edema . 1 have taken Prilosec and then Prevacid for years to treat severe heartburn legal issues paxil . When I began to suffer weakness and confusion, I started taking 1,000 micrograms of vitamin B,, daily drug-resistant gonorrhea spreading rapidly cipro . Within a relatively short time, the horrible symptoms began to subside fda reports strattera vision loss .
My doctor does not really see the relationship, but I sure do! What can you tell me about this side effect?
A acyclovir and constipation . Long-term suppression of stomach acid can sometimes interfere with efficient absorption of vitamin B12 high blood pressure medicine norvasc tab . This nutritional deficiency can cause nervous system problems, which may show up as insomnia, memory problems, depression, burning tongue, sore mouth, difficulty walking, and tingling or numbness in feet or fingers fda lipitor .
One reader reported a conversation with a nurse who noticed an amazing improvement in a woman with dementia after a vitamin B12 deficiency was discovered and treated pennsylvania exelon carin anders .
0 0 *
This vitamin deficiency often appears very gradually zoloft and sweating . Patients may describe complaints such as mental fuzziness, a sensation of burning on the tongue, or poor coordination for months or even years before a proper diagnosis is made warfarin country origin . Anyone who has been on PPIs for many months (or years) should request a blood test for iron and vitamin B,2 synthesis metronidazole . It’s not enough to just look for vitamin B,,, though tougera clindamycin phosphate . Be sure to be tested for serum cobalamin (that is vitamin B,2) and methylmalonic acid (MMA) fosamax and heart attack . When MMA is elevated and cobalamin is low, that is an indication of a probable vitamin B,, deficiency homemade cialis .
PPI ADDICTION?
Another unspoken concern among some gastroenterologists is PPI-induced “physical dependence lipitor celecoxib combo limits cancer .”414 That’s a nice way of saying addiction isotretinoin for ichthyosis treatment . Now, no one is getting high on PPIs ranitidine tachycardia . But some pcgpke dysreflexia after ditropan . may tl)d it difficult to quit taking such medications once they start down the long and winding road of acid suppression montelukast side effects .
Here’s the sad story leukopenia and sporanox . Proton pump inhibitors like omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid) are so effective at shutting down acid production that the body seems to rebel diflucan treatment length . As previously noted, gastrin is produced in large quantities, and it stimulates cell growth augmentin cheap . These are cells that want to make acid, but PPIs prevent them from doing their job inability to smell and testosterone levels . They proliferate, though, and if the PPI is stopped, they start churning out acid to is higher dose of effexor better . make up for lost time zyrtec and dose and weight . The consequence is something called “rebound acid hypersecretion cipro plue bactrim for diverticulitis .” This means the body really starts generating excess acid when these drugs are discontinued low cost flomax .
What’s so insidious is that it takes several days for the effect to show up using strattera with fluoxetine . So someone might be fine for a while, but within 2 weeks of stopping a PPI there is maximal acid production from stomach cells dexamethasone drug dosage . 5 And here’s the kicker prepare tramadol for injection . This rebound hyperacidity effect lasts for more than 2 months could amoxicillin cause hives .416
Dear reader, this is nothing short of astonishing try prilosec $20 coupon . Think about it for just a moment bupropion marijuana . Tens of millions of people have spent billions of dollars on acid-suppressing medications for years and years to soothe the fires in their upper gastrointestinal tract meloxicam side affects and dangers . But Mother Nature does not forgive or forget zocor bottom feet hurt . No sooner are the drugs discontinued than she turns on the acid-making machinery and puts the pedal to the metal for months metoprolol succinate tabs .
Within a few days of stopping the medicine, someone with indigestion or heartburn is likely to feel the effect lotensin aciphex phentermine pharmacy chicago . Not surprisingly, the first thing people experiencing rebound hyperacidity are likely to do is reach for their PPI dr mercola and synthroid . According to Norwegian researchers, “Discontinuing treatment may prove difficult in some patients even if the dose of proton pump inhibitor is slowly tapered kamagra jelly pharmacy . melatonin amlodipine . talking clozapine chat . natrural viagra . In these cases the use of high doses of 1-12-receptor antagonists or antacids should be considered stopped taking clomid .”‘ 17 From a drug company’s perspective, PPIs could be the perfect pills lamictal and bi-polar side effects . As long as people take them, they feel pretty good prescriptions lexapro and effexor . But if they stop, they could be punished for a very long time lithium formate amino acids . That’s strong motivation to beg the doctor for more medicine—indefinitely equine testosterone and estrogen levels .
So, what’s a person to do? Well, our recommendation would be to be cautious half-life of ibuprofen . These drugs are great for short periods of time kaufen levitra . They control symptoms of heartburn quite well and have relatively few side effects caffeine free coca-cola . If a doctor recommends that you take a PPI for longer than 2 or 3 months, though, be prepared for rebound hyperacidity when you stop the medicine analytical methods caffeine .418
Conclusions
Persistent symptoms of pain, burning, or pressure behind the breastbone should be investigated by a doctor to rule out a seri-ous condition synthroid atrial flutter . For an occasional attack of indigestion, however, there are lots of things you need to consider amaryl generation . Before pulling out the heavy artillery of acid-suppressing drugs, there are many options to contemplate caffeine 50mg . Here is a quick snapshot:
• Avoid foods or drugs that might make the lower esophageal sphincter lazy and let gastric juice creep back into the esophagus side effects of duricef . There are few good studies, but some possible culprits include chocolate, carbonated beverages, smoking, diazepam, and progesterone can taking effexor cause anxiety .
• Cut back on Garbs the history of pseudoephedrine . Although the data are preliminary, there is some suggestion that the typical high-carbohydrate American diet may be contributing to reflux wellbutrin sr 100mg discussion boards .
• Keep your eyes on itopride cheap rimonabant without a prescription . This prescription drug works differently than acid-suppressing drugs to relieve indigestion and heartburn dexamethasone mode of action . Its success in Japan and India and a fascinating report in the New England Journal of Medicine (February 23,2006) have us looking forward to FDA approval lipitor bilirubin . •Saliva is the body’s natural buffering agent and fire extinguisher for heartburn lithium levels affected by dehydration . Chewing gum or sucking on hard candy can help relieve symptoms prescription sildenafil .
• Chamomile or ginger tea also can wash acid out of the esophagus and back into the stomach where it belongs hydrocodone tramadol carisoprodol . These traditional remedies also may help calm an upset stomach penile discharge flagyl .
• Home remedies such as sipping diluted apple cider vinegar or even swallowing yellow mustard may help side effects on lamictal . Each person is different, though, so trial and error will be the only way to find out if a home remedy will work for you p1p synthesis of pseudoephedrine .
• Baking soda remains a time-honored solution for occasional heartburn inhalation dexamethasone . Dissolve ‘47 teaspoon of powder in 4 ounces of water bose wave radio testosterone . For those on sodium-restricted diets because of congestive heart failure or high blood pressure, this is not an option amitriptyline lansoprazole .
• If you need an antacid, calcium carbonate remains one of the cheapest and most effective in the pharmacy decongestant with atenolol . Turns Ultra contains 1,000 milligrams of calcium carbonate and is a cost-effective option clomid vitex .
• In our opinion, a sensible first choice for an OTC acid-suppressing drug is Pepcid Complete ketoconazole used for . It combines the immediate action of antacids (calcium carbonate and magnesium hydroxide) with the longer-acting H2 antagonist famotidine how to increase free testosterone . Short-term use should be safe how much clonidine should i take .
• If you feel you must take a powerful acid-suppressing PPI, we would opt for Prilosec OTC safer alternitives to ibuprofen . If you have great insurance coverage, you might save money if your doctor prescribes generic omeprazole instead used to make testosterone . We think a little vitamin insurance is appropriate whenever acid-suppressing drugs are taken for any length of time (vitamin B12, vitamin C, and vitamin E) wellbutrin xl and weight lose .

FEVERFEW
Feverfew (Tanacetum parthenium) has a history of use by healers that goes back to the ancient Greeks propranolol public speaking . Seventeenth-century English settlers brought it with them to the colonies and used it to treat fever, vertigo, depression, and headaches desogen causing depression . Although it fell out of favor by the 19th century, it has experienced a revival in the last decade or so itraconazole vs fluconazole winston antifungal . Studies have shown
that it can indeed help headaches, but it is used primarily for migraine prevention rather than for treatment sildenafil infrared .
Feverfew is used more often in Europe and Canada than in the United States, perhaps because their regulatory bodies have authority over herbal products will theophylline help my dogs cough . In Canada, feverfew prod
** Feverfew
A feverfew extract with at least 0 effexor withrawal .1 percent parthenolide might be helpful in preventing migraines verapamil cluster . It is taken daily molecular weight of enalaprilat not enalapril . Look for a standardized product such as the Canadian nonprescription medicine Tanacet wellbutrin sunburn .
Side effects: Canker sores, mild indigestion, and flatulence Downside: May interact with anticoagulant medicines flagyl stomach problems . Pregnant women should avoid this herb synthroid drip . Discontinuation should be done gradually; stopping abruptly has been associated with a “rebound effect” of severe migraines and steep disturbance side affects of zetia .
Cost: Approximately $3 to $4 for a month’s supply
ucts must by law contain a minimum of 0 verapamil 240mg .2 percent parthenolide imodium ad for children dosage . In France, the minimum is 0 dangers of cirrhosis and levitra .1 percent is tramadol an anti inflammatory .Animal studies have confirmed that parthenolide is the active ingredient get tadalafil . 311 For migraine prevention, the herb is taken daily for at least 2 months getting off lipitor .
A rigorous review of double-blind, placebo-controlled trials involving feverfew found that the results were mixed sertraline and hair loss . Not all the studies supported the efficacy of the herb as a migraine preventive cheapest viagra online . 331 The reviewers did conclude, however, that feverfew appears to be safe effexor side effects not working . A more recent German study demonstrated that a supercritical carbon dioxide extract of feverfew was more effective than placebo in reducing the frequency of migraine headaches caffeine amounts in monster energy drink .337 In this study, side effects were equally uncommon with the feverfew extract and the placebo paxil and cannibus .
Feverfew is generally thought not to be effective for treatment once a migraine headache has begun, but a small preliminary study had patients take a product called GelStat Migraine under their tongues as soon as they had an inkling that a migraine WaS aW111 10 occur digoxin in treating dogs . This nonprescription product contains both feverfew and ginger hydroxyzine 25 mg . A majority of patients who used it got relief, but the study was not placebo-controlled, and further research is needed to confirm these results zion energy solutions exelon .
BUTTERBUR
Butterbur (Petasites hybridus) is another old-fashioned herb that has just resurfaced lithium n cell batteries . In Europe, it is sometimes referred to as “plague plant,” despite a lack of any evidence that it was effective against the plague diovan generic substitute . There is evidence that butterbur can be useful in preventing migraine headaches, but only a few randomized, double-blind studies have been reported cellulitis and clindamycin . 331,11 One study without placebo control found that butterbur root extract can reduce migraine frequency in children and adolescents atenolol side effects prostate problems . 341
Questions have been raised about the long-term safety of some butterbur products because the plant contains pyrrolizidine alkaloids, which are toxic to the liver wellbutrin and xanax for social anxiety .The manufacturer of the patented butterbur root extract used in one of the trials, Petadolex, has reported that the studies conducted on this product confirm its safety for humans cephalexin great dane . 142 The supercritical carbon dioxide extraction process leaves behind the dangerous pyrrolizidine alkaloids discontinuation of wellbutrin xl .343
A product intended for prevention is taken on a daily basis for a long time zelnorm class action . If you decide to try butterbur, we suggest you stick with one that is extracted with supercritical carbon dioxide and check in with your doctor oxybutynin drug .
Acupuncture
Quite a few studies have evaluated acupuncture for treating migraine headaches trazodone stories . The majority of them demonstrate that acupuncture is helpful in alleviating the pain, whether it is used as a preventive measure or in treating an acute headache fosamax total bilirubin .-344 In one large British study, patients undergoing acupuncture took fewer sick days and used less pain medication than they had before treatment pediatric chlorzoxazone dosage .345
Oddly enough, acupuncture seems to achieve these goals even though a properly randomized trial, with sham acupuncture serving as the placebo treatment, couldn’t distinguish between the benefits of real Chinese acupuncture and those of fake acupuncture cardizem la prostrate .346 Both “acupuncture” treatments were clearly superior to doing nothing, as shown by the results from patients in a second control group, who received no treatment during the study ld 50 of omeprazole . Both were also equal to standard preventive drug treatment in another well-designed study is caffeine a dieurectic .347
Not everyone responds to acupuncture, but for those who do, it appears to be a reasonable way to cope with migraine headaches, with a minimal risk of side effects appetite metformin . For treating an acute headache, acupuncture is better than placebo, but not quite as good as sumatriptan (Imitrex) dizziness coumadin atrial fibrillation .348
*** Acupuncture
In general, acupuncture seems to be a safe way to reduce the frequency of migraines and help sufferers cope with them better celebrex deths . Despite research showing that sham acupuncture works just as well, we suggest that you consult a doctor who has been formally trained in acupuncture technique and is experienced in its use for migraine coumadin overdose suicide .
Side effects: Serious side effects are rare mesalamine and diarrhea .349 Minor pain or bruising at the needle site is fairly common soma tabs . 1,0
Downside: Not everyone responds to acupuncture lipitor clinical trials . Some studies suggest the effect is essentially a strong placebo reaction manufacture of penicillin .
Cost: Approximately $60 to $120 per session zyprexa zydas . May be covered by insurance,
Other Nondrug Approaches
As limited as it is, the research literature on herbal products like butterbur and feverfew is almost extensive in comparison to a few other approaches that pop up in medical journals here and there side effect of amoxicillin anxiety . A Brazilian study suggests that melatonin (3 milligrams daily) is effective in preventing migraines yasmin interaction amoxicillin fluconazole .3′ Another study, this one carried out in Switzerland, found that coenzyme Q,,), given at a dose of 100 milligrams three times a day, was supenor to placebo does predisilone effect despo provera .-12 Both of these treatments are readily available without a prescription and reasonably safe cymbalta commercial song . Coenzyme Q , probably should be avoided by people taking the anticoagulant Coumadin (warfarin), however, because of the potential for interaction between the two vasopressin citalopram .
Since the age of 231 have had frequent migraine headaches methotrexate in use for ectopic pregnancy . Over the years, many doctors have prescribed medicines to prevent them, but none has worked prednisone during pregnancy and large baby . Drugs can stop the migraine if I take them early enough, but they shouldn’t be taken too often nolvadex for pct .
I was told the headaches would disappear at menopause, but instead they got worse 10mg of accutane effectiveness . For the past 10 years I have awakened three or four times a week between 2 and 4 a buy topamax online canada .m side effects aripiprazole . with a migraine celebrex celecoxib capsule . I look at my bedside clock when the headache wakes me fluoxetine average doses .
I read an article about people taking melatonin for jet lag and wondered if my headaches were due to a body clock problem imitrex and rebound headache . The article didn’t say anything about migraines, but I tried an experiment keflex antibotic . I started taking one 3-milligram melatonin tablet each evening, and I stopped waking up with a headache in the wee hours vytorin side effects muscles .
For years I have been avoiding all sorts of foods that might be migraine triggers abstracts on caffeine tear production . The success with melatonin made me brave and I ate some of them h pylori doxycycline . No headache, as long as I take the melatonin naproxen long term use . I consider myself lucky and want to share my discovery thyroxine diet supplements .
Another treatment that seems to be both safe and fairly effective is biofeedback to help people learn to warm their fingers floxin otic in perforated eardrum . Presumably this activity also affects the blood vessels in the head that are believed to be involved in migraine altace and bloodpressure . This type of biofeedback has been studied and found helpful in children and adolescents mobic alternatives .-”‘ Finding a professional to supervise biofeedback training and maintaining practice in the biofeedback technique might be a challenge for families oral estradiol for ivf .
We have heard from a number of people who have used hot, spicy soup to stop a migraine quickly when they feel one coming on pepcid ac alcohol . There’s not much research on this approach but no harm in trying it, either mebendazole indications for treatment .
0 0 *
Q zyrtec liquid tablet . I have enjoyed reading about spicy gumbo and hot and sour soup for migraine and cluster headaches sumatriptan imitrex prescription . No one can imagine how terrible cluster headaches can be patient information on wellbutrin sr . Anything that could help stop the cycle of pain would be a blessing images of simvastatin .
A testosterone level . People have described cluster headaches as feeling like a blowtorch applied to the eye or a red-hot poker being thrust into the skull tetracycline does not effect eukaryotes . To make the agony worse, cluster headaches may recur a few times a week or even several times in a day discounted celebrex .
People tell us that hot peppers in a variety of forms can be helpful in cutting the cycle short recreational viagra use . One fellow prefers a spicy Chinese tofu dish called mapo dofu, but he says anything with enough hot sauce works for him medical lexapro .
Another man relies on Tabasco sauce under his tongue citalopram para agorafobia . He chases this “strong medicine” with a glass of ice water and reports relief “in 5 minutes max anti anxiety buspar treating com .”
The active ingredient in hot pepper is capsaicin coumadin versus warfarin .
Though it may not work for everyone, sipping spicy soup seems worth a try ultram coupons .
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None of these approaches is a substitute for regular medical care effects of glucophage on weight . A person with migraines should be under the care of a health-care provider, usually a physician, who can diagnose the problem and supervise the treatment how long to take prilosec . That is doubly true for anyone whose headaches are so frequent that prevention is an appropriate strategy digitek computer products . If you are interested in nondrug approaches to headache prevention, find a doctor or nurse practitioner who ho is comfortable discussing them with you and keep that person informed of what treatment you are using and how well it is working atenolol and migraine umaxppc .35′ There are a number of drugs that can be effective both for preventing and treating migraine headaches energiser aa lithium .
Migraine Medications
There are no advantages to having migraine headaches apotex generic plavix . By all accounts, it is a miserable experience cephalexin cellulitis . But a person who is tuned in to her body may have an advantage in outflanking the migraine: Sometimes there are early warning signs—the so-called aura—that tip a person off that a migraine is on its way herbal doxycycline . These sensations can range from “little blinky lights” (as one caller described them on our radio show), to tingling in the fingers, to a hint of nausea photo phenergan 12.5 mg . (Full-blown nausea and even vomiting are frequent components of a migraine orexis as good as viagra .)
If you arc a migraine sufferer, get to know your own warning signals of an oncoming headache and act immediately provera barr . Any kind of medicine used to treat a migraine works best if it is taken at the earliest possible stage, before the headache has really taken hold paxil cr availability . Don’t wait to see if your early warni~gwas accurate; assume it was and lake action acyclovir teva .
Over-tire-Counter Painkillers
Because migraines are heavy-duty headaches, we tend to think of treating them with prescription medicine-s elavil dosage no prescription . That may be completely appropriate for people whose headaches often include nausea or frequently drive them to take to their beds azithromycin sun . But for less incapacitating headaches, an OTC combination This widely available nonprescription medicine contains acetaminophen, aspirin, and caffeine zoloft works wonders . The caffeine may help it take effect quickly doxycycline and cacner . It works better than placebo and also better than nonprescription ibuprofen and prescription sumatriptan pills going off fosamax .
This medicine is not intended for the most severe migraines celexa 4741 . The dose of two tablets should be taken as soon as a migraine sufferer suspects a headache is on its way overdose of amitriptyline in cats .
Side effects: Uncommon, but nervousness and nausea have been reported otc paroxetine .
Downside: If this medication is overused, an occasional migraine could become chronic how did penicillin lead to warfare . At that point, the potential side effects of liver and kidney problems would be worrisome cialis non generic . If you find you are using this medicine more than twice a week, seek professional help for your headaches esomeprazole magnesium buy .
Cost: Approximately 10 to 15 cents per dose
drug containing acetaminophen, aspirin, and caffeine (Excedrin Migraine) is surprisingly effective dexamethasone chemotherapy university chicago 2004 .
OTC ibuprofen has also been tested for the treatment of migraines altace rampiril tingling . Randomized, double-blind studies have shown that both Advil Migraine liquigels and Motrin Migraine Pain tablets are better than placebo albuterol inhaler dose .”"” But Excedrin Migraine outperformed ibuprofen in a head-to-head trial zoloft with sudafed .357 What’s more, the acetaminophen-aspirin-caffeine combination also beat out the prescription drug sumatriptan (Imitrex) in reducing pain and associated symptoms and reducing the amount of additional pain medication that study subjects needed celexa depakote .3-58
Prescription Migraine Medicines
The biggest advance in the treatment of migraines has been the development in the last decade and a half of medicines called “triptans hydroxyzine hcl 25 mg tab .” These selective serotonin receptor agonists are now the mainstay treatment for severe migraine headaches prednisone doesage amount for cat . Taken early in an attack, they reverse the chemical changes that lead to migraines and actually stop the headache pain in many cases generic equivalent to zyprexa .
The first triptan to be developed was a self-administered injection of sumatriptan (Imitrex), but before long both Imitrex and other triptan compounds became available as oral medicines singulair in children .The injection may still be very helpful for some individuals who become so nauseated at the onset of a migraine that pills won’t stay down prednisone withdrawl itching .
The triptans are available only by prescription valtrex $89.00 500 mg . In studies that have compared them to the older migraine medicine, ergotamine and caffeine (Cafergot), the triptans have done well, relieving the headache pain more quickly and effectively without significant side effects canine use of loratadine .359,3W
The doctor will need to know about certain aspects of your health and medical history that might make one of these medications too dangerous ultram and information . For example, there have been some unanticipated heart attacks among people taking one of these drugs during a migraine, so the prescriber will want to know about your risk of heart attack theraputic dose of generic wellbutrin . Do you have high blood pressure, diabetes, or high cholesterol? Is there a family history of heart attack or stroke? Such serious reactions, fortunately, are rare, but make sure your physician gets all the relevant details new york celebrex versus vioxx . It’s your life at stake nystatin and triamcinolone cream .
One possible benefit of the extremely high price tags on most of the triptans is that it would discourage anyone from overusing these medications prozac depressions . Of course, without insurance that covers prescription drugs, a migraine sufferer might find it difficult to afford them at all guaranteed lowest price on norvasc . If cost is an issue, ask your doctor whether an older, less expensive drug such as ergotamine and caffeine (Cafergot) might work for you zanaflex drug abuse . Ergotamine
TRIPTANS
• Almotriptan (Axert)
• Eletriptan (Relpax)
• Frovatriptan (Frova)
• Naratriptan (Amerge, Naramig)
• Rizatriptan (Maxalt)
• Sumatriptan (Imitrex, Imigran)
• Zolmitriptan (Zomig)
WHAT THE FDA KNEW
After a woman in Kansas City died following an injection of Imitrex, we followed up on a lead from reporter Kelly Garbus in the Kansas City Star prozac herbal . Through a Freedom of Information Act request (Number F95-00866), we discovered that the FDA was aware of this risk even before the drug was - approved water retention lovastatin . These lines were included in a memo from Paul Leber, MD, who headed the section that reviewed the drug, to Robert Temple, MD, director of the FDA’s Office of Drug Evaluation I:
‘Used appropriately, Imitrex is reasonably safe; used in the patient with pre-existing cardiovascular disease, however, it may be dangerous, even deadly fertility clomid . atomic spectrum for lithium . cialis weight loss silagra cumwithuscom . ropinirole and approval and parkinson .
‘The division’s recommendation to approve the Imitrex NDA (New Drug Application) reflects a risk benefit assessment which, in common with all such determinations, turns as much on personal values and implicitly held private assumptions as it does on evidence and reason dangers of prednisone tablets . medicine lookoup cap davis dilantin . fioricet carisoprodol . prednisone schering pl .
‘In sum, a case can be made that, from the viewpoint of the public health, the benefit accruing to the population of migraineurs is outweighed by the injury and fatalities that Imitrex’s marketing seems certain to cause recommended dosage cipro .” 361
Dr singulair 4mg tablets . Leber had advanced this argument just for the sake of thorough consideration of every angle and titled it “Alternative Perceptions of Imitrex’s Risks and Benefits lithium codeine .” This memorandum makes clear, however, that the FDA knew before approval that the drug was likely to kill some patients is there caffeine in faygo soda .
is not appropriate for people with a history of heart disease and should not be taken by pregnant women because of a risk of birth defects lipitor outcomes .
TOPAMAX
A migraine sufferer who discovers that she needs to use her migraine medicine to stop a headache more than 2 days a week on a regular basis s should definitely schedule an ap- pointment with the doctor caffeine curbs appetite .’6′ Frequent use of any migraine medicine has risks, not the least of which is a “rebound” that makes headaches more frequent medical drug vytorin . If headaches are coming that fast and furious, a preventative medicine could make more sense amlodipine besylate pill .
The most recent drug to be approved for migraine prevention is topiramate (Topamax) testosterone supplement side effects . It was originally developed as an anticonvulsant, but the FDA has approved it for preventing migraine headaches as well triamcinolone diacetate for poison ivy . It works better than placebo to ward off migraines in children and teenagers is cymbalta an maoi inhibitor . 363 Adults who take 100 milligrams of Topamax daily have roughly two fewer migraines per month cannondale 29 er caffeine .364 This is similar to the results achieved with other preventive medicines and significantly better than placebo viagra psuedo .365 Side effects with Topamax include tingling and numbness (paresthesia), confusion or mental fuzziness, and
weight loss ibuprofen for allergies .366
There are other, older medications that the doctor may prescribe for migraine prevention if topiramate is not appropriate risperdal consta side effects . A different anticonvulsant, divalproex, is prescribed for this purpose doxycycline and weight loss . Even before doctors started using anticonvulsants to prevent migraines, though, they had found that betablockers could be helpful overnight shipping of generic cialis . Propranolol and atenolol are the two that are most often used, and because they are available
*** Triptans
These prescription medications usually work well at stopping a migraine attack, especially if they are taken early in the process amiodarone lung pleural effusion . Sometimes a second dose is needed a few hours later albuterol relaxes esophageal sphyncter .
These medications (which come as pills, nasal spray, and injection) are the standard treatment now for the most severe migraines lipitor for alzheimer’s disease . There are some important differences among them what does generic cialis . You and your doctor will have to work together to find one that works well for you with a minimum of side effects caffeine coffee consumption statistics .
Side et WSI caffeine and electrolyte . Dizziness, flushing, tingling, nausea, drowsiness Downside: Expensive; in rare cases, serious reaction may include a lack of bloodflow to some parts of the body, including the heart asacol and kidney problems . Notify the doctor immediately if you faint or experience chest pain or pain in the jaw or left arm after taking this drug diflucan ingrediants gluten .
Cost: Varies; most run $15 to $20 or more per tablet Topiramate (Topamax)
Topamax is taken on a daily basis to prevent migraines acyclovir vomiting . In clinical trials, nearly half of the patients taking Topamax were able to cut their migraine frequency in half prednisone for treating acne . This averages out to reducing migraines by two per month bijwerking misoprostol .
Side effects: Numbness (paresthesia), cognitive dysfunction, weight loss, tiredness
Downside: In rare cases, topiramate can cause a serious metabolic problem, with a buildup of ammonia in the body clomiphene not working . It may also cause visual problems and glaucoma nolvadex and .
Cost: Approximately $150 to $175 per month
in generic form, they are quite affordable will prednisone get you high . This use is distinct from their use for heart problems or high blood pressure synthesis of tramadol and analogous .
In addition, a small study found that people who have both frequent migraine headaches and elevated blood pressure can benefit from the blood pressure medicine olmesartan (Beni-car) cymbalta patient assistance .3″ A few patients felt dizzy, but the drug was well tolerated otherwise duloxetine buy online .
Headache specialists are experimenting with Botox injections for migraine prevention cyclosporine 0.2 for dogs . Double-blind studies have been somewhat promising no prescription clomiphene with overnight delivery . -168,161 zocor tablets .3′0 Although the experts have still not figured out exactly who is the best candidate for this type of preventive treatment, it is generally well tolerated and far less invasive than a type of heart surgery that is also now being studied as a way of preventing persistent, recurrent migraines coca-cola caffeine .
For Women Only: Menstrual Migraines
Women far outnumber men as migraine sufferers, and menstrual migraines might be part of the reason imitrex butalbital . Within the past few decades, clinicians have recognized that many women’s periodic migraines are tied to their menstrual cycles and are presumably triggered by regular hormonal fluctuations hives and femara . Estrogen and progesterone both affect the brain chemicals that are believed to be important in the development of migraine headaches only plant testosterone .371 Migraine attacks, especially migraines without aura, are about twice as common during the first few days of -menstruation as at other times of the cycle fluconazole interactions . 372
Knowing when the migraine is likely to strike can allow for a preventive strategy coumadin clinic in magan az . Women susceptible to menstrual migraines are often advised to take a nonsteroidal anti-inflammatory drug (NSAID) such as mefenamic acid (Ponstel) for several days prior to the expected start of menses and continuing for a few day& 371 An OTC NSAID such as naproxen (Aleve) or ibuprofen (Advil, Motrin) might also work aleve commercial rollergirl . The most common side effect of such pain relievers is digestive upset is prednisolone an immuno supresant .
Another treatment that may be useful in preventing menstrual migraine is the mineral magnesium propecia tablet . A placebo-controlled study found that taking 360 milligrams of magnesium daily starting on day 15 of the cycle through the start of menstruation reduced the number of headache days and the severity of pain clopidogrel definition .374 There are also a few small studies showing that soy isoflavones taken daily can help prevent menstrual migraines drug interaction fluconazole and xanax . 375,376
I
Doctors have also experimented with longer-acting triptans, particularly Amerge, Frova, and Naramig effects of zelnorm during pregnancy . These drugs are frequently used to stop a headache once it has begun, but they also can be used when a headache is anticipated to prevent the
-177
menstrual migr aine _ tramadol roomed online . In some women, oral contraceptives will help prevent menstrual migraines, especially those that limit the number of menstrual periods to just a few each year vytorin adverse reactions . 171
Not Tonight, Dear: Sex Headaches
The term sex headache sounds like an elaborate excuse or maybe a setup for a stand-up comic, but they are no laughing matter interaction of paxil and general anastesia .These are headaches, often severe, that occur at or just before orgasm neurontin side effects treatment of fibromyalgia .
For the last few years I have been plagued with migraine headaches during the last week of my cycle, when my birth control pills contain no hormones amlodipine in pediatrics .
I discussed this problem with my doctor, and she prescribed Mircette erythema multiforme bupropion . This brand of birth control pill is supposed to have hormones during the last week oxycodone decreased testosterone . Unfortunately, I still suffered terrible headaches during that week how to raise estradiol levels . I was at my wits’ end because I could hardly function lexapro and elderly .
I bought soy isoflavones containing “natural hormones soma atp .’ I began taking these capsules three times a day during the last week of my next packet of pills walmart sertraline . For the first time in many years, I had no headache! I dreaded the next month, fearing the success of the soy isoffavones had been a fluke, but it has worked for 3 months in a row medication called requip .
Q lotensin hct 20 12.5mg . I have a problem my doctor and neurologist can’t help testosterone levels morning afternoon evening graph . I am hoping you can give me a hint as to what to
do aztrazeneca arimidex .
Whenever I strain in heavy lifting or in hanky-panky (don’t laugh), I get severe pounding headaches lasting 5 to 15 minutes nortriptyline warnings . They are incapacitating zetia and acne . My neurologist says they are “benign sex headaches” caused by my blood pressure going high, but I’m on Accupril for hypertension seroquel the drug . Do you have any ideas?
A testosterone therapy women dose hair loss . Two kinds of headache are associated with sexual activity and exertion how to withdraw from celexa . One develops gradually with a dull, throbbing ache at the back of the head dilantin and coumadin . The other type is explosive and excruciating, starting just before or during orgasm and lasting 5 to 15 minutes voltaren reactions .
Neurologists often prescribe NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin 115), naproxen (Aleve), or indomethacin (Indocin) to be taken prior to lovemaking mexico fluconazole . An alternate approach is the blood pressure pill propranolol (Inderal) as a preventive measure pamelor for headaches . Consult a headache specialist to find out if such treatment would be appropriate in your case dosage for cipro .
0 9 0
The first important step to take if such a headache strikes is to schedule an appointment with the doctor without delay seroquel forthe dope non prescript . There are several potential causes of sex headache, and some of them require treatment to prevent great harm irbesartan without lactose . If a workup eliminates the possibility of a serious underlying problem, a nonsteroidal anti-inflammatory drug such as ibuprofen, naproxen, or the prescription drug indomethacin usually works well for preventing or relieving the pain of a sex headache accutane penis bumps .
0 0 0
Q testgen testosterone . My doctor thought I was nuts when I complained of a sex headache metronidazole suspension ingredients . It happens only when I’m on top sugar in infant ibuprofen . This position gives me the most pleasure, but I have been avoiding it for fear of a stroke taking celexa with 5-htp . The only other time I had such a headache was after going down a steep water slide manufacturers of lithium . My kids and husband were terrified I was dying aa rechargable lithium .
I have high-normal (130/80) blood pressure viagra experiences . I take naproxen for arthritis and Zyrtec for allergies metronidazole ciprofloxacin manufacturer . The headache is explosive and excruciating exelon rivastigmine . Your article on sex headaches vindicates me and assures me I am not alone!
A yerba mate caffeine . Have a specialist evaluate your headaches low testosterone high blood pressure . If they are “benign sex headaches,” there are a number of treatments pile au lithium . For example, the naproxen you use for arthritis may prevent such headaches if taken before lovemaking propecia hair loss .
It is extremely important to rule out other potential causes of severe headaches revia neurotransmitter . One woman responded to the same article:
“I read with great concern your column about the man who asked for help with headaches that occurred with exertion or sexual activity cr discount paxil .
“When my husband was 25, he had a very similar headache while having sex subaction showcomments viagra start from remember . The doctors told him it was viral uroxatral cost . After a week of bed rest and Tylenol he felt better and went back to work bupropion vs budeprion . The next week while having a bowel movement it recurred, but this time the headache was fatal risperdal granular . He had a ruptured aneurysm in his brain liqid nolvadex . Please tell your readers to rule out all possibilities of problems with blood vessels zoloft sexual side effects .”
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abciximab A monoclonal antibody that inhibits platelet aggregation and thrombus formation. Used as an adjunct to heparin in percutaneous transluminal coronary angioplasty under expert supervision. (ReoPro).
glaucoma, as it decreases intraocular pres    9 sure by reducing formation of aqueous humour. It has also been used in epilepsy. Dose: 250 nig-1 g daily. In severe conditions it may be given in similar doses by i.v. injection. Side-effects are drowsiness, gastrointestinal disturbances and paraesthesia. (Dianiox). See page 138 and Table 16.
acamprosate An analogue of GAGA used in alcoholism. It assists in the maintenance of abstinence in alcohol-dependence, but prolonged treatment for a year may be required. Dose: 666 mg 3 times a day. (Campral).
acarbose An inhibitor of alpha-glucosidase, the enzyme that converts dietary carbohydrates to soluble sugars. Used in noninsulin-dependent-diabetes to reduce hyperglycaemic peaks after food. Dose: 50 mg daily initially, rising to 150 mg daily if required. Side-effects are flatulence and diarrhoea; a hypoglycaemic reaction can be treated with oral glucose. (Glucobay). See page 131 and Table 13.
ACE inhibitors See angiotensin-converting enzyme inhibitors.
acebutolol A beta-adrenergic blocking agent with the actions, uses and side-effects of propranolol, but with a more cardioselective effect and less likely to cause bronchospasm.
Dose: in hypertension, 400-800 mg daily; in severe angina, up to 1.2 g daily. It is contraindicated in cardiogenic shock, atrioventricular-block and heart failure. Care is necessary in obstructive airway disease and renal failure (Sectral). See page 148 and Table 21.
aceclofenec A non-steroidal anti-inflammatorydrug (NSAID) used for the relief of pain in arthritic and rheumatoid conditions. Dose: 200 mg daily. (Preservex). See page 131 and Table 29.
acemetacin A derivative of indomethacin with similar actions and uses, but said to be better tolerated.
Dose: 120-180 ing daily. (Finflex). See page 165 and ‘[’able 29.
acetazolamide An inhibitor of the enzyme carbonic anhydrase that has been given as a mild diuretic, as it increases the excretion of bicarbonate. Now used mainly in mild
acetomenaphthone A synthetic form of vitamin K, formerly used in prothrombin deficiency. Menadiol and phytonienadione are now preferred. Acetoinenaphtlione is present in some chilblain preparations.
acetylcholine The neurotransmitter of the parasympathetic nervous system. A 1% solution is sometimes used as a miotic to obtain rapid contraction of the pupil after cataract surgery. (Miochol).
acetylcysteine A mucolytic agent used as eye drops 5% in tear deficiency. Of value in the early treatment (10-15 hours) ofparacetarnol poisoning.
Dose: initially 150 nig/kg by slow i.v. injection, followed by smaller doses up to a total dose of 300 mg/kg over 20 hours. It is inef1ictive, and possibly harmful, if given at a later stage. (Parvolex). See methionine.
acetylsalicylic acid See aspirin. aciclovir See acyclovir.
acipimox A derivative of nicotinic acid used in hypercholesterolaemia.
Dose: 500–750 mg daily. Side-effects are hushing, erythema, nausea and malaise. (Olbetani). See page 146 and Table 20.
acitretin A vitamin A derivative (retinol) used in severe psoriasis resistant to other treatment.
Dose: 20-30 mg daily. Teratogenic - see specialist literature. (Neotigason).
aclarubicin An anthracene cytotoxic agent of the doxorubicin type used in resistant acute non-lymphatic leukaemia. (Aclacin). See specialist literature.
acrivastine one of the newer antihistamines. It is less likely to cause drowsiness, as it does not cross the blood-brain barrier to any great extent, but is correspondingly less effective in non-allergic pruritus. Dose: 24 mg daily. (Semprex). See
page 110 and Table 2.

clobazam A benzodiazepine tranquillizer with the actions and uses of diazepam, but with reduce(] sedative effects. It is used mainly in the short-term treatment of anxiety.
Dose: 20-30 mg as a single nightly dose. III severe anxiety larger but divided doses niav be given under medical control. It is also useful in the auxiliary treatment of epilepsy. (Frkiuni). See page [ 17 and'i'able.5.
clobetasol A potent corticosteroid used as a cream or ointment (0.05%) in the short-term treatment of severe inflammatory skin conditions not responding to less powerful drugs. The application should be used sparingly as absorption with systematic and local side-effects may occur with excessive or prolonged treatment. (Dermovate).
clobetasone A locally acting corticosteroid, used as a cream or ointment (0.05%) in eczema and inflammatory skin conditions not responding to less potent drugs. (Fumovate).
be withdrawn. Clofibrate may potentiate tile action of oral anticoagulants.
clomiphene An anti-oestrogen used to stimulate ovulation in some types of anovulatory sterility.
Dose: 50 mg daily for 5 days a month, repeated if ovulation does not occur, Its use has resulted in occasional multiple births. If pregnancy does not follow tip to 6 courses, further treatment is of little use. Side-effects are hot flushes, and abdominal discomfort; visual disturbances indicate that treatment should be withdrawn. Contraindicated in hepatic disease and ovarian neoplasm. (Cloinid; Scroplictic).
clomipramine A tricyclic antidepressant with the actions, uses and side-effects of inupramine and related drugs, but with reduced sedative properties.
Dose: 30-150 mg daily orally; up to
150 nog daily by im. injection. (Anafranil). See page 128 and Table 11.
clodronate sodium A bisphosphonate used like etidronate and pamidronate in the hypercalcaemia of malignancy.
Dose: 1.6-3.2 g daily as a single dose
I hour before or after food. May also be given i.v. by infusion as a single daily dose of 300 mg for 7-10 days. Long oral treatment is necessary, and serum calcium and phosphate levels should be checked. Side-effects are nausea and diarrhoea. (Hollefos; Loron).
clofazimine An antileprotic agent given in association with dapsone and rifampicin to prevent the incidence of resistance. Dose: 300 Ing monthly; in lepra reactions, 300 ing daily for 3 months. It may cause discoloration of the urine, skin and lesions. (Lunprcric).
clofibrate A plasma lipid-regulating agent used in hyperlipidaernia in conjunction with dietary measures, to reduce excessive plasma levels of cholesterol and
t riglycerides.
Dose: 2 g daily, with regular checks on plasma lipid levels. Side-effects are transient nausea and abdominal discomfort.
It increases the biliary excretion of cholesterol, and gall stones are a contraindication. A myosins-like reaction may occur in renal impairment, and the drug should
clonazepam A benzodiazepine with a marked anticonvulsant action of value in all types of epilepsy.
Dose: I mg daily initially, increased LIP to 8 nog daily according to need. fit status epilepticus, I mg by slow i.v. injection, but apnoea and hypotension, requiring prompt treatment, may occur. Side-effects include drowsiness, dizziness and irritability and occasionally, paradoxical aggression. (Rivotril). See page 136 and Table 15.
Clonidine A centrally acting antihypertensive pertensive agent, now used less frequently.
Dose: 150-300pg daily initially, increased it required up to 1.2 mg daily. Doses of 150-300 pg have been given by slow i.v. injection. Sudden withdrawal of the drug may provoke a I P
hy ertensive crisis.
(Catapres). Clonidine is also used in doses of 100 pg daily in the prophylaxis of migraine. (Dixarit). The side-effects include sedation, dry mouth, fluid retention and bradycardia. See pages 154 andTible 21.
clorazepate A benzodiazepine tranquillizer with the actions, uses and side-effects of diazepam. Used mainly in the short-term treatment of anxiety.
Dose: 7.5-22.5 mg daily, or it single dose of I  mg at night. (Tranxene). See page 117 and Table 5.

clotrimazole An antifungal agent used local]) in vaginal candidiasis.
Dose: 104-200 mg as vaginal tablets or pessaries for nightly insertion. Also used as a 1% cream, lotion or dusting powder for fungal infections of the skin and cars. Side-effecis are local irritation and erythema. (Canestall).
cloxacillin An acid-stable, semi-synthetic penicillin that is not broken down by the enzyme penicillinase, and so is effective in infections due to penicillin-resistant staphylococci.
Dose: 2 g daily before lbod. In severe infeL bons 250-500mg by injection 6-hourly. Now largely replaced by flucloxacillin. The side-coccus are those of the penicillins generally. (Orbenin).
antibacterial action, but when given with a penicillin the antibiotic is able to
penetrate into the cell without loss of
activity. The combination is of value in    33 infections due to penicillin-resistant penicillinase-producing bacteria, including most staphylococci.
Dose: as amoxycillin 750 mg daily, doubled in severe infections, or 3-4 g daily by slow i.v. injection. The side-effects, are similar to those of arnpicillin, but a posttreatment reaction is cholestatic jaundice. (Augmentin).
co-beneldopa tablets of levodopa and henzerazide. (Madopar). See levodopa.
cocaine A local anaesthetic. Still used occasionally in ophthalmology as a 2% solution, often with homatropine.
clozapine A potent but potentially toxic dopamine-receptor blocking agent used in schizophrenia resistant to other drugs.
Dose: 12.5-50 mg daily initially (with care -risk of hypotension), slowly increased to 300 mg daily according to need. A serious side-effect is neutropenia that may lead to agranulocytosis, and treatment must be
Linder hospital supervision with regular blood monitoring. Patient, doctor and hospital pharmacist must be registered with the Clozaril (clozapine) Patient
Monitoring Service to maintain the necessary strict control of treatment. (Clozaril).
coal tar Tile black viscous liquid obtained from the distillation ofcoal. It is used mainly as Zinc and Tar Paste in psoriasis and atophic eczema.
co-amilofruse tablets of the diuretics ainiloricle and frusemide. (Fruinil; Lasoride).
co-amilozide Tablets of the diuretics amiloride and hydrochlorothiazide. (Moduretic).
co-amoxicla A mixture of clavulinic acid and amoxycillin.The resistance to penicillin by staphylococci and other organisms is due to penicillinases such as beta-lactamase in the bacterial cell wall. Those enzymes inactivate penicillin before it call enter the cell and exert its antibacterial action. Such inactivation can be prevented by inhibitors of beta-lactamase such as clavidanic acid. That acid has no
co-careldopa Tablets of levodopa and carbidopa. (Sinemet). See levodopa.
co-codamol Tablets of codeine and paracetamol.
co-codaprin Tablets of codeine and aspirin.
co-darrthramer Tablets of danthron and poloxamer.
cod-liver oil A rich source of vitamins A and 1). It is used as a dietary supplement to improve general nutrition, promote calcification and prevent rickets.
Dose: 2-10 in[ daily.
codeine One of the alkaloids of opium. It depresses the cough centre and is used in the treatment of useless cough. It also reduces intestinal motility, and is useful in the symptomatic treatment of diarrhoea. It also has mild analgesic properties, and is present with aspirin in co-codaprin and similar preparations. In large doses the constipating action may be a disadvantage. Dose: 10 60 mg.
co-dergocrine A cerebral vasodilator, sometimes used in the treatment of senile dementia.
Dose: 1.5 mg daily, but the response is unreliable. Side-effects include nausea, rash and bradycardia. (Hydergine).
co-dydramol Tablets of dihydrocodeine and paracetamol.

Drugs for Asthma
The drug treatment of asthma is far more complex than for any other allergic disease. Drugs prescribed for asthma fall into two basic categories: those that open up the airways by relaxing the airway muscles, called relievers, and those that treat the inflammation in the lining of the airways, called preventers. The former offer a ‘quick fix’ - like taking an aspirin when you have a headache. Just as the actual cause of the headache is not treated by an aspirin, so the actual cause of the asthma attack is not addressed by relievers. Preventers, on the other hand, tackle the basic problem - the inflammation that triggers the contraction of the airway muscles (see p. 36).
In the past ten years, there has been a quiet revolution in asthma treatment, with far more people being given preventer inhalers, usually low-dose steroids. The aim is to get the airways in better condition, with the inflammation thoroughly damped down, so that the airway muscles don’t go into spasm. The ultimate objective is to make people far less reliant on reliever inhalers, because the potential hazards of over-using them are now realised.
The details of modern asthma management, and the different approaches used, are described on p. 160, following the discussion of the main types of drug used for asthma treatment.
Beta-2 relievers (beta-agonists)
Our airways open up when we produce adrenaline. This is the body’s natural response to feeling angry or frightened. The adrenaline widens the airways so that we can run faster or fight more vigorously.
Adrenaline (epinephrine), given as a drug, was among the earliest treatments for asthma. However, it also stimulates the heart to beat faster and raises
the blood pressure. While it is useful for emergency treatment (see p. 155) the side effects make it too hazardous for routine use.
The beta-2 relievers work by mimicking adrenaline – they bind to the same receptors in the airways, the beta-2 receptors. Binding to these receptors stimulates the airway muscles to relax, so that the airways open up.
In other respects, the beta-2 relievers are not like adrenaline. Clever chemical manipulation has made them sufficiently different from adrenaline to have little effect on the heart and other organs, when taken at normal doses.
Beta-2 relievers are best taken by inhalation. Although tablets and syrup are available these are far more likely to bring on side effects, because the dose needed is so much bigger.
Inhaled beta-2 relievers target the drug directly on the airways, so the dose can be smaller. They also have the great advantage of taking effect soon after being inhaled, and giving full relief from airway narrowing within 10-15 minutes.
There are two different kinds of beta-2 relievers:
•    the traditional short-acting beta-2 relievers whose effects last for 3-6 hours (usually about four). The modern consensus is that these should be used only when needed, not taken routinely.
•    the newer long-acting beta-2 relievers, which last up to 12 hours. These drugs are prescribed for more severe forms of asthma (see p. 154), and are generally used routinely, twice a day.
A key question for asthma sufferers is: How often can short-acting beta-2 relievers be used? Ideas about this have changed considerably over the last 20 years, and no doctor would now want to have patients using a Ventolin inhaler five, six or more times a day - something that was quite common in the past. This level of need for beta-2 relievers indicates that the asthma is poorly controlled and requires treatment with a preventer, to quell the inflammation in the airways.
Detailed policy on beta-2 relievers still varies from one part of the world to another. British guidelines state that anyone who needs to use a short-acting beta-2 reliever more than once a day, or who suffers from nocturnal asthma, should be given a preventer as well. The international guideline is more stringent: if a short-acting beta-2 reliever is needed more than three times a week, a preventer should also be prescribed.
How safe are these drugs in the long term? The cause of the big re-think on beta-2 relievers was an epidemic of asthma-related deaths in New Zealand between 1976 and 1988. The death rate from severe asthma attacks was 2-4 times its previous level for a while, and over a thousand New Zealanders died in the epidemic.
There has been a huge controversy over what exactly caused these deaths. Most researchers now agree that the main cause was a new brand of inhaler that delivered a double dose of the drug fenoterol, a short-acting beta-2 reliever with a very powerful effect on the airways and quite high levels of side effects involving the heart. The same brand of inhaler may have been linked to increased death rates in Canada and Germany.
Research suggests that the problem was greatest in New Zealand because sales of the new inhaler were highest there, and because many patients got their inhalers through repeat prescriptions. As a result, people whose asthma was deteriorating badly were not seen by a doctor and were using large amounts of beta-2 reliever, rather than taking preventer drugs. This is now believed to be a major cause of asthma deaths. There are three separate factors involved:
•    The beta-2 reliever covers up the effects of the severe inflammation of the airways. People feel reasonably well, because the reliever is opening up their airways, and don’t realise just how bad their asthma really is. The untreated inflammation in the airways can eventually lead to a very serious, and potentially fatal, asthma attack.
•    The short-acting beta-2 reliever, used regularly, makes the airways more sensitive to exercise, and to allergens such as dust mite or pollen. This means that an asthmatic who is already allergic to these allergens reacts to them at much lower levels in the air.
•    The airways become less and less responsive to the beta-2 reliever itself, so that when a serious attack occurs, requiring hospital treatment, huge doses of beta-2 reliever are needed to open up the airways. These massive doses carry a risk of serious side effects involving the heart.
The details of the New Zealand epidemic still evoke controversy. Was fenoterol itself, which is stronger than other beta-2 relievers, the cause of the deaths? Or was it just that the inhaler delivered a double dose - would any short-acting beta-2 reliever be dangerous at twice the normal dose? Or was it over-use of all beta-2 relievers and lack of preventer drugs?
Some common brand names
Common brand names include:
short-acting beta-2 relievers in inhalers - Aerolin, Airomir, Bricanyl, Ventolin short-acting beta-2 relievers in tablets - Bambec, Bricanyl, Volmax short-acting beta-2 relievers in syrup - Monovent, Ventolin
long-acting beta-2 relievers in inhalers - Bambec, Foradil, Oxis, Serevent
Until this is resolved, safety-conscious asthmatics may want to assume that any of these possibilities could be correct. An ultra-cautious approach would include:
•    Avoiding fenoterol (it is no longer available in Britain, except in the Duovent inhaler, combined with an anti -choli nerg ic drug)
•    Not using double-dose inhalers of any beta-2 reliever (i.e. inhalers that deliver 200mcg/ micrograms per puff)
•    Not routinely taking two puffs of a single-dose inhaler (check with your doctor if you have been told to take two puffs)
•    Using any short-acting beta-2 reliever only I as needed’ – which should be once a day or less according to British guidelines. Note that, with this level of use, there is absolutely no risk from these drugs: it is only regular over-use that is damaging and dangerous.
•    Using a peak-flow meter and ensuring that you are assessed regularly by your doctor
•    Always taking your preventer medication as prescribed.
Since about 1990, the death rate from asthma has been falling, particularly in countries with a policy of reducing use of beta-2 relievers, and increasing inhaled steroids. The death rate in New Zealand is now the lowest it has been for 50 years, and at the same level as in other Western countries.
Unnecessary alarm
While investigating the causes of the New Zealand epidemic, medical researchers discovered that patients inhaling a short-acting beta-2 reliever four times a day had more irritable airways after just two weeks. Their airways were also less responsive to the drug, even after this brief period of use.
Some researchers began to ask if the asthma epidemic itself – the increasing number of cases of asthma – could actually be due to these drugs. Maybe children with mild wheezing, which might have cleared up if left untreated (and which would have gone untreated in the past) were becoming full-blown asthmatics because they were now using beta-2 inhalers?
Many doctors became very concerned about these questions, and a leading medical journal
published an article with the provocative title: ‘Worldwide worsening wheezing – is the cure the cause?’ That was in 1992. Since then, much more research has been done, and it is clear that this particular fear about beta-2 relievers was unfounded.
Unfortunately, there are a few books and other publications around that are spreading unnecessary alarm about these drugs by reporting the debate as it was in 1992. They have taken up that question ‘Is the cure the cause?’, assumed that the answer is ‘yes’, and ignored all the subsequent research, which shows the opposite.
Beta-2 relievers in severe asthma
A few patients with severe asthma remain breathless and wheezy, even though they are inhaling moderate doses of a steroid preventer every day. Increasing the dose of inhaled steroids does not make a huge difference to their symptoms, and it substantially raises the risk of steroid side effects.
Taking a long-acting beta-2 reliever often works wonders for such patients. These relatively new drugs relax the airway muscles, and go on working for 12 hours or more.
There has obviously been concern about long-acting beta-2 relievers having the same sort of insidious side effects as their short-acting colleagues (see p. 153), and so increasing the likelihood of deaths from asthma. However, studies of people taking these drugs suggest that the risks are minimal. Certainly, long-acting drugs taken twice a day are very much safer than short-acting drugs taken four times a day.
Other studies show that the chemical differences of the long-acting drugs, as well as prolonging their effects, also give them a more complex set of actions in the body. For example, they improve the effect of steroids in calming inflammation, and may even have some small anti-inflammatory effect of their own.
Doctors believe that, for patients with troublesome asthma, the benefits of long-acting beta-2 relievers greatly outweigh the risks. But they should only be used in combination with inhaled steroids. Various other options, such as allergen avoidance and the new anti - leukotriene drugs (see p. 159), should probably be investigated as well.
If you are taking long-acting beta-2 relievers, do use them regularly, once every 12 hours – the good effect gradually builds up with consistent use.
Generally speaking, you should not take additional doses in between. These are not intended for use if you have a sudden asthma attack – your doctor will prescribe a short-acting beta-2 reliever for this. This limitation on the use of long-acting beta-2 relievers is certainly appropriate for salmeterol (which was the first of the long-acting beta-2 relievers to be developed) because it is very slow to take effect on the airways. However, one of the newer long-acting beta-2 relievers, called formoterol, begins to work just as quickly as a short-acting beta-2 reliever. Formoterol could, in theory, be used on an ‘as-needed’ basis to combat asthma attacks. You may want to discuss this possibility with your doctor.
Finally, don’t stop taking your preventer drug (e.g. inhaled steroid or cromoglycate), even if you feel a lot better. Long-acting beta-2 relievers are not a substitute for preventers.
Some patients with very severe asthma need to take regular doses of short-acting beta-2 relievers as well as long-acting beta-2 relievers. You should obviously follow the advice of your asthma specialist closely if you are on this kind of drug regime, and not change anything without approval. However, it might be worth discussing other options, such as anti -leukotriene drugs. In addition, do all you can to combat your asthma in other ways – by reducing allergen exposure, avoiding asthma triggers (see p. 39), and employing various other self-help measures (see p. 41).
Immediate side effects of beta-2 relievers
Minor immediate side effects of these drugs include:
•    headache
•    nervousness, trembling, restlessness, anxiety; children may become more excitable, and some are badly behaved or even aggressive.
•    flushing
•    dry mouth
•    muscle cramps.
These side effects – all of which are due to the resemblance of beta-2 relievers to adrenaline – usually wear off relatively quickly. Some long-acting beta-2 relievers may cause nausea and vomiting.
A pounding heart is usually a relatively minor side effect, but it can be more serious, and should be reported to your doctor.
A few asthmatics find that their airways tighten up when these drugs are inhaled, rather than opening. This is called paradoxical bronchoconstriction. If this happens, stop using the inhaler and see your doctor as soon as you can.
Even more rarely, asthmatics can develop allergic reactions to the drugs, or suffer hallucinations or seizures. Obviously you should stop using the inhaler immediately if you experience side effects of this kind, and should see your doctor.
There can be an interaction between beta-2 relievers and other drugs or medical conditions. Should you need a diuretic, tell the doctor or pharmacist that you are also taking a beta-2 reliever, and ask which diuretics are safe. If you have high blood pressure, a heart problem, or a thyroid condition, make sure the doctor remembers this when prescribing beta-2 relievers.
Adrenaline inhalers
Adrenaline inhalers are for use in emergencies. Technically, they are not available in Britain, but they can be imported under special licence, and your doctor may be persuaded to obtain one for you if he or she thinks it might be useful. They are given to people who have asthma and have sometimes had attacks of anaphylaxis (see p. 58), for example in reaction to food, latex or an insect sting. The inhaler provides prompt emergency treatment for the kind of severe asthma attack that you may experience during anaphylaxis.
You should probably be carrying an adrenaline auto-injector as well, as you may need to use both (see p. 98). Those who usually have fairly mild reactions to their allergen can use the inhaler first, to treat symptoms in the mouth, throat and airways. If other symptoms develop, such as faintness or widespread nettle rash,
Asthma alert
If you ever find that your short-acting beta-2 reliever has no effect within ten minutes, or is needed more than once every four hours, this indicates a serious asthma attack and you need urgent medical help (see p. 100).
During a severe asthma attack, while getting to hospital or waiting for a doctor to arrive, up to 30 puffs of a short-acting beta-2 reliever should be taken as an emergency treatment, to get the airways open. There is a risk of death if you don’t use the reliever fully in this situation. (This emergency dose is safe for almost everyone, but there may be risks if you have a heart condition – get detailed advice from your doctor in advance.)
then the adrenaline injector can be used. Those with a history of more severe reactions should start with the adrenaline injector and then use the inhaler if there are still symptoms in the mouth or airways.
Don’t exceed the maximum number of puffs stated on the canister, as the propellant can cause problems. If you have a heart condition, your doctor will advise you about using this kind of treatment safely - adrenaline can affect the heart.
Ephedrine
Ephedrine and orciprenaline (brand name Alupent) belong to the previous generation of reliever drugs. They are chemically very similar to adrenaline and therefore cause a lot of side effects, especially involving the heart.
These drugs are no longer recommended, and will soon be phased out completely. Some older asthmatics may still be using them, just because they have been on them for years and no one has reviewed their treatment.
If you are taking such drugs, ask your doctor about switching to a newer form of reliever - it will be more effective in treating your asthma, as well as having fewer side effects.
Anti -cho linerg ics
These drugs, also known as anti-muscarinics, are relievers. However, they work in a completely different way from the beta-2 relievers. They block the action of the parasympathetic nervous system, a set of nerves that are the biological equivalent of auto-pilot - working without the intervention of conscious thought. The parasympathetic nervous system has many effects on the body, including keeping the airway muscles nicely toned (see box on p. 235). By blocking the parasympathetic, anticholinergics help the airway muscles to relax.
Anti-cholinergics are taken by inhaler, and require 30-90 minutes to achieve their full effects. They should continue working for 3-6 hours.
Some common brand names
Common brand names of anti-cholinergics include: inhalers – Atrovent, Oxivent
nasal spray - Rinatec
For most asthmatics, especially those with a strong allergic component to their asthma, anti-cholinergics are generally less effective than beta-2 relievers. But they are useful to children under one year, who may not respond to beta-2 relievers. They also have a role where asthma is combined with chronic bronchitis -here the anti -choli nerg ics can sometimes be more effective than beta-2 relievers - and they are particularly useful for asthma with a lot of mucus, because blocking the parasympathetic tends to reduce mucus production. For severe asthmatics, anticholinergics may be combined with beta-2 relievers.
Anti -choli nerg ics should be taken only when needed, not regularly several times a day. If used regularly, they can make the airways more sensitive, just as short-acting beta-2 relievers can (see p. 153).
Side effects
Minor side effects of anti-cholinergics may include a dry mouth, blurred vision, constipation, and irritation of the mouth and throat. A few people suffer nausea or difficulty in passing urine.
Serious side effects are rare. Any increase in the stickiness of the sputum coughed up may be a cause for concern, especially in children. If there is an increase in wheezing or coughing, stop taking the drug and see your doctor.
If you already have glaucoma or prostate problems you should be monitored carefully by your doctor, as these conditions can get worse with anti -choli nerg ic drugs.
When anti -choli nerg ics are used in a nebuliser, it is vital that the mask fits well (see p. 163).
Anti-cholinergics for the nose
Another use for anti-cholinergics is in nasal sprays, for the treatment of vasomotor rhinitis, a non-allergic condition that is frequently mistaken for allergic rhinitis (see p. 29). In this disorder, the constant flow of mucus is caused by a malfunction of the parasympathetic nervous system, which is why anti-cholinergics work well.

A blocked or runny nose in Allergy
THAT LASTS ALL YEAR
`Everyone has heard of hayfever, but it’s news to most people that you can have this sort of problem all year round,’ complains Elizabeth. ‘Before we got the treatment sorted out, Benny was “the kid with the constant cold”, and I did notice other mothers looking less than enchanted at the prospect of his coming over to play.’
Benny suffers from allergic reactions to house-dust mites and cats which cause hayfever-style symptoms (26) all year round. This condition doesn’t even have a common name – the medical one is perennial allergic rhinitis – yet it is one of the most common allergic diseases.
Any airborne allergen that is found in the air all year round can cause perennial allergic rhinitis:
• House-dust mite is the number one suspect in most parts of the world. Particles from other insects, such as midges and mosquitoes outdoors, and cockroaches, house flies, bloodworms (used for fish food) or carpet beetles indoors, can also cause nasal allergies.
• Mould spores can be the problem: they are found both indoors and out.
• In some regions, certain types of pollen are airborne all year round (27).
• All pets other than fish produce allergenic particles (even snakes).
• Allergens encountered at work (133) can also produce symptoms in the nose. This is a warning sign gn you should not ignore – it often means that occupational asthma is on its way (132).
Occasionally, the offending substance is being eaten not inhaled. This is less common, so you should investigate inhaled allergens first, before trying an elimination diet (29).
Skin-prick tests (91) will help to identify any airborne allergens that are responsible, but where food is the culprit, skin-prick tests are often negative (69)
Triad and NARES
Diagnosis of perennial allergic rhinitis is complicated by the fact that there are two other conditions – called triad and NARES – which produce similar symptoms and involve the immune system but are not, strictly speaking, allergies.
Triad is so called because it involves three distinct symptoms:
• perennial rhinitis
• polyps in the nose – little fleshy growths that can kill your sense of smell
• asthma.
People with triad tend to collect all three symptoms gradually, in no fixed order, over a period of years or even decades. Many are sensitive to aspirin and related drugs, and almost everyone with triad develops this sensitivity eventually.
Aspirin sensitivity can come on very suddenly and produces a reaction akin to anaphylaxis (101). This can be fatal, so it is probably best to avoid all aspirin-like drugs if you have triad, even though you have not reacted to aspirin in the past Aspirin-like drugs are found in painkillers, arthritis drugs and cold remedies – check with a pharmacist before you buy (151).
If you have asthma, think twice about operations on the nose to remove polyps – they can make the asthma much worse.
The initial letters of Non-Allergic Rhinitis with Eosinophilia have been stretched a bit to get NARES. (This is a medical joke –the Latin word Hares means nostrils.) The problem is caused by eosinophils (19), which flock into the nose and cause severe inflammation. Some people with NARES go on to develop triad.
Collateral damage
Having the nose swamped with mucus can lead to knock-on problems in the ears, sinuses and airways.
If the tube that leads from the ear to the nose (the Eustachian tube) becomes blocked, then fluid cannot drain away from the middle ear. This is called secretory otitis media, or glue ear - it dulls the hearing and causes an unpleasant ‘popping’ sensation. The ears may also feel blocked and itchy, but if children have had this problem since they were tiny they may not complain because they assume that’s just the way ears are supposed to feel. Deafness is often the first sign anyone notices.
Sinusitis is another possible complication, because fluid from the sinuses should also drain into the nasal cavity. With the ouflow blocked, mucus builds up in the sinuses and can become infected by bacteria (30).
Post-nasal drip can also occur with perennial allergic rhinitis. The over-abundant mucus runs down the back of the nose, into the throat and then the airways. This produces a persistent phlegmy cough, which may occasionally be mistaken for asthma.
When the rhinitis is treated effectively, all these problems should sort themselves out, although additional treatment is usually necessary in the case of persistent sinusitis (33).
Treatment
Where an allergen such as house-dust mite or mould spores has been identified as the source of the problem, eradicating it from your house (see Chapter 4) will make a huge difference, and may avoid the need for drugs. If the allergen is unavoidable, immunotherapy (see pp. 164-8) or some alternative form of desensitisation (see pp. 210-13) could be very helpful.
Where drugs are needed, nose drops are best. They get the drugs right to the target so doses are minimal, which means very few side effects. The drugs used are:
• cromoglycate to prevent the allergic reaction before it starts (148)
• antihistamines to block the allergic reaction before it produces inflammation (138)
• steroids to calm down inflammation (144). Steroid nose drops are also useful for NARES and triad. If you are taking steroid drops continuously, your doctor should check the membranes inside your nose every six months. Make sure you put the drops in correctly, especially if you have polyps (144).
If you suffer stinging, burning or dryness, it might be due to preservatives in the drops, not the drug itself (see box on p. 33), so talk to your doctor about a different formulation.
Don’t use over-the-counter decongestant drops: they do nothing to treat the allergy or inflammation, and are little more than a ‘chemical crowbar’ to open up the nose. Your nose gets addicted to them in a few days, and when you stop using them you get ‘rebound congestion’ - absolute and total blockage. It does wear off eventually, but is unpleasant meanwhile. If you are suffering this problem at this very moment, don’t put more decongestant drops in - your nose needs to go ‘cold turkey’ to recover, not have its addiction fed!
If none of the anti-allergy drugs work, but decongestant drops do, then you probably have a non-allergic disease called vasomotor rhinitis. The symptoms are very similar to allergic rhinitis, but without the sneezing and itching. See your doctor again, because there is an effective treatment that uses anticholinergic drugs (see box on p. 156). Acupuncture (see below) can also be helpful.
An elimination diet (194) will diagnose any food reactions. It works wonders for some people with severe and unexplained perennial rhinitis, Including people with such a flood of mucus that they can scarcely work or live normally. You should certainly give this diagnostic diet a try if there are clues that suggest food is the culprit (69) or if no airborne allergen can be identified. Yeast - found in bread, beer and B-vitamin tablets -is quite often the culprit in rhinitis, but it could be any food.
Acupuncture is worth trying, to reduce the blockage in the nose and stem the flow of mucus, because the autonomic nervous system (see box on p. 235) plays some part in the symptoms of allergic rhinitis (and is the sole cause of the symptoms for those with vasomotor rhinitis). For those with severe sinusitis, osteopathy can be good for draining mucus from the sinuses.
Very occasionally, psychological or emotional reactions play a part in perennial allergic rhinitis, with symptoms getting significantly worse during stressful events. One possible manifestation of this is post-coital rhinitis, where sex brings on rhinitis (and sometimes asthma as well). In such cases, psychotherapy should be considered. (But check you are not just allergic to the dust mites in your bed first…)
A nose by any other name…
Rhinitis means inflammation (-itis) of the nose (rhin-). The same Greek word gives us rhinoceros - ‘nose-horn’.