Posts Tagged ‘vomiting’

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
Capecitabine (ca pe-SE-ta h -been)
Brand Name
XelVA
Type of Drug  Antimetabolite.
Prescribed For
Breast cancer and colorectal cancer.
General Information
Capecitabine is prescribed for stages of breast and colorectal cancer in place of 5-FU, an injected drug that has been the basis for many chemotherapy programs. Capecitabine is converted in the body to 5-FU. Unlike many anticancer medications, capecitabine can be taken by mouth and has relatively few serious side effects.
Cautions and Warnings
Do not take capecitabine if you are allergic or sensitive to any of its ingredients or to 5-FU.
People taking warfarin or certain other blood-thinning medications are at risk of potentially fatal bleeding when capecitabine is added to their therapy. People taking these medications together should be closely monitored for changes in their response to the blood thinner.
People with liver disease should be carefully monitored by their doctors because capecitabine’s effect on the liver is not known.
This drug is largely eliminated through the kidneys. People with severe kidney disease should not take it. Dose adjustments are required for those with moderate kidney disease.
Capecitabine may reduce fertility.
Capecitabine use is associated with heart and blood-vessel disease.
Capecitabine may cause severe diarrhea. Call your doctor if you experience symptoms (see “Special Information”).
Jaundice has occurred in patients taking capecitabine requiring an interruption of medication until symptoms resolved.
Possible Side Effects
✓    Most common: diarrhea, constipation, nausea, vomiting, mouth sores, abdominal pain, hand-and-foot syndrome (see “Special Information”), inflammation of the skin, tingling or pain in the hands or feet, fatigue, loss of appetite, low blood-cell counts, eye irritation, and fever.
✓    Common: upset, &~)MaCb, nail problems, headache, dizziness, sleeplessness, dehydration, swelling, muscle aches, and pain in the arms or legs.
✓    Less common and rare side effects can affect the stomach and intestines, skin, nervous system, tear ducts, lungs and Possible Side Effects (continued)
respiratory system, heart and blood vessels, blood, urinary and reproductive tracts, liver, and other organs. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Combining antacids and capecitabine can increase the amount of drug absorbed by about 20%. Separate doses of antacids and capecitabine by 2 hours.
•    Leucovorin (a drug used in cancer treatment) increases the side effects of 5-FU. This combination has caused death in several seniors.
•    Combining capecitabine with warfarin can cause excessive bleeding.
•    When combining capecitabine with phenytoin, doses of phenytoin may need to be reduced due to an increase in side effects.
Food Interactions
Capecitabine should be taken within 30 minutes of a meal to avoid stomach problems.
Usual Dose
Adult (age 18 and over): 3000-5600 mg a day, depending on height and weight, in 2 doses. Capecitabine is used in 3-week cycles: 2 weeks on the drug, followed by 1 week off. Dosage may be reduced by 50% in people who experience severe side effects.
Child (under age 18): not recommended.
Overdosage
Symptoms include nausea, vomiting, diarrhea, bleeding and reduced blood-cell counts, and stomach irritation. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Stop taking capecitabine and call your doctor if you have 4-6 more bowel movements a day than normal, vomit 2-5 times in 1 day, or become very nauseous. Depending on the severity of your symptoms, your doctor may reduce your dosage.
Capecitabine has caused hand-and-foot syndrome. Symptoms of this condition include numbness, tingling, pain, swelling, redness, and skin loss and blistering of the hands or feet. Stop taking the drug and call your doctor if you experience any of these Symptoms.
People who develop stomatitis (symptoms include swelling, pain, or sores in the area of the mouth or tongue) should stop taking the drug and call their doctor at once.
Call your doctor, but do not stop taking the drug, if you develop a fever of 100.5°F or higher or other signs of infection.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and space the remaining daily dosage evenly throughout the day. Go back to your regular schedule the next morning. Call your doctor if you miss more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Capecitabine can harm the fetus. Its potential benefits must be carefully weighed against its risks when capecitabine is considered crucial by your doctor. Effective contraception is absolutely necessary while taking this drug.
It is not known if capecitabine passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to side effects, especially diarrhea and other stomach problems.

Generic Name
Buspirone (bue-SPYE-rove) OG
Brand Name  BuSpar
Type of Drug
Minor sedative and antianxiety drug.
Prescribed For
Anxiety and generalized anxiety disorders; also prescribed for the aches, pains, fatigue, and cramps of premenstrual syndrome (pMS).
General Information
Buspirone hydrochloride has a potent antianxiety effect. It is approved by the Food and Drug Administration (FDA) for short-term relief of anxiety, but it may apparently be used safely for more than 4 weeks. The exact way in which buspirone works is not known, but it seems to lack the addiction dangers associated with other antianxiety drugs, including benzodiazepines. It neither severely depresses the nervous system nor acts as an anticonvulsant or muscle relaxant, as other antianxiety drugs do. Minor improvement will be apparent after only 7-10 days of drug treatment, but the maximum effect does not occur for 3 or 4 weeks.
Cautions and Warnings
Do not take buspirone if you are allergic or sensitive to any of its ingredients.
Buspirone should be used cautiously by people with timer or kidney disease.
Buspirone does not have any antipsychotic effect and should not be taken for symptoms of psychosis.
Although buspirone has not shown a potential for drug abuse, you should be aware of this possibility.
Buspirone should not be used with monamine oxidase inhibitor (MAGI) antidepressants.
Possible Side Effects
♦    Most common: dizziness, drowsiness, nausea, and head-
ache.
•    Common: fatigue, nervousness, lightheadedness, excite-
ment, dry mouth, and insomnia.
•    Less common: heart palpitations, muscle aches and pains, tremors, rash, sweating, clamminess, rapid heartbeat, dif-
ficulty concentrating, anger or hostility, depression, loss of interest, diarrhea, constipation, vomiting, and blurred vision.
♦    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
•    Combining buspirone with an MAGI antidepressant may produce severe hypertension and may be dangerous.
•    The effects of combining buspirone with other drugs that work in the central nervous system (CNS) are not known. Do not take other sedatives or antianxiety or psychoactive drugs with buspirone unless prescribed by a doctor familiar with your complete medical history.
•    Erythromycin, itraconazole, ketoconazole, clarithromycin, diltiazem, verapamil, fluvoxamine, and ritonavir may increase blood levels of buspirone. When used in combination, your buspirone dosage may need to be adjusted.
•    Buspirone may increase the side effects of haloperidol and diazepam.
•    Studies show that buspirone is not affected by alcohol, but this combination should still be used with caution because buspirone causes drowsiness and dizziness.
•    The combination of buspirone and trazodone may cause liver inflammation.
•    Combining rifampin with buspirone may decrease buspirone’s effectj\18″eSS.
Food Interactions
This drug may be taken either with or without food, but for the most consistent results, always take your dose at the same time of day in the same way—that is, with or without food. Avoid drinking large amounts of grapefruit juice with this drug.
Usual Dose
Adult: starting dosage-7.5 mg twice a day. Dosage may be increased gradually to 60 mg a day.
Overdosage
Symptoms of overdose are nausea, vomiting, dizziness, drowsiness, pinpointed pupils, and upset stomach. The overdose victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Buspirone may cause CNS depression, drowsiness, and dizziness. Be careful while driving or operating hazardous equipment. Avoid other CNS drugs and alcoholic beverages because they will enhance buspirone’s effects.
Contact your doctor if you become restless, develop uncontrolled or repeated movements of the head, face, or neck, or have any intolerable side effects.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Though buspirone has not been found to cause birth defects, be sure to inform your doctor if you are or might be pregnant while taking this drug. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known how much buspirone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Several hundred seniors participated in drug evaluation studies without any unusual problems. However, the effect of this drug in seniors is not well known, and special problems may surface, particularly in those with kidney or liver disease.

Type of Drug
Bowel Anti-Inflammatory Drugs (5-ASA Type)
Brand Names
Generic Ingredient: Balsalazide Colazal
Generic Ingredient: Mesalamine 0
Asacol    Pentasa
Canasa    Rowasa Lialda
Generic Ingredient: Olsalazine Dipentum
Prescribed For
Ulcerative colitis; rectal products prescribed for distal ulcerative colitis, proctitis, and proctosigmoiditis.
General Information
Chemical cousins of aspirin, these bowel anti-inflammatory drugs (5-ASA type) are used to treat symptoms of bowel inflammation. No one knows exactly how they work, but they are believed to have a local effect on the bowel. The tablet forms are made to delay drug release until they reach the colon. Little of the drug is absorbed into the blood; 70-90% remains in the colon.
Cautions and Warnings
Do not take bowel anti-inflammatories if you are allergic or sensitive to any of their ingredients or to aspirin. Although people who are sensitive or allergic to sulfasalazine have generally been able to tolerate mesalamine—which is an active agent in sulfasalazinethey should be cautious.
Bowel anti-inflammatories may worsev\ 4zo%Vis or cause cramping sudden abiboYrimall pain, bloody diarrhea, fever, headache, or rash. Stop taking the drug at once and call your doctor if any of these symptoms develop.
Some people taking mesalamine have developed kidney problems. People who have or have had kidney disease should be cautious about using these drugs. All people taking mesalamine should have kidney function tests before and during drug therapy.
Possible Side Effects
Bowel anti-inflammatories are generally well tolerated. Tablets and capsules have the most side effects, suppositories the least.
Tablets
♦    Most common: headache; abdominal pain, cramps, or discomfort; belching; nausea; sore throat; and generalized pain.
♦    Common: constipation, diarrhea, upset stomach, vomiting, muscle weakness, dizziness, fever, runny nose, rash, skin spots, achy joints, back pain, and stiff muscles.
✓    Less common: worsening of colitis, gas, runny nose, chills, sweating, feeling unwell, tiredness, acne, itching, arthritis, chest pain, conjunctivitis (pinkeye), painful menstruation, swelling, and flu-like symptoms.
♦    Rare: sleeplessness, hair loss, leg or joint pain, and urinary burning or infection. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Capsules
♦    Less common: abdominal pain, cramps, or discomfort; diarrhea; nausea; headache; respiratory infection; rash; and skin spots.
♦    Rare: worsening of colitis, constipation, gas, vomiting, dizziness, fever, sleeplessness, belching, upset stomach, sweating, feeling unwell, tiredness, itching, acne, achy joints, leg or joint pain, muscle aches, conjunctivitis (pinkeye), swelling, and hair loss. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Suppositories
✓    Common: headache.
✓    Less commQ(v, abdominal palecramps, or discomfort; diarrhea or frequent stools; worsening of colitis; flatulence or gas; nausea; rectal pain, soreness, or burning; dizziness; dry mouth; fever; sore throat; cold symptoms; acne; rash; skin spots; and swelling.
Possible Side  Effects (continued)
Rectal Suspension
♦    Common: abdominal pain, cramps, or discomfort; gas; nausea; headache; and flu-like symptoms.
• Less common: bloating; diarrhea; hemorrhoids; pain on enema insertion; rectal pain, soreness, or burning; dizziness; fever; feeling unwell; tiredness; cold symptoms; sore throat; itching; rash; skin spots; back pain-, leg pain: and joint pain.
♦    Rare: constipation, muscle weakness, sleeplessness, swelling, hair loss, and urinary burning or infection. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
None known.
Food Interactions
Take the tablet and capsule with food.
Usual Dose
Balsalazide
Tablets: 2250 mg 3 times a day for 8 weeks.
Mesalamine
Tablets: 800 mg 3 times a day for 6 weeks.
Once-daily tablets: 2-4 (1.2 mg each) once a day with a meal.
Capsules: 1000 mg 4 times a day for up to 8 weeks.
Suppositories: one 500-mg suppository twice a day for 3-6 weeks. Retain the suppository for 1-3 hours for maximum benefit.
Rectal Suspension: 1 bottle of suspension taken as an enema at bedtime every night for 3-6 weeks. The enema liquid should be retained for about 8 hours.
Olsalazine
k4kft, MO mg a day in 2 divided doses.
Overdosage
Symptoms are likely to include: ringing or buzzing in the ears, fainting or dizziness, headache, lethargy, confusion, drowsiness, sweating, rapid breathing, vomiting, and diarrhea. In case of overdose, call your local poison control center or hospital emergency room. You may be told to induce vomiting with ipecac syrup—available at any pharmacy—before taking the victim to the emergency room. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
The tablets and capsules must be swallowed whole. Call your doctor if they are visible in your stool. When using suppositories, handle them as little as possible to prevent melting.
Call your doctor if you develop chest pain, breathing or urinary difficulties, fever, unusual bleeding or bruising, worsening of colitis, or any bothersome or persistent side effects.
If you forget to administer a dose, do so as soon as you remember. If you take a tablet or capsule and it is within 4 hours of your next dose, skip the dose you forgot and continue with your regular schedule. If you take the suppositories or rectal solution and you do not remember until it is almost time for the next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Bowel anti-inflammatories can pass into the fetal circulation. When your doctor considers these drugs crucial, their potential benefits must be carefully weighed against their risks.
Small amounts of these drugs can pass into breast milk. Nursing mothers who must take these drugs should consider using infant formula.
Seniors: Seniors may use these drugs without special restriction.

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There are potential side effects, however zovirax insert . Fenugreek can cause diarrhea, flatulence, and allergic reactions celexa testimonies . It might, in theory, interact with warfarin (Coumadin) or other anticoagulant medicines and probably should be avoided by people who take them trazodone for bipolar . There is always a possibility of hypoglycemia when blood sugar–lowering botanical medicines are added to prescription drugs for blood sugar control, so careful monitoring is essential rx neurontin . The usual dose is around 1 or 2 grams of seeds three times a day, but it may also be taken as a tea 250
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G atenolol personality changes . I found a spice in my spice rack that I had never heard of, and I had no instructions on how to use it lack of response to furosemide . I looked up fenugreek as a spice and found that it is a medicinal herb celebrex chemotherapy colon cancer .
It is used to lower cholesterol and control blood sugar provera for bodybuilders . The only side effect I found is nausea if you take too much specific heat lithium . What do you know about this herb? -
A adderall and selegiline together . Studies in animals and humans show that fenugreek can lower cholesterol and blood sugar methyl prednisone acetate . If diabetics take fenugreek, they should monitor their blood sugar to make sure it doesn’t fall too much xeno lithium .
Fenugreek seeds are rich in soluble fiber and can be used to treat constipation paroxetine heart rate . At high doses, this herb can cause digestive distress evista floaters in eyes .
o 0 *
GYMNEMA SYLVESTRE
This herb comes from India and has been used in traditional Ayurvedic medicine for centuries ms avoiding caffeine . Animal studies have demonstrated that it is capable of lowering blood sugar viagra lasting .”‘ No serious side effects have been reported, but perhaps the scarcity of well-controlled clinical trials explains that to some extent canadian pharmacy bupropion .
NOPAL (Opuntia sp caffeine in tea bags .)
One interesting botanical treatment has only a little bit of research to support it, but it is becoming increasingly popu-far viagra photo woman . We heard several years ago from a physician who said one of his diabetic patients had improved his blood sugar control with prickly pear tea side effects of stopping tamoxifen . This cactus, called nopal in Mexico, has been studied primarily in animals beta celexa citalopram interferon lyrica pregabalin . That research indicates that the cactus can help lower blood sugar fosinopril solium . 252,253 Research in humans is preliminary, but it suggests that nopal may also be useful in helping to control blood sugar in type 2 diabetes united states wellbutrin bupropion hcl . 254 Close monitoring and medical supervision are advised zithromax ear book .
lama family practitioner and want to share an herbal remedy with you allopurinol and blood pressure . A 60-year-old male Hispanic diabetic patient has had trouble controlling his blood sugar ovulation pain with clomid . Despite intensive diet changes and a prescription for Glucovance, his blood sugar still ran around 160 to 100-plus testosterone treatment and prostate cancer .
One day he came in with his diary showing consistent blood sugars of 90 to 100 fexofenadine solubility in isopropylalcohol . I asked what he was doing differently and he said in a low voice, “I’ve got a new girlfriend from Mexico online fexofenadine . She makes me tea from nopalito [prickly pear> cactus and has me drink it three times a day advil motrin recalls . Now my sugars are doing better buy celecoxib low cost . -
Finding fresh nopal cactus outside of Mexico or the desert of the southwestern United States could be tricky loratadine 180 . When we shared the story about nopalito tea (nopalito is a young stem segment from the cactus), we were inundated with questions from readers who wanted to know how they could get some nopal cactus leaves does prednisone cause sterility . Short of moving, you might try looking for this natural plant product in your local health-food store (or on the Web) voltaren info . Although it is unlikely you will find fresh leaves, you will be able to locate capsules labeled prickly pear cactus (Opuntia) or nopal cactus avandia zantac .
Careful blood sugar monitoring is essential age testosterone . One reader who blended cactus with apple juice kept careful track of his cholesterol levels, triglycerides, and glucose bladder infection ibuprofen . In 6 months, his triglycerides dropped from 191 to 139 and his total cholesterol went from 202 to 169 web md doxepin . More interesting, his blood glucose drifted down as well seafood allergies and atrovent . Here is his account:
I read your article about nopalito tea, so I started using cactus in April and had good results what’s the main resources of caffeine . My doctor knows about it zithromax for oral suspension . I blend one bag of cactus and 3 112 cups of apple juice into a drinkable liquid effexor memory . I drink 4 ounces three times a day mens viagra . Here are my results why is caffeine bad in pregnancy .
Blood Glucose (average)
Jan 147 no cactus
Feb 143 no cactus
Mar 158 no cactus
Apr 142 with cactus
May 132 with cactus
Jun 126 with cactus
Jul 135 with cactus
Aug 128 with cactus
I write down every food I eat every day and take my test every morning and keep a record of it natural alternative to caffeine . I can see which food does what, and I take my medicine as always and my doctor has been kept informed battery lithium watch .
This gentleman is the poster child for responsible blood sugar control doxycycline burns treatment . Not only is he tracking his sugar levels carefully, he is also working closely with his physician to make sure what he does is safe and effective amsterdam nederlands sildenafil .
STEVIA
Stevia (Stevia rebaudiana) is a nonsugar sweetener derived from the leaves of a South American shrub phenytoin effects lab values . It is not approved as a sugar substitute in the United States but is frequently used in Japan didanosine causing lipoatrophy . Some preliminary research suggests that using stevia instead of sugar might have a benefit beyond simply not consuming sugar on levoxyl but still having symtoms . A small study in Brazil found that stevia tea could improve glucose tolerance in nondiabetic individuals simvastatin 80mg tablet . 255 The plant can also lower blood pressure celexa twice normal dose . No significant toxicity has been reported do cardiologists order toradol .
Stevia is a natural sugar substitute fosinopril side effects . In addition to sweetening food and drinks without raising blood sugar, stevia may be capable of improving glucose tolerance 1 2 aa lithium 3.6v battery . Be sure to monitor your blood sugar when adding this sweetener to a medication regimen automobile lithium ion battery .
Downside: In laboratory tests, high doses of stevia interfered with animals’ reproduction ketorolac pediatric .
Cost: Approximately 10 or 20 per serving Easing Stress
There is a direct connection between your level of stress and your blood sugar paroxetine and . For someone without diabetes, this is probably no big deal, unless you are always under stress warfarin metallic taste . But for a diabetic, anxiety, fear, depression, and emotional pressure will boost blood sugar and make the condition harder to control lyrics for lithium .211,2″ Giving a speech, having a fight with your partner, or going in for your annual performance review at work can all affect your stress level and your blood sugar singulair and weight loss . Doctors often look at diet, exercise, and other physical factors ibuprofen crush . They are less likely to consider emotions, even though they have such a profound impact on a diabetic’s health novartis v pfizer zithromax .
How can a diabetic learn how to manage stress successfully? There is no cookie-cutter answer to this question is cipro sulfa based . Everyone handles stress differently phenergan sudaphed contraindication . For some, the only effective strategy might be to quit a highly demanding job and move to a cave decadron for oral surgery . Doing that would stress others out even more preparation of ethinyl estradiol . Finding the right approach may take trial and error xenical caps orlistat roche .
Avoiding people who make your hands cold is a good place to start hartford zyprexa attorneys . Buy a mood ring (a relic of the 1970s) aluminum lithium etchant . It reacts to skin temperature viagra side effects diarrhea . Whenever your hands get cold as a response to stress, you should do something different from your current activity to warm them up decadron contain only t4 . Relaxation tapes can be helpful if you can carve out time to listen lithium arizona . Our favorites are by Emmett Miller, MD chemical composition of neuronal soma . Dr felodipine reaction . Miller has been in this business a long time and has a soothing voice 7 day doxycycline symptoms disappear . We guarantee that if you listen to his Letting Go of Stress, you will be more relaxed afterward viagra levitra cialis comparison .
Some people may benefit from individual psychological counseling or biofeedback training to learn to cope with stress prednisolone hot flashes . But others may be able to find a group that is learning stress management techniques accutane colitis . 251 If you need a guide to doing it yourself, we suggest you look for a copy of Richard Surwit’s book, The Mind-Body Diabetes Revolution requip and compulsive gambling . It has some good
DR what does bactrim treat . MILLER’S SOOTHING SOUNDS
To purchase Dr metformin 500 571 . Miller’s CDs or tapes, you can visit his Web site, www topical oinment chloramphenicol .DrMiller methotrexate how long .com, or call 800-52-TAPES omnicef stomach . Letting Go of Stress or the Ten-Minute Stress Manager is a good starting place celebrex docing information .
tips on learning to relax and overcome stress as well as background on the importance of psychological issues in diabetes citalopram hydrobromide capsules .
When all else fails, an antianxiety agent can be surprisingly effective at controlling blood sugar in the short term remeron childrens studies . If, for example, you know that traveling makes you anxious and throws your blood sugar out of kilter, you may want to ask your doctor whether a short course of diazepam (Valium), alprazolam (Xanax), or some similar medicine might help you deal with the hassle of travel no prescription claritin .259 Such drugs can be habit-forming, however, so relying on them for long periods of time is not desirable veetids expire .
Depression also has a major impact on diabetes and messes up efforts to keep blood sugar where it should’be information about nexium . Everything feels much harder to manage when you’re down in the dumps, and your attention to exercise, diet, medication, and self-care may well suffer viagra doseages effects . Changes in brain biochemistry associated with depression might also contribute directly to a higher risk of diabetes complications lithium battery explosions . MO Blood clots leading to heart attacks or strokes are more likely when diabetics are depressed; so are irregular heart rhythms and inflammation methotrexate factoids . It’s just as crucial for a diabetic to be evaluated regularly for depression, and to get treatment when it is needed, as it is for her to get regular eye exams and foot care prostatitis and flomax .
Pills to Lower Blood Sugar
Quite often, diet and exercise alone are not enough to control blood sugar glyburide 2 mg . There is a bewildering array of medicine the doctor may prescribe: metformin, which also is dispensed under the brand name Glucophage; medicine with “glitazone” in the generic name, like pioglitazone (Actor); and old-fashioned blood sugar—lowering drugs similar to chlorpropamide or tolazamide, or their newer cousins glyburide (Micronase), glimepiride (Amaryl), or glipizide (Glucotrol) zoloft causing cardiac arrythmias . Newer drugs that stimulate insulin secretion, called nateglinide (Starlix) and repaglinide (Prandin), might be used instead of one of the older blood sugar—lowering drugs levaquin diflucan interactions . Eventually, if blood sugar and glycosylated hemoglobin can’t be brought down to acceptable levels, even type 2 diabetics may end up using insulin bacterial vaginosis flagyl did not work . But it usually makes sense to try oral medicines first metaloproteinase cipro .
It is difficult to tell which of these pills would work best for any given patient hold dose metoprolol . As with everything else pertaining to diabetes, people vary in their responses salbutamol and hyperstimulation . Some do well on a single drug, while others need a complicated regimen class action lawsuits against provera . Only you and your doctor can determine which medication(s) are likely to be safest and most effective for you amoxicillin dental work .
To try to sort out the patterns and give doctors some guidance, scientists at Kaiser Permanents, an enormous HMO in northern California, reviewed the organization’s vast database efficacit gel testosterone 50mg j . First they created a registry of the diabetic patients, and then they examined the data to see which drugs were most effective over time male devo provera . Even though most patients are started on one of the medicines like chlorpropamide or glyburide, this was the least effective treatment for getting HbAl down to
target personal experiences of people on wellbutrin .261
The most effective treatment was triple therapy: a
“glitazone”-type drug in combination with metformin and a drug like glyburide onset action lamictal days . Next best after that was metformin together with insulin pepcid indication gi protect .
One of the most interesting features of the Kaiser Permanents study was that patient behavior could be used to predict success, aside from the drug used hydroxyzine helps withdrawls of opium . Patients who monitored their blood sugar frequently and those who kept all or nearly all of their appointments were significantly more likely to get their blood sugar under control and keep it there clomipramine hcl tablets and alcohol . 262 Making sure that you are on top of your diabetes treatment, taking your medication, monitoring your blood sugar, keeping track of HbA, following a sensible diet and exercise regimen, and controlling your weight as much as possible may be nearly as important as which drugs your doctor prescribes atomoxetine medication diaes .
Metformin (Glucophage)
A review by the Cochrane Collaboration of most of the world’s diabetes literature shows that metformin (Glucophage) alone, if used to keep blood glucose under tight control, is an excellent treatment inderal la medicine .263 Metformin improves blood sugar control by improving the cells’ response to insulin and reducing the amount of sugar that the liver makes risperidone weight gain . Unlike some other oral diabetes drugs, it doesn’t lead to weight gain and may even help people get their weight under control amitriptyline mylan .
It can be dangerous, however, for people with kidney disease testosterone replacement therapy cycles . They should not take the drug, and everyone on metformin should have their kidney function monitored regularly (at least once a year) altace absorption . People with congestive heart failure should not take metformin, either sulfamethoxazole ds tabitp .
SYMPTOMS OF LACTIC ACIDOSIS
• Muscle aches or weakness
• Shortness of breath
• Stomachache, nausea, or vomiting
• Lethargy or drowsiness
• Irregular heartbeat
• Feeling generally awful
Metformin has two nasty side effects that patients must know about drugs and norvasc . One, lactic acidosis, is rare, but it is a medical emergency if it occurs villa allegra . Lactic acidosis can be lethal estrace homrmone . People with kidney disease or congestive heart failure are more susceptible to this problem, which is why they must not take metformin hormone replacement therapy weight premarin . Otherwise healthy diabetics might also develop lactic acidosis on metformin, especially if they drink alcohol watermellon viagra .
What makes metformin so tricky is that patients frequently experience digestive tract distress when they first start taking this medicine tramadol ships next day apo . Side effects can include diarrhea, nausea, vomiting, indigestion, and stomachache accutane atlanta attorney . After several weeks, however, these side effects should fade away strattera testimonies . If digestive symptoms
*** Metformin (Glucophage)
Metformin improves insulin sensitivity caffeine and hunger . It may control blood sugar alone or be combined with other diabetes drugs to improve blood sugar control attack heart ibuprofen . Common side effects include diarrhea, nausea and vomiting, flatulence, fatigue, indigestion, and headache intas strattera for sale online .
Avoid guar gum in low-fat foods (salad dressing, frozen desserts, etc depo provera transexual drug .), because it reduces metformin’s absorption and effectiveness is prevacid an nsaid .
Downside: Lactic acidosis, a rare reaction, requires emergency medical attention and can be fatal nifedipine ointment preparation .
Cost: Approximately $90 to $120 per month; generic $65 to $100
recur, they must be brought to the doctor’s attention immediately since they might be symptoms of lactic acidosis ct scan heart and lopressor .
The other side effect is depletion of vitamin B12 snorting bupropion . Because this vitamin is stored in the body, the depletion is gradual and the symptoms either may not be noticed or may be attributed to some other cause can lovastatin subscriptions cause cough . The physician should test for methylinaIonic acid (MMA) as well as for vitamin B,2 levels compare kytril and zofran . Fortunately, it is easy to treat vitamin B12 deficiency with supplements birth defect imuran . The vitamin does not need to be injected in such cases; oral supplements of around 1 milligram daily (a large dose of vitamin B12) will work prednisone before surgery . Do check with your doctor to find out if this is appropriate for you sten testosterone .
I am a retired physician with type 2 diabetes metoclopramide and dialysis . Metformin has kept my blood sugar in the normal range for 10 years malassezia ketoconazole dog . Despite good control of my blood glucose and glycosylated hemoglobin, my foot numbness was getting worse warfarin back pain . I was also a tilde unsteady on my feet though it was very subtle flomax pseudoephedrine .
I reviewed the medical literature and discovered that metformin interferes with vitamin B1, absorption fertility insemination estrace uterine lining . I suspected I might be deficient in this vitamin, and I started taking oral vitamin B,
Within a week, I noticed that my mental capacity was sharper combivir and other antivirals . I had not realized before this that I was having any cognitive problems new england journal of medicine lipitor . I stopped having any trouble walking, and my foot numbness has decreased effects effexor alcohol .
Many older diabetics take metformin doxycycline cellulitis . ff they developed subtle neurological and mental deficits as a result of lack of vitamin B,, these problems could be treated but may well be overlooked zoloft vs xanax .
Pioglitazone (Actos)
Pioglitazone (Actos) is a newer diabetes medicine that increases insulin sensitivity and decreases insulin resistance aldactone for treating acne . These actions reduce the amount of insulin in the bloodstream and should lower HbAl rash from paxil . Not only can this medication bring fasting blood sugar down, it can also help control blood sugar levels after meals 1 4 propecia .” In the Kaiser Permanents study mentioned above, drugs in this class were the medications most likely to get HbA,, down to normal range by themselves lithium ion battery car fire .
Actos has received a lot of attention from doctors who specialize in treating diabetes es because it has a favorable im- pact on some blood lipids vytorin side effects muscle pain . It doesn’t seem to do much for Pioglitazone (Actos)
Pioglitazone improves insulin sensitivity’and decreases insulin resistance reference range estradiol . It lowers triglycerides and raises HDL, which might result in a lower risk of cardiovascular problems viagra and reduced ammunity . It is taken once a day escitalopram with titration .
Downside: May interact with oral contraceptives to make them less effective
Cost: Approximately $100 to $115 per month
bad LDL cholesterol, but it raises good HDL cholesterol (no mean feat) and lowers triglycerides atrovent peanut . 265
No one knows if these improvements in blood fats will result in a lower risk of heart attack or other cardiovascular complications in the long run gabapentin gaba . That, after all, is the really important issue, since diabetics are at such high risk of cardiovascular catastrophes ibuprofen versus rofecoxib . But Actos is fairly effective in preventing the closing up of a cardiac stent after it is put into a coronary artery study volunteers for topamax and alcohol .266 And a head-to-head study of Actos and Avandia (a similar medication) showed that Actos has a better effect on several measures of cholesterol and blood lipids ibuprofen liquid mg per ml . 261 If this translates down the road into reducing the likelihood of a heart attack or stroke, it would certainly be worthwhile allopurinol lab hahnemann .
Pioglitazone can cause fluid retention and as a result is not appropriate for use by patients with congestive heart failure lotrel azor . Side effects include a greater susceptibility to sore throats, colds, bronchitis, and the like; headaches; toothaches; sinusitis; and muscle pain allegra beach resort . A competing drug, rosiglitazone (Avandia, Avandamet), has also been linked to fluid retention celexa cs zoloft . More worrisome, though, is the possibility that this drug may contribute to fluid accumulation in the back of the eye purpose of flagyl .This macular edema could lead to blurred vision and eye damage claritin and cold medicine .
Repaglinide (Prandin)
The goal of treating diabetes is to keep blood sugar within the normal range, because that reduces the likelihood of serious complications prozac overdose nuerological damage . If you can’t achieve this with metformin or one of the “glitazones,” the doctor may add a medicine to stimulate the secretion of insulin lamictal and sunburn . Two drugs, nateglinide (Starlix) Repaglinide (Prandin?
Repaglinide lowers blood sugar by stimulating insulin release and is especially effective for reducing blood sugar following a meal cellcept indications . Repaglinide is taken before meals, usually within 15 minutes before beginning to eat can zovirax treat epstein barr virus .
Downside: Blood sugar may fall too much (hypoglycemia) brompheniramine and pseudoephedrine extended release . Repaglinide may contribute to weight gain caffeine memory .
Cost: Approximately $130 to $140 per month
and repaglinide (Prandin), make beta cells in the pancreas pump out more insulin at mealtime edward drummond m d and cymbalta . 268 This helps keep blood glucose levels from going too high after eating effexor ejaculation .
Some studies have compared these two medicines alone or in various combinations scarring accutane . The results aren’t definitive, but comparing nateglinide alone to repaglinide alone suggests that there is an advantage to repaglinide whats stronger than ultram .269 Prandin lowered HbA, signifi- cantly more than Starlix did; it brought down fasting blood sugar better; and more than half (54 percent) of the patients on Prandin were able to get their HbA below 7 percent, whereas fewer than half (42 percent) of those or Starlix managed that osteoporosis lamotrigine . Of course, there’s a price amitza or zelnorm . Patients on Prandin were more likely to suffer from hypoglycemia (low blood sugar) rimonabant effect on abdominal fat . They also gained more weight (almost 4 pounds in 4 months), a discouraging side effect patient assistance program for accutane . -
These drugs are more effective in combination with metformin than they are on their own memory loss zoloft . 270 tricor cholesterol statin .27L272 Side effects of repaglinide include headache, joint or back pain, and tipper respiratory infection no prescription needed glyburide . Drugs such as ketoconazole (Nizoral) and clarithromycin (Biaxin) boost blood levels of repaglinide, and that could increase the likelihood of unpleasant reactions 2cialis compare levitra . Grapefruit affects the same enzyme (CYP3A4) and might have a similar effect side effects of mircette .
Exenatide (Byetta)
Exenatide (Byetta) is another treatment option for type 2 diabetics prograf pronounced . It has an interesting history zoloft user review . because it got started with research into the saliva of a poisonous Southwestern lizard called a Gila monster what is lexapro medicine . Byetta is injected and is used in combination with metformin or a blood sugar–lowering drug like glyburide claritin d warnings . Byetta reduces the bump in blood sugar after meals and can help diabetics lose weight kidney infection cipro .
The most common side effect is nausea, but the most serious is hypoglycemia sustiva drug . Adding Byetta to a medicine like glyburide increases the risk of a dangerous drop in blood glucose level difference between prilosec and zantac . Patients using Byetta must learn what to do if blood sugar drops too low zoloft causing excessive sweating . Other side effects include vomiting, diarrhea, dizziness, jitters, headache, and indigestion michael soma . Byetta should not be given to people with kidney problems or serious digestive disease prozac vs cymbalta . 273
Conclusions
By now, we hope you appreciate the importance of controlling blood sugar asacol delayed release tablet . Diabetes is common (some diabetologists believe it will soon affect nearly half the population), and its complications are devastating pfizer class action involving zoloft . We have tried to give you a variety of strategies to prevent or control this disease viagra and generic . Remember, though, that whatever tactics you adopt, you must work in close collaboration with your health-care providers prednisone and tracleer .
Below you will find an overview of our recommendations in this chapter rechargable aa lithium ion .
• Preventing diabetes is possible nolvadex steroids . Keep your weight under control, emphasize nonstarchy vegetables over pasta or bread, and avoid soft drinks, fruit juice, and processed meats you made everything possible again viagra .
• Get plenty of exercise, preferably including some time outdoors so you have 10 to 15 minutes of sunshine on your face and hands several days a week celexa proper dosage . If you don’t get outside, take 800 to 1,200 IU of vitamin D3 daily quetiapine and sustained release and dissolution .
• If you are diagnosed with diabetes, learn to monitor your blood sugar can toprol cause chronic abdominal distress . Keep track of how exercise and food affect it prozac and nerve receptors . Consider cinnamon or vinegar to help smooth out blood sugar in reaction to a carbohydrate meal nexium and indications .
• If you’re considering using herbs or dietary supplements such as chromium, bitter melon, fenugreek, Gymnema sylvestre, or nopal, check with your health-care providers before taking them zofran wafer . Monitor your blood sugar carefully ultram nopain .
• If medication becomes necessary, make sure that you and your physician find the safest and most effective option for you viagra nils . You shouldn’t have to suffer with dreadful side effects to keep your blood sugar under control iv ampicillin .

dimethicone Activated dimethicone is an antifoaming agent, said to reduce flatulence and protect mucous
membranes. It is a constituent of many antacid preparations. It is also present in some water-repellent skin creams.
dipipanana A rapidly acting morphine-like analgesic of value in the sever rain 4 to -1 dk–
Dose: 30-3450 mg (fail),, but it is usually• given in association with cyclizine as Diconal. The side-effects are similar to those of morphine.
dipivefrine A pro-drug that is converted into adrenaline after absorption. It is used
in chronic open angled- glaucoma as eye
drops (0.1%). (Propine). See page 138 and Table 16.
dimethylsulphoxide (DMSO) An organic liquid, it has been used for the symptomatic relief of interstitial cystitis
(Hunner’s ulcer) by the bladder instillation of 50 ml of a 50% solution. (Rimso-50).
dinoprost Prostaglandin F,.. It has actions and uses similar to dinoprostone.
(Prostin 112).
dinoprostone A synthetic form of prostaglandin E,. It has been used to initiate contractions of the pregnant uterus. Dose: 500 pg orally to induce labour, repeated if necessary at hourly intervals; as vaginal tablets or gel, 3 mg. Side-effects are nausea, diarrhoea, shivering and dizziness. (Prostin E2; Prepidil).
dioctyl sodium sulphosuccinate See dOCUSalC.
diodone injection A solution of a complex organic iodine compound, used as a contrast agent in X-ray examination of kidneys and ureters.
diphenhydramine One of the early antihistamines, with a more sedative action, and use(] in the temporary relief of insomnia. Dose: 10-25 trig. (Medinex. Nytol). It is also present in some cough preparations and nasal decongestants.
diphenoxylate A derivative that resembles codeine III reducing intestinal activity. It is used for the symptomatic relief of diarrhoea, and is usually given with a small dose of atropine to discourage excessive dosage and to reduce the risk of dependence. Dose: 10 mg initially, then 5 nig every 6 hours as required. (Lomotil;’Fropergen).
diphenylpyraline An antihistamine used as .I decongestant in colds and sinusitis. Present in Eskornadc.
dipyridamole An inhibitor of thrombus formation by reducing the adhesiveness of blood platelets in the arterial circulation. Dose: 300-600 mg daily before food. s I
ide-effects include nausea, diarrhoea and headache. (Persantill).
disodium cromoglycate See sodium cromoglycatc.
disodium etidronate See etidronate. disodium pamidronate See pamidronate.
disopyramide A quinidine-like drug used in the treatment of cardiac arrhythmias especially after myocardial infarction. Dose: 300-800 mg daily; dose by slow i.v. injection under ECG cover, 2 nig/kg up to 150 mg, followed by oral therapy as soon as possible. By its anticholinergic action care is necessary in glaucoma and prostatic enlargement. Contraindicated in heart block. (Dirythmin; Rythmodan). See page 1;6 and “fable 24.
distigmine An inhibitor of cholinesterase similar to neostigmine but with a longer action.
Dose: in the control of myasthenia gravis 5-20 mg as a single morning dose before breakfast; in urinary retention after surgery, 5 trig daily. It is sometimes used in neurogenic bladder disorders. Side-effects are nausea, abdominal cramp, diarrhoea and weakness. (Ubretid).
disulfiram When taken with even small amounts of alcohol, disulfiram permits the accumulation of acetaldehyde in the body, with side-effects such a flushing, giddiness, vomiting and headache that may be severe. Distilfiram is used in chronic alcoholism, but prolonged treatment and co-operation of the patient are essential.

Dose: after at least 24 alcohol free hours: 800 nig on the first day, falling over 5 days to 100-200 mg daily. Acute confusion may occur if given at the same time as tucLro-
llidazole. (Antabuse).
dithranol Synthetic compound used locally in the treatment of psoriasis. It is a powerful irritant, and treatment should be commenced with a simple ointment or zinc paste containing 0.1% ofdithranol, gradually increased to 1% if well tolerated. Higher concentrations are sometimes used in ’short -contact -time’ therapy.
Dose: 100 mg/m’ by i.v. infusion over
I hour. Rapid and severe hypersensitivity reactions (hypotension, bronchospasm) may occur, and treatment must be irrnediat4y available. Reaction risks may be reduced by premedication with jexalnetha&one given the day before treatment and continued for 5 days. Rash, pruritus and neutropenia may occur, and blood counts and liver function tests are necessary. (Taxotere). See page 122 and Table 8.
docusate A surface-active agent used as a faeces -softening laxative.
Dose: ill, to 500 nig daily. (Dioctyl).
diuretics The most widely used group of diuretics is the thiazides, represented by bendrofluazide (see page 14I ). They act mainly by increasing the excretion of
sodium by inhibiting its re-absorption by the distal tubule of the kidney, and evoke a rapid response which may persist over 12-24 hours, although some, such as chlorthalidone, have a still longer action. They are given in mild cardiac failure, oedema and in hypertension, but in more severe conditions, and in pulmonary occlema, the more powerful ‘loop’ diuretics, such as frusemide, which act at a different point, are preferred. A side-effect of some thiazides is an increase in the excretion of potassium which may require the use of potassium supplements or a change to a potassium sparing diuretic such as trianiterene. Spironolactone, an aldosterone antagonist, is a more powerful diuretic, of value in resistant oedema. Osmotic diuretics such as mannitol are used mainly in cerebral oedema. Simple diuretics such as potas slum citrate arc mainly used to alkalize the urine and promote diuresis in cystitis and similar conditions. See page 141 and Table 18.
dobutamine A sympathomimetic agent similar to isoprenaline, but with a more selective stimulant action on the beta, receptors in the heart. It increases cardiac contractility but is less likely to cause tachycardia. Useful in acute heart failure and cardiogenic and septic shock. Dose: 2.5-5 pg/kg/min by i.v, infusion, carefully adjusted to need. (Dobutr= Posiject). See page 141 and Table 18.
docetaxel A potent cytotoxic agent derived from the Pacific Yew. Used in advanced breast cancer resistant to other therapy.
domperidone An antiemetic that functions as a dopamine antagonist, as it prevents dopamine from reaching the receptors in the chemoreceptor trigger zone (see antiemetics). It is mainly of value in the severe nausea and vomiting caused by cytotoxic drugs, and is also useful in fum clonal dyspepsia. It is of little value in postoperative and travel sickness.
Dose: 10-20 mg 4-8-hourly; 30-60 nig by suppository. Sedative side-effects are infrequent, as domperidone does not cross the blood-brain barrier. (Motilium). See page 77.
donepezil A reversible inhibitor of anti-cholinesterase. Alzheimer’s disease is linked with a deficiency of acetylcholine in the brain, and donepezil may relieve sonic of the symptoms of that disease by increasing brain acetylcholine.
Dose: 5-10 mg at night. Diarrhoea and muscle cramps are side-effects. (Aricept ).
dopamine A sympathomimetic agent with actions and uses similar to dobutamine. Dose: 2.5-10 pg/kg/min by slow i.v. infusion. Careful control ofdose is essential, as dopamine may cause vasoconstriction with higher doses and increase the risk of heart failure. (Intropin). Dopamine is also a central neurotransinifter, and a deficiency is associated with parkinsonism. See levodopa, page 141 and “table 18.
dopexamine A short-acting drug of the dopamine type but with a more powerful action on the 0,-receptors. It is used in heart failure during cardiac surgery.

dextromoramide A powerful synthetic analgesic with a shorter and less sedating action than morphine. Of value in severe and intractable pain, and in terminal disease.
Dose: 5 ing or more either orally or by injection, according to need and response. Care is necessary in liver dysfunction and respiratory depression. (Palfitunt).
dextropropoxyphene An orally effective analgesic. Of value in many painful conditions, and in malignant disease its use may delay the need to resort to the opiate analgesics.
Dose: 250 ing or more daily, but doses in excess of 700 mg daily may cause toxic psychoses and convulsions. (Doloxene). See co-proxaniol.
dextrose See glucose.
diazoxide An inhibitor of insulin secretion. Dose: given orally in doses of 5 ing/kg or more daily in severe hypoglycaemia. Also of value in severe hypertensive crisis, in
doses up to 150 mg by rapid i.v. injection. Side-effects arc nausea, tachycardia and oedema. (Eudernine).
diclofenac A non-steroidal anti-inflammatory drug (NSAID) of the naproxen type, pe, and used in rheumatoid, arthritic and similar conditions.
Dose: 75-150 ing daily, after food. Suppositories of 100 nigare useful at night, but may cause local irritation. In acute conditions and in postoperative pain, doses of 75 mg once or twice a day by deep i.m. injection for not more than 2 days. (Diclomax; Voltarol). Like other NSAIDs, diclofenac may cause gastric disturbance and hypersensitivity reactions. See page 165 and Table 29.
diamorphine A derivative of morphine with a more powerful analgesic an(] cough-suppressant action. It is also less liable to cause nausea. Valuable for the relief of severe pain and the suppression of useless cough. Addiction is a constant risk owing to the euphoric effects of the drug.
Dose: 5-10 nig orally or by injection, repeated as required. For severe pain in the terminally ill, addiction is of no consequence, and much larger doses are given according to need: if necessary, by continuous infusion or a syringe-pump device.
diazepam A benzodiazepine of value in anxiety states, insomnia, acute alcoholic withdrawal, and for premedication. It also has a muscle relaxant action, and is valuable when given by injection in status epilepticus and in the control of the spasm of tetanus.
Doses: 5-30 mg daily, 10-20 mg by slow i.v. injection as required, up to a maximum of 3 mg1kg in 24 hours. Absorption after Lin. injection is unreliable. It is sometimes given as suppositories of 5-10 ing. Side-effects are drowsiness, dizziness, respiratory depression and hypersensitivity reactions. Care is IICLL’N nary in glaucoma and renal and hepatic impairment. Fxterided treatment may lead to dependence and addiction, and withdrawal should be slow to avoid the risks of precipitating toxic psychosis, confusion and convulsions. (Stesolid; Valium). See pages 177 & 136, an(] Tables 5 & 15.
dicobalt edetate A specific antidote in acute cyanide poisoning; toxic in other conditions.
Dose: 300 mg by slow i.v. injection, followed by 50 ml of glucose solution 50%, repeated if required. (Kelocyanor). Sec .odium nitrite.
dicyclomine An anticholinergic agent used to reduce gastric hyperacidity and the smooth muscle spasm of gastrointestinal disorders.
Dose: 30-60 mg daily. Side-effects
include dryness of the mouth and blurred vision. (Ivlcrbcnlyl).
didanosine An antiviral agent used in HIV infections not responding to zidovudine. Dose: 400 mg daily before food. Diarrhoea, vomiting and peripheral neuropathy are side-effects. (Videx contains didanosine with antacids). See page 144 and Table 19.
dienoes A synthetic oestrogen used as a 0.025% cream for senile or atrophic vaginitis.
diethylcarbamazine A synthetic drug used in filariasis but long-term treatment is necessary.
Dose: I mg/kg daily initially, slowly increased to 6 mg/kg daily, and continued for 21 days. Low initial doses are necessary to reduce allergic reactions due to proteins released front dead %vornis. Side-effects include headache, nausea, rash and conjunctivitis. (I letrazan). See ivermectin.

diflucortolone A corticosteroid used topically as a 0.13′0 or 0.3% cream or ointment in steroid-responsive dermatoses. Of value in resistant conditions. (Nerisone).
diflunisal An anti-inflammatory and analgesic drug (NSAID), chemically related to aspirin, but with actions and uses similar to napmxen.
Dose: 500 ilig– I g daily. Care is necessary in aspirin-sensitive patients, and in peptic ulcer. (Dolobid). See page 163 and Table 29.
Digibind A highly purified preparation of sheep-derived digoxin-specific antibodies, given by i.v. infusion in digoxin overdose or poisoning. It mobilizes digoxin from cardiac receptor sites and binds it as an inert complex which is excreted into the urine, and symptoms of digoxin toxicity subside within an hour.
Dose: depends oil the amount of digoxin absorbed; 40nigcan neutralize about 600ligofdigoxiii.
I Dim
250-500 jig initially according to need. Nausea and vomiting are often signs of overdose. If the heart rate falls below 60 beats per minute, dosage rcquiresadill.ltmclit. See page 1.11 and Table 18.
digoxin- specific antibody See Digibind.
dihydrocodeine An analgesic derived from codeine, but with a more powerful action. Of value in many painful conditions where mild analgesics are inadequate. Dose: 30 mg orally after food, or 50 ing
by i.m. or deep s.c. injection at intervals of 4-6 hours according to need. Dizziness and constipation are side-effects. MIA 18).
dihydrotachysterol A sterol related to calciterol, but with more rapid calcium-mobilizing properties. It is used mainly in hypocalcaemia and parathyroid tetany, but is sometimes effective in calciferolresistant rickets.
Dose: 200 jig daily, adjusted to need according to plasma calcium levels as a solution in oil. (AT 10).
39
digitalis The dried leaf of the foxglove. It has a powerful strengthening and regulatory action oil the heart, but is now used as digoxin.
digitoxin The most powerful cardiac glycoside of digitalis and of value in heart failure and atrial fibrillation. Absorption is rapid but excretion, which depends on metabolism by the liver, is very slow, and cumulative effects may occur.
Dose: (maintanence) requires careful .iditminent, varying from 50-200 f.ig daily.
digoxin The principal cardiac glycoside obtained from digitalis leaf. It is rapidly absorbed orally, and is widely used in cardiac failure, paroxysmal tachycardia and atrial fibrillation. The diuresis of digoxin therapy is a secondary effect following on the improvement in the renal circulation.
Dose: for rapid digitalization, 1-1.5 mg initially over 24 hours: subsequent maintenance close 62.5-500 pg daily. For slow digitalization, 250-500 pg may be given daily for about a week, with subsequent closes based on the response. Elderly patients and children respond adequately to smaller doses, and tablets of 62.5 pg (Lanoxin-111G) are available for such patients. In emergency, digoxin call be given by slow i.v. injection in closes of
diloxanide A well-tolerated aniciellicide used in chronic intestinal anicielliasis when only cysts are present in the faeces. It is also used in acute infections, 5 days after a course of metronidazole.
Dose: 1.5 g daily for 10 days. (Furamide).
diltiazem A calcium channel blocking agent, used in the prophylaxis and treatment of angina, and useful when beta-blocking agents are unsuitable or ineffective.
Dose: 180-360 nig daily, reduced in renal impairment. It may cause bradycardia, ankle oedema and hypotension. potension. (Adizen; Tildiern). Sonic long-acting products with various brand mantes are used in hypertension. They should not be regarded as interchangeable, as the duration of action may vary. See page 114 and Table 4.
dimenhydrinate An antihistamine used mainly as all antiemetic in nausea, travel sickness and vertigo.
Dose: 100-300 ing daily. It may cause more drowsiness than sonic related drugs. (Dramamine).
dimercaprol (SAL) A specific drug for the treatment of poisoning by arsenic, mercury, gold and other heavy metals.

co-fluampicil -tablets of flucloxacillin and ampicillin
co-flumactone Tablets of spironolactone and hydrochlorothiazide.
colchicine The alkaloid obtained from meadow saffron. It is used in acute gout. Dose: 500mg every 2 hours until relief is obtained. A total dose of 10mg should not be exceeded, but relief of pain or the onset of vomiting or diarrhoea usually renders full doses unnecessary. It is also used prophylactically in doses ol’500pg 2 or 3 times a day during early treatment with allopurinol, probericcid and sulphiripyrazone. Gire is necessary in the elderly, and in renal impairment. See page 140 and’I'able 17.
corticotrophin The adrenocorticotrophic hormone of the anterior pituitary gland. It stimulates the production of corticosteroid hormones by the adrenal cortex. It is now used mainly as a test of adrenocortical function. See tetracosactrin.
Hydrocortisone.
cortisone one of the corticosteroids secreted by the adrenal cortex. Although it is rapidly absorbed orally, it is inactive until converted in the liver to hydrocortisone. It therefore has the actions, uses and side-effects of hydrocortisone, which is often the preferred corticosteroid. It should be noted that cortisone is of no value for topical application. See hydrocortisone, page 250 and Table 36.
colestipol An exchange resin used in hyperlipidaemia that acts by binding with bile salts in the gut and preventing their reabsorption, and so indirectly lowers the plasma level of cholesterol.
Dose: 10-30g daily. May interfere with the absorption of many drugs. (Colostid). See page 146 and Table 20.
colfoseeril A pulmonary surfactant used in the respiratory distress syndrome of the new-born. (Exosurf). See beractant.
colistin An antibiotic used mainly for bowel sterilization.
Dose: 4.5-9 mega-units daily. In systemic gram-negative infections 2 mega-units 8-hourly by injection have been used, but less toxic antibiotics are now preferred. Colonlycin).
collodion When applied to the skin, it dries to form a flexible film, and is used as a vehicle for the extended local application of drugs such as salicylic acid.
co-phenotrope tablets of diphenoxylate
and atropine. (Lomotil; Tropergen).
co-prenozide Tablets of oxprenolol and cyclopenthiazide. (Trasidex).
co-proxamol Tablets  and paracetamol. (Distalgesic).
corticosteroids Hormones secreted by the cortex of the suprarenal gland. The principal hormone is hydrocortisone but more potent synthetic derivatives such as dexamethasone are also in use.
co-tenidone Tablets of atenolol and chlorthaliclone. (Tenoretic).
co-triamterzide Tablets of hydrochlorothiazide and triannerine. (Diazide).
co-trimoxazole A mixture of trimethoprini and sulpliaiiietlioxazole. Trimethoprim, like the sulphonamides, interferes with the folic acid cycle of bacterial metabolism, but at a different point, and the mixture has an increased antibacterial action. It was once widely used, but is now advised only for Prieunjocystis carinii pneumonia. Occasionally given in acute bronchitis and urinary infections when no other drug is acceptable.
Dose: 120 nig/kf; daily lot- 14 days; 960 ing 12-hourly by i.v. infusion. (Bactrin); Septrin).
coumarins Compounds that depress the formation in the liver of prothrombin and other blood coagulation factors. See warfarin and phenindione.
counter-irritants Substances, also referred to as rubifacients, that, when applied to the skin, produce a mild, local irritation and inflammation, and give symptomatic relief in painful conditions of the muscles and joints. Creams and liniments containing methyl salicylate, turpentine, capsicum resin and menthol are examples of rubifacients.
crisantaspase Asparagine is an aminoacid essential for the development of some malignant cells. Crisantaspase is an enzyme, also known as asparaginase, that breaks down asparagine, and so has an indirect cytotoxic action. It is used to induce remission in acute lymphoblastic leukaemia in children.
Dose: (after pre-treatment with other drugs): 1000 units/kg by slow i.v. injection daily for 10 days. Side-effects include anaphylactic reactions, and skin tests to detect hypersensitivity
are essential before initial and re-treatment. (Erwinase).
crotamiton An ascaricide and antipruritiL. Used by local application as cream or lotion (10%) in the treatment of scabies and itching conditions. (Eurax).
crystal violet A dyestuffwith a selective action against Gram-positive organisms and yeasts. Used as a 0.5% solution for infected skin conditions, and for skin
preparation.
cyanocobalamin The anti-anaemic factor present III liver. It is specific in the treatment of pernicious anaemia and its neurological complications, and of value in some other anaernias due to nutritional deficiencies.
Dose: in pernicious anaemia, I Ing by i.m. injection at monthly intervals. It has been largely replaced by hydroxocobalamin, which has a more prolonged action. (Cytanien). See page 112 and’I'able 3.
cyclizine An antihistamine, used mainly in I ravel sickness and nausea generally. Also useful in vertigo.
Dose: 100-150 mg daily. Side-effects include dryness of the mouth, headache and drowsiness. (%Ialoid).
cyclopenthiazide A thiazide diuretic with the actions, uses and side-effects of bend roll tiazide.
Dose: I mg initially, 250-500mg daily or on alternate days, in the morning, according to need. (Navidrex). See page 148 and Table 21.
cyclopentolate An anticholinergic agent use(] to produce cycloplegia and mydriasis. The action is more rapid and less prolonged than atropine, particularly in children. (Mydrilate).
cyclophosphamide A widely used alkylating
cytotoxic agent, active orally and by injec-
tion. Used in I lodgkin’s disease, chronic
lymphocytic leukaemia and lymphomas. Dose: 100-300 Ing daily, orally or i.v., or 300 mg-1 g weekly. A high fluid intake is necessary, as a metabolite may cause hacm- ( )rrhagic cystitis, and it is sometimes used with mesna to reduce the risk of such cystitis. Nausea and vomiting are common side-effects, as is epilation with high doses. (Endoxana). See page 122 and Table 8.
cyclopropane An inhalation anaesthetic of high potency with which induction and recovery are rapid. It causes some respiratory depression and cardiac irregularities, and its administration requires care. It is used with closed-circuit apparatus as it forms an explosive mixture with air and oxygen. Supplied in orange-coloured cylinders.
cycloserine An antibiotic used in
pulmonary tuberculosis when standard drugs are ineffective. Occasionally used in urinary infections.
Dose: 250-750 mg daily. Side-effects include drowsiness, vertigo and rash. See page 170 and Table 31.
cyclosporin An antibiotic with a powerful inuininosuppressant action. It is used under expert control to prevent graft rejection in organ and bone marrow transplantation, and in the prevention of graft-versus-host disease (GVI-ID). Prolonged therapy over some months may be required. Side-effects may include tremor, gastrointestinal disturbance, hypertrichosis and nephrotoxicity (Neural; Sandinimun).
cyproheptadine A compound with antihistamine and antiserotonin properties. Sonic allergic reactions are due not only to histamine, but also to serotonin, and cyproheptadine is useful in conditions not responding completely to an antihistamine. Dose: 4-20 ing daily. It has been used as an appetile stimulant in doses of 12 mg daily and in refractory migraine. (11criactin). See page 110 and Table 2.
cyproterone An anti-androgen used to reduce libido in sexual deviants. Dose: 50-100 nig daily. It is also used in the palliative treatment of prostatic carcinoma, particularly in advanced cases that have become resistant to other therapy. Dose: 300 mg daily.

Steroid inhalers
Most asthmatics nowadays are given a steroid inhaler at some point, as part of their asthma treatment (see p. 160). It will probably be a low-dose inhaler, and the risks of side effects from this are very small. Even at higher doses, inhaled steroids are relatively safe. Many people are unnecessarily afraid of inhaled steroids and refuse to use them until their asthma becomes really incapacitating. It is important not to delay using an inhaled steroid for too long, as this could cause permanent damage to the airways: inflammation eventually thickens the airway wall, leaving it less flexible and therefore less capable of widening.
For side effects of inhaled steroids see p. 145, and for common brand names see p. 147.
Steroid tablets
These are usually a treatment of last resort. But when you need them you need them – and if your asthma has got badly out of control, they can, quite literally, be a life-saver. On the other hand, if there are any other means by which you can tackle your asthma, so that you do not need steroid tablets again in the future –avoiding allergens and irritants, for example, or using other preventer treatments – those means should definitely be taken.
For side effects of steroid tablets see pp. 141-3, and for common brand names see p. 147.
Cromoglycate-type drugs
For asthma, these drugs are taken by inhalation only. They work by blocking the allergic reaction (see p. 148), and are therefore a type of preventer drug.
Cromoglycate-type drugs are usually inhaled four times a day, although your doctor may recommend more frequent inhalations to begin with. Once your asthma is well controlled, you may be able to reduce the dosing regime to three times a day, or possibly twice a day: ask your doctor’s advice about this.
Should you decide to stop taking these drugs at some point, talk to your doctor first. It is generally best to reduce the dose gradually, over a period of 7-10 days. Some asthmatics need to introduce (or reintroduce) steroids at this time, to maintain control of the airway inflammation.
Side effects
When inhaled, cromoglycate-type drugs can produce short-lived irritation in the throat, which may lead to coughing. This sometimes develops into temporary bronchospasm, causing you to wheeze, but this is really only a minor side effect – it does not indicate that the drug is making your asthma worse.
Asthmatics are sometimes advised to use a short-acting
beta-2 reliever (such as Ventolin) before their cromoglycate inhaler, to overcome this problem. However, this would involve using the beta-2 reliever four times a day, which is no longer considered a good idea (see pp. 153-4). Talk to your doctor again if you have been given this advice.
Inhalers that combine sodium cromoglycate with a short-acting beta-2 reliever (e.g. Aerocrom) are not recommended for the same reason.
A better way around the problem of throat irritation may be to switch to an aerosol inhaler, because the irritation is much less than with dry-powder inhalers. Using a spacer along with the aerosol inhaler (see p. 162) will help even more.
Serious side effects of these drugs are very rare (see p. 149). For common brand names, see p. 148.

FOOD SENSITIVITY IN ASTHMA, ECZEMA AND OTHER ALLERGIC DISEASES
In 1995, medical researchers in North Carolina, USA, asked over a hundred dermatologists how they treated atopic eczema. All used standard treatments such as moisturisers and steroid creams, but only 14% mentioned the possible role of food to the parents of children with eczema.
Between them, the dermatologists in this study treated about 17,000 children with atopic eczema per year. Using the most widely accepted estimates for food sensitivity in atopic eczema –38% of eczematous children are sensitive to food – one can calculate that there were over 5000 children in this study area who might perhaps have benefited from avoiding a problem food, but whose parents were never told about this treatment option.
North Carolina is by no means unique. The situation is much the same in other parts of the world, which adds up to millions of children and parents not even being told about a treatment that is frequently effective.
Other allergic diseases (see right) can also be triggered by food, although the percentage of patients affected is much lower than for atopic eczema. Here too, many doctors are unaware of (or sceptical about) the possible role of food.
These reactions are best described as ‘food sensitivity’. They cannot be called food allergy (see p. 62) if there are no symptoms in the mouth or gut and if skin-prick tests are negative – as is often the case. Negative skin tests suggest that the reaction is not IgEmediated (see box on p. 12).
However, in some children with atopic eczema. the skin-prick tests to culprit foods are positive. When these foods are eaten after a period of avoidance, such children sometimes suffer an
immediate reaction, with symptoms typical of true food allergy. For these individuals, their atopic eczema seems to be a symptom of IgE-mediated food allergy.
How can an atopic eczema reaction in response to food be IgE-mediated in one individual and not in another? Research is finally beginning to answer this question (see pp. 18-19).
The allergic conditions that may sometimes be induced, or simply aggravated, by a non-immediate reaction to food are:
• atopic eczema (atopic dermatitis)
• asthma
• perennial allergic rhinitis (constantly blocked or runny nose)
• chronic sinusitis
• secretory otitis media (’glue ear’).
In all of these conditions, many other causes exist. Except in the case of eczema, the other causes are far more likely than sensitivity to food. This fact will weigh heavily with your doctor, whose instinct, quite sensibly, is to look for likely causes first.
Taking asthma as an example, food sensitivity is relatively unusual as a primary cause, whereas allergy to airborne items. such as pollen or house-dust mite, is very common. Food probably affects only 8-10% of asthmatics overall, but is much more important for those with brittle asthma (the most severe and unstable form), affecting as many as 60% in a recent study.
The pollen connection
People who suffer from both birch-pollen allergy and atopic eczema may have worsening eczema when they eat certain fruits and vegetables, e.g. apples and carrots. These same foods cause Oral Allergy Syndrome (see box on p. 63) in some with birch-pollen hayfever, but they can aggravate eczema without causing Oral Allergy Syndrome.
Diagnosis
Consider other likely allergens first. Look at p. 28 for the airborne allergens that could play a part in perennial allergic rhinitis, chronic sinusitis, secretory otitis media (’glue ear’), and asthma. Only in the case of children with atopic eczema is food a prime suspect (between 38% and 69% of children with atopic eczema are affected by food), but even here there are a lot of other factors to consider (see pp. 43-4).
If you do decide to investigate the role of food, don’t abandon basic treatments in the meantime. By neglecting these. you could make the whole problem a great deal worse.
There are various clues that food is at fault:
• If you have other symptoms that suggest food intolerance (see p. 76). These problems often seem to go together with food-induced asthma or rhinitis.
• If you have noticed that a particular food makes your symptoms worse. Where there is intolerance to one food, there could well be intolerance to another, which you have not noticed.
• If you have exercise-induced asthma (see p. 41) and sometimes respond severely to exercise but sometimes have little or no reaction. Sensitivity to a food or foods may be instrumental in changing the response to exercise.
• If you have brittle asthma – but you must get your doctor’s consent for an elimination diet. Foods must be tested under medical supervision as severe life- threatening asthmatic reactions can occur on testing.
• If there are also digestive problems such as diarrhoea, vomiting or belching. This is a strong clue in the case of children with atopic eczema. Symptoms such as diarrhoea frequently precede atopic eczema, and it seems likely that a reaction to food in the gut increases the leakiness of the gut wall, allowing more food molecules through to the blood.
• If there is pronounced eczema around the mouth in children (but this can also be due to constant licking),
• For adults with atopic eczema, if there is a persistent rash on the hands, or the lips. Where there is a blistering rash on the hands that erupts at regular intervals, food is often the problem – or it may be metal contaminants of food such as nickel (see pp. 55-6). In general, food sensitivity is rarer among adults with atopic eczema than it is among children.
Skin-prick tests (see p. 91) for commonly eaten foods are worth
trying in all the diseases – if they give a positive result, they should
be noted, but if they give a negative one, they should be disre-
garded. The many alternative tests being marketed (see p. 93) are
highly inaccurate and unlikely to help.
Research from Tampere University Hospital in Finland suggests that babies are much more likely to give false-negative skin-prick tests for food than older children and adults with atopic eczema. The Finnish researchers found that 52% of babies with atopic eczema give a negative skin-prick test despite having a genuine reaction when tested by food challenge. In an attempt to tackle this problem, they have devised a patch test, similar to those used for contact dermatitis. The patch test, in which food is applied to intact skin and left there for two days, gives false negatives in only 39% of babies.
The best way to detect food-sensitive eczema, according to Dr Erika Isolauri. who heads the Finnish research team, is to use both tests, and take note of a positive reaction to either. This detects 80-90% of eczema-causing food reactions in infants.
Few other doctors are currently using patch tests for atopic eczema; because so much controversy surrounds this topic, and no standardised method has yet been devised. You may be lucky and find a specialist who does these tests.
To confirm the role of particular foods in atopic eczema, a food challenge test is essential, having first avoided the food carefully for two weeks. Great care is needed in testing (see p. 198).
If you cannot get suitable tests done. a simple elimination diet will be needed (see p. 198).
Treatment
There is a choice here, between avoiding the offending food, or eating normally and controlling the symptoms with drugs.
The difficulty comes when parents have to make this decision on behalf of their children. Unfortunately, there is insufficient evidence as regards the consequences of this decision. Treating food sensitivity can reduce the eczema symptoms substantially in the short term, but it does not necessarily improve the long-term prospects for the child. Orthodox doctors tend to think that eating a normal diet is much better for a child nutritionally and socially, and they have a point.
Doctors with a special interest in food sensitivity generally believe that treating the problem at source, rather than just suppressing the symptoms with drugs, must take the pressure off the child’s immune system, and give the child a better chance of growing out of sensitivity reactions in the long run.
The decision is yours – but it is vital that the diet is not more of an encumbrance than the disease itself, and that the child’s interests come first (see pp. 170-71). Whatever you do, don’t allow a child to become malnourished (see p. 198).