Examples:
Take one capsule 3 times daily with food for stomach upset.
Take one capsule ½ hour before bedtime with juice for sleep.
Take one capsule every 4 hours between meals for infection until gone.
4. Have your physician put on the label the number of refills you have.
5. When you receive your prescription, read the label out loud to the pharmacist. Make sure you understand how, when, for how long, and why you are supposed to be taking the drug. If you have any questions, ask your pharmacist. The container may also contain an expiration date and tell how it should be stored.
6. Tell your physician and your pharmacist about any other drugs (prescription or over-the-counter) you are taking. If you drink a lot of alcohol, coffee, or soft drinks or if you smoke, be sure to mention it.
7. If you are allergic to any foods or drugs, tell your physician and your pharmacist. If you are pregnant, lactating, or trying to become pregnant, tell your physician and your pharmacist.
8. If you notice any side effects after taking a medication such as dizziness, light-headedness, nausea, vomiting, diarrhea, skin rash, or any other out-of-the-ordinary symptom, call your physician or pharmacist immediately. You may experience these side effects right away or in a few days or weeks. You can literally be taking a drug for years without any side effects but then have them suddenly appear.
9. Throw away any medications you are no longer using. Look through your supply of medications, check the expiration dates, and throw any old medications in the trash. If you have kids or teens in the house, or anyone prone to drug addiction or abuse, empty the pills from the container and dispose of them separately, putting the drug into a trash receptacle where you are sure it won’t be found. If there are refills left, remove the label from the bottle.
10. Keep all of your medicines out of the reach of children, and never give your prescription drugs to anyone else, even friends or family.
11. Read the labels on all your over-the-counter medicines. Look for cautions or contraindications.
How you answer the following questions may give you some indication of whether you are inappropriately dependent on your medication:
1. Do I need to take my medicine more often than it was prescribed?
2. Do I become tense, nervous, or anxious if I don’t take the medicine for more than one day?
3. Can I sleep without it?
4. Do I have to have extra supplies because I am afraid I will run out?
5. Do I have two M.D.s writing prescriptions for the same drug, in case one cuts me off?
6. Do I feel in a fog mentally when I take the drug?
7. Do I feel more alert when I take the drug?
8. Do I talk about the drug a lot to my friends and family?
9. If a pill breaks, do I save the bits and pieces?
10. Have I tried to stop taking the drug without success?
11. Do I want to stop taking the drug?
12. Have I tried to stop taking the drug and experienced such bad withdrawal symptoms that I went back on it?
If you answered yes to any of these questions, please consider the possibility that you are abusing the drug or drugs you are taking and get some help. Resources for prevention and recovery are listed in “Resources and Recommended Reading” at the back of the book.
Can Your Children and Grandchildren Get into Your Drugs?
Just because you can’t open that childproof cap on your medication bottle, don’t assume that your grandchild can’t. It’s a fact that more kids get into medicines at their grandparents’ homes than at their own homes. Grandparents are more likely to be taking medication and are less likely to be vigilant about keeping it away from curious youngsters. If you have children in your house, even for just a few hours, be sure all your medications are out of reach or inaccessible. This also applies when you’re visiting someone who has children—you have to assume they will wander into your room, open your bags, and act accordingly. Many pills come in attractive colors and are small enough to be easily swallowed. Some new pills look like little jelly beans and smell like candy.
Prescription drug abuse is a growing problem. Most addiction is created out of ignorance of the dangers of drugs. The key to preventing and avoiding addiction to prescription drugs is awareness, both for yourself and loved ones.
Chapter 3
Drug Interactions and How Your Body Processes Drugs
Most drug testing is done on adult men between the ages of 25 and 50, but this is insufficient since drugs may act and interact very differently in children, teenagers, women, pregnant and nursing women, menopausal women, and particularly the elderly, where nutrient absorption and liver function is an issue. Your physician’s only way of gauging your tolerance to a drug is to begin with the standard dose for an adult male and see what happens. If you don’t complain of side effects or that there is no effect, chances are the dose will never be changed.
Dozens and dozens of factors can influence what effect a drug has on you, from how much sleep you got last night and what you had for breakfast to the condition of your liver and your blood pressure. For example, alcohol abuse can greatly increase or decrease tolerance to a drug, as can obesity, exercise, stress levels, and exposure to pollutants such as car exhaust, pesticides, or industrial chemicals. The elderly are far more sensitive to most drugs because their liver and kidney function is diminished; yet they are the population most likely to be taking handfuls of drugs each day. Entire medical journals are devoted to the metabolism of drugs, and new discoveries are made daily about how drugs interact with each other and in different people. For that reason, anytime you want to start taking a new drug—prescription or over-the-counter—we encourage you to talk to your pharmacist or go online and read the prescribing information sheet for that drug. If you’re taking other drugs, find out if they might interact with the new one. In the section “Resources and Recommended Reading” at the back of this book, you’ll find suggested online resources for checking drug interactions and side effects.
Drugs That Are Metabolized Differently in Women Than in Men
Probably many more drugs than just these are metabolized differently in women than in men, but these are the ones we currently know about. If you are given a drug and experience negative side effects, ask your physician to try changing the dosage.
Biorhythms and Time of Day
One factor that’s rarely taken into account in drug studies is the time of day, yet it can have a profound effect on how your body processes drugs. For example, the adrenal hormone cortisol tends to be highest in the morning and low before bedtime. The worst asthma attacks tend to occur between 2 A.M. and 6 A.M. when cortisol is at its lowest. Your stomach lining is more susceptible to damage from drugs such as aspirin in the morning, and aspirin reduces blood pressure more effectively when taken at night. Some types of chemotherapy are more or less effective at certain times of day or night.
Drugs and nutrients can affect each other in your digestive system, in your bloodstream, in your liver and kidneys, or at the cell level where the drug or nutrient receptor is. Just as it takes a variety of vitamins, minerals, amino acids, and enzymes to process food so that your cells can use it, drugs also go through changes as the body uses them. They are changed as they are made useful, as they are being used, and as they are being excreted from the body. Any interference in this process caused by nutritional deficiencies or interference from other drugs, food, or alcohol can raise or lower drug levels.
Factors That Can Increase Drug Levels
Drugs and Their Potential Side Effects
Common Drugs That Can Cause Breast Enlargement in Men
Drugs That Can Cause Diarrhea
Antibiotics
Antidepressant/antianxiety drugs (benzodiazepines, lithium, valproic acid)
Antihypertensives (reserpine, guanethidine, methyldopa)
Cholesterol-lowering drugs (clofibrate, gemfibrozil, the statins)
Cholinergic drugs (metoclopramide)
Gastrointestinal drugs (laxatives, antacids)
Heart drugs (digitalis drugs, quinidine, hydralazine, beta-blockers, ACE inhibitors, diuretics)
Common Drugs That Can Decrease the Effectiveness of Oral Contraceptives
If you’re taking oral contraceptives and are prescribed one of these drugs, be sure to use an alternative form of birth control during the time you’re taking these drugs and for at least two weeks afterward. If you get pregnant while on the pill, you may not realize it until the progestins it contains have put the fetus at significant risk of birth defects.
Drugs That Can Cause Weight Gain
If You’re Pregnant or Breast-Feeding, Don’t Take It
There are virtually no drugs that have no effect on a developing fetus, and the effects are nearly always negative. Unless you are in a life-threatening situation, it’s just not worth it.
Drug effects are poorly studied in pregnant animals, and for all practical purposes they are unstudied in humans. An indication on the drug package insert that no negative effects have been found does not mean there aren’t any. It may just mean it hasn’t been studied. You have to assume that any drug you take will hurt your baby.
The same goes for breast-feeding. There are few drugs that don’t end up in breast milk. Those that don’t may end up there eventually or affect it in other ways. Something as seemingly harmless as an aluminum-containing antacid taken when a woman is breast-feeding can cause developmental retardation.
Pregnancy and breast-feeding are wonderful opportunities to use nutrition as your medicine and to explore safe, gentle alternative approaches such as acupuncture and acupressure, massage, chiropractic, and meditation.
If you absolutely must use a medication while breast-feeding, refer to the online information offered by Thomas Hale, R.Ph., Ph.D., at ibreastfeeding.com. That’s also the best place to find the latest edition of his book, Medications and Mother’s Milk. Dr. Hale is the world’s foremost expert on mixing drugs with breast-feeding. He catalogs hundreds of drugs and gives detailed information about whether they can be used at all by nursing mothers and how to use them to minimize their effects on the baby.
Potentially Dangerous Drugs to Avoid
The following drugs are included on the FDA watch list because of concerns about serious side effects. There are actually many more drugs on the list. Please visit the FDA website and its MedWatch section for a more detailed list. Notice that some of the medications are as seemingly simple as an eczema cream (elidel), shampoo for lice (lindane), or heartburn drug (prevacid), yet could have serious side effects. The FDA’s MedWatch list changes frequently, so it’s worth checking it against any new medications you may be taking.
Your Body’s Drug Disposal Systems
The four major routes for excreting a drug from the body are the kidneys, liver, skin, and lungs. Most drugs are processed out through the liver and then the kidneys.
If you have kidney or liver disease, how your body handles drugs is profoundly affected. Food, drink, or lifestyle habits that stress and damage your kidneys or liver, such as alcohol abuse or chronic exposure to toxins such as solvents and paint fumes, can also affect how you process drugs. Even taking as seemingly harmless a drug as Tylenol (acetaminophen), which is hard on the liver, can affect drug levels. Kidney or liver stress or damage usually raises drug levels higher than normal by slowing down the excretion process. Smoking can cause drugs to leave the body more quickly than usual.
The aminoglycoside antibiotics such as streptomycin, kanamycin, and gentamicin cause kidney damage in as many as 15 percent of patients treated with them, but thousands of other drugs cause less obvious stress on your kidneys. When your drug information insert indicates renal (kidney) problems, you should be aware that the drug is probably going to be hard on your kidneys.
Drugs That Can Stress or Damage the Kidneys
Keeping Your P-450 Pathways Clear
Many types of drugs are prepared for clearance out of the body through the liver using the cyto-chrome P-450 enzymes, also known as the cyto-chrome P-450 pathways.
In a drug-free body or in the presence of only one drug, the P-450 pathways can handle the load. When you have more than one drug cleared through the same pathway, the system quickly gets overloaded, stalling the removal of the drugs from the system. The result is an overdose that can be life threatening.
Some examples of drugs that either use the P-450 pathways or block their action are Cimetidine (Tagamet)
Cholesterol-lowering drugs in the statin family
Macrolide antibiotics such as erythromycin and clarithromycin
Most antifungal drugs such as ketoconazole and miconazole
Antiarrhythmic drugs such as disopyramide (Norpace)
Phenytoin (Dilantin), used to treat seizures
Bromocriptine (Parlodel), used to treat Parkinson’s
Benzodiazepine antianxiety drugs such as diazepam (Valium) and nefazodone (Serzone)
Calcium channel blockers such as nifedipine (Procardia)
Theophyllines used to treat asthma
Tricyclic antidepressants such as Elavil (amitriptyline)
Blood thinner warfarin (Coumadin)
Tacrine (Cognex), used to treat Alzheimer’s Caffeine
These are just the most commonly used drugs. Grapefruit juice also uses this pathway, which is why drinking it is contraindicated with some drugs.
Are you getting the picture? This is a very popular pathway through the liver for clearing certain types of waste matter from the body.
How many people do you suppose have been killed in a scenario similar to this one: Joe is taking a calcium channel blocker long-term, is temporarily put on a macrolide antibiotic to treat chronic bronchitis, and then has a glass of grapefruit juice and a cup of coffee with breakfast. This raises his levels of the calcium channel blocker so high that his blood pressure drops precipitously, causing heart failure. It’s not an unlikely scenario. Or let’s say it’s the evening, and he takes some Tagamet (which is available over-the-counter) for heartburn and a Valium to help him sleep. Our guess is that this type of mismatching harms or kills hundreds of people every day.
Since it’s unlikely that the package insert on the drug you’re taking will tell you it’s cleared through the P-450 pathways, your best bet is to check with your pharmacist before mixing any drugs, even over-the-counter drugs. Labels that warn of such things as hepatic (liver) toxicity, injury, dysfunction, or function impairment, which is medicalese for liver poisoning, should flash a red light in your head. This doesn’t necessarily mean that it’s a P-450 drug, since most prescription drugs are hard on the liver in some way, but it should make you very wary if you’re taking other drugs.
Taking Care of Your Liver When You Take Drugs
The liver is one of the busiest organs of the body, working constantly to process food for transport through the bloodstream and to metabolize waste matter for excretion through urine or feces. The list of prescription drugs that stress or damage the liver is probably longer than those that don’t. If you drink alcohol in excess and take liver-stressing drugs, you could be doing substantial damage to your liver.
If the Drug You’re Taking Causes Drowsiness, Don’t Drive!
According to an organization called Citizens Against Drug-Impaired Drivers (CANDID), prescription and over-the-counter medications that cause drowsiness contribute to more than 100,000 car crashes a year. If your drug insert warns against driving while under the influence of the drug, please take that warning seriously!
Some symptoms of liver toxicity are swelling and redness in the palms of the hands, yellowish skin and whites of eyes, itching, small benign fatty tumors and reddish spots on the skin, or lumps under the skin of damaged blood vessels.
Drugs That Are Hard on the Liver
Nearly all prescription drugs are hard on your liver, but these are at the top of the list:
Acetaminophen
A
nalgesic painkillers
Anesthetics (given during surgery)
Antibiotics
Anticoagulants
Antihistamines
Anti-inflammatory drugs
Blood-pressure-lowering drugs
Chemotherapy drugs
Cholesterol-lowering drugs
Diabetes drugs (oral)
Heart disease drugs
Oral contraceptives
Parkinson’s drugs
Tuberculosis drugs
Use Caution with Acetaminophen
One of the most commonly used drugs that damages the liver is acetaminophen (Tylenol), which is loudly touted in advertising for pain relief because it doesn’t upset the stomach the way aspirin and ibuprofen do. What those ads neglect to tell you is that acetaminophen is very hard on the liver.
Recent research has shown that acetaminophen may inflict most of its damage on the liver by blocking the production of the important anti-oxidant glutathione. Without glutathione, the liver’s ability to break down toxins for elimination is impaired. According to a study published in the journal Free Radical Biology and Medicine, one hour after an injection of acetaminophen, glutathione levels decrease by as much as 83 percent! That is a vulnerable liver. If some type of stress is placed on the liver (i.e., alcohol, pesticides) at the same time the acetaminophen hits it, the damage could be considerable.
If you’re in pain, you may be in the position of having to pick your poisons, so here’s a health-protecting strategy: if you’re going to take acetaminophen, take the liver-protective herb milk thistle beforehand (follow the directions on the bottle) and add 500 mg of N-acetyl cysteine to your daily vitamins. Cysteine is the precursor to glutathione. Also be sure to avoid alcohol when you’re taking acetaminophen.
Drugs That Can Impair Athletic Performance
Prescription Alternatives Page 5