The following are side effects specific to the form of epinephrine:
• Inhaled form. Palpitations, anxiety, fear.
• Injected form. Cerebral hemorrhage caused by rapid rise in blood pressure, especially in elderly people with diseased arteries in the brain. Agitation, disorientation, memory impairment, assaultive behavior, panic, hallucinations, suicidal or homicidal tendencies, and other serious psychological disturbances can be a result of epinephrine injection. Children may faint after being injected. Fatal arrhythmias, spasm of the arteries that feed the retinas of the eyes, and shock have also been reported. Other side effects may include pain, itching, hemorrhage, or raised red welt at injection site.
What Are the Interactions with Food? Foods rich in the amino acid tyramine, such as aged cheeses, wine, and chocolate, can interfere with enzymes needed to metabolize sympathomimetic drugs such as epinephrines. Side effects of mixing these foods with epinephrines in sensitive people can include severe high blood pressure, intracranial bleeding, severe headache, chest pain, sweating, palpitations, changes in pulse rate, vision problems, breathing difficulties, and even coma.
Examples of Xanthine Derivatives
Aminophylline (Phyllocontin, Truphylline)
Dyphylline (Dilor, Lufyllin)
Oxtriphylline (Choledyl)
Theophylline (Theo-Dur, Slo-Phyllin, Theolair, Quibron-D Dividose, Bronkodyl, Elixophyllin, Aquaphyllin, Theoclear, Theostat, Accurbron, Asmalix, Elixomin, Lanophyllin, Aerolate, Slo-Bid Gyrocaps, Theo-24, Theospan-SR, Theovent, Theochron, Quibron-T/SR Dividose, Respbid, Sustaire, Theo-Sav, Theo-X, T-Phyl, Uni-Dur, Uniphyl)
What Do They Do in the Body? These are a class of drugs known as the xanthine derivatives or methylxanthines, which relax the smooth muscle that lines the blood vessels of the bronchial tubes and lungs. These drugs also stimulate the central nervous and respiratory systems, induce water loss (diuresis), decrease the tone of the lower esophageal sphincter, and inhibit uterine contractions.
What Are They Used For? Relief of symptoms and prevention of bronchial asthma or other bronchospasm associated with COPD. Regular use may improve lung function and shortness of breath in COPD patients. Xanthine derivatives are rarely used today to treat asthma, as they have high potential for toxicity and interact harmfully with a very long list of other drugs and foods. These medicines are used more often for COPD.
What Are the Possible Side Effects? If theophylline clearance from the body is reduced, harmful levels of the drug can accumulate in the body. Carefully consider any potential for interactions with other drugs, and don’t take anything sold over-the-counter without consulting your physician or pharmacist.
At even slightly elevated blood levels of this drug, you’re likely to experience nausea, vomiting, diarrhea, headache, insomnia, and irritability. In some people, the first signs of dangerous levels of theophylline in the body may be more severe. Moderately high blood levels lead to high blood sugar, low blood pressure, irregular heart rhythms, seizures, brain damage, and even death.
Other potential adverse effects at normal blood levels of theophyllines include fever, flushing, high blood sugar, oversecretion of antidiuretic hormone (which can cause fluid and electrolyte imbalances), rash, hair loss, irritability, restlessness, headache, insomnia, overexcited reflexes, muscle twitching, convulsions, nausea, vomiting, stomach pains, vomiting of blood, diarrhea, heartburn (gastroesophageal reflux) during sleep, life-threatening heart rhythm abnormalities, circulatory failure, changes in breathing patterns, respiratory arrest, protein in the urine, and rapid loss of fluid through the urine.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have peptic ulcer.
• You have an underlying seizure disorder that is not being treated with anticonvulsant medication.
• You have heart disease, low blood oxygen levels, liver disease, high blood pressure, or congestive heart failure, are elderly, or are or have ever been an alcoholic.
• You are a man over 55 years of age.
• You have heart failure.
• You are suffering from a sustained high fever.
In an acute episode of asthma, don’t rely on theophylline to open your airways. Keep albuterol or another fast-acting beta-agonist inhaler around just in case.
Drug Interactions to Be Aware Of. Theophylline is one of the most dangerous drugs to combine with other drugs. The list of drugs it interacts with could go on for pages. If you’re taking any type of theophylline drug, do not take any other drug or natural remedy without checking with a pharmacist or the drug information sheet first. Here are some lesser-known theophylline interactions:
• Theophylline can reduce the effectiveness of benzodiazepines (sedatives such as Ativan, Valium, and Xanax).
• Halothane and theophylline used together may lead to heart rhythm irregularities.
• Ketamine and theophylline used together may lead to seizures.
• Blood levels of lithium (used for depression and manic-depression) may be reduced by theophylline.
• The use of tetracycline along with theophylline increases the likelihood of side effects.
What Are the Interactions with Food? Theophylline has a shorter duration of action when you consume a low-carbohydrate, high-protein diet. On the other hand, the drug stays in the body longer with a high-carbohydrate, low-protein diet.
Charcoal-broiled beef is high in polycyclic carbon, which diminishes the effectiveness of theophylline. Avoid large amounts of cocoa, tea, coffee, or other caffeinated drinks. Be aware that chocolate contains caffeine, too.
Hot pepper sauces, such as Tabasco sauce, can increase blood levels of theophylline, but this hasn’t been demonstrated to be dangerous.
To avoid toxicity that results when sustained-release capsules empty into the body too quickly, take theophylline on an empty stomach. If you aren’t using sustained-release tablets, you can take them with food, but less of the drug may be absorbed.
Eaten in large amounts, cruciferous vegetables such as broccoli, cauliflower, cabbage, and brussels sprouts increase the rate at which your body metabolizes theophylline.
Foods that acidify the urine cause the drug to be emptied more quickly from the bloodstream, while foods that alkalinize the urine have the opposite effect. Meat, chicken, fish, eggs, and grains tend to acidify the urine. Vitamin C and cranberries also acidify the urine. Foods that alkalinize the urine include most fruits (exceptions are cranberries, plums, and orange juice), dairy products (except cheese), and vegetables.
What Else to Take If You Take These Drugs. Studies have shown that asthmatics tend to be deficient in the mineral magnesium and that the body’s ability to cope with stressful situations is compromised when low on this mineral. Daily use of beta-agonists such as albuterol, salmeterol, and epinephrine, as well as the use of theophylline, can further deplete the body’s magnesium stores. Supplement with one of the following forms of magnesium: malate, citrate, gluconate, or glycinate, 500 mg a day in divided doses.
Examples of Leukotriene Receptor Drugs
Montelukast sodium (Singulair)
Zafirlukast (Accolate)
Zileuton (Zyflo)
What Do They Do in the Body? These relatively new drugs block or inhibit leukotriene receptors. Leukotrienes are one of the inflammatory substances produced during an allergic reaction. Levels of leukotrienes shoot up during an allergic asthma attack and montelukast sodium, zafirlukast, and zileuton block the swelling of the airways that results.
What Are They Used For? Prevention and treatment of asthma in people above the age of 12. These are not widely used, because they aren’t as effective as other asthma drugs. A meta-analysis of 13 studies comparing leukotriene inhibitors to inhaled steroids for control of mild to moderate asthma found that the steroids were substantially more effective. Other studies show that patients who need to add a drug to their inhaled steroids to control their symptoms are better off with LABAs than with leukotri
ene inhibitors.
These drugs are not suitable for treating an acute attack. Keep a fast-acting beta-agonist or epinephrine inhaler with you to serve this purpose.
What Are the Possible Side Effects? People over the age of 55 who took leukotriene inhibitors reported more frequent respiratory infections, especially when they also used corticosteroids.
• Montelukast sodium. The FDA is investigating a possible association between the use of Singulair and behavior or mood changes that include suicidal thinking and behavior, and actual suicide. Please take this warning seriously! Other possible side effects include headache, dizziness, stomach infections, acid indigestion, increased incidence of flu, cough, nasal congestion, abdominal pain, fatigue, and fever.
• Zafirlukast. Headache, dizziness, nausea, diarrhea, abdominal pain, vomiting, infection, generalized pain, weakness, muscle aches, fever, back pain, and stomach discomfort.
• Zileuton. Headache, abdominal pain, weakness, lowered white blood cell counts, and muscle pain. Side effects frequently cause people to stop taking zileuton.
The most serious side effect that occurs with these drugs is elevation of liver enzymes, which indicates that there may be liver damage. Your physician should check your liver enzyme levels regularly, especially if you are 65 or older.
CAUTION!
Think Twice About Taking These Drugs If . . .
You have liver disease or transaminase elevations that are three or more times the upper limit of normal. This is an indication that your liver cells are being damaged by something and you shouldn’t risk further harm to this vital organ by taking these drugs. Leukotriene antagonists aren’t cleared from the body as well when the liver isn’t doing its work properly.
Examples of Corticosteroid Inhalers
Beclomethasone (Beclovent, Vanceril, Vancenase)
Budesonide (Pulmicort, Rhinocort)
Flunisolide (AeroBid)
Fluticasone (Flovent, Flovent Rotadisk)
Triamcinolone (Azmacort)
What Do They Do in the Body? These drugs belong to a class of drugs called corticosteroids. Steroid drugs are usually given to reduce inflammation. These inhaled corticosteroids minimize the systemic side effects commonly seen with versions taken in pill form.
What Are They Used For? Control of asthma symptoms not adequately controlled by other means.
What Are the Possible Side Effects? The side effects of these medications make the choice to use inhaled steroids a tough one. It can seem so much easier to puff on an inhaler than to enact the lifestyle overhaul that may be necessary to address asthma symptoms at their root—until you understand how those drugs may be adversely affecting your body. No matter what you choose to do, it is essential to control airway inflammation and shortness of breath in a proactive way. Letting asthma symptoms persist without doing anything about them can lead to permanent respiratory damage.
Some research suggests that dosages of steroid inhalers are often higher than necessary for symptom control. To minimize side effects, talk with your doctor about finding the minimum effective dose.
The classic signs of long-term excess steroids in the system are puffy cheeks, weight gain, unstable blood sugar, and thin skin that breaks and bruises easily.
Inhaled corticosteroids may increase your risk of open-angle glaucoma, an eye disease that causes blindness, by up to 50 percent. Solid evidence also exists that long-term use can lead to loss of bone mass. This may not seem significant in a young person, but the more bone mass you build in your youth, the more you can afford to lose as you age before you end up with symptomatic osteoporosis. Many people who use inhaled steroids use them for years and years, so this can be a very real risk. If you must use inhaled steroids, do all you can to keep bones strong by following our recommendations in Chapter 20 for calcium, magnesium, vitamin D, and weight-bearing exercise.
Fungal yeast (candida) infections of the throat are a common side effect of inhaled corticosteroid use. This can cause irritation or hoarseness, rash, wheezing, and swelling of the face.
Even inhaled steroids can cause side effects throughout the body. Dozens of side effects may occur, including weight gain, water retention, increased susceptibility to infection (especially in the upper respiratory tract), high blood pressure, imbalances of minerals such as potassium and calcium, decreased growth in children and adolescents, and protein loss.
Other side effects may include hypersensitivity (allergic) reactions, bronchospasm (the very problem it’s given to treat), acne, bruising, itching, wheezing, cataract, light-headedness, unpleasant tastes or smells, loss of senses of taste and smell, nausea, vomiting, dizziness, agitation, depression, mental disturbances, fatigue, insomnia, migraine, eczema, rash, skin discoloration, coughing, nasal congestion, abdominal pain, dry mouth, digestive problems, rapid heartbeat, palpitations, nervousness, shakiness, menstrual disturbances, and headache.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You are having an acute attack of asthma. Corticosteroids don’t work fast enough to help under these circumstances. Always keep a fast-acting inhaler on hand just in case.
• You have any kind of systemic fungal infection, including candida, a very common problem that can be made much worse by taking steroid drugs.
The full impact of long-term use of inhaled corticosteroids won’t be completely understood for some time. These are relatively new drugs that many people will end up taking for years or decades. With what is known at this juncture about the effect of these drugs on bone health and immune function, however, we suspect that allopathic medicine is underplaying the long-term risks. Although your physician may tell you that inhaled steroids are essentially free of the side effects of systemic versions, some people who use them for extended periods may experience weight gain, mood swings, or even adrenal suppression, and recent studies indicate that inhaled steroids may cause systemic side effects—including osteoporosis—more quickly than anyone suspected.
Use Caution Withdrawing from Steroid Drugs
If you have asthma, you are particularly vulnerable to a life-threatening attack while you are withdrawing from steroids taken by mouth (oral steroids), such as prednisone or hydrocortisone, or high doses of inhaled steroids. Taking large doses of steroids may cause your adrenal glands to shut down or greatly decrease their production of these substances. If you have been taking steroids regularly for a long period of time, your endocrine system may take several months to recover. In older people, the adrenal glands may never recover, and they may end up dependent on steroid drugs for life.
Anyone who is taking or has recently stopped taking oral corticosteroids or large doses of inhaled steroids over a long period of time should carry a warning card with this information on it. If you have an acute attack of asthma during this time or are under a lot of stress, resume the systemic steroid immediately and see your doctor.
One way to minimize the risk of dependency while taking oral steroids is to use the smallest possible dose of hydrocortisone, the natural form of cortisone, rather than the more potent synthetic drugs such as prednisone.
Even inhaled steroids should not be stopped suddenly. You could end up having a severe attack. Stop using one only under the guidance of a physician.
Lesser-Known Interactions to Be Aware Of. Corticosteroids interact with many other drugs, and you should check with your pharmacist or the drug information sheet before taking any additional drug or natural remedy. The following are some of the lesser-known interactions with corticosteroids:
• If you are taking oral anticoagulant drugs and corticosteroids, your physician may have to adjust the anticoagulant dose; in some cases, corticosteroids cause the anticoagulant to be less effective.
• Theophylline and corticosteroids used together may result in some alteration of the effects of either or both.
• Alcohol can add to the stomach irritation that can be a side effect of corticosteroid use.
•
Use salt in moderation if you are using a steroid drug. The two together can cause stomach irritation, and fluid and sodium retention.
What Else to Take While Taking This Drug. Corticosteroids cause increased excretion of potassium, calcium, zinc, and magnesium, and this can result in depletion of these important minerals. Use supplements of each mineral.
Your need for the vitamins B6, C, and D is increased during corticosteroid therapy.
Use extra probiotics to help maintain healthy intestinal flora, and be sure to rinse your mouth thoroughly (without swallowing the water) after each inhaled dose to prevent candida infection in the mouth and throat.
With oral administration of steroid drugs, high-fat meals cause increased drug absorption, appetite is increased, and foods in general are better absorbed, so weight gain can result. The body can absorb enough of the inhaled form to cause these side effects.
Examples of Combination Long-Acting Beta-Agonists (LABAs) and Inhaled Steroids
Fluticasone propionate/salmeterol (Advair)
Budesonide/formeterol (Symbicort)
What Do They Do in the Body? Advair and Symbicort are combination drugs. They contain an inhaled steroid and a long-acting bronchodilator. Advair is prescribed far more often.
What Are They Used For? Long-term maintenance treatment of asthma.
What Are the Possible Side Effects? Headache; cough; diarrhea; nausea; vomiting; dizziness; dry mouth; mouth, throat, and sinus irritation; sinus infection; muscle pain; stomach pain; and weight gain.
CAUTION!
Think Twice About Taking These Drugs If . . .
You have any history of heart problems, liver problems, diabetes, high blood pressure, cataracts, glaucoma, depression, recent infections, or low thyroid activity (hypothyroidism).
What Else to Take While Taking This Drug. Follow the guidelines for salmeterol and inhaled steroids.
Prescription Alternatives Page 25