Prescription Alternatives
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Miscellaneous Asthma Drugs
Ipratropium bromide (Atrovent)
What Does It Do in the Body? Inhibits the body’s overreaction to asthma triggers by blocking the action of the excitatory neurotransmitter acetylcholine. It also has antisecretory effects, helping relieve the discomfort of a runny nose.
What Is It Used For?
• Bronchial inhalers. Reversal of broncho-spasm caused by asthma, emphysema, or other cardio-pulmonary diseases.
• Nasal inhalers. Relief from nasal allergies and common cold symptoms.
What Are the Possible Side Effects? Headache, nausea, flulike symptoms, back and chest pain, dizziness, dry mouth, constipation, coughing, shortness of breath, bronchitis, paradoxical bronchospasm, increased production of sputum, upper respiratory infection, inflammation of the pharynx, runny nose, and inflammation of the sinuses.
CAUTION!
Think Twice About Taking This Drug If . . .
• You are sensitive to the drug atropine, soy lecithin (commonly found in processed foods and chocolate), soybeans, or peanuts.
• You are trying to treat an acute asthmatic episode; it won’t work quickly enough.
Use caution if you have narrow-angle glaucoma, enlarged prostate, or bladder neck obstruction.
When using Atrovent, be very careful not to get it in your eyes.
Nedocromil (Tilade)
Cromolyn (Intal)
What Do They Do in the Body? These drugs are mast cell stabilizers, which means that they suppress the release of inflammatory chemicals like histamine in the airways. They don’t work as well as inhaled steroids but have less severe side effects. Mast cell stabilizers have been in use for a very long time, but almost no research has been done on them since the 1980s.
What Are They Used For?
• Bronchial inhaler. To prevent asthma attacks.
• Nasal inhaler (Nasalcrom). Relief from nasal allergies.
What Are the Possible Side Effects? Sore or dry throat, bad taste in the mouth, wheezing, nausea, cough, nasal congestion, sneezing, worsening asthma, allergic reaction, drowsiness, itchy nose, nosebleeds, burning nose, stomach-ache, dizziness, painful or frequent urination, joint pain or swelling, watery eyes, headache, muscle pain.
Omalizumab (Xolair)
What Does It Do in the Body? This drug is a monoclonal antibody made with recombinant DNA technology. It reduces the body’s asthmatic response to allergic triggers. Because it is relatively new, and thus relatively untested, we don’t recommend it at this time.
What Is It Used For? Xolair is only administered by injection in people with allergic asthma for whom other asthma medications don’t control their attacks well enough. A blood test for response to allergic triggers is performed by the doctor to determine whether this drug is suitable. It takes up to 17 weeks of once or twice monthly injections to reduce asthma symptoms.
What Are the Possible Side Effects? Anaphylaxis (bronchospasm, fast drop in blood pressure, fainting, rash, fluid collecting around the heart) is a significant risk with this injected drug, even if you have been using it for a while. When it’s given in the doctor’s office, your doctor should be at the ready with epinephrine to treat this kind of reaction. Other possible side effects include injection site reaction, viral infection, upper respiratory tract infection, sinusitis, headache, and throat inflammation.
CAUTION!
Think Twice About Taking This Drug If . . .
• Please think twice about taking this drug, period. This drug was issued a black-box warning by the FDA due to the risk of anaphylaxis previously mentioned. This is the FDA’s most serious warning.
• You have ever had an anaphylactic reaction to this drug.
• You are trying to treat an acute asthmatic episode; it won’t work quickly enough.
Drugs for Allergies
Examples of Antihistamines
Azatadine maleate (Optimine)
Azelastine (Astelin)
Brompheniramine maleate (Dimetapp)
Cetirizine (Zyrtec)
Chlorpheniramine (Chlor-Trimeton, Aller-Chlor)
Clemastine fumarate (Antihist-1, Tavist)
Cyproheptadine (Periactin)
Desloratidine (Clarinex)
Dexchlorpheniramine maleate (Polaramine)
Diphenhydramine (AllerMax, Benadryl, Banophen, Diphenhist)
Fexofenadine (Allegra)
Levocetirizine (Xyzal)
Loratadine (Claritin)
Phenindamine (Nolahist)
Promethazine (Phenergan, Allergan)
Pyrilamine maleate
Tripelennamine (PBZ)
There are dozens of prescription and over-the-counter varieties of antihistamines. Because histamine is only one of many substances that cause allergy symptoms, these drugs work only 40 to 60 percent of the time. They are most effective at relieving sneezing and itching but don’t have much effect on nasal congestion.
You may notice that several of these drugs seem similar to others in their class: Claritin (loratadine) and Clarinex (desloratidine), for example, or cetirizine (Zyrtec) and levocetirizine (Xyzal). The latter in each pair is a “me-too” drug—a chemical that was developed and sent through the FDA approval process not to create a better drug but to maintain patent protection or compete with other similar drugs from other drugmakers. We’re not aware of any research showing that you will better control your symptoms with big-bucks, brand-name Clarinex or Xyzal than with generic, over-the-counter versions of loratadine or cetirizine.
All antihistamines have the potential to adversely affect heart rhythms; terfenadine (Seldane) and astemizole (Hismanal), which were finally pulled off the market, can cause a very rare and potentially fatal arrhythmia. If you still have these drugs in your medicine cabinet, please throw them away.
Fexofenadine (Allegra) is chemically similar to terfenadine but has not been found to cause this rare arrhythmia. Allegra’s most common side effects are nausea, vomiting, weakness, and sleepiness. It should not be used by those taking monoamine oxidase inhibitors (MAOIs) or by anyone with urinary retention, narrow-angled glaucoma, high blood pressure, or heart disease. Allegra-D and Claritin-D are combinations of an antihistamine and the decongestant pseudoephedrine, which is described later in this chapter.
Some other antihistamine combinations include an analgesic (painkiller) such as acetaminophen, an expectorant such as guaifenesin, or an antitussive (anticough) such as menthol, codeine, or dextromethorphan. Well-known brand names of such combinations include Actifed, Advil Cold & Sinus, Alka-Seltzer Plus, Naldecon, Benylin, Chlor-Trimeton, Comtrex, Robitussin, Sudafed, Contac, Vicks, Dimetapp, Tylenol, and Dristan. Read labels carefully, and be aware of possible side effects and interactions of all of the drugs in these combinations, should you end up using them.
Ethylenediamines (pyrilamine maleate, tripelennamine) are associated with more digestive system side effects than other anti-histamines, and cyproheptadine (Periactin) appears to cause more pronounced increases in appetite and weight gain than other drugs in this class.
Most antihistamines cause drowsiness, even so-called nonsedating versions, and other sedating drugs will have an additive effect, so don’t combine them with alcohol or antianxiety drugs such as Ativan, Librium, Xanax, or Valium.
Fiorinal (a drug for tension headaches), tricyclic antidepressants, antiseizure drugs, prescription pain relievers, and muscle relaxants can also make you sleepy when taken with most antihistamines.
Don’t use any antihistamine without a doctor’s supervision if you have high blood pressure, cardiovascular disease, diabetes, enlarged prostate, or hyperthyroidism.
What Do They Do in the Body? These drugs compete with histamines at specific receptor sites, blocking allergic symptoms.
What Are They Used For? Relief of symptoms associated with seasonal allergies or the common cold, including runny nose; watery, itchy eyes; sneezing; and itchy rash. Claritin and Allegra don’t cause drowsiness.
What Are
the Possible Side Effects? Some people are allergic to antihistamines. Fluid retention (edema) in the extremities, throat, or even around the heart can occur. Other signs of allergy to antihistamines include dermatitis, asthma, lupuslike symptoms, rash, increased sensitivity to light, or even life-threatening anaphylaxis.
Other side effects that have been observed include precipitous dips in blood pressure when moving from sitting to standing or from lying down to standing, palpitations, heart rhythm irregularities (ranging from merely uncomfortable to life threatening), faintness, blood pressure changes, and changes on electrocardiogram (ECG) readings.
Drowsiness, sedation, dizziness, disturbances in coordination, headache, and irritability are among the more common side effects. Also reported are stomach distress; anorexia; weight gain; nausea; vomiting; diarrhea; constipation; urinary problems (difficulty urinating or too-frequent urination); breast development in males (gynecomastia); spontaneous lactation in women; decreased libido; impotence; thickening of bronchial secretions; chest tightness; wheezing; nasal stuffiness; dry or sore mouth, nose, or throat; depressed respiratory function; tingling; feeling of heaviness; weakness of hands; easy bruising; jaundice; skin redness; stomach inflammation; high or prolonged glucose tolerance curves; increased levels of glucose in the urine (a symptom of diabetes); changes in blood cell and spinal fluid protein counts; increased blood cholesterol levels; excessive perspiration; chills; hair loss; vision disturbances; cough; menstrual disturbances; nightmares; mild to moderate transaminase elevations (indicating liver damage); and anemia.
CAUTION!
Think Twice About Taking These Drugs If . . .
• Do not give these drugs to children under the age of 2 without a specific recommendation from a physician. The FDA reports that Phenergan (promethazine) has caused deaths in children under the age of 2 and that it is dangerous in older children. Even if a doctor does prescribe this drug for your child, be aware that it’s dangerous and could be fatal.
• You are taking MAOIs.
• You have sleep apnea. In people with this disorder, the sedative effects of antihistamines can cause respiratory depression.
• Don’t use these drugs if you have narrow-angle glaucoma, stenosing peptic ulcer, symptomatic enlarged prostate, bladder neck obstruction, pyloric (stomach) or duodenal (small intestine) obstruction, or liver disease.
Taking the drugs erythromycin, ketoconazole, or itraconazole can prompt life-threatening arrhythmias if taken with Claritin.
Taking antihistamines during a bout of lower respiratory tract disease (such as asthma, emphysema, or chronic bronchitis) can thicken bronchial secretions, making them more difficult to cough up.
People over the age of 60 are more likely to experience dizziness, sedation, fainting, confusion, and dipping blood pressure.
Be sure to tell your doctors that you use an antihistamine if you require general anesthesia. The activity of anesthetic drugs is increased by antihistamines, and the anesthesiologist will need to reduce the dosage.
Children using these drugs may become less mentally alert or become very excited. Overdoses in children can lead to hallucinations, convulsions, or even death.
It’s a good idea to stay out of the sun while taking loratadine. It can make you more sensitive to ultraviolet light.
These drugs will not work to reverse the bronchospasm that occurs during an acute asthma attack.
Be Aware of Alcohol and Antihistamine Interactions. Alcohol and other central nervous system depressant drugs can have an additive effect when taken with antihistamines. Your ability to drive may be impaired by very small amounts of alcohol when you take antihistamines.
What Are the Interactions with Food? Citrus and other acidic juices can cause decreased drug activity when mixed with antihistamines. Vitamin C can help your kidneys clear antihistamines from the body.
Drugs for Colds, Coughs, and Allergies
Examples of Expectorants
Guaifenesin (Guiatuss, Anti-Tuss, Genatuss, Glyate, Halotussin, Mytussin, Robitussin, Siltussin, Scot-Tussin Expectorant, Tusibron, Uni-Tussin, Diabetic Tussin EX, Organidin NR, Naldecon Senior EX, Breonesin, GG-Cen, Hytuss 2X, GeeGee, Glytuss, Duratuss-G, Guaifenex LA, Fenesin, Humibid LA, Liquibid, Monafed, Muco-Fen-LA, Pneumomist, Respa-GF, Sinumist-SR Capulets, Tonro EX)
What Does It Do in the Body? Guaifenesin is an expectorant. It enhances the output of lubricating fluid in the respiratory tract so that mucus is easier to expel by coughing. Coughs are less frequent and more productive.
What Is It Used For? Relief of dry, nonproductive cough and respiratory conditions where mucus is present.
What Are the Possible Side Effects? Nausea, vomiting, dizziness, headache, and rash.
CAUTION!
Think Twice About Taking This Drug If . . .
Your cough is caused by asthma, smoking, or emphysema, or you have excessive mucus in your respiratory tract.
A cough that won’t go away may be an indication of a serious medical condition. If it persists for more than one week or if you seem to have recurrences frequently, see a health professional for evaluation. If the cough is accompanied by a rash or a headache that won’t go away, you should also consult with your doctor.
According to the American College of Chest Physicians (ACCP), over-the-counter cough medicines don’t help recovery from coughs, because they don’t contain high enough doses of cough suppressants and expectorants. Trying to use these medicines to suppress coughs can delay diagnosis of something that urgently requires medical treatment, such as whooping cough or bronchitis that could turn into pneumonia. The ACCP’s recommendation: if you are going to use over-the-counter medications to treat a cough, try antihistamines or decongestants to dry up mucus. But keep in mind that a cough is designed to eliminate disease-causing substances from your body. Let it run its course when possible, using natural methods (described later in this chapter) to help the cough do its job.
Over-the-counter cough medicines can be hazardous to children’s health. They are a common drug of abuse in the 12-to-25 set in the United States. In this age bracket, cough syrups and decongestants are used for the purpose of getting high, roughly as often as LSD, Ecstasy, and methamphetamine. To get high, all a teen needs to do is guzzle a bottle of cough syrup that contains dextromethorphan (DMX) or codeine. Second, parents who unintentionally give too many over-the-counter cough and cold medications to their young child can easily cause harm. What kind of harm? Even recommended doses of these medications can cause damage. These drugs were approved back in the 1970s and were never adequately tested in pediatric populations.
Children under the age of 2 are most at risk for harm from over-the-counter cough and cold medications. If you are a parent, know that it’s easy to overdose a very young child, and that combining drugs with multiple ingredients (decongestant, pain medication, cough suppressant) can lead to dangerous interactions or overdoses. In 2007 the Centers for Disease Control and Prevention (CDC) issued a warning that cough medicines given to children under the age of 2 can cause serious illness and death. One of the common causes of these reactions is giving adult doses of medication to children.
Examples of Decongestants
Epinephrine (Adrenalin Chloride)
Naphazoline (Privine)
Oxymetazoline (Afrin, Allerest, Dristan 12-Hour Nasal)
Phenylephrine (Alconefrin, Neo-Synephrine, Rhinall, Sinex)
Pseudoephedrine (Afrin, Drixoral Non-Drowsy Congestion Relief, Genaphed, Halofed, Pseudo-Gest, Sendotabs, Sudafed, Sudex, Cenafed, DeFed-60, Efidac/24, Allermed, Triaminic AM, Decofed Syrup, Cenafed Syrup, PediaCare Infants’)
This class of drugs works by constricting blood vessels. Decreased blood flow to the nasal passageways and sinuses helps reduce swelling and mucous congestion. They are often used along with antihistamines and are available in oral and topical (nasal spray and eyedrop) versions.
After three to five days’ use of topical decongestants, rebound congestion often occurs. Desp
ite repeated use, nasal congestion is no longer relieved with the drug. If this happens to you, gradually wean yourself from the medication and allow one to two weeks for things to get back to normal.
When taken orally, decongestants cause central nervous system stimulation. Nervousness, irritability, insomnia, elevations in blood pressure and heart rate, irregular heartbeats, headache, pupil dilation, and palpitations can result. If you use a beta-agonist asthma medication (albuterol, salmeterol) and add a decongestant, the two drugs can have additive effects, making you feel as though you’ve had a few too many cups of coffee. This effect can be dangerous in people with high blood pressure and other types of heart disease.
What Do They Do in the Body? Swollen mucous membranes in the nose and eyes are a hallmark of seasonal allergies, colds, and flu. These over-the-counter drugs counter this inflammation by causing constriction of mucous membranes.
What Are They Used For? Hay fever, nasal allergies, sinusitis, common cold symptoms, and relief of congestion in the middle ear caused by infection. Inhaled through the nose, some can work directly on nasal inflammation or relieve ear blockage and pressure during air travel.
Pseudoephedrine and phenylpropanola-mine are mixed-acting agents, which means they have a more generalized effect on the body, while epinephrine is a direct-acting agent with very specific effects on the airways.
What Are the Possible Side Effects? With topical use as a nasal spray: burning, stinging, sneezing, dryness, local irritation, and rebound congestion after stopping the drug. When taken internally: fear, anxiety, tension, restlessness, headache, light-headedness, dizziness, drowsiness, tremors, insomnia, hallucinations, psychological disturbances, convulsions, central nervous system depression, weakness, heart rhythm abnormalities, low blood pressure connected with cardiovascular collapse, transient high blood pressure, nausea, vomiting, paleness, difficulty breathing, loss of tone in the muscles of the face and mouth, sweating, urinary problems, twitching of the eyelids (blepharo spasm), eye irritation or tearing, and heightened sensitivity to the sun (photosensitivity).