Phenylpropanolamine: avoid this drug!
Phenylpropanolamine (PPA), once an ingredient in decongestants and diet drugs, increases stroke risk significantly, especially in women between the ages of 18 and 49. It may be responsible for hundreds of strokes in people under the age of 50. The FDA has released consumer advisories to tell the public that PPA is not a safe drug and has told drugmakers not to put it into their products anymore. You may still find it on store shelves in decongestants and diet pills. Toss older products that contain PPA in the trash, and avoid buying products that contain PPA in the future.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You are taking MAOIs.
• You are hypersensitive to stimulating drugs. Some people’s bodies respond very strongly to small doses. If you are experiencing dizziness, weakness, tremor, and heart arrhythmias, you may be getting too high a dose.
• You have glaucoma. If you are using the ophthalmic decongestant naphazoline, don’t use nasal sprays containing these drugs.
Powerful stimulation of the central nervous system by these medications can lead to convulsions or cardiovascular collapse. Don’t take internally if you have severe hypertension or heart disease. Use with caution if you have any of the following conditions: hyperthyroidism, diabetes, any kind of cardiovascular disease, elevated intraocular pressure (often a warning sign of glaucoma in its early stages), or enlarged prostate. Consult with your doctor if you have high blood pressure and want to use an over-the-counter decongestant.
There is some potential for addiction to phenylpropanolamine and pseudoephedrine. Use only when necessary, and discontinue as soon as you can.
In elderly people, long-term, high-dose therapy can lead to toxicity and psychosis more easily than in young people.
Beware of rebound congestion, particularly with nasal sprays. Don’t fall into a pattern of increasing doses to compensate. Even the nasal inhaler can deliver enough drug to your system to cause toxicity.
Be Aware. Theophylline and nasal decongestants taken together can lead to theophylline toxicity. Dangerous heart arrhythmias can result.
Beta-blockers increase levels of epinephrine in the bloodstream when they are taken together. A hypertensive episode followed by slowed heartbeat can result. Diabetics may need to use higher doses of insulin or oral hypoglycemic drugs while using epinephrine.
Examples of Steroid Nasal Decongestants
Beclomethasone dipropionate (Beconase AQ, Vancenase, Qvar)
Budesonide (Rhinocort Aqua Nasal Spray)
Ciclesonide (Omnaris)
Flunisolide (Nasalide)
Fluticasone propionate (Flonase, Flounce)
Mometasone furoate (Nasonex)
Triamcinolone acetonide (Nasacort, Tri-Nasal Spray)
What Do They Do in the Body? When inhaled through the nose, these steroid preparations have an anti-inflammatory effect on nasal mucous membranes. As with the steroid inhalers used for asthma, inhalation somewhat decreases the risk of the adverse effects commonly seen with steroid medications.
What Are They Used For? Relief of symptoms of nasal allergies.
What Are the Possible Side Effects? Mild inflammation of the nose and throat, burning, stinging, dryness, and headache are most common. More rarely occur light-headedness, nausea, nosebleed, bloody mucus, rebound congestion, bronchial asthma symptoms, occasional sneezing attacks, decreased sense of smell, loss of or unpleasant taste in the mouth, throat discomfort, ulceration or deterioration of the mucosa that lines the nasal passages, watery eyes, sore throat, vomiting, Candida albicans infection in the nose or throat, and reduced resistance to infection.
Steroids are powerful medicines and can have long-term adverse effects even when used intranasally. Children who use nasal steroid sprays long-term have been found to have slight (half an inch) reduction in growth during the time the sprays are used. Other potential side effects of long-term nasal steroids include wearing through of the septum that separates the nostrils, raised intraocular pressure (which can lead to glaucoma), cataract, hypercorticism (known as Cushing’s syndrome) including swelling of the face and weight gain around the middle of the body, and osteoporosis.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have an untreated infection of the nasal mucous lining. Don’t use intranasal steroids.
• You are already using systemic steroid drugs such as prednisone. Adding a nasal steroid inhaler can increase the likelihood of suppression of the body’s natural production of steroid hormones. If your doctor is weaning you off of systemic steroids and onto inhaled versions, look out for signs of adrenal insufficiency (joint and muscle pain, lack of energy, depression).
• You have been using intranasal steroids long-term. You should have regular exams to be sure your nasal passages don’t suffer permanent damage.
Some people who are sensitive to these medications may develop acne, menstrual irregularities, swelling of the face, weight gain, or other symptoms of elevated levels of steroid hormones.
Use these drugs cautiously if you have tuberculosis; an untreated fungal, bacterial, or systemic viral infection; or herpes of the eye, or if you are recovering from an ulcerated nasal septum, or nasal surgery or trauma, as healing is slowed by steroid drugs.
Avoid exposure to chicken pox or measles while using these drugs.
Other Tips on These Drugs. If your nose is very runny, you may want to use a topical nasal decongestant for the first couple of days you use intranasal steroids. This will dry things up a bit so that the nasal steroid isn’t simply flushed out of your nose without being absorbed.
Examples of Cough Suppressants
Codeine (Codeine sulfate)
What Does It Do in the Body? Suppresses cough (at low doses), blocks pain response (at higher doses).
What Is It Used For? Relief of symptoms of cough caused by respiratory tract irritation or relief of mild to moderate pain.
What Are the Possible Side Effects? Codeine is an addictive narcotic and should not be used unless absolutely necessary. Nonaddicting drugs with similar actions are available.
Nausea, vomiting, sedation, dizziness, and constipation are the most common side effects. Other side effects can include allergic reactions, central nervous system depression, light-headedness, euphoria, restlessness, weakness, headache, hallucinations, disorientation, vision disturbances, convulsions, biliary tract spasm, heart rhythm irregularities, fainting, decreased urinary output and other urinary problems, water retention, and rapid blood pressure changes when moving from lying to sitting or from sitting to standing.
CAUTION!
Think Twice About Taking This Drug If . . .
• You have recently had a head injury or if you have known intracranial lesions or elevated pressure of the fluid surrounding the brain and spinal cord. Codeine is more likely to have dangerous side effects in these cases. Drowsiness, dizziness, and other symptoms of head injury are also side effects of codeine, so you should avoid taking any medications containing this drug until you’ve been thoroughly evaluated. The same goes for acute abdominal conditions.
• You have asthma or other COPDs. Codeine can depress respiratory function.
• You are prone to drug dependency. Addiction can occur. Use only when absolutely necessary. Don’t use this drug for more than a few days at a time.
Be Aware. Central nervous system depressants (opiates, general anesthetics, phenothiazines, tri-cyclic antidepressants, tranquilizers, and alcohol) and codeine have additive effects, meaning they increase the effects of the other drugs and can impair your ability to drive or perform other tasks.
Hydrocodone combinations
What Does It Do in the Body? Hydrocodone is a narcotic cough suppressant and analgesic (pain reliever) that works by blocking receptors that transmit pain impulses and by suppressing the cough reflex. It causes euphoria, sedation, and general physical depression. It is used in comb
ination with other painkiller drugs such as acetaminophen and the ibuprofen-type drugs.
What Is It Used For? Relief of moderate to severe pain, and for relief of cough. It is also used before and during surgery to enhance the effects of anesthesia. A few over-the-counter drugs contain hydro-codone in very small amounts. It’s a very potent narcotic analgesic, it’s addictive, and it was the most-prescribed drug in the United States in 2001. If anybody at the FDA was paying attention, it might have occurred to them that when an addictive drug is found among the top 10 prescribed drugs in the country, we must have an abuse problem with that drug on a national scale. Please be aware that hydrocodone drugs found in family medicine cabinets are commonly abused by teens.
What Are the Possible Side Effects? The FDA has issued a warning that Tussionex, a combination of hydrocodone and the antihistamine chlorpheniramine, can cause life-threatening breathing problems and death when given above or more frequently than the recommended dose and says that Tussionex should not be used in children less than 6 years old.
Most frequent side effects include light-headedness, dizziness, sedation, nausea, vomiting, and sweating. Also, respiratory depression or arrest, apnea (irregular breathing), circulatory depression, coma, shock, cardiac arrest, drastic mood swings, delirium, insomnia, agitation, dis-orientation, drowsiness, sedation, lethargy, physical impairment, headache, mental cloudiness, vision changes, increased intracranial pressure, pupil dilation, cramps, abdominal pain, taste alterations, dry mouth, loss of appetite, constipation, spasm of the biliary tube (where bile passes from the gallbladder into the intestines), facial flushing, chills, faintness, heart rhythm irregularities, dramatic blood pressure fluctuations, urinary problems, and reduced libido. Other possible side effects include bronchospasm, depression of the cough reflex (although hydrocodone may be administered for this purpose, complete suppression of coughing may do more harm than good), interference with the body’s ability to regulate its temperature, muscular rigidity, and tingling in the extremities. Those who are hypersensitive to narcotic analgesics may have rash, itching, profuse sweating, spasm of the larynx, or fluid retention.
CAUTION!
Think Twice About Taking This Drug If . . .
• You are hypersensitive to narcotics.
• You are having an asthma attack.
• You have diarrhea caused by poisoning. The toxic material should be eliminated from the system completely before you use any narcotic-containing drug.
• You are prone to depression or addiction. This is good reason to stay away from this drug completely. Hydrocodone is addicting. OxyContin and Vicodin, prescription versions of this drug, are major drugs of abuse in the United States.
• You have had a head injury, or have a brain tumor or any other kind of brain lesions. These conditions make hydrocodone an unsafe choice for you.
Use any narcotic-containing drug with extreme caution if you are elderly or debilitated. Those with cardiovascular disease, convulsive disorders, raised eye pressure (which can lead to glaucoma), alcoholism, delirium tremens, hardening of the arteries in the brain, ulcerative colitis, fever, emphysema, severe obesity, hypothyroidism, Addison’s disease, enlarged prostate, urinary problems, gallbladder disease, or recent gastrointestinal or urinary tract surgery are at special risk when using narcotics.
Those with asthma or another COPD should use extreme caution when taking this drug. It significantly depresses respiratory function, decreasing both the depth and frequency of breaths.
If you are prone to low blood pressure, you should know that hydrocodone can cause blood pressure to dip further.
Kidney or liver impairment can cause this drug to accumulate in the bloodstream, making adverse effects more likely.
This drug may cause you to become constipated. Those with ulcerative colitis should be aware that narcotics can cause diarrhea or toxic dilation of the colon.
Be Aware. The following drugs may prolong the effects or increase the potency of hydro-codone: alcohol, barbiturate anesthetics, chlorpromazine, and cimetidine (adverse effects more likely).
Examples of Drugs for Flu
Oseltamivir phosphate (Tamiflu)
Zanamivir (Relenza)
What Do They Do in the Body? Both drugs are neuraminidase inhibitors. They inhibit enzyme activity in flu viruses, which in turn inhibits their growth and spread. Relenza is inhaled, and Tamiflu is taken as a pill. They have to be taken within 36 to 48 hours of the onset of flu symptoms to be effective. Even when taken within this time frame, studies show only a one- to a one-and-a-half-day shortening of the illness’s duration on average. Keep in mind that these medications do not prevent you from passing the flu on to others.
Some studies have looked at the use of Tamiflu for flu prevention in people who don’t have flu symptoms but who stand at risk of catching the disease. Most of these studies suggest only a small benefit of neuraminidase inhibitors for prevention, if any at all. With the adverse-effect profiles of these drugs, it’s unlikely that they will ever be used widely for prophylaxis.
What Are They Used For? Treatment or prevention of influenza.
What Are the Possible Side Effects? The following are drug-specific side effects:
• Tamiflu. Nausea, vomiting, insomnia, and vertigo. Rarely, unstable angina, anemia, colitis, pneumonia, and tonsil abscesses have occurred. Additional side effects have been reported in children, including abdominal pain, nosebleed, ear disorders, and conjunctivitis.
• Relenza. Malaise, fever, abdominal pain, muscle pain, joint pain, itching, and dizziness. In children without the flu who received the drug as a preventive, far more adverse effects were reported, including nasal symptoms, throat or tonsil discomfort or pain, and cough.
A few years after their approval by the FDA, 25 people under the age of 21 had been reported to have died while using Tamiflu. Around 600 reports came in about abnormal behavior, hallucinations, and convulsions in people between the ages of 10 and 19 who were taking this oral neuraminidase inhibitor. (Most of these took place in Japan, where these medicines are much more widely used.) In two separate instances, a 12-year-old and a 13-year-old jumped out of a second-floor window after taking Tamiflu; others fell from windows or balconies or ran into traffic. Relenza, the inhaled version, has been the subject of at least 115 reports of psychiatric side effects as well.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have been symptomatic for more than 40 hours. No studies have shown that neuraminidase inhibitors work once flu has progressed this far.
• You have asthma or other chronic lung disease. In some asthmatics, zanamivir caused their airways to constrict. Adverse events are more common in people with pulmonary disease, and the drug has not been shown to help them.
Some strains of flu are resistant to these drugs. If you happen to be infected with one of these strains, the drugs will not be effective.
Should You Get a Flu Shot?
At this writing, the flu vaccine is recommended for children 6 months of age to 5 years of age; anyone over 50; people with chronic health conditions, including asthma, diabetes, coronary artery disease, or HIV; and any health care practitioners or others who come into regular contact with people at high risk of having the flu. The general buzz is that everyone should probably have a flu shot. After all, who wants to end up with the flu? Even when it’s not life-threatening, it keeps us home from work and school and makes us miserable. Better safe than sorry . . . right?
The flu can be deadly. According to government statistics, pneumonia and influenza (P&I) deaths are among the top 10 causes of death in the elderly. However, these statistics combine deaths from two very different disease conditions that are common in the elderly, which makes it hard to know the true mortality rate from influenza alone. And wouldn’t it be wonderful if flu shots were the magic bullet they’re made out to be? But deaths from flu are increasing in spite of flu shots. According to statistics released by the CDC,
even adjusting for the fact that there are increasing numbers of people over the age of 65, who are more susceptible to death from the flu, P&I deaths have increased by 44 percent among people 65 and older since 1979.
Let’s put aside continuing uncertainty about the actual number of influenza deaths versus pneumonia deaths and figure that deaths from both of these conditions are increasing at roughly the same rate. If flu vaccinations are working so well, why is this happening? One reason is that as you age, which is when you need the most protection from flu, your body’s ability to create antibodies in response to the vaccine deteriorates. It is known that only about half of the elderly who receive flu shots can mount an antibody response strong enough to be protective. A study from the Netherlands showed that among two groups of elderly people, one that received flu shots and one that received a placebo, the group receiving the flu shot had only a 1 percent lower incidence of flu than the placebo group!
Research published in the journal Lancet, which used Great Britain’s socialized medicine database, found that while flu shots in the elderly did help protect against some strains of flu, overall flu shots did not reduce the risk of dying.
The strains of flu that sweep through North America are different every year, and to get vaccines made and distributed in time, the CDC have to make an educated guess at which strains to include in the vaccine well before flu season hits. The antibody response is less protective if the manufacturers of the vaccine pick the wrong flu virus. In the 2007–2008 flu season in the United States, researchers chose the wrong strains, and the vaccine was only half as protective as it would have been if the right strains of the virus had been used. A well-matched vaccine in young, healthy adults or children reduces chances of catching the flu by 70 to 90 percent. The vaccine is less effective in very young children, whose immature immune systems are not yet ready to mount an adequate antibody response. The 2007–2008 vaccine only reduced those chances by 44 percent. In other words, a lot of people who got the jab also got the flu.
Prescription Alternatives Page 27