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Archive for the ‘Medications’ Category

epipen

I am absolutely shocked by the recent news of the incredible rise of prescription drug prices. Attention to this problem started with the actions of CEO Martin Shkreli of Turing Pharmaceuticals who bought the rights to manufacture a one of a kind parasite fighting drug and who then increased the price of the drug from $13.50 to $750 per pill!

Most recently in the news, we’ve heard about the increased price of the Epipen made by Mylan Drugs. The Epipen is a vial of adrenaline which can be self injected by the victim of a life threatening allergic reaction (think bee sting or peanut allergies). This is truly a life saving drug. It contains approximately one dollars worth of adrenaline. Some 5 years ago it sold for $40 and just recently jumped to around $600. (Coincidentally the CEO of the company has seen a salary increase from 2 1/2 million dollars to 18 million dollars.)

This same CEO then came out saying the company would give out coupons which would help some but not all the people who needed Epipens. And now they have developed their own generic version of the Epipen which they plan to sell for $300. Who knows what’s next. This still is a far cry from the price of a few years ago, especially for those many families that need to have on hand several Epipens to care for potential allergic emergencies, not to mention that the devices expire after one year and need to be replaced.

I find these examples of drug price gouging to be unconscionable and unsustainable. For those of us with life threatening diseases, myself included, we seem to be held hostage by the prices of our life sustaining treatments.

Years ago I felt that drug companies did a fantastic job in the research and development of all kinds of new drugs which were offered at fair prices and which helped to conquer a variety of diseases throughout the world. Now it appears they have become greedy. I am all for a free market capitalistic system as we have in the United States, but when it comes to drug companies charging as much as they possibly can, I feel they are holding patients hostage.

Unfortunately, when patients can’t afford their medications, they will often skip doctor’s appointments, tests, or procedures. They may not even fill their prescriptions or take less than directed. All of this is very unhealthy.

The government needs to step in and help to control drug prices because as of now drug companies can charge whatever they want. If it’s a life enhancing or life saving drug, there is little choice but pay the asking price.

The government has various ways to control drug prices such as allowing U.S. patients to purchase cheaper drugs from other countries such as Canada, or by encouraging the development and sales of cheaper generic drugs. We, as citizens and drug purchasers, must contact our elected officials and demand that they help to control drug prices while allowing drug companies a fair profit and enough money to continue new drug development.

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ColdFluMeds

With the cold and flu season approaching, I want to repeat an article I did several years ago about what over the counter medications are available to help alleviate the miserable symptoms of the winter illnesses.  Almost all of the hundreds of products available over the counter contain at least one or a combination of the following ingredients:

  • Tylenol (acetaminophen) or Advil (ibuprofen) for aches and pains
  • Sudafed with either pseudoephedrine or phenylephrine, a decongestant
  • Guaifenesin an expectorant (thins mucus)
  • Dextromethorphan a cough suppressant
  • Antihistamines such as diphenhydramine or chlorpheniramine

We could probably get by with only five different bottles of cold medications on those pharmacy shelves, each containing one of the above medications. I think that taking these drugs individually rather than in combination is better so that one can tailor one’s symptoms to a specific medication and avoid taking something that might not be necessary.  Always read the label on the medication package to check on potential interactions with drugs you may already be taking and to know the possible side effects or warnings.

Here’s how these drugs work.  Tylenol or Advil work equally well for relieving the aches and pains of an illness as well as helping to reduce a fever. Read the directions carefully. The maximum daily dose for acetaminophen is 3000 mg. per 24 hours.

Sudafed, for those who do not have high blood pressure, may be helpful to relieve the swelling of the nasal/sinus passages and to relieve the pressure in the ears due to blocked eustachian tubes. Sudafed with the main ingredient pseudoephdrine, has changed from over the counter to behind the counter and it will need to be signed out for purchase through the pharmacist. It’s probably worth the effort. Sudafed with ingredient phenylephrine can still be purchased over the counter but may be a bit less effective than the pseudoephridine.

Guaifenesin is an expectorant which means it helps to thin out mucous in the nose and sinuses, as well as in the lungs, which makes it easier to either blow out or cough up the mucous.  Dextromethorphan is a cough suppressant which should help at least a little to lessen one’s cough. Honey has also been found to be effective in slowing down a cough. Neither of these remedies is strong enough to actually stop a cough and will not interfere with the healing process.

Antihistamines are really most useful for the symptoms of allergies like hay fever, but they may help colds by slowing down mucous production.  Perhaps they help most by their side effect of drowsiness, thereby helping one to sleep.

Another highly effective way to decongest the nose and sinuses is to perform sinus rinsing using either a netti pot or my preferred method, a Neil Med sinus rinsing kit found at most pharmacies. I have found rinsing to be highly effective to alleviate sinus symptoms and to even treat or prevent sinus infections.

In Summary:

  • For aches and pains from a cold or flu, use Tylenol or Advil.
  • For stuffy nose, sinus congestion or plugged ears use Sudafed.
  • To loosen mucous use guaifenesin such as Mucinex or Robitussin.
  • To help slow down a cough, use a medication with dextromethorphan, such as Robitussin DM or Vicks 44, or try a couple tablespoons of honey in a hot beverage.
  • Get plenty of rest and drink lots of liquids.

Closely follow the directions for proper dosage found on the medication labels.

These are some basic guidelines for choosing medications for the symptomatic relief of common cold and simple flu. I have to admit the effectiveness of these drugs is somewhat limited but worth trying. Adequate rest, liquids, and time still play a major role in recovery from these miserable conditions.

See your health care provider if you have a fever for more than 4-5 days, if you have a fever of more than 103 degrees, or if you have any significant concerns about your illness.

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Medical-Marijuana

My goal in this article is not to judge the use of marijuana as good or bad, legal or illegal or right or wrong. My intention is to provide information now available from current medical literature of its medical benefits, known side effects, and when not to use it.

Marijuana has been used for medicinal purposes for several thousand years beginning with the ancient Chinese. It was used at that time for a multitude of medical problems, from the treatment of malaria to the treatment of constipation.

Marijuana was introduced to the United States in the mid 1800s and was prescribed by physicians for its therapeutic benefits until 1937 when it was prohibited from being prescribed. Then in 1970 it was legally prohibited for anyone to even possess or use marijuana.

Because of public demand for the medical use of marijuana in California, in 1996 it became legal to use for medical purposes and soon other states followed suit.

The benefits of marijuana are attributed to its cannabinoid compounds of which some 100 have been identified. The two most researched and well known of these are tetrahydrocannabinol which is also the main component for the mind altering effects of Marijuana, and cannabidiol which causes less of a high.

Most patients smoke the dried plant for the quickest results. Marijuana’s active ingredients can also be delivered through capsules, vaporizers, liquid extracts, foods, and beverages. One major problem is that dosing can be unpredictable since the level of active ingredients varies between plants, as well as the fact that absorption of ingested forms varies among patients.

THC has also been synthesized and available in the U.S. for medical use under the generic names of dronabinol and nabilone, both of which can be prescribed by a Physician.

Although many users have found multiple health benefits from marijuana for the treatment of numerous health problems, there are really only of few that have passed scientific testing. They include:

  • Nausea, especially when caused by cancer chemotherapy and AIDS.
  • Chronic pain especially when due to neuropathy, cancer, or AIDS.
  • Glaucoma
  • Multiple sclerosis
  • Epilepsy
  • Appetite and weight loss in cancer patients.

Again, I want to emphasize that there is a myriad of other conditions that may be helped by marijuana but they, so far, are not backed up by scientific evidence. Most medical practitioners would prefer that patients first use traditional proven treatments for most health problems and to use marijuana for treatment failures.

There are known health risks to the use of marijuana including:

  • Impairment of thinking, problem solving skills, and memory.
  • Increased anxiety and panic attacks.
  • Reduced balance and coordination.
  • Increased risk of heart attacks, inflammation of heart muscle, and atrial fibrillation.
  • Possible hallucinations and withdrawal symptoms.
  • Lowering of blood glucose and blood pressure, and increased risk of bleeding.

Smoking marijuana, which is the most common method of use, has its own set of potential problems. It is associated with possible increased chronic bronchitis and lung cancer (although much less likely than smoking tobacco). A review of current literature shows agreement that the possible harm to the lungs from smoking marijuana does not endorse the safety of its use in this manner.

At this time experts recommend limiting the use of medical marijuana to adults older than 18 years of age. There are also other health related conditions where marijuana should not be used including:

  • History of schizophrenia or other psychiatric disorders.
  • Severe heart or lung disease.
  • Severe liver or kidney disease.
  • Pregnancy or planned pregnancy, and breast feeding.

Even with the possible side effects and the non uniformity of doses and strengths of its various forms, I would encourage the use of medical marijuana for the known conditions where it has been proven to be helpful. I can also accept its use in any number of conditions when more conventional treatments have failed.

As marijuana use becomes more widely legalized it should open the door to much needed research which would provide more information as to the best doses and delivery systems for medical use as well understanding the risks and benefits for all users. This information would be of great help to both physicians and patients.

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generic

“Billions wasted on pricey drugs” was the headline in the newspaper this week. Medicare claims that the program is wasting hundreds of millions of dollars because doctors continue to prescribe and patients continue to ask for pricey name brand drugs when cheaper generic drugs are available.

I agree that this is a major problem which needs to be addressed. My own medical group is working hard and with good success to change the prescribing habits of doctors to use the more reasonably priced generic drugs whenever possible.

What exactly are generic drugs? They are copies of brand name drugs which have the same dosage, side effects, intended use, risks, strength and safety of the brand name drug. In other words, the brand name drug and the generic version of it should be identical.

The generic version of a drug can be manufactured and sold once the patent on the brand name drug has expired. The generic costs much less than the brand name drug mainly because the generic manufacturers don’t have to duplicate the hundreds of millions of dollars spent on research, development and marketing conducted by the original manufacturer.

There is concern by many that generic drugs are cheaper because of a compromise in quality or effectiveness. However, the Food and Drug Administration requires that generics be as safe and effective as the brand name drug. The generic must be bioequivalent to the name brand product, which means that the amount of active ingredient is delivered to the body at the same time, and used in the body in the same way as the brand name. The generic will often be a different color, shape or flavor than the brand name and it also may have different inactive ingredients, but the active ingredients must always be the same.

There are a few classes of drugs, such as anti-seizure medications, thyroid hormone replacement, and blood thinning drugs, where it is best not to switch back and forth between generic and brand name versions. Your doctor can explain this in more detail.

Since nothing in life seems perfect, I recognize that there may be instances where a generic version of a drug just doesn’t seem to work as effectively as its brand name equivalent. This needs to be discussed with your doctor and dealt with appropriately since the number one issue in the doctor patient relationship should be: What’s best for the patient?

Patients do, for the most part, have a choice of generic versus name brand drugs, but must realize that both private and public insurance plans may not pay for the non-generic or will require a higher co-pay, thus increasing the out of pocket cost of the drug. Feel free to discuss this with your doctor and pharmacist.

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pain relief medications

Does your back ache? Do you have a headache, toothache or sprained ankle? What medication should you choose for pain relief?

In most cases these types of pain are common and can be treated with over the counter pain medications which make up a $2 billion a year industry. The few basic medications available to treat your pain must be chosen wisely and you must be aware of the possible side effects of these drugs so that they don’t cause more harm than good.

The potential for harm rises with increasing doses of the medication and in taking it for long periods of time. The elderly and those with chronic medical conditions face a greater chance of experiencing troublesome side effects.

In spite of the pharmacy shelves being filled with a mind boggling combination of available pain relieving drugs, they are really all made up of any one of the following types of drug:

Acetaminophen (Tylenol)

This is probably the safest of the drugs when taken at the recommended doses. It is classified as an analgesic (pain reliever) as well as a fever reducer. It can be used by all ages, except infants under 3 months old. It can have a toxic effect on the liver and should be used very cautiously, if at all, by those with liver disease or those who drink more than three alcoholic beverages a day. A big advantage of acetaminophen over the others is its tendency not to irritate or harm the stomach. It can be taken if one is also taking a blood thinning medication. Follow the dosing directions carefully.

Ibuprofen (Advil, Motrin IB)

This is called an anti-inflammatory analgesic because it acts not only on most any type of pain but also on inflammation. Many people use this medication for relief of soft tissue aches and pains associated with vigorous exercise or hard physical labor. Like acetaminophen, it is very effective as a fever reducer for young and old. Do not use in infants under six months of age without consulting your doctor.

Unlike acetaminophen, it does not harm the liver in recommended doses, but, it can be very irritating to the stomach possibly leading to bleeding and/or stomach ulcers. Long term high dose usage has been linked to increase risk of heart and kidney disease. It should not be taken while taking a blood thinning drug.

Naproxen Sodium (Aleve)

This is also an anti-inflammatory drug taken for the same indications as ibuprofen. It can be taken less frequently than ibuprofen and still achieve the same benefit. It causes similar side effects to ibuprofen with perhaps less likelihood of stomach and kidney problems.

ASPIRIN (Bayer, Excedrin)

This time-honored drug is also an anti-inflammatory, analgesic, and fever reducer. Under the care of a physician, it is now being used in a low dose to help prevent heart disease. It’s cheap and plentiful, but has more potential side effects compared to the others. It is more frequently associated with stomach irritation and bleeding. It is not recommended in children less than 16 years old. Because of the potential side effects, I personally would not take aspirin to treat routine pain unless there was no other choice.

The bottom line is that if you have mild pain for whatever reason, any of the above drugs could be helpful, but results vary for each individual. Pay close attention to the various side effects which I have listed and which can be found on the medication label. Be sure to see your doctor if you get no pain relief from these commonly used mentioned medications or if your pain lasts more than a few days.

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Pills

On occasion I have patients present to me with the sensation that a pill was stuck in their throat. This is not an uncommon occurrence. A number of people do have problems swallowing medication in tablet or capsule form. When a pill actually does get stuck it is usually not really in the throat but in the upper esophagus just below the throat.

Certain conditions involving the esophagus will predispose one to having difficulty swallowing pills such as strictures (narrowing), scleroderma (hardening) and a condition called presbyesophagus where the muscles of the esophagus do not function properly.

Warning signs of a stuck pill are:

– Feeling of a tablet or capsule stuck in the throat.

– Pain with swallowing.

– Achy dull pain in chest after swallowing a pill.

There are techniques that help one to swallow pills more easily:

– Relaxing and taking several deep breaths before swallowing.

– Taking several sips of water prior to swallowing a pill to help lubricate the throat.

– Cutting large pills (not capsules) in half after consulting with your pharmacist to be sure it’s OK to do this. Use a pill cutter purchased at your pharmacy rather than a kitchen knife.

– Do not lie down shortly after taking your pill or it will be more likely to get stuck in your esophagus. This is especially true when taking medicine just before lying down to sleep at night.

Pills and capsules can also be more easily swallowed when mixed with food. If you have trouble swallowing them whole, pills can be crushed and mixed in most any type of food. Capsules can be opened and sprinkled on food. They can be mixed with small servings of applesauce, pudding, or flavored Jello. Some pills are time released and should not be crushed. Again check with your pharmacist to ensure that your particular pill or capsule can be mixed with food.

Any pill that gets stuck in the esophagus will usually dissolve within one to two days causing no harm and the sensation will disappear. There a few pills worth mentioning that may cause damage, usually temporarily, to the esophagus. These are aspirin, doxycycline (a commonly prescribed antibiotic), potassium chloride, vitamin C, and iron.  On rare occasions one of these stuck pills can cause an ulcer or a more dangerous perforation (hole) in the esophagus.

The same advice, with approval from the pharmacist, can be used for children’s medication which is usually prescribed as a liquid. It can be made more pleasant tasting when mixed with chocolate syrup, ice cream, jelly or jam.

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In a recent column, I said that antibiotics are usually not necessary to treat most upper-respiratory infections. I have been asked to discuss antibiotics in more detail.

An antibiotic is a type of medication that kills bacteria, or at least inhibits growth, thus curing an infectious disease.

The first antibiotic to be discovered was penicillin, which was produced from a common mold and was discovered accidentally by Alexander Fleming in 1928. It wasn’t used to treat disease until 1941, but it became extremely helpful when it was found to cure the myriad infections of the soldiers in World War II.

Today, there are more than 100 different antibiotics on the market, treating bacterial infections ranging from the minor, such as strep throat, to the life-threatening, such as meningitis.

As of yet, we have very few antibiotics that can treat viral infections. There are none to treat the common cold and only a few that can help treat influenza. However, bacterial infections — the cause of such common diseases as strep throat, bladder infections, skin infections and many ear infections, for example — can be cured by the use of antibiotics.

If an antibiotic is used, your physician will choose the one most likely to be effective against the type of germ causing your infection. Other factors in the choice of an antibiotic include medication cost, dosing schedule and potential side effects.

Antibiotics have been over-prescribed for a number of reasons, including patients’ expectations or insistence on use of antibiotics; physicians prescribing them because they don’t have the time or willingness to explain why they are not necessary; and medical legal reasons.

The consequences of over-prescribing antibiotics are twofold.

First is the possibility of a bad reaction to the antibiotic. This might span from minor conditions — a bothersome rash, diarrhea or a yeast infection — to a life-threatening allergic reaction called anaphylactic shock.

The bigger problem, as I see it, is the emergence of resistant germs. This happens when the overuse of antibiotics allows the development of germs that are no longer killed by most of the common antibiotics.

As opposed to the post-World War II decades, when drug companies were pumping out new antibiotics faster than germs could become resistant, we are now in a situation in which, for various reasons, drug companies are not putting in the resources to develop new antibiotics. This will become a serious crisis when we reach a time when many infections will not be treatable with existing antibiotics.

As I have emphasized previously, when seeing your physician for an illness, it is best not to have expectations of being treated with antibiotics. Rather, let your physician decide whether antibiotics are needed, and expect an explanation from him or her as to the reasoning behind that decision. You should also be given suggestions as to what you can do to make yourself feel better during the course of your illness.

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Tylenol

I’ve had patients recently voicing their concerns about the “recall” of Tylenol products. I will use the terms Tylenol (the most recognized brand name) and acetaminophen (the chemical name) interchangeably in this article. A Federal Drug Administration panel has recently made several recommendations concerning Tylenol and Tylenol containing products.  Again, these are only recommendations and are not written in law as of this time. The FDA recommendations are as follows:

  • That prescription Vicoden (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen) be banned from further use.
  • That over the counter products that contain acetaminophen (there are literally hundreds of such medications) carry stronger warning labels.
  • Reduce the maximum over the counter strength of a Tylenol pill from 500 mg. to 350 mg.

What’s at issue here is the fact that acetaminophen in high doses can cause liver damage and in very high doses can cause liver failure and death.  This problem usually occurs when patients take more than the recommended daily dose of Tylenol or when they take Tylenol plus another combination drug that also contains Tylenol, such as Theraflu or Nyquil, thus unknowingly exceeding the recommended dose.

Since it is well known that alcohol also has a negative affect on the liver, the combination of alcohol and Tylenol consumption together has an even greater negative affect on the liver.

Tylenol has been around for decades and has been consumed by millions of people worldwide for the relief of pain and fever.  I believe that when taken in recommended doses it is safe and effective.  The alternatives to Tylenol such as aspirin or anti inflammatory drugs such as ibuprofen have their own risks in terms of stomach bleeding.  The decision to take either Tylenol or an aspirin product is a matter of risk versus benefit. You may wish to speak with your doctor about this.

I agree with the panel’s findings and recommend the following:

  • Tylenol or its various products should not be used if one consumes more than two alcoholic drinks per day.
  • The maximum single adult dose should be no greater than 650 mgs.( two 350 mg. tablets)
  • The maximum daily dose should be less than the currently recommended dose of 4,000 mg.  I propose taking no more than 2800 mg. per day which is equal to taking two 350 mg. tablets every six hours.
  • Always carefully read the label on the bottle of any over the counter medication to see if acetaminophen is one of the ingredients.

Be careful but not fearful of Tylenol.  For treating pain or fever it is a very useful medication when used properly.

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When receiving a new prescription medication from your doctor, I recommend the following steps:

  • Inform your physician of any allergies you may have.
  • Bring a list of all the medications you already take, or bring the actual medications in their original containers.
  • Make sure your doctor is aware of any other medical condition for which another practitioner may be treating you.
  • Ask about the benefits and risks of the new medication.
  • Notify your doctor if you have difficulty swallowing pills or liquid medication and also if you prefer to take the lowest number of doses possible.

After agreeing on the new medication, make sure you have the following information from either the doctor or the pharmacist. (A pharmacist always gives a computerized handout with most of the important information about the drug.)

  • The name of the medication.
  • When, how much and how long to take the medication.
  • What it’s supposed to do.
  • What are the possible side effects.
  • What food, drinks or activities might affect the medication.
  • How the medication should be stored.

Discard any medication that has:

  • Expired.
  • Been discontinued by your doctor.
  • No label on the container.
  • Changed color or smell or seems different from how you remember it.

Since September 2008, it has officially been illegal to discard medicines and sharps (needles, etc.) by flushing them down the toilet or throwing them into the trash.

Most local pharmacies will accept unwanted medications and sharps. Sharps should be transported in an approved safe container that can be inexpensively obtained from any participating pharmacy.

Medications that should be safely discarded include prescription drugs, over-the-counter medications, pet medicines, vitamins, medicated creams and ointments and liquid medication in containers.

Contact your local pharmacy to ensure that they accept your throw-away drugs and sharps. For more information on this topic:               831-454-2160        or http://www.sharpmedsolutions.org.

Editor’s note: This is the third and last in a series of columns about prescription medication.

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Many people take more than one medication, see more than one doctor or have more than one health problem — that makes it essential that you and your doctor are aware of all the medications you take and understand any possible drug interactions that may occur.

When seeing your doctor, bring all your medications or a list of medications you take.

It is very important to read the information given by the pharmacist when picking up your medication. This information can describe possible drug interactions, which can have several harmful consequences.

  • Drug and drug interactions: when two or more drugs interact with each other, such as a sleeping pill (a sedative) taken with an allergy medication (an antihistamine).
  • Drug and food/beverage interactions: food can interfere with drug absorption.
  • Drug and condition interactions: taking the decongestant Sudafed when one has high blood pressure can significantly raise blood pressure.
  • Drug and over-the-counter-medication interactions: taking an antacid can block other medication from being absorbed in the stomach.

One common drug-drug interaction is taking an antibiotic and the effect it has on birth control pills. Medical literature says that antibiotics pose a very small risk of a woman getting pregnant, though they can make birth control more ineffective. A woman being advised of this small risk may decide to temporarily use a back-up birth control method.

Some medications are altered by what you eat and when you eat it. Food may delay or decrease the absorption of a drug, causing it to be less effective. Most medications work best on an empty stomach, which means taking it either one hour before eating or two hours after eating. On the other hand, some drugs work better when taken with food just after a meal. Your medication label will tell you how to take it. If there is no mention of taking it with or with out food, then it can be taken either way.

Patients often ask if alcohol can be consumed while taking medication. The general rule of thumb is that medication and alcohol taken close together may change the potency of a drug. The most serious reaction is the combination of alcohol and narcotic pain medications, sleeping pills or sedatives. Many accidental or suicidal deaths we hear about in the media are the result of these drugs being combined with alcohol.

I do not advise consuming alcohol while taking medication, but I realize that it is a fact of life. If drinking is done in moderation, then it is best that the consumption of alcoholic beverages and the taking of medications be separated by at least two hours.

Regardless, it is important to stress that when taking prescription medication, carefully read the instruction sheet given by the pharmacist as well as the label on the container. This will help to ensure safe and effective use of your medication.

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