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Friday, September 21, 2012

Should Talcum Powder Use Be Avoided ?



Dear Readers,

You have probably used talcum powder or other talc powder containing products (i.e. feminine hygiene products) in the past without ever thinking that they may cause serious health problems.  However, it appears that talcum powder may cause significant lung damage (or even lung cancer) if inhaled, in addition to, increasing the risk for ovarian cancer. However,despite these apparent risks, the FDA has still not pulled this product from the market or forced manufacturers to place more comprehensive warning labels informing consumers about the possible health risks related to the usage of talcum containing products.

Evidence Supporting Talc's Possible Health Risks

Recommendations:


Informational Videos Regarding The Possible Risks From Talc





Sources for this post include:

http://www.preventcancer.com/consumers/cosmetics/talc.htm
http://www.cancer.org/Cancer/CancerCauses/OtherCarcinogens/AtHome/talcum-powder-and-cancer
http://www.nlm.nih.gov/medlineplus/ency/article/002719.htm
http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8.pdf 
http://www.baliadvertiser.biz/articles/paradise/2011/powder.html
http://www.cbn.com/health/naturalhealth/cosmeticdangers.aspx
http://www.theecologist.org/green_green_living/behind_the_label/462086/behind_the_label_talcum_powder.html
http://pediatrics.aappublications.org/content/68/2/265
http://www.livestrong.com/talcum-powder/
http://www.ncbi.nlm.nih.gov/pubmed/10739536
http://www.ncbi.nlm.nih.gov/pubmed/20406962
http://www.ncbi.nlm.nih.gov/pubmed/19052443
http://www.ncbi.nlm.nih.gov/pubmed/17928389
http://www.ncbi.nlm.nih.gov/pubmed/2496400
http://www.ncbi.nlm.nih.gov/pubmed/21951993
http://www.ncbi.nlm.nih.gov/pubmed/5044100
http://cebp.aacrjournals.org/content/19/5/1269.abstract
http://www.osha.gov/OshDoc/data_General_Facts/crystalline-factsheet.pdf
http://householdproducts.nlm.nih.gov/cgi-bin/household/brands?tbl=brands&id=10001040
http://www.webmd.com/parenting/features/baby-skin-care-lotions-powders-soaps-sunscreens

Tuesday, August 28, 2012

Avoid Fluoride Toothpaste and Fluoride-Based Dental Rinses





Dear Readers,

Fluoride has been found in toothpastes since the 1890's and in our water systems since the 1940's.  Despite what we were told about using fluoride toothpaste, dental rinses and fluorinated water etc. with respect to preventing tooth decay, it appears its efficacy is limited and its risks outweigh any potential benefits.  Furthermore, evidence shows that fluoride (if excessively ingested during childhood) can actually damage the enamel of tooth resulting in tooth staining known as dental fluorosis http://poisonfluoride.com/pfpc/html/dental_fluorosis.html .

Evidence Rejecting the Safety and Efficacy of Fluoride:
  • Fluoride ingestion has been implicated in causing many health-related problems (i.e. thyroid disease, cancers (especially bone cancers in young men), reduced thyroid function, reduced IQ, increased risk for bone fractures, immune deficiencies, arthritis, possibly even atherosclerosis (hardening of the arteries) etc.).  
  • In 1990 forty US dentists brought a case against the American Dental Association contending that the Association purposefully shielded the public from data that links fluoride to genetic defects, cancer and other health problems (Columbus Dispatch, Oct 21, 1990). 
  • Since 1990 over 45 U.S. cities have rejected fluoridation. 
  • Europe has largely rejected fluorination of water since about 98% of Europe’s drinking water is now fluoride free.
  • In 1987 the National Institute of Dental Health did a large study involving over 39,000 school children and found the incidence of cavities in communities that used fluoridated water vs. those that did not use fluoridated water was not significantly different.  (Dr J. Yiamouyiannus Water Fluoridation & Tooth Decay Study, Fluoride 23 : pp 55-67, 1990.).
  • National Cancer Institute did a study and found that as exposure to fluoride increases, so does the incidence of oral cancer; sometimes by as much as 50%.
  • Fluoride in water supplies up to 1 ppm were associated with an increase incidence of hip fractures in women. The study concluded that fluoride may accumulate in the body (reaching toxic levels with age) ultimately increasing the risk for bone fractures. (Danielson, C., et al, "Hip Fractures and Fluoridation in Utah's Elderly Population", Journal of the American Medical Association, Vol 286, No.6, August 1992, pp.746-748)
  • The lethal dose of fluoride is about 5 mg fluoride for every 2.2 lbs. (1 kilogram) of body weight.  However, it is important to note that only one tube of toothpaste if swallowed there is enough fluoride to kill a 60-pound (30-kilogram) child. 
  • Even the National Research Council (NRC) which is the nations primary scientific advisory body states that fluoride has essentially no benefits after age 8 when teeth are fully developed.
  • EPA HEADQUARTERS UNION OF SCIENTISTS OPPOSES FLUORIDATION OF DRINKÄ°NG WATER http://www.nteu280.org/Issues/Fluoride/NTEU280-Fluoride.htm .
  • A review of 11 studies involving more than 7,000 children showed that the effect of fluoride supplements on primary teeth could not be determined. One study even showed that fluoride had no cavity-reducing effect.
Recommendation(s):
  • Unless you are considered by your dentist to be "high risk" for developing cavities, use fluoride-free toothpastes like (Tom's of Maine, Theodent etc.) or brush your teeth using baking soda http://healthylivingtalk.org/brush-teeth-baking-soda.html.  
  • If you continue to use a fluoride based toothpaste, use only a very small amount (pea-sized) and rinse out your mouth out thoroughly.....do not swallow !!!  
  • Avoid using fluoride-based dental rinses....here is a fluoride-free version for your review http://www.herbalhut.com/detail.aspx?ID=26492 .

Informational Videos Regarding the Dangers of Fluoride 


Dr. Osmunson on Fluoride (Very informational discussion)




Fluoride: The Hard to Swallow Truth Documentary 
(An excellent documentary)



Theodent "Chocolate" Toothpaste





Sources for this post include:

http://www.fluoridealert.org/health/ 
http://www.fluoridealert.org/fluoride-facts.htm
http://newsdailybrief.com/new-fluoride-recommendations-go-against-traditional-advice/352742/ 
http://naturalsociety.com/breaking-fluoride-linked-to-1-cause-of-death-in-new-research/
http://naturalsociety.com/fluoride-is-not-safe-despite-cdc-claims/
http://naturalsociety.com/cancer-linked-fluoride-doesnt-even-effectively-prevent-cavities/
http://naturalsociety.com/government-calls-for-lower-fluoride-levels-admits-it-harms-children/
http://www.livestrong.com/article/133760-side-effects-fluoride/
http://thyroid.about.com/cs/toxicchemicalsan/a/flouride.htm
http://fluoridedangers.blogspot.com/
http://www.webmd.com/vitamins-supplements/ingredientmono-1068-FLUORIDE.aspx?activeIngredientId=1068&activeIngredientName=FLUORIDE
http://articles.mercola.com/sites/articles/archive/2010/07/01/paul-connett-interview.aspx
http://articles.mercola.com/sites/articles/archive/2010/11/13/cdc-and-ada-now-advise-to-avoid-using-fluoride.aspx
http://www.naturalnews.com/036680_fluoride_bottled_water_children.html
http://www.sailhome.org/Concerns/BodyBurden/Burdens/Fluoride.html
http://www.gsmcweb.com/wp-content/uploads/2008/02/healthmatterssepoct2006.pdf
http://www.allvoices.com/contributed-news/12308216-toothpaste-and-soap-and-toothbrush
http://www.nofluoride.com/scientific_studies.htm
http://www.dentalwellness4u.com/layperson/fluoridefacts.html
http://www.tellinitlikeitis.net/2012/01/the-fluoride-controversy-the-facts-the-fiction-by-paul-g-rubin-dds-miaomt.html
http://www.consumerhealth.org/articles/display.cfm?ID=19990303222823
http://www.nteu280.org/Issues/Fluoride/NTEU280-Fluoride.htm
http://clinicalnature.com/2011/03/why-i-changed-my-mind-about-water-fluoridation/
http://canadianawareness.org/2012/01/breaking-fluoride-linked-to-1-cause-of-death-in-new-research/


Friday, August 10, 2012

Hydrogen Peroxide to Fight Colds and Flu

Dear Readers,

During my literature review, I only found a few articles that support the claim for using hydrogen peroxide as a treatment for the cold or flu.  However, I thought I would mention this treatment to you since I have successfully used this treatment for years.  Note: I usually do not see a complete resolution of my symptoms, but there is significant improvement.  I do think this therapy is definitely worth trying since it appears to be effective, safe and inexpensive !!!  

What evidence supports using hydrogen peroxide in the ear for the cold or flu ?
  • According to a Richard Simmons, M.D. in 1928, he stated that in fact cold and flu viruses could enter our body through the ear canal. (Note: Traditionally, we think of viruses initially entering our system only through our nose, throat or lungs where they multiply and eventually cause a systemic infection.)
  • Bacteria and viruses can multiply in the ear (even on headsets which can contaminate the ears). 
  • Apparently, German physicians often treated cold/flu symptoms successfully using this technique for years in the 1930's. 
  • Hydrogen peroxide does have a wide spectrum of antibacterial and viral activity, thus it can kill the common cold and flu viruses upon contact.
What is the procedure ?

  • Thoroughly wash your hands first.
  • Using a dropper, place one or two drops of hydrogen peroxide into one ear. Wait a few minutes at which time the bubbling sound will stop or diminish, drain and repeat with the other ear.  
  • Personally, what I do is get a small piece of a cotton ball and saturate it with hydrogen peroxide then place the small piece of saturated cotton ball in my ear and wait until the bubbling noise is gone (usually about 3-5 minutes).  Then I get a Q-tip or cotton swab and clean-out and dry-out the ear.  Then, I repeat with the other ear.
  • The important thing to remember is that you utilize this method early-on when cold or flu symptoms first appear for maximal benefit.
  • You may need to repeat this process several times a day for the first couple of days.  
  • One thing to point out is that I noticed the bubbling noise is usually only found in the infected ear(s) and when the therapy is completed the bubbling noise no longer exists.
  • Do not try this method if you have a perforated ear drum.

Informational Video by Dr. Mercola that gives some great advice how to treat flu or colds and mentions the hydrogen peroxide ear treatment. 



Sources for this post include:

Tuesday, August 7, 2012

OTC Medication Safety with the Elderly



General Information Regarding Medications In The Elderly



  • The term "elderly" is defined as any person age 65 or older. Some studies show that elderly are 2-4 times more likely to have adverse drug reactions as compared to non-elderly. In addition, some reports estimate that up to 30-50 percent of all hospital admissions involving the elderly are due to some sort of drug-related problem (especially if they are in poor health and are taking multiple medications).
  • As we get older, our body composition changes(less body water, less body weight, more body fat, fewer protein stores, etc.) which can in effect increase the amount of drug exposure per body weight. 
  • In addition, the elderly also have less ability to clear drugs via the liver and the kidneys which may lead to drug accumulation.
  • Elderly also have less ability to compensate or tolerate drug side effects as compared to non-elderly. 
  • As we age, levels of a chemical messenger or neurotransmitter known as "Acetlycholine" in our nerve cells which is responsible for memory, learning and concentration, in addition to, supporting the function of the heart, blood vessels, airways, and urinary and digestive organs reduces as we age. Thus, medications that alter acetylcholine levels in any way often can have a profound effect on the function of brain and other organs.
  • Furthermore, the elderly often suffer from several chronic disease states and take multiple prescription medications which can increase the risk for adverse side effects and drug interactions(especially with OTC drugs). Thus, all these factors mentioned above may contribute to causing adverse drug events in the elderly.

Which OTC Medications Do I Need To Be Especially Cautious With In The Elderly And Why ?
  • First Generation antihistamines and OTC Sleep aids(i.e. diphenhydramine(Benadryl), chlorpheniramine (Chlortimeton, Allerest), clemastine fumarate (Tavist), dimenhydrinate (Dimenhydrinate), brompheniramine(Dimetapp) and doxylamine(Nyquil, Alka-Seltzer Plus Night-Time Cold Medicine)....commonly used as a OTC sleeping aid .
Commentary:

First generation antihistamines cause a marked reduction in levels of a chemical messenger (neurotransmitter) found in nerve cells called acetylcholine.  Side effects are often referred to as "anti-cholinergic side effects".  Common anticholinergic side effects include: confusion, dry mouth, constipation, urinary retention, cognitive impairment, blurred vision and delirium. Also, these drugs can increase the risk for "falls" in the elderly. Note: Antihistamines may accumulate in the elderly due to reduced body clearance which may cause more pronounced "anticholinergic side effects"compared to non-elderly. Recommend using second generation "non-sedating" antihistamines particularly cetirazine(Zyrtec), fexofenadine(Allegra) or desloratadine (Aerius) instead.  Note: Although, loratadine(Claritin) is also a second generation antihistamine it has been reported to also worsen delirium, confusion, urinary retention and constipation in the elderly (especially in people who already experience delirium, confusion and urinary retention). I will talk about natural alternatives in a future blog (i.e Quercetin).

  • H2 Blockers (famotidine (Pepcid AC), cimetidine (Tagamet HR), nizatadine (Axid AR), ranitidine (Zantac 75). 
Commentary: 

Though, these agents have relatively weak anti-cholinergic activity, it seems that cognitive impairment is enhanced in the elderly possibly due to drug accumulation, increased drug sensitivity or lack of B12 absorption in the elderly (especially if they have existing cognitive impairment and use the drug long-term).  Thus, caution should be placed if you intend to use H2 Blockers to treat heartburn or upset stomach in the elderly long-term.  Recommend using oral antacids to temporarily treat symptoms instead (i.e. Gaviscon (contains alignate, aluminum and in some formulas magnesium, Tums etc.) Try to implement lifestyle (i.e. lose weight if needed, exercise, reduce stress, stop smoking) and dietary changes (eat smaller meals, avoid trigger foods, avoid alcohol etc.) Would not recommend using antacids that contain sodium bicarbonate (i.e. Alka Seltzer) since it may further elevate blood pressure in patients with existing hypertension.  Also, would not recommend long-term use of aluminum containing antacids long-term since they have been noted to weaken bones and be associated with Alzheimer's disease. Also, be careful using magnesium containing antacids in elderly with poor kidney function. Consider treating heartburn naturally using probiotics, digestive enzymes, betaine, ginger or apple cider vinegar etc. (I will talk about these remedies in more detail in a later blog).  You may refer to my article about H2 Blockers use in the elderly http://www.naturalnews.com/036634_acid_blockers_brain_damage_elderly.html .

  • Proton Pump Inhibitors (omprazole (Prilosec OTC), omeprazole/sodium bicarbonate (Zegerid OTC), lansoprazole(Prevacid OTC),  esomeprazole magnesium (Nexium OTC)
Commentary:

Long-term use may cause bone fractures which is already a concern in the elderly.  In my opinion, may consider for short-term use only.  Also, proton pump inhibitors may be reduce B12 levels http://www.livestrong.com/article/335118-proton-pump-inhibitors-b12-deficiency/ that can cause cognitive problems and increase risk for a serious condition called C. Difficile diarrhea http://www.aafp.org/afp/2005/0301/p921.html .

  • NSAIDS (Nonsteroidal anti-inflammatory drugs) ibuprofen (Advil, Motrin), naproxen sodium (Aleve), ketoprofen (Orudis KT, Actron), aspirin (Bayer, Ecotrin).
Commentary:

Use sparingly in the elderly since they can increase the risk for GI bleeding, ulcers, can elevate blood pressure and may reduce kidney function.  These medications inhibit a chemical called prostaglandins that are involved with causing inflammation and pain.  It is important to note, prostaglandins also play a role in the stomach to reduce acid secretion, needed for the production of  protective mucus in the stomach, help regulate blood pressure and are needed for blood clotting. Thus, when you inhibit them you can expect the side effects as mentioned above.  If you are using aspirin, use less than 150mg/day suggest using 81mg/day (since it is no less beneficial than 150mg/day and has fewer side effects). May consider taking a a proton pump inhibitor daily short-term to reduce risk of GI bleed (stomach bleed) if a NSAID is needed to temporarily control pain (I am not referring to low dose aspirin in this case).  May consider using a topical NSAID (i.e. diclofenac sodium (Voltaren Emulgel),Ibuprofen 5%(Nurofen Gel) etc.) since very little of the topical form of the drug is absorbed into the blood stream this reduces risks for side effects. (Note: Topic NSAIDs may also be less effective than their oral counterparts.) May also consider using acetaminophen (Tylenol) at doses not greater than 3 grams/day for temporary pain relief.  I will talk about natural alternatives like glucosamine, omega-3 fish oil, bromelain etc. in future blogs.

  • Oral decongestants (i.e pseudoephedrine (Sudafed Congestion), phenylephrine HCl (Sudafed PE) etc) or Antihistamine/decongestant combinations (i.e. pseudoephedrine/chlorpheniramine (Allerest), pseudoephedrine/triprolidine (Actifed) acetaminophen/chlorpheniramine/phenylephrine (Alka-Seltzer Cold Plus) etc.
Commentary:
In general, the side effects of decongestants are more pronounced in the elderly.  Decongestants relieve nasal stuffiness by constricting the vessels in the nose, but they can also do this systemically causing hypertension, nervousness and insomnia. In some instances, myocardial infarction and stroke have been reported when the oral decongestants were given to the elderly.  Thus, if possible avoid the use of oral decongestants in elderly (especially if they a have poorly controlled hypertension, anxiety, insomnia or palpitations).  If a decongestant is needed, I would recommend using a nasal decongestant (i.e. Oxymetazoline (Dristan, Afrin), phenylephrine hydrochloride (Neo-Synephrine) etc.) since they have fewer systemic side effects by working more locally in the nasal passage....use short-term only (no longer than 3 days).  

Informational Video Regarding Drug Safety in the Elderly



Sources for this post include:

http://www.huffingtonpost.com/leo-galland-md/memory-loss-drugs-_b_822245.html
http://www.naturalnews.com/036634_acid_blockers_brain_damage_elderly.html
http://www.usafp.org/Word_PDF_Files/Annual-Meeting-2012-Syllabus/Spieker%20-%20New%20Drugs%20in%20Medicine%20Cabinet%20STOPP.PDF
http://www.ima.org.il/imaj/ar07jun-3.pdf
http://www.angelfire.com/az/sthurston/alzheimers_and_aluminum_toxicity.html
http://www.naturalnews.com/027979_digestive_enzymes_bloating.html
http://www.naturalnews.com/036336_PPIs_acid_reflux_side_effects.html
http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm213206.htm
http://www.drugs.com/news/proton-pump-inhibitors-increase-risk-bone-fractures-13148.html
http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm
http://www.webmd.com/heartburn-gerd/news/20100510/c-diff-infections-fractures-linked-to-acid-reflux-drugs
http://www.ihaveosteoarthritis.com/what-are-the-medical-treatments.php
Enclyclopedia of Elderly of Elder Care Second Edition 2008.

Saturday, August 4, 2012

Breastfeeding and OTC Drugs

General Information 
  • In general, breast milk is considered a superior form of nutrition to ensure the health of the infant when compared to infant formulas. However, if a medication is needed to control a symptom, caution may be necessary to prevent exposure to infant during breast-feeding. 
  • In most cases, only a small amount of drug (1-2%) ends up in breast milk which is usually harmless to the infant.
  • Although, adverse drug reactions during breast feeding are rare, they are more likely to occur in premature infants or in infants 2 months or younger.
  • Despite the common misconception the breast is like a bladder where drugs just accumulate, it is a compartment where drugs can diffuse out over time. Thus, in most cases you can minimize exposure to the infant if you just take the medication right after you have breast-fed the baby or right after the baby is due for a long sleep. Note: It is rarely necessary to pump and discard breast milk after a medication has been taken by the mother to reduce infant exposure (only in exceptional circumstances involving a contraindicated drug).
  • The drug's characteristics determine how much of  the drug will pass into the mother's breast milk.  For instance, drugs that have a low molecular weight (MW<500), are very lipid soluble, have low protein binding, are weak bases and drugs with long half-lives are more likely to accumulate in breast milk. 
  • Read the "Warning" section of the OTC product label for information regarding use of drugs during breastfeeding.
General Guidelines Involving OTC Medication Use During Breastfeeding
  • If possible, try not to use any OTC medications to treat symptoms first.
  • Avoid alcohol containing medication preparations when possible.
  • If you cannot avoid medication therapy, try to use single ingredient OTC products to treat your symptom(s), avoid extra-strength and long-acting/sustained release formulations of the medication to reduce number of medications and overall exposure to the breastfeeding infant.
  • Watch the infant closely during breast-feeding to see if adverse reactions occur (i.e. changes in behavior such as irritability, loss of appetite, sleepiness or other reactions like skin rash, vomiting, diarrhea, colic etc.).
  • Time medication administration after breast feeding is completed or just after the baby is put to bed for an extended period of time.
  • Vitamin and mineral administration is generally fine if taken within normal dosage ranges.
  • Please check with pharmacist or doctor regarding all medications and herbal remedies if you do not know the safety of the product during breastfeeding. 
  • You may use the following websites to check the safety of common medicines and herbal products during breastfeeding. Drugs and Lactation Database (LactMed) http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT (a peer-reviewed and fully referenced database) along with the following websites that give some basic information about safety of medications/herbal products during breastfeeding http://www.itmonline.org/arts/breast.htm, http://kellymom.com/bf/got-milk/herbs_to_avoid/.
  • In general, avoid aspirin and all aspirin containing products (i.e. Pepto Bismal, Alka Seltzer, Anacin, Excedrin, Bayer Aspirin etc.) due to risk of bleeding  and  Reye Syndrome in the infant http://www.reyessyndrome.org/what.html .
  • Use acetaminophen (Tylenol) or ibuprofen (Advil) for pain/fever relief since they both have a shorter half-life, enter breast milk at very small concentrations and are considered by most experts to be drugs of choice while breastfeeding. 
  • Loratidine (Claritin) is considered by many experts to be the OTC antihistamine of choice. Other antihistimines may decrease milk supply and cause adverse side effects (i.e. drowsiness, irritability, colicky symptoms, refusal to feed etc.). Although not contraindicated, limit exposure to other antihistamines (i.e. chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl), doxylamine (Nyquil).
  • Nasal decongestants (i.e. phenylephrine (Neo-Synephrine), oxymetazolone (Afrin) are preferred over oral decongestants like pseudoephrine (Sudafed) because nasal decongestants are locally administered and have limited absorption into the maternal blood stream.
  • Antacids like aluminum hydroxide (Alternagel, Amphojel),magnesium hydroxide, calcium carbonate (Tums) and combinations with simethicone are all compatible with breastfeeding (i.e. Mylanta, Maalox).
  • Although H2 antagonists (i.e. ranitidine(Zantac), famotidine(Pepcid), cimetidine(Tagamet), nizatidine(Axid) are not contraindicated during breastfeeding, however, antacids are preferred to treat heartburn/upset stomach symptoms since oral absorption is quite limited.
  • Proton pump inhibitors (i.e. omeprazole (Prilosec OTC)) are generally not recommended as a first line treatment during breastfeeding and should be reserved if only deemed necessary by your physician. 
  • Antitussives/expectorants (i.e. guafenesin (Robitussin), dextromethorphan (Robitussin DM))are generally compatible with breastfeeding.
  • Most topical OTC creams and ointments when used short term are compatible with breastfeeding (except acne creams which have not been studied extensively). Note: If the area of use is the breast itself wipe the area clean prior to breastfeeding.
Lactation Risk Categories

L1 Safest
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.

L2 Safer
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3 Moderately Safe
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4 Possibly Hazardous
There is positive evidence of risk to a breastfed infant or to breastmilk production, bu the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant. (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5 Contraindicated
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Informational Videos About Breastfeeding and Medications





Sources for this post include:

Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 6th edition,Baltimore, MD: Williams & Wilkins,2002.
http://www.breastfeedingbasics.com/articles/drugs-and-breastfeeding
http://otcsafety.org/en/experts/questions-breastfeeding-moms-ask-about-otc-medicines/
http://www.medsmilk.com/pages/introduction
http://www.uspharmacist.com/content/c/10278/?t=women's_health
http://www.ncbi.nlm.nih.gov/pubmed/18603972
http://www.elpasotimes.com/living/ci_21187589/breast-feeding-is-beneficial-but-be-aware-drug
http://www.infantrisk.com/content/drug-entry-human-milk
http://www.infantrisk.com/content/safely-managing-pain-during-lactation
http://www.medsafe.govt.nz/Profs/PUarticles/lactation.htm#Transfer
http://www.itmonline.org/arts/breast.htm
http://tidsskriftet.no/article/2269161/en_GB/
http://kellymom.com/bf/got-milk/herbs_to_avoid/
http://www.lalecheleague.org/ba/nov97.html
http://pharmacistsletter.therapeuticresearch.com/home.aspx?cs=&s=PL

Friday, June 22, 2012

Pregnancy and OTC Medications




General information to consider before taking medications while pregnant
  • Risks and benefits of medications should always be evaluated when deciding to use medications during pregnancy.
  • There may be times during pregnancy where you must decide whether or not you really need to take a medication for a simple symptom that you may be able to tolerate (i.e. stuffy nose, simple headache) or whether or not you need a medication for a more serious matter that requires chronic medical management (i.e. diabetes, asthma etc.).  
  • If possible, try to avoid all use of medications during the 1st trimester since this is the time the fetus is developing and is at most risk from developing medication-related defects.
  • No medication is considered to be totally safe despite the pregnancy risk rating below.
  • Medications are rarely tested in pregnant women before they come to market because it is considered unethical to expose a pregnant woman to a drug with unknown effects.
  • Most information for detecting birth defects is collected after the medication has already hit the markets.  However, only after a large number of defects have be seen can an association be made between a particular medication causing birth defects. (Note: In the general population there is a 3-5% risk of having a child with a birth defect or mental retardation.)
  • The Food and Drug Administration (FDA) has developed letter categories for all prescription medications to help explain risks of taking medications during pregnancy.  However, OTC drugs do not have classification on their label, although many OTC drugs were once prescription medications (where they were classified in such a manner).
  • OTC medications do not have a letter classification like below, but on the label it contains a statement regarding the safety and possible risks of taking the OTC medication during pregnancy.
  • If you are not sure, please contact your physician or pharmacist before taking any OTC medication since they have appropriate references and databases to help verify the risks (and if necessary provide safe alternatives).
FDA's Pregnancy Letter Categories For Prescription Medications and Interpretation
  • A    Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal    abnormalities to the fetus in any trimester of pregnancy.
  • B    Animal studies have revealed no evidence of harm to the fetus, but there are no adequate and well-controlled studies in pregnant women or animals which have shown an adverse effect. However, adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
  • C    Animal studies have shown an adverse effect on the fetus, but there are no adequate and well-controlled studies in pregnant women (or studies in women and in animals are unavailable).Drugs should be given only if the potential benefit justifies the potential risk to the fetus.
  • D    Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.
  • X    Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities or risks. The use of the product is contraindicated in women who are or may become pregnant.
Cough and Cold Medicines During Pregnancy
  • It is important to remember that most cold symptoms are self-limiting.  Thus, it is recommended to try non-drug treatments first (i.e. hydration, saline nasal sprays, use of humidifiers etc.) to relieve symptoms especially during the first trimester.
  • Drugs that are commonly utilized for a cough and cold may include the following classes of drugs: analgesics/antipyretics (to relieve pain and fever), antihistamines (to relieve runny nose and watery eyes), cough suppressants, expectorants (to help drain mucus from lungs) and decongestants (to relieve nasal congestion). 
Safest OTC Analgesics and Antipyretics During Pregnancy
  • Acetaminophen or Paracetamol (Tylenol, Anacin Aspirin Free) is pregnancy risk B and is considered the safest analgesic/antipyretics and drug of choice during pregnancy. Safe for short term use. Do not exceed more than 3 grams/day. Other analgesic/antipyretics (i.e. Aspirin, NSAIDS (non-steroidal anti-inflammatory drugs like ibuprofen(Advil, Motrin), naproxen (Aleve)) have more risk to the fetus and I recommend avoiding their use during pregnancy altogether.
  • Natural alternative: Suggest eating fresh ginger root, taking ginger root capsules (not extract) up to 1500mg/day or drinking ginger tea.  The ginger can help reduce pain, swelling and fever.
Safest OTC Antihistamines During Pregnancy
  • Doxylamine is preganancy risk category A (very safe), but unfortunately is usually found in combination products that have other ingredients like dextromethorphan or alcohol which should(i.e. avoided during pregnancy (i.e.Nyquil).  You can find this as a singular ingredient sold as an OTC sleeping aid (i.e. Unisom Sleep Tabs).  Dosage: Recommend taking 12.5mg every 6 hours if needed (half of a 25mg Unisom sleep tab).  Note: It can cause severe drowsiness.
  • Chlorpheniramine (Chlor-Trimenton) is Pregnancy risk category B and considered a good choice if an antihistamine is needed during pregnancy. Do not exceed a dose of 24mg/day.  Normal doses may include 4mg every 6 hours.  Controlled release and sustained release formulations are available 8mg and 12mg tablets. May cause drowsiness.
  • Diphenhydramine (Benadryl) Pregnancy risk category B.  May use during the first semester. Normal dose: 25mg every 6 hours.  May cause drowsiness.
  • Clemastine (Tavist-Allergy) Pregnancy risk category B. If possible, avoid combination products (i.e. Tavist-D) with the decongestant  phenylpropanolamine or pseudophedrine (Pregnancy risk category C). Normal dose 1mg clemastine tablet every 12 hours if needed. May cause drowsiness.
  • Cetirizine (Zyrtec) is a Pregnancy risk category B.  Note: This is a second generation antihistamine that has less potential to cause drowsiness. It may be used as a safe alternative to Doxylamine, Chlorpheniramine or Diphenhydramine except during first trimester.  Normal dose: 5-10mg/day.
  • Loratidine (Claritin) is preganancy risk category B.  My also be used as an alternative to Doxylamine, Chlorpheniramine or Diphenhydramine except during first trimester since it causes much less drowsiness. If possible, avoid Claritin-D since it contains pseudophedrine unless absolutely necessary since it is a risk category C. However, if a decongestant is necessary, then pseudophedrine is considered the oral decongestant of choice during pregnancy except during the first trimester.  Normal dose: One 10mg tablet per day.
Safest OTC Decongestants During Pregnancy
  • Oxymetazoline (Dristan Nasal Spray, Afrin Nasal Spray) Pregnancy risk category C. Limit use to 3 days.  Only use if necessary.  Considered decongestant of choice during pregnancy. Normal dose: 2-3 sprays per nostril ever 12 hours if needed.
  • Pseudophedrine (Sudafed) Pregnancy risk category C. Considered the oral decongestant of choice during pregnancy.  Avoid use during the first trimester. Normal dose: 30mg every 6 hours if needed. Only use if necessary during pregnancy, otherwise avoid use altogether since it can impair placental blood flow.
  • Natural Alternative: Use plain saline nasal spray or use saline water in neti pot. Also you may eat onions.
Safest OTC Expectorants and Cough Suppressants
  • Guaifenesin (Robitussin, Humibid) Pregnancy risk category C. Avoid use during first trimester due to some risk for child developing inguinal hernia http://www.babycenter.com/0_hernias_1176787.bc with use. Probably safe if use after first trimester. Not that effective at clearing secretions. Normal dose: 200-400mg every 4 hours.  Max dose. 2.4 grams.  Recommend to use sparingly.
  • Dextromethorphan (Delsym) Pregnancy risk category C. Use only if necessary to relieve cough to avoid possible risk to fetus. Doses vary based on formulations.  Normal dose for Delsym: 30mg every 12 hours if needed. Don't use more than 120mg/day. Found in many combination products (i.e. Robitussin DM).
  • Natural alternatives: Use Honey and Ginger Tea to relieve cough and drink plenty of fluids to help clear secretions.





Sources for this post include:

http://www.foxnews.com/health/2011/05/26/women-using-medications-pregnancy/
http://www.otispregnancy.org/
http://www.otispregnancy.org/otis-fact-sheets-s13037#1
http://women.webmd.com/pharmacist-11/pregnancy-medicine
http://www.webmd.com/baby/guide/taking-medicine-during-pregnancy
http://depts.washington.edu/druginfo/Formulary/Pregnancy.pdf
http://www.womenshealth.gov/publications/our-publications/fact-sheet/pregnancy-medicines.cfm
Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 6th edition,Baltimore, MD: Williams & Wilkins,2002.
http://www.perinatology.com/index.html
Pharmacists Letter Database 2012.
http://www.webmd.com/pain-management/news/20110728/new-dosing-labels-for-extra-strength-tylenol
http://www.babycenter.com/0_chart-over-the-counter-medications-during-pregnancy_1486462.bc
http://www.motherisk.org/women/pregnancyResources.jsp
http://www.americanpregnancy.org/pregnancyhealth/naturalherbsvitamins.html
http://www.drweil.com/drw/u/QAA400749/Avoid-Ginger-While-Pregnant.html
http://www.livestrong.com/article/315819-is-ginger-root-safe-during-pregnancy/
http://www.acupuncturetoday.com/mpacms/at/article.php?id=27849
http://oregon.providence.org/ptkattachments/recommendedresource/medications%20that%20are%20safe%20during%20pregnancy[1].pdf
http://findarticles.com/p/articles/mi_m0689/is_8_56/ai_n27355452/
http://www.obfocus.com/reference/Formulary/Drugs%20in%20Pregnancy/Dextromethorphan.htm
http://www.obfocus.com/high-risk/meds1.htm
http://www.livestrong.com/article/516421-a-cough-suppressant-for-pregnant-women/

Wednesday, June 20, 2012

Proper Drug Storage and Safety


Important Tips to Consider When Storing Medications
  • Most medications need to be stored at "controlled room temperature" which is defined as a room temperature 20-25 degrees Celsius (68 degrees Fahrenheit to 77 degrees Fahrenheit).
  • Excessive heat (40 degrees Celsius/104 Fahrenheit) or freezing temperatures can result in loss of drug strength/potency or even alter the chemical characteristics of the medicine which can result in patient harm.
  • Moisture can also reduce the potency of medications.  If you have a medication bottle that contains a cotton plug,  it is recommended to have it removed since that can draw moisture into your medication. Do not store medications in bathroom cabinets !!!
  • Always check the expiration dates on stored drugs.  If expired, please dispose of the product by mixing the unused medicine in your trash or give back to your local pharmacy for disposal.
  • During the summer make sure home has appropriate air conditioning or climate control measures to ensure that medications are not exposed to excessive heat.  Also, during the summer do not store your medications in the car or trunk to avoid extreme temperatures.
  • If you are traveling by plane make sure you carry the medications with you rather placing them in your checked-in luggage to avoid possible extreme changes in temperature.
  • You may consider refilling medications every month vs. every 3 months (mainly for prescription medications) to ensure the medication maintains its strength or potency.
  • Keep medications out of reach of children and adolescents.  Sometimes they can abuse them and/or unknowingly poison themselves.
  • If the product has changed color, texture or odor (regardless of the expiration date) please do not use the medication and dispose of properly.


Video From CVS Regarding Proper Medication Storage


Video From The FDA About Drug Safety with Children

Sources for this post include:

http://printer-friendly.adam.com/content.aspx?productId=117&pid=1&gid=007189&c_custid=758
Handbook on Injectable Drugs 11th edition 2001.
http://www.safemedication.com/safemed/MedicationTipsTools/WhatYouShouldKnow/TravelingSafelywithMedicines.aspx

Monday, June 18, 2012

Understanding OTC Product Labels




  • Active Ingredient(s): This section lists the substance(s) that makes the OTC medicine or product work.
  • Uses: This section tells you what symptoms or illnesses the OTC medicine or product is intended to treat.
  • Warnings: 
    • This section may provide information about particular medical conditions and certain circumstances where the OTC product may cause harm.
    • This section tells you when not to use the product.
    • When to ask your doctor if it is safe to take the medication if you have a certain medical  condition(s) or take a certain medication that is listed on the label.
    • What side effects you may expect from the product
    • When to stop using the product.
    • What to do if you are pregnant or breast feeding.
  • Directions:
    • Provides information how to use the product safely. 
    • Often here you will find different instructions for children that may be based on weight or age.
    • Depending on the medication it may provide a maximal daily dose.
  • Other Information:
    • Provides additional safety and storage instructions. You may also find information regarding if the product contains substantial amounts of calcium, potassium or sodium in its formulation. 
  • Inactive Ingredients:
    • Inactive ingredients are added to all drug products to make them look and taste appealing, to maintain their shelf life and to help the active ingredients blend together properly.
    • Often these "inactive ingredients" do not cause harm.  However, some people do experience untoward reactions to these ingredients.  Thus, if you have a known sensitivity or allergy to a certain "inactive ingredient(s)" (i.e. wheat, soy, milk, dyes etc.) it is important to review this section carefully before using an OTC product.
    • It is important to note that children that have "Celiac Disease" (a known sensitivity to wheat, rye and barley) must be careful because there is no requirement for companies to place whether or not their product contains gluten on their label.  Thus, you may consider calling the company, talking to your pharmacist or going to the following website glutenfree.com to find out whether or not the OTC product contains gluten. 


Sources for this post include:

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143551.htm
http://www.nclnet.org/health/100-over-the-counter-medicines/271-understand-your-otc-drug-facts-labels
http://www.excedrin.com/products/back-and-body.shtml
http://www.safemedication.com/safemed/MedicationTipsTools/WhatYouShouldKnow/GluteninMedication.aspx

Saturday, June 16, 2012

Common Misconceptions and Knowledge Gaps about OTC Medications


  • OTC drugs are very safe and do not have a risk of causing harmful side effects or toxicity since they can be obtained without a prescription. 
  • All OTC medications are safe enough to be taken for as long as I need to treat a certain illness or symptom.
  • OTC medications are very different than prescription therapies.
  • Since it is an OTC medication, I can use higher doses than indicated in the directions.
  • I never need to consult with my doctor or pharmacist before starting an OTC medication.  
  • OTC drugs behave the same in adults as they do in children and the elderly.
Since many OTC drugs were once prescription medications, many of them carry similar risks and potential toxicities of prescription products. For example: Tylenol (acetaminophen) which is one of the most widely used OTC pain relievers is responsible for about 450 deaths from acute liver failure, 56,000 emergency room visits, and 2600 hospitalizations each year in the U.S. . Another group of pain relievers known as NSAIDS  (OTC versions Advil (ibuprofen), Aleve (naproxen), Aspirin etc.) are responsible for an estimated 100,000 hospitalizations and possibly up to 20,000 deaths each year. In addition, OTC cough and cold medicines  (decongestants, expectorants, antihistamines, and antitussives (cough suppressants) )are another group of OTC drug products that can cause also cause potential serious harm and should not be used in infants or children under the age of two years. Thus, it cannot be assumed that all OTC medications have an excellent safety record.  Lastly, OTC medications (like all medications) may not behave as predictably in children and the elderly (as they do in adults) which could lead to serious side effects, adverse reactions, medical emergencies or even death. 

Sources for this post include:

http://www.nytimes.com/2006/12/20/health/20drug.html?_r=2
http://www.ncbi.nlm.nih.gov/pubmed/3066202
http://www.slate.com/articles/health_and_science/explainer/2011/12/emergency_contraceptives_over_the_counter_are_they_more_dangerous_than_other_drugs_.html
http://www.healthsentinel.com/joomla/index.php?option=com_content&view=article&id=2668:more-hospitalized-from-nsaid-bleeding-than-all-american-war-casualties&catid=5:original&Itemid=24
http://pediatrics.aappublications.org/content/123/6/1464.short
http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/drugsafetyinformationforheathcareprofessionals/publichealthadvisories/ucm051137.htm
http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/drugsafetyinformationforheathcareprofessionals/publichealthadvisories/ucm051137.htm
http://pediatrics.aappublications.org/content/59/2/309.abstract?sid=9705c742-f0f4-4973-b6d2-019ce9abb11d
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116839.htm

Important Tips Before Using OTC Medications or Supplements

Definition:

Over-the-counter (OTC) medicines or products can be purchased without a prescription. According to the FDA, OTC medications tend to have more benefits than risks, a low risk for drug abuse, and are easy to select and use without the help of a healthcare professional. However, not all OTC medications or products really meet this criteria and can be dangerous if not used correctly.
  • Select a product that is intended to treat your symptom or symptoms with the least number of active ingredients to minimize risk for side effects or drug/nutrient interactions.
  • Follow the OTC medication's or supplement's label carefully with respect to directions or warnings.
  • Warnings may involve drug, food, disease interactions, cautions during pregnancy or certain age groups, or cautions regarding performing certain activities like driving or using heavy machinery.
  • If you have any medical concerns or questions, please consult a physician or pharmacist before starting a new OTC medication or supplement.
  • Store medications in a cool and dry place away out of reach of children.
  • Check the expiration date before starting any OTC product.
  • Always consult your physician or pharmacist if you are pregnant, breast feeding or taking a prescription medication before starting a new OTC drug therapy (since it could harm the unborn infant, enter the breast milk and potentially harm a breast fed baby or interact with your prescription medication).
  • It is also important to note the maximum number of doses you can use per day and the number of days you can use the product before needing to contact a physician.
  • It is important to remember that when people have decided to self-diagnose and medicate themselves using OTC products it may delay proper medical treatment. 

Monday, June 11, 2012

Introduction

Welcome to the "OTC Guide to Common Medical Conditions". My name is Daniel C. Mizzi and I am a registered clinical pharmacist who understands the medical concerns of consumers. Unfortunately, due to many time constraints and other distractions, pharmacists often do not have the opportunity to properly counsel patients and evaluate their drug therapies.  Thus, in response to the reality of pharmacy practice today, I created this blog-site to help improve consumer awareness, education, safety and healthcare outcomes. Ultimately, I hope this blog-site will help consumers make rational decisions about OTC  medications and natural therapies used to treat common medical conditions.