Posts Tagged ‘Aspirin’

Generic Drugs: What’s in a Name?


PharmD 2011 | houspian@myhousecallmd.com

Most patients know their medications by one of their two names. Even more patients will wonder why their medications need two names. Is it a first and a last name? Are they having an identity crisis? Why in the world can’t we just pick one name and all call it that? The answers to the questions above: are no, no and we do. For further explanation keep reading.

Read the rest of this entry →

11

08 2010

Will an Aspirin a Day Keep the Doctor Away?


PharmD 2011 | houspian@myhousecallmd.com

You’ve may have noticed that your grandmother takes an aspirin everyday as part of her arsenal of medications. You may wonder why she’s taking aspirin when she’s in no apparent pain.  When you asked grandma she replied with her sagely tone, “The doctor said its good for my heart.” You nodded, pretending to understand, and wrote the answer off as another one of grandma’s “senior moments.” Well, it turns out that this time grandma is right. Although her answer is a simplified version of the truth, it is the truth nonetheless. Before you start popping aspirin yourself, read on to find out who should take daily aspirin and how it works to help your heart.

Read the rest of this entry →

12

07 2010

Would you like some beer with your prescription?

by Tania Houspian, PharmD 2011

It’s inevitable and happens at least twice a month.  Plans will be made to go out to a bar with friends and, as the first cocktail is being ordered, someone remembers that they’re on antibiotics for an infection they’d rather not talk about. The question is raised about whether or not it’s OK to drink alcohol with that particular medication.  At that point, everyone turns to the friend with some form of medical training and asks, “So can I drink or what?” Members of the House Call, MD staff have experienced this so often we’ve started to avoid going out for drinks with infection-prone friends.  What a loaded question!  If the answer is, “No”, then the friend will spend the rest of the night pouting about not being able to drink and secretly blame the messenger for it.  To avoid those awkward conversations, we’d like to take a moment and explain why sometimes it better to put the drinks aside when on certain medications.  We apologize in advance for your drink-less night out.

Why does alcohol interact with certain medications?

Alcohol is broken down by two parts of your body: your stomach and your liver. When that shot of whiskey reaches the stomach some of the alcohol is broken down and the rest is absorbed into your blood stream. From your bloodstream, the alcohol is delivered to your liver via the portal vein.  In the liver, about 10% of the remaining alcohol is broken down. The remaining alcohol is passed back into your bloodstream and is free to create all those magical affects alcohol has on your brain (i.e. thinking you’re a better dancer than you really are, being exceedingly friendly with strangers, etc.).  At any of those stops that alcohol makes in your system (stomach, liver or brain) there is a possibility for it to interact with any medications that may possibly be taking the same path (1).  Below we’ll go through different classes of medications, covering specific medications from each class and how they interact with alcohol.

Class: Antibiotics/Antifungals

Medications: Metronidazole, Nitrofurantoin, Tinidazole, Ketoconazole, Cycloserine, Cefoperazone, Cefotetan, and Griseofulvin

Just a shot of vodka along with any of these medications and you may be hugging the porcelain throne earlier in the night than you had planned. When mixed with alcohol, these medications can cause a violent reaction in your stomach called a “disulfiram-like reaction.” This reaction results in a sudden increase in heart rate, turning beet red, upset stomach, nausea, vomiting and, in worst case scenarios, death (2).  Antabuse is the name of a medication whose main component is disulfram. When people want to quit drinking they are prescribed Antabuse so that if they do give in to their urge to drink they’ll have a violent reaction to the alcohol.  The smart alecks in the crowd are now thinking, “Well I’ll just make sure to separate my antibiotic and alcohol by a long enough interval so that they’ll never meet in my stomach! I win!”  We hope you can define a “long enough interval” (and if so, let us know) because everyone’s stomach empties these medications at different rates.  As such, we can’t even being to make recommendations as to how much time you should allow for so that none of the antibiotic will meet the alcohol.  The bottom line is that if you mix the above medications with alcohol, you’re asking for some serious punishment.  You can’t say we didn’t warn you.

Class: Antihistamines

Medications: Loratadine, Fexofenadine, Diphenhydramine, Desloratadine, Loratadine, Brompheniramine, and Cetirizine

Having read Attack of the Common Cold, you know that antihistamines can help with a lot of cold symptoms.  Since they’re available to buy at the pharmacy without a prescription, some people make the mistake of assuming they’re completely safe and won’t interact with other medications or alcohol.  We are sorry to say that this assumption is wrong.  On their own, antihistamines can cause some drowsiness.  When mixed with alcohol, you might as well tuck yourself in for the night.  Aside from making you drowsier, it’s also possible to become dizzy from a drop in your blood pressure.  Dizziness can lead to falling and falling leads to all sorts of serious injuries (i.e. broken bones, concussions, etc.)(2).  Antihistamines are found in all sorts of cough, cold, and allergy combination drugs like Nyquil so read the back of the label and see if any of the above medications are in there.  We don’t recommend that you take antihistamines and drive until you know their affect on your level of alertness.  If you’re going to drink and take antihistamines, absolutely do not drive (not that you need to be reminded that you should not drink and drive!).

Class: Cough Medications

Medication: Dextromethorphan (Robitussin)

If you’ve ever had a cough and taken Robitussin, you know how sedating it is.  Imagine mixing alcohol with that.  Two words: lights out.  Mixing the two can lead to hallucinations and strange behavior (more so than alcohol alone).  While this may sound like fun to some people, believe us when we tell you that it is dangerous and harmful to your brain (2).  Don’t do it.

Class: Heartburn Medications

Medications:  Nizatidine, Metoclopramide, Cimetidine, and Ranitidine


Heartburn is very unpleasant and we completely understand your need to alleviate that toxic feeling with medications. You pop a Zantac (Ranitidine) and start to feel better so you decide you will join your friends at the pub.  What can you expect to happen after your second vodka tonic?  Nothing good.  Your heart rate will increase suddenly and so will your blood pressure.  Imagine how the heartburn made you feel and amplify that ten-fold. In addition mixing alcohol with these medications can increase the affect alcohol has on you. If you’re someone who usually feels tipsy after six drinks you may start feeling not so great after two.  This happens because the heartburn medications decrease the breakdown of alcohol in your stomach so your body is exposed to more alcohol than it normally would be. In turn, alcohol inhibits the metabolism of the heartburn medications so you experience more severe side affects from those medications (the increased heart rate and blood pressure) (2).

Class: Pain Relief

Medications: Ibuprofen, Naproxen, and Aspirin

Whatever the source of pain (cramps, muscle pain, hangover, headache, etc.) most people reach for one of these trusty painkillers.  Aspirin has lost some of its popularity as a painkiller but Ibuprofen and Naproxen are gaining in popularity due to their anti-inflammatory properties that help with lots of different sources of pain.  How do these trusty pain-alleviating friends of ours interact with alcohol?  Ibuprofen, Naproxen, and Aspirin all disrupt the lining of your stomach and add to the erosive affects of alcohol.  Combine the two and you asking for some serious stomach pain. Together they can completely disrupt the lining of your stomach and allow the acidic contents of your stomach to reach the stomach tissue.  Long-term combination of alcohol and these agents can lead to bleeding in your stomach (a.k.a. gastrointestinal bleeding). Not fun and filled with long-term consequences.  It’s generally recommended that you separate these agents and alcohol by 8-10 hours or play it safe and don’t combine them in the same day (1).

Class: Antipyretic (Anti-Fever)

Medication: Acetaminophen (Tylenol)

Tylenol can be used for both pain relief and to reduce fever. It gets its own separate section from the other pain relievers because it comes with an entirely different risk when combined with alcohol. Tylenol, like alcohol, is broken down by the liver. When Tylenol and alcohol meet in the liver, the alcohol causes Tylenol to be broken down into a toxic compound.  This toxic compound causes the death of liver cells!  Did your liver just quiver out of fear? We don’t blame it.  Long-term combination of alcohol and Tylenol can cause liver failure, meaning that you’ll ultimately need a liver transplant.  Not good.  Avoid taking more than 4 grams of Tylenol a day and absolutely do not drink when taking Tylenol (1).

Class: Antidepressants

Medications: Phenelzine, Isocarboxazid, and Tranylcypromine

The antidepressants listed above are from the Monoamine Oxidase Inhibitor class (MAOI’s for short, we love acronyms in the medical world).  They have lost popularity in recent years because of the many interactions they can have with food and alcohol.  Aged foods (think salami, aged cheeses, etc.) and aged drinks (wine is the main culprit here) contain a compound called tyramine.  The metabolism of tyramine is prevented when someone is taking MAOI’s so the tyramine builds up in your body.  When tyramine builds up, it causes a sudden increase in heart rate and blood pressure that we call a hypertensive emergency (1). Yes, the kind of emergency people end up in the hospital for.  So if you are taking any of these antidepressants, do not drink aged alcoholic beverages.

Class: Sedatives

Medications: Diazepam, Lorazepam, Zolpidem, Eszopiclone, Estazolam, Ramelteon, Phenobarbital and Temazepam

The entire point of these medications is to help people fall asleep. Add on the sedating affects of alcohol and you’ll have an extremely un-alert person. This might not sound like reason enough not mix them with alcohol since being extra sleepy is something an insomniac may want.  However, the downside is that you may become completely unaware of your actions and experience amnesia. On the other hand some people become aggressive and anxious due to combining these medications with alcohol (2).  The reaction can vary from person to person.  Even with the variance among individuals, all the manufacturers of these medications clearly warn against taking these medications with excessive amounts of alcohol.

Class: Opioid Pain Killers

Medications: Morphine, Oxymorphone, Meperidine, Methadone, Propoxyphene, Oxycodone, Hydromorphone, and Codeine

Generally prescribed for serious pain, the consequences of mixing these medications with alcohol are serious.  Like with the sedatives, mixing these medications with alcohol can cause increased sedation, amnesia and loss of control.  If that’s not enough to scare you then maybe the fact that you may stop breathing will.  Opioid painkillers cause respiratory depression (decreased breathing) and alcohol adds to that affect (1).  It is this combination of painkillers and alcohol that has claimed the lives of several celebrities in the past.

There are a lot of other medications that interact with alcohol but the medications above are the most commonly used in our society.  Never assume it’s safe to combine medications or take medications with alcohol until you check with your pharmacist or doctor.  One night of fun is not worth any long-term damage you may cause your self.  The next time the answer is, “It’s probably best not to drink while on that medication,” trust us…we’re on your team.  We’ll even take you out for a drink when you’re medication-free.

Questions? E-mail the Author: houspian@myhousecallmd.com

References:

1.    Alcohol Related Drug Interactions. Pharmacist’s Letter/Prescriber’s Letter. Jan 2008. Vol 24.

2.    Harmful Interactions: Mixing Alcohol with Medicines. National Institute of Alcohol Abuse and Alcoholism. 2007.

19

06 2010

Expiration Dates: An Evil Ploy for Your Money?

by Tania Houspian, PharmD 2011 | houspian@myhousecallmd.com

You open your refrigerator door and take out a milk carton (non-fat of course) to top off  your morning cereal.  As you tilt the carton, expecting a stream of delicious white liquid, you instead get disgusting clumps of a cottage cheese-like substance. It’s safe to say that the milk has passed its expiration date. You, being the sensible human being that you are, throw away the expired milk and settle for a granola bar for breakfast instead and plan to buy a new carton of milk on your way home from work.

Let’s look at another scenario.  You open your medicine cabinet and take out a bottle of Motrin wanting to take a couple of tablets to alleviate the muscle pain from a rough game of basketball last night (those 16 years olds didn’t look so tough at first).  You scan the bottle looking for how many you should take and notice that it expired June 2009. You open the bottle and see that the pills look fine. There is no molding… they don’t smell funny…so you figure it’s fine to take. Besides, you have a stellar conspiracy theory that expiration dates are an evil ploy by pharmaceutical companies to get you to buy medication more often. You pop two tablets and go on with your day.

If you find yourself nodding emphatically saying,  “That’s so true.  I totally do that!” then you’re not alone.  One of the most common questions pharmacists are asked is “Can I take this medication even though it expired last year?” On the other hand, you don’t ever go back to the grocery store and ask the clerk, “Can I drink this milk even though its been expired for a year?”  This paradigm makes sense, though. When there’s proof of spoilage (i.e. stinky cottage cheese instead of milk) we’re way more likely to believe the expiration date. We don’t blame you, old milk tastes horrible but old Motrin still has that delicious sugary coating.

So, what’s the final verdict? Are expiration dates just a way to get you to buy more medications or did your Motrin become ineffective as of June 2009?

The Evil Ploy Side:  The main argument presented by the “Expiration Dates are for Pansies” faction of society is a study performed by the military and presented to the FDA in 2002. In the study, the military evaluated all of their expired stockpiles of medication and discovered that some were still considered stable and efficacious for up to 54 months after their noted expiration date.

Now you can take those results and run with them or you can look at the details of the military’s findings. The military noted that the “degree of stability” depended greatly on the medication, manufacturer, and lot number. They were not issuing a blanket statement saying all medications are good for 54 months after the printed expiration date.  They merely found that some drugs remain good after the date on the bottle.  This fact, though, may be enough for some to call into question the validity of the expiration date on that Motrin bottle.

Here is the take home message: You are not the military.  Earth-shattering, we know. What we mean by that is that you don’t store and care for your drugs the way the military does (just a guess).  The military stores their stockpiled medications in cool, dry, dark, and temperature controlled warehouse-type locations.  Where do most people store their medication?   A few common “store houses”:  medicine cabinet in the bathroom, spare cabinet in the kitchen and, last but not least, purses. Think about all the temperature and humidity changes those locations go through.  Repeated exposure to temperature variations and light affects the stability of medications.  Even though the pharmaceutical company knows the medication will be good for 10 years, they may decide to give it a 5 year expiration date to account for variations in how people store their medications.  The date printed on your bottle of Motrin takes into account all the abuse you dare inflict on your personal medication supply.

Now you say: “So what! I took some expired Motrin (Tylenol, Nyquil, etc.) and nothing bad happened to me!”  Okay, but there’s also a chance that nothing good happened either.  When a medication passes its expiration date it means that the company that manufactured it no longer guarantees it will work for you.  You may not get any relief from your muscle pain, sore throat, runny nose, or whatever symptom you were trying to treat.  Not the kind of medicine we endorse.  The treatment of the aforementioned mild conditions may not be life altering but the issue of efficacy is important with medications that are used to treat life-threatening conditions.  Medications like nitroglycerin, insulin or antibiotics should never be taken past their expiration date.  If these medications don’t work properly, the stakes are much higher (read hospitalization or, even worse, death).

Anytime you ask a health professional if it’s okay to take a medication past its expiration date the response you’re most likely going to get is, “No.” It’s just not worth the possibility of not receiving adequate treatment.  For the skeptics in the room, there is one time that you’ll hear of medications being used past their expiration date: severe shortages.  At those times, desperate times call for desperate measures and the medical community works with the limited resources available.   Next time you look at the back of your medication bottle and see its expired, ask yourself: Is this really a desperate time or can I easily get more medication that’s guaranteed to work?  I think we all know the answer.

Questions? E-mail the Author: houspian@myhousecallmd.com

02

06 2010

The Hangover: Make it go away!

by Joshua Goldman, MD, MBA

the-hangover-wallpaperIt’s 9am and you’re cuddling your fire truck-esk alarm as you wake up to realize that you’re already an hour late for work.  You sit up and immediately notice the pounding sensation in your head, reminding you of your alcoholic escapades from the night before.  It’s official, you’re hungover.  The question is “What do you do now?”  We’re here to offer a few suggestions to help mitigate hangovers with some preventive steps before and during drinking, and some hangover-relieving tricks for the morning after.

Rather than accepting a hangover as the unfortunate side effect of a night out, there are a few tricks to help reduce the likelihood of ever becoming hungover.  Here’s our recommendations:

  • Drink slowly (obviously).  Frank the Tank is well on his way to a hangover after beer bong number 3.

  • Eat a full meal before drinking.  One study showed that glucose (which your body gets from food) effectively inhibits the metabolic disturbances induced by ethanol (i.e. a hangover).  The glucose in the meal also helps build up a store of energy so you won’t feel as weak the next day.

  • Drink in moderation. For those of you who aren’t sure what this means, The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day (one drink = a 12-ounce bottle of beer, a 4-ounce glass of wine, or a 1 1/2-ounce shot of liquor).  WaterAlso, the average individual can process one of these alcoholic beverages per hour.  Two drinks in one hour makes you one drink drunk.  Five drinks in two hours make you three drinks drunk.  You follow?

  • Drink a glass of water in between alcoholic drinks. This will help you drink less alcohol while simultaneously hydrating you (remember that a large part of your hangover is dehydration).

We realize that these tips are not ideal for those of you looking to get a little wild during your night out on the town.  As such, here are some additional tips to help mitigate the pounding in your head that you will experience the next morning once the hangover has set in:

  • Replace all the fluids and electrolytes you lost. If you remember, alcohol is Rehydrating with Electrolyte Drinkdehydrating and, unfortunately, you lose a lot of electrolytes along with the fluid (mainly sodium, potassium, and magnessium).  There are a number of great electrolyte drinks (pedialyte, Gatorade Performance, Powerade, Smart Water, etc.) that can replace both water and electrolytes simultaneously.  If you prefer a more natural approach, water plus bananas and a salty snack can help replenish your fluids as well as the missing sodium and potassium.  You can also take a multivitamin to rapidly (and thoroughly) get all your needed minerals back on board.

  • Replenish your energy stores. Consume foods and drinks that contain fructose (such as fruit juice or honey). There is some evidence that fructose will help your body break down and eliminate the alcohol faster.  Also, remember that alcohol inhibits your body’s production of glucose (your body’s form of gasoline).  When you wake up the next morning, your body is in desperate need of glucose replenishment.  A healthy carbohydrate-rich meal will quickly replenish these glucose stores.  Add some protein (think eggs) to breakfast and you can simultaneously boost your body’s cysteine level which will help counteract the brutal effects of alcohol’s metabolites.

  • Stock up on Vitamin C. Vitamin C has been shown to increase your body’s level of glutathione, the chemical needed to breakdown alcohol that becomes depleted in hangovers (1).  Vitamin C also neutralizes free radicals (which are formed at an increasing rate during drinking) that can cause damage to your body in the aftermath of a night out.  Oranges or those tasty chewable Vitamin C tablet will both do the trick.

  • Get your liver back on track. In addition to Vitamin C, milk thistle is an excellent way to replace your liver’s glutathione stores (which you need to process all the alcohol you consumed).  You can also find glutathione in asparagus and spinach.  Eggs are rich in cysteine which is a building block of glutathione.  Vitamin B6, riboflavin, and selenium are required in the manufacture of glutathione (they can be found in most multivitamins) and are essential to getting your body back to normal.

  • Upset StomachBe gentle on your stomach. You spent a good portion of last night dumping the equivalent of battery acid into your digestive track.  It’s understandable that it’s not feeling so hot the next morning.  The alcohol you consume irritates the lining of your digestive track much like the way it is irritated with very spicy foods.  This irritation causes you to feel nauseous and makes it hard to eat.  To help your stomach heal, eat bland foods the next day and save the spicy peppers and chili sauce for another day.  If your upset stomach is sucking your will to live, try Pepto-Bismol (it acts as a temporary stomach lining protecting your irritated gut from its natural acid while it heals…yes, the picture on the pink bottle is true).

  • Get plenty of rest. Alcohol inhibits your ability to reach your most deep and restful phase of sleep.  As such, you will be tired regardless of the number of hours you spent in bed.  Try to take a midday nap to allow your body time to catch up on some much needed deep sleep.

  • Take an aspirin. Aspirin (as well as ibuprofen and naproxen) has been proven to be effective in minimizing the pain in many types of headaches including a hangover headache.  Avoid taking any medications for your hangover that contain acetaminophen (such as Tylenol), because it may cause liver damage when combined with alcohol.  Your liver is already angry; no need to push it over the edge with Tylenol.

House Call, MD’s Hypothetical Hangover Remedy:

In simplified terms, this is our best (scientifically supported) guess at what can get you back on track:

  1. A carbohydrate-rich breakfast with eggs on the side (but remember to keep it bland)

  2. Electrolyte-enhanced fluids…lots of them

  3. A multivitamin (make sure it has Vit B6, B12, riboflavin, and selenium)

  4. Vitamin C – Consume any way you’d like (OJ or oranges will kill two birds with one stone)

  5. Aspirin – One dose in the AM is probably all you need

  6. Rest – Try an afternoon nap…you look like you need it.

References:
1. Johnston CJ, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in healthy adults. Am J Clin Nutr 58:103-5, 1993
2. Kera Y, Ohbora Y, Komura S (1989). “Buthionine sulfoximine inhibition of glutathione biosynthesis enhances hepatic lipid peroxidation in rats during acute ethanol intoxication”. Alcohol Alcohol. 24 (6): 519–24.

09

10 2009

WordPress SEO