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Drugs and Medicines I CHEMISTRY 100 ATENEO DE ZAMBOANGA UNIVERSITY Ms. M.A.

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CLASSIFICATION OF NSAIDs 1) COX-1 SELECTIVE INHIBITORS - acetylsalicylic acid at low dosage 2) NONSELECTIVE COX INHIBITORS - acetylsalicylic acid at high dosage - diclofenac - ibuprofen - ketoprofen - flurbiprofen - indomethacin - piroxicam - naproxen 3) MORE COX-2 SELECTIVE INHIBITORS - nimesulid - etodolak - meloxicam - nabumeton 4) COX-2 SELECTIVE INHIBITORS - celecoxib - etorcoxib - valdecoxib ANTI-INFLAMMATORY EFFECTS OF NSAIDs This effect of NSAIDs is due to the inhibition of the enzyme COX, which converts arachidonic acid to prostaglandins, TXA2 and prostacyclin. Acetylsalicylic acid irreversibly inactivates COX-1 and COX-2 by acetylation of a specific serine resideu. Other NSAIDs reversibly inhibit COX-1 and COX-2 Additional anti-inflammatory mechanism may include: - interference with the potentiative action of other mediators of inflammation bradykinin, histamine, serotonin - modulation of T-cell function

- stabilization of lysosomal membranes - inhibition of chemotaxis ANALGESIC EFFECT OF NSAIDs This effect of NSAIDs is thought to be related to the peripheral inhibition of prostaglandin production, but it may also be due to the inhibition of pain stimuli at a subcortical site. NDAIDs prevent the potentiating action of prostaglandins on endogenous mediators of peripheral nerve stimulation ( e.g. bradykinin ) ANTIPYRETIC EFFECT OF NSAIDs This effect is believed to be related to inhibition of the interleukin-1 and interleukin-6 induced production of prostaglandins in the hypothalmus and the resetting of the termoregulatory system, leading to vasodilation and increased heat loss

CLINICAL USES O NSAIDs 1) analgesia 2) inflammation 3) antipyresis 4) antiplateled effect 5) cancer preventive agents ADVERSE EFFECTS OF NSAIDs 1) gastrointestinal effects: abdominal pain, gastric and duodenal ulcer, diarrhea, pancreatis gastrointestinal hemorrhage, hepatotoxicity 2) renal effects - disturbances of renal function with water and sodium retention 3) inhibition of platelet aggregation 4) central symptoms: headache, decreased hearing, tinnitus, dizziness, confusion, dpression

5) allergic reactions: asthma, rashes, photosensitivity PHARMACODYNAMIC INTERACTION NSAIDs WITH OTHER DRUGS NSAIDs + hypotensive drugs ( -blockers, ACE-inhhibitors, diuretics ) = hypotensive effect NSAIDs + ehanol = risk of bleeding from gastrointestinal tract NSAIDs + ticlopidine or clopidogrel = risk of bleeding NSAIDs + lithium = lithium toxicity NSAIDs + cylosporine or ACE-inhibitors or takrolimus= nephrotoxicity of drugs NSAIDs + fluoroquinolons = toxic action of fluoroquinolons on CNS NSAIDs +oral antidiabetic drugs = risk of hypoglycemia NSAIDs + cumarines = risk of bleeding from gastrointestinal tract PHARMACOKINETIC INTERACTION NSAIDs WITH OTHER DRUGS NSAIDs + oral antidiabetic drugs = risk of hypoglycemia NSAIDs + cumarines =risk of bleeding NSAIDs + corticosteroids = risk gastropathy and bleeding from gastrointestinal tract NSAIDs + aminogycosides = ototoxicity and nephrotoxicity of aminogycosides NSAIDs + fenytoine or valproinic acid = action of fenytoine or valproinic acid NSAIDs + metotrexat or digoxin = action and toxicity metotrexat or digoxin NSAIDs + tricycles antidepressive drugs neuroleptics or antiarrhytmic drugs or selective serotonin reuptake inhibitors ( SSRI ) = action of drugs

NSAIDs (Non-steroidal anti-inflammatory drugs) Celecoxib (Celebrex) Diflunisal (Dolobid) Etodolac (Lodine) Ibuprofen (Advil, Motrin, Rufen) Indomethacin (Indocin) Meloxicam (Mobic) Midrin Nabumetrone (Relafin) Naproxen (Naprosyn, Alleve) Oxaprozin (Daypro, Duraprox) Piroxicam (Feldene) Salsalate (Disalcid) Sulindac (Clinoril) Tolmetin (Tolectin) Trilisate Ketoprofen (Orudis, Oruvail)

What are NSAIDs? NSAID stands for non-steroidal anti-inflammatory drug. These anti-inflammatory medications relieve some lupus symptoms by reducing the inflammation responsible for the stiffness and discomfort in your muscle, joints, and other tissues. NSAIDs are milder than many other lupus drugs and may be taken either alone to treat a mild flare or in combination with other medications. NSAIDs come in both prescription and over-the-counter forms, but you should always talk to your doctor before taking any over-the-counter medication. There are many NSAIDs currently on the market; common examples include ibuprofen (Advil, Motrin), naproxen (Naprosyn, Alleve), etodolac (Lodine), celecoxib (Celebrex), and meloxicam (Mobic). Everyone responds differently to different medications, so you and your doctor should work together to find the most effective NSAID for your lupus symptoms.

How do NSAIDs work?

NSAIDs work at a chemical level by blocking the formation of molecules in your body called prostaglandins. Prostaglandins are involved in both your bodys normal maintenance and your bodys inflammatory response. These prostaglandins are controlled by enzymes proteins that help to bring about chemical changes in your bodycalled Cox-1 and Cox-2. Specifically, Cox-1 controls the formation of the prostaglandins involved in the normal function of many of your bodys organs. Cox-2 controls the formation of the prostaglandins involved in your bodys inflammatory response. So, by stopping your body from making prostaglandins, NSAIDs allow you to experience less swelling and less pain.

Most NSAIDs block both Cox-1 and Cox-2 enzymes. Since the Cox-1 enzyme helps some of your organ systems to function normally, you may experience some side effects when taking NSAIDs, such as upset stomach. [A full list of possible side effects can be found below.] However, some newer NSAIDs, such as celecoxib (Celebrex), block only the Cox-2 enzyme, which may help your body to avoid some of the more traditional side effects. A Cox-2 inhibitor is sometimes called a selective inhibitor. Your doctor will help you to decide which type of NSAID works best to treat your lupus symptoms, while minimizing the possible side effects.

What side effects can occur from taking NSAIDs? NSAIDs can cause certain side effects. These side effects can be similar to symptoms of increased lupus, so it is important to notify your doctor if they occur. Most side effects will go away once the drug is stopped. Some side effects will only be apparent from your blood tests, so it is important to get regular complete blood counts (CBCs) every 3-4 months, including tests of your liver and kidney function.

Potential side effects of NSAIDs include:

Upset Stomach Headache Easy bruising High blood pressure Fluid retention Dyspepsia (gnawing or burning pain in the pit of your stomach, sometimes with bloating) Gastritis (stomach inflammation) or gastric ulcers may occur, causing either hidden or apparent bleeding. This blood loss may lead to anemia. Increased risk of heart attack or stroke.

Effects on blood platelets, cells that help your blood to clot normally Most NSAIDs have some effect on blood platelets. When platelet function is reduced, it takes longer for your blood to clot. While this effect can be bad for some, it can be beneficial for others. In fact, aspirin is often prescribed to reduce the risk of blood clots in people who have antiphospholipid antibodies. However, it is important that you speak to your doctor before taking any NSAIDs if you are on low-dose aspirin therapy, since certain NSAIDs such as ibuprofen (Advil, Motrin, Rufen) can interfere with the effectiveness of this treatment. Selective inhibitors (Celebrex) do not affect platelets. If you already have blood pressure or kidney problems, NSAIDs may worsen kidney function. Fluid retention or further elevation in blood pressure may occur. Reduced kidney function can occur with either Cox-1 or Cox-2 inhibitors. If you have lupus nephritis, you and your doctor should closely supervise your use of NSAIDs to reduce the potential for further harm to your kidneys. Occasionally lupus patients may experience elevations in their liver enzyme blood tests, suggesting a mild liver inflammation (hepatitis). Usually this does not mean that the medication must be stopped, but liver tests should be performed on a regular basis. Worsening of symptoms in people with asthma or inflammatory bowel disease. Severe headache with neck stiffness may occur exclusively in people with lupus, usually only with ibuprofen. Skin rashes can occur, either in the form of hives or a light- or sun-sensitive rash. Sometimes these rashes can mimic a flare of your lupus, so it is important you speak with your doctor if you experience this reaction. This reaction is more common with piroxicam (Feldene)

What if NSAIDs irritate my stomach? Always take NSAIDs with food to help protect your stomach from irritation. If you experience stomach pain or other side effects when taking NSAIDs, your doctor may prescribe medications to control these symptoms. Medications such as cimetidine (Tagamet), ranitidine (Zantac), omeprazole (Prilosec), and lansoprazole (Prevacid) help your stomach from producing acid. Misoprostol (Cytotec) may help to maintain the protective lining of your stomach wall. It is important to remember that you may experience stomach irritation from one NSAID but not another. Speak with your doctor if you are experiencing stomach pain. There could be another drug that works better for you.

What should I keep in mind if I have been taking NSAIDs for a long time? If you have been undergoing long term NSAID therapy, you should have your blood count measured periodically (a test called a CBC) to make sure you are not experiencing any hidden gastric bleeding. This type of bleeding can cause anemia, which affects your bloods ability to clot and can lead to easy bruising.

Limit your alcohol intake while taking NSAID medications, since alcohol can irritate the stomach. People taking NSAID medications should not smoke. In fact, individuals with lupus should not smoke at all due to their increased risk of cardiovascular disease (the number one cause of death in lupus patients).

Lastly, it is important that you talk to your doctor about any other medicationsprescription and over-the-counter drugs, vitamins, and supplementsthat you may be taking.

Can I take NSAIDs if I am pregnant or thinking of having a baby? NSAIDs are forbidden during pregnancy, even while trying to conceive.

Talk to your doctor if you:


Have decreased kidney or liver function, or an uncontrolled or undiagnosed liver problem (for example, hepatitis) Have ever had an ulcer, gastritis, or bleeding from the intestinal tract Take blood thinners (anticoagulants) like Coumadin, heparin, aspirin, or Plavix Take steroids such as prednisone Have a low platelet count Have Crohns disease or ulcerative colitis Have a history of stroke, heart attack, hypertension, or congestive heart failure Have asthma or chronic lung disease Are allergic to aspirin or any other NSAIDs Have nasal polyps Have reflux disease, indigestion, or hiatal hernia Are pregnant, may become pregnant, or are breast feeding Drink more than 7 alcoholic drinks per week or more than 1 per day Are over 65 Do not accept blood products due to religious or other reasons.

Get emergency help right away if you experience any of the following symptoms:

Chest pain Shortness of breath Weakness in one part of the body Slurred speech.

Pain Relief: How NSAIDs Work


NSAIDs are among the most common pain relievers in the world. And lately, they're among the most controversial. Find out what these antiinflammatory pills actually do inside your body.
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AAA By R. Morgan Griffin WebMD Feature Reviewed by Marc C. Levesque, MD, PhD NSAIDs -- or nonsteroidal anti-inflammatory drugs -- are among the most common pain relief medicines in the world. Every day more than 30 million Americans use them to soothe headaches, sprains, arthritis symptoms, and other daily discomforts, according to the American Gastroenterological Association. And as if that wasn't enough, in addition to dulling pain NSAIDs also lower fever and reduce swelling. But how do those little pills do so much? And if they're so good in some ways, why do they also raise the risk of heart problems in some people? The answer is complicated. Even researchers don't fully understand how NSAIDs work. Nonetheless, with the benefits and risks of NSAIDs in the headlines frequently, WebMD turned to four experts for a rundown of what researchers do know. Our panel consisted of:

Byron Cryer, MD, a spokesman for the American Gastroenterological Association and an associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas. Nieca Goldberg, MD, a spokeswoman for the American Heart Association and chief of Women's Cardiac Care at Lennox Hill Hospital in New York. John Klippel, MD, president and CEO of the Arthritis Foundation in Atlanta. Scott Zashin, MD, clinical assistant professor at the University of Texas Southwestern Medical Center in Dallas and author of Arthritis Without Pain.

Here is their explanation of how NSAIDs help ease your pain -- and sometimes cause side effects in the process.
Self-Assessment: Are You Doing All You Can to Manage Your Rheumatoid Arthritis?

What Is Pain? First, it helps to understand what pain is. On a basic level, pain is the result of an electrical signal being sent from your nerves to your brain. But the process is not only electrical. When you get injured -- say with a sprain -- the damaged tissue releases chemicals called prostaglandins, which are like hormones. These prostaglandins cause the tissue to swell. They also amplify the electrical signal coming from the nerves. Basically, they increase the pain you feel.

How Do NSAIDs Help Relieve Pain? NSAIDs work on a chemical level. They block the effects of special enzymes -- specifically Cox-1 and Cox-2 enzymes. These enzymes play a key role in making prostaglandins. By blocking the Cox enzymes, NSAIDs stop your body from making as many prostaglandins. This means less swelling and less pain. Most NSAIDs block both Cox-1 and Cox-2 enzymes. They include the over-the-counter drugs:

Aspirin (Bufferin, Bayer, and Excedrin) Ibuprofen (Advil, Motrin, Nuprin) Ketoprofen (Actron, Orudis) Naproxen (Aleve)

Other NSAIDs are available by prescription. They include:


Daypro Indocin Lodine Naprosyn Relafen Voltaren

Aspirin has some benefits that other NSAIDs do not. The biggest is that aspirin works against the formation of blood clots. As a result, you are less likely to form the clots that can cause heart attacks and strokes. Other NSAIDs do not have this effect. Cox-2 inhibitors are a newer form of prescription NSAID. As you might guess, they only affect Cox-2 enzymes and not Cox-1. Two of them -- Bextra and Vioxx -- are no longer sold because of concerns about their side effects. The third, Celebrex, is still available.

Drugs and Medicines A. OTC Drugs Pain Killers Antihistamines Decongestants Cough Medicines Steroidal Drugs Laxatives Antidiarrheal Antacids B. Prescription Drugs C. Illlegal Drugs

OTC Medicines and How They Work


This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals. In this section, you'll learn what you need to know to make wise choices about over-thecounter (OTC) medicines for you and your family. The following information has been adapted from the AAFP guide for physicians, "Appropriate Use of Common OTC Analgesics and Cough and Cold Medications."

What does OTC mean?


OTC is short for over-the-counter. These are medicines you can buy without a prescription from your doctor. Chances are, Do you know what's in you've used OTC medicines many times to relieve pain and the medicines you take? treat symptoms of the common cold, the flu and allergies. In this section, you'll learn about four of the most common types of OTC products and how each works. Many OTC medicines contain the

Pain relievers Antihistamines Decongestants

same ingredient found in prescription medicines. By combining a prescription medicine with an OTC medicine, you may be getting more than the recommended daily dose of the active ingredient. This medication chart can help you sort out what medicines have the same ingredient so you can avoid taking too much. If you have any questions, ask your pharmacist

Cough medicines
Pain Relievers

The OTC products that relieve your headache, fever or muscle aches are not all the same. That's because the pain relievers you see in the aisles of your local drug store or pharmacy are either nonsteroidal anti-inflammatory drugs (called NSAIDs, which include aspirin, ibuprofen, naproxen and ketoprofen) or acetaminophen. Each of these drugs has a different way of working: Aspirin and NSAIDs relieve pain by stopping the production of prostaglandins, which are natural chemicals in the body. Prostaglandins irritate nerve endings, triggering the sensation of pain. Commonly used NSAIDs include: Aspirin, the medicine in products such as Bayer and St. Joseph Ibuprofen, the medicine in products such as Advil and Motrin IB Naproxen, the medicine in products such as Aleve Ketoprofen, the medicine in products such as Orudis KT

Acetaminophen (aka paractamol-mad)relieves pain and reduces fever. We don't completely understand the way acetaminophen relieves pain. We do know that unlike aspirin and NSAIDs (which work in the skin, muscles and joints), acetaminophen blocks painful sensation in the brain and the spinal cord. Acetaminophen is in products such as Tylenol and Tempra.

Antihistamines Antihistamines work by blocking the receptors that trigger itching, nasal irritation, sneezing and mucus production. The three types of antihistamines are: Diphenhydramine, the medicine in products such as Banophen, Benadryl Allergy and Diphenhist Brompheniramine, the medicine in products such as Dimetapp Allergy Chlorpheniramine, the medicine in products such as Aller-Chlor, Chlo-Amine and Chlor-Trimeton Allergy Decongestants Decongestants work by narrowing blood vessels in the lining of the nose. As a result, less blood is able to flow through the nasal area, and swollen tissue inside the nose shrinks. Pseudoephedrine is the only decongestant used in OTC products. Pseudoephedrine is in products such as Allermed, Genaphed and Sudafed. Cough Medicines Cough medicines are grouped into two types: antitussives and expectorants. Antitussives, or cough suppressants, block the cough reflex.

Dextromethorphan is a common antitussive and is in products such as Delsym, Drixoral, Pertussin CS and Robitussin Pediatric. Expectorants, on the other hand, are thought to thin mucus and make coughing more productive in clearing the mucus from the airway. Guaifenesin is the only expectorant used in OTC products and is in products such as Guiatuss, Robitussin and Tusibron. Timeline of Symptoms Associated with the Common Cold There is no cure for the common cold. Medicine can only make your symptoms less bothersome until your body can fight off the virus. Medicine wont make your cold go away completely. The following are tips to help you feel better when you have a cold: Stay home and rest, especially while you have a fever. Dont smoke and avoid secondhand smoke. Drink plenty of fluids like water, fruit juices and clear soups. Dont drink alcohol. Gargle with warm salt water a few times a day to relieve a sore throat. Throat sprays or lozenges may also help relieve the pain. Use salt water (saline) nose drops to help loosen mucus and moisten the tender skin in your nose.

Many cold medicines are available over-the-counter. If you decide to use an OTC medicine to treat your cold symptoms, consult the chart below. DaySymptomsOTC Medicine1Fatigue, mild sore throatAcetaminophen (some brand names: Panadol, Tempra, Tylenol) or nonsteroidal anti-inflammatory drug (ibuprofen [some brand names: Advil, Menadol, Motrin])2Runny noseAntihistamine (diphenhydramine [some brand names: Benadryl Allergy, Banophen, Diphenhist], chlorpheniramine [some brand names: Aller-Chlor, Chlo-Amine, Chlor-Trimeton Allergy])3Stopped up noseDecongestant (pseudoephedrine [some brand names: Allermed, Genaphed, Sudafed])4Dry coughAntitussive (dextromethorphan [some brand names: Drixoral, Pertussin CS, Robitussin Pediatric])5Moist, productive coughExpectorant (guiafenesin [some brand names: Guiatuss, Robitussin, Tusibron])6Voice breaks or disappears altogetherNo medicine will help your voice come back sooner. Resting it is the only thing that will help.

How to Read an OTC Drug Label


You don't need a prescription to buy OTC medicine. But like prescription drugs, OTC medicines can also cause unwanted and sometimes dangerous side effects. Before you buy an OTC medicine, it's important to read and thoroughly understand the information on the drug label. Use the following as a guide. If you have questions about a medicine, ask your pharmacist or family doctor.

1. Active Ingredient. The active ingredient is the chemical compound in the medicine that works to relieve your symptoms. It is always the first item on the label. There may be more than one active ingredient in a product. The label will clearly show this. 2. Uses. This section lists the symptoms the medicine is meant to treat. The U.S. Food and Drug Administration (FDA) must approve these uses. Uses are sometimes referred to as "indications." 3. Warnings. This safety information will tell you what other medicines, foods or situations (such as driving) to avoid while taking this medicine. 4. Directions. Information about how much medicine you should take and how often you should take it will be listed here. 5. Other Information. Any other important information, such as how to store the product, will be listed here. 6. Inactive Ingredients. An inactive ingredient is a chemical compound in the medicine that isn't meant to treat a symptom. Inactive ingredients can include preservatives, binding agents and food coloring. This section is especially important for people who know they have allergies to food coloring or other chemicals. 7. Questions or Comments. A toll-free number is provided to address any questions or comments you may have about the medicine.

How to Get the Most from Your Medicine OTC medicines can help you feel better. But if they are taken the wrong way, they can actually make you feel worse. To use OTC medicines correctly, follow the guidelines below. Talk to your family doctor If there is something you don't understand about a medicine you're taking or are planning to take, ask your doctor or pharmacist. If you still don't understand, ask him or her to explain things more clearly. If you are taking more than 1 medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems when they are taken together (called a drug interaction). Below is a list of questions you can ask your doctor to learn how to use each medicine correctly and safely: What does the medicine do? When and how should I take the medicine? What are the possible side effects (reactions your body may have to the medicine)? Will the medicine react to any other medicines, foods or drinks? Should I avoid any activities while I'm taking the medicine? How will I know if the medicine is working?

Know about the medicine you take You should know the following things about each medicine you take: Name (generic name and brand name)

Reason for taking it How much to take and how often to take it Possible side effects and what to do if you experience them How long to continue taking the medicine Special instructions (taking it at bedtime or with meals, etc.)

Know what to avoid while taking the medicine Some foods can cause side effects, such as stomach upset, if you are taking medicine. Drinking alcohol is generally not a good idea while you are taking medicine. Some medicines cause reactions such as sun sensitivity (getting a sunburn or sun rash), so you may have to limit your outdoor activities or protect your skin from the sun. Read the label to see what to avoid while you are taking an over-the-counter medicine. Follow the instructions just as you would with a prescription medicine. If you have questions, ask your doctor or pharmacist. Follow these dos and don'ts: Do read the label carefully. Do take your medicine exactly as your doctor tells you to. Do make sure that each of your doctors (if you see more than one) has a list of all of the medicines you're currently taking. Do make sure everyone you live with knows what medicine you're taking and when you're supposed to take it. Don't combine prescription medicines and OTC medicines unless your doctor says it's okay. Don't stop taking a medicine, change how much you take or how often you take it without first talking to your doctor. Don't take someone else's medicine. Don't use medicine after its expiration date. Don't crush, break or chew tablets or capsules unless your doctor tells you to. Some medicines won't work right unless they are swallowed whole. Understand generic vs. brand name Just like foods, some medicines come in both brand names and generics. Generic medicines are generally cheaper. Compare the list of ingredients. If the generic has the same ingredients as the brand name, you may want to consider using it. But be careful: the generic may contain different amounts of certain medicines. Ask your doctor or pharmacist if you have questions about which medicine to choose. Follow these tips for choosing medicines If you have questions, ask your doctor or pharmacist. Although it can seem overwhelming, take the time to look at all the choices. Read the label carefully and note what symptoms the medicine will treat.

Look for a medicine that will treat only the symptoms you have. For example, if you only have a runny nose, don't pick a medicine that also treats coughs and headaches. Note how much medicine you should take, and what side effects it may cause. Note what medicines or foods you should not take with the medicine. Check to see if the medicine causes problems for people with certain health problems (such as asthma or hypertension). Know when to call your doctor If you're taking an OTC medicine and it doesn't seem to be working, call your doctor. Your symptoms can get much worse if you wait too long to get treated by your doctor. You should also call if you have side effects or any concerns about the medicine you're taking.

Potential Side Effects of OTC Medicines in Adults


While OTC medicines have a low risk of side effects when used occasionally by healthy adults, they can pose risks for very young children, the elderly, people with kidney problems and people taking more than one medicine. These people have an increased risk of side effects when they take OTC medicines. Potential side effects are described below. Aspirin and NSAIDs The main side effect associated with aspirin and other NSAIDs is gastrointestinal (GI) problems. These problems can range from upset stomach to GI bleeding, a serious event that is most likely to occur in older people. The chances of experiencing GI problems from NSAIDs or aspirin increase the larger the dose you take and the longer you take them. NSAIDs can cause a variety of side effects related to kidney function. These side effects range from reversible inflammation to permanent kidney damage. Aspirin and NSAIDs may make high blood pressure worse or interfere with blood pressure medicines. High doses of aspirin pose a risk of liver damage for people who have liver disease, juvenile arthritis or rheumatic fever. Acetaminophen Although safe in the majority of users, long-term use of high doses of acetaminophen, especially in products that also contain caffeine (such as Excedrin) or codeine (such as Tylenol with Codeine), has been shown to cause a form of kidney disease called analgesic nephropathy. This serious condition may develop after years or decades of daily use. Antihistamines

Antihistamines can cause sedation or drowsiness and, therefore, can significantly impair a person's ability to drive or operate machinery. The sedative effects of antihistamines may increase the risk of falling. Antihistamines can also cause temporary dry mouth or eyes. Decongestants Pseudoephedrine can temporarily cause nervousness, dizziness and sleeplessness. It can make you lose your appetite or retain urine. It can also cause heart palpitations, high blood pressure or high blood sugar levels. Cough Medicines Codeine, when used as a cough suppressant, can temporarily cause nausea, sedation and constipation. Dextromethorphan, the medicine in Drixoral, Pertussin CS and Robitussin, has a lower risk of sedation and GI side effects. It can, however, cause feelings of confusion, agitation, nervousness or irritability. Drug-Drug Interactions The body processes (metabolizes) every drug differently. If drugs are used together, their metabolism and effect on the body can change. When this happens, the chance that you will have side effects for each drug may become greater.

Alcohol and OTC Medicines


Pain Relievers If you drink more than 1 alcoholic beverage per week and use NSAIDs, including aspirin, you may be at increased risk of GI bleeding. People who consume 3 or more alcoholic beverages each day should consult their physician before using any pain reliever. Acetaminophen is much less likely than NSAIDs to be associated with GI problems, including bleeding. But to minimize the risk of serious liver injury, you should never take more than the recommended daily dose (4g per day). Antihistamines, Decongestants and Cough Medicines The combination of OTC antihistamines and alcohol can increase drowsiness, especially in elderly people. In addition, alcohol makes the drowsiness, sedation and impaired motor skills associated with the cough suppressants dextromethorphan (in products such as Drixoral, Robitussin) and codeine worse.

Special Groups
Some groups of people may be more likely to experience the side effects associated with OTC medicines. The sections below include tips for using OTC medicines in the following special populations:

Children Older adults Pregnant or breastfeeding women Other groups


Children

When used properly, OTC medications pose little risk to children. However, children metabolize drugs differently than adults. You should know how OTC drugs will affect your children before you use them. Talk with your family doctor if you have any questions about giving your child OTC medicines. Acetaminophen is generally considered the treatment of choice for children's pain relief. Do not give ibuprofen to a child younger than 6 months of age. Do not give aspirin to children under the age of 18 because of the risk of Reye's syndrome (a drug reaction that can lead to permanent brain injury). Do not use nasal decongestants, cough medicines and cold medicines in young children, especially those under 2 years of age. These medicines can produce dangerous side effects. In addition, cough and cold medicines are not effective in treating young children. It can be helpful for parents and other caregivers to keep track of the medicine a child is taking. One way to do that is with a medication log. Using a log can help avoid giving too much medicine or giving it too often. It can also provide important information to your family doctor if there is a problem.

Medicine and Your Child: How to give the right dose


Here are some tips on giving the right dose: When your doctor says to give the medicine "every 6 hours" that generally means the medicine is taken 4 times a day (for example, at breakfast, lunch, supper and bed time). It doesn't generally mean to wake the child up in the night to take medicine. And "take every 8 hours" generally means the medicine should be taken 3 times a day. Pay close attention to the dosage given on the label. Labels for liquid medicines give measurements in both teaspoons (tsp) and in milliliters (mL). Your pharmacist can give you a measuring device (a spoon that's made especially for measuring medicine, a syringe or a cup) that's labeled with both tsp and mL. Your pharmacist should also show you how to use it. One tsp is not the same as 1 mL. Read the label carefully and make sure you give the right amount of medicine to your child. An ordinary kitchen teaspoon may not hold the correct amount of medicine. Measure the medicine carefully. If you're using a measuring cup, set it on a level surface such as a countertop and then pour the medicine in it.

"If a little medicine is good, a lot is better (or will work quicker)" is wrong. Giving too much medicine can be harmful. Be sure you only give the recommended dose of each medicine. If you use a syringe-type measuring device to give liquid medicine to your child, first throw away the small cap of the syringe. Children can choke on these caps. If your child has a bad reaction to a medicine or is allergic to a medicine, tell your doctor right away. Also, keep a record of the following information at home: the name of the medicine, the dosage directions, the illness the medicine was used for and the side effects the medicine caused. Older Adults The elderly use a number of medications at the same time and therefore need to pay careful attention to drug-drug interactions between OTC medications and prescription medications. Older adults should talk with their doctor about the medicines they take and potential interactions with OTC medicines. There is a relatively high risk of kidney disease and GI bleeding in elderly patients who use NSAIDs. Discuss this risk with your family doctor. Pseudoephedrine can increase blood pressure and the pressure in your eye that can lead to glaucoma. It can also make existing blockages in the urinary tract worse. Pseudoephedrine interacts negatively with many other drugs such as beta-blockers, antidepressants, insulin and some medications that treat low blood sugar. If you use a monoamine oxidase inhibitor (MAOI), a type of prescription antidepressant, or take any medication for a seizure disorder, you should avoid using pseudoephedrine. Pseudoephedrine can change the way these drugs work in your system. Some common MAOIs include Marplan (generic: isocarboxazid), Nardil (generic: phenelzine sulfate) and Parnate (generic: tranylcypromine sulfate). If you use a MAOI, you should not use dextromethorphan. Dextromethorphan interferes with the way MAOIs work. Pregnant or Breastfeeding Women Pregnant or breastfeeding women should talk with their doctor before using any medicine. Some can affect your baby. The following are some general guidelines. Pregnancy Acetaminophen is generally considered safe for short-term pain relief during pregnancy. Avoid using aspirin during pregnancy. It can cause birth defects or problems during delivery. Avoid using other NSAIDs, especially during the third trimester of pregnancy. They can cause heart defects in the baby. Breastfeeding Acetaminophen and NSAIDs such as ibuprofen provide safe pain relief for women who are breastfeeding.

Avoid using aspirin because it is excreted in breast milk and can cause rashes and bleeding problems in nursing infants. Limit long-term use of antihistamines. Antihistamines are excreted in breast milk, and may cause side effects such as sedation, irritability, crying and sleep disturbances in nursing infants. Antihistamines may also interfere with the production of milk. General Tips These steps can help minimize the risk of side effects during pregnancy and breastfeeding: Talk to your doctor about possible alternatives to medicine. Avoid the use of medicines during the first trimester. Take oral medicines after nursing or before the infant's longest sleep period. Avoid the use of extra-strength, maximum-strength or long-acting medicines. Avoid "combination" products. Watch your infant for possible side effects, such as a rash, difficulty breathing, headache or other symptoms that your child didn't have before you took the medicine and then breastfed. Other Groups People with health problems such as kidney disease, heart disease, diabetes, asthma, blood clotting disorders or gout may be at increased risk of side effects associated with OTC medicines.

Bibliography
OTC Labeling Questions and Answers. FDA Web Site. Available at: www.fda.gov/cder/otc/label/quesanswers.htm. Accessed February 27, 2002. Aspirin PI (RxList). Available at: www.rxlist.com/cgi/generic/asa_wcp.htm. Accessed March 18, 2002. Dextromethorphan drug information. Available at: www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682492.ht

ml. Accessed October 20, 2003.


Diphenhydramine PI (RxList). Available at: www.rxlist.com/cgi/generic/dihydram_wcp.htm. Accessed March 18, 2002. Guaifenesin PI (RxList). Available at: www.rxlist.com/cgi/generic2/guaifen_wcp.htm. Accessed March 18, 2002. Ibuprofen PI (RxList). Available at: www.rxlist.com/cgi/generic/ibup_wcp.htm. Accessed March 18, 2002. Naproxen sodium PI (RxList). Available at: www.rxlist.com/cgi/generic/naproxsod_wcp.htm. Accessed March 18, 2002.

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Prescription Nonsteroidal Anti-Inflammatory Medicines


How do prescription nonsteroidal anti-inflammatory drugs work?
Nonsteroidal anti-inflammatory drugs (also called NSAIDs) stop cyclooxygenase enzymes (also called COX enzymes) in your body from working. COX enzymes speed up your body's production of hormone-like substances called prostaglandins. Prostaglandins cause the feeling of pain by irritating your nerve endings. They are also part of the system that helps your body control its temperature. By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis. They also help reduce inflammation (swelling), lower fevers and prevent blood from clotting.

What are some common prescription NSAIDs?


There are 2 classes of prescription NSAIDs. Traditional NSAIDs include the following: Diclofenac (brand names: Cataflam, Voltaren) Etodolac (brand name: Lodine) Fenoprofen (brand name: Nalfon) Flurbiprofen (brand name: Ansaid) Ibuprofen (2 brand name: Advil, Motrin) Indomethacin (brand name: Indocin) Ketoprofen (brand names: Orudis, Oruvail) Meclofenamate Meloxicam (brand name: Mobic) Nabumetone (brand name: Relafen) Naproxen (brand names: Anaprox, Naprelan, Naprosyn) Oxaprozin (brand name: Daypro) Piroxicam (brand name: Feldene) Sulindac (brand name: Clinoril) Tolmetin (brand name: Tolectin)

COX-2 inhibitors include celecoxib (brand name: Celebrex).

If you need to take a prescription NSAID, your doctor will help you find one that is right for you.

What's the main difference between traditional NSAIDs and COX-2 inhibitors?
You have 2 types of COX enzymes in your body: COX-1 and COX-2. Researchers believe that one of the jobs of COX-1 enzymes is to help protect your stomach lining. The COX-2 enzyme doesn't play a role in protecting your stomach. Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX1 enzymes are blocked, pain and inflammation is reduced, but the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers and bleeding in your stomach and intestines. COX-2 inhibitors only stop COX-2 enzymes from working. Since the COX-2 enzyme doesn't help to protect your stomach, COX-2 inhibitors may be less likely to irritate your stomach or intestines.

Do prescription NSAIDs have any side effects?


Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often. Common side effects of prescription NSAIDs may include the following: Dizziness or headache Nausea, excess gas, diarrhea or constipation Extreme tiredness or weakness Dry mouth Serious side effects of prescription NSAIDs may include the following: Allergic reaction, such as difficulty breathing, hives, swelling of the lips, tongue or face Muscle cramps, numbness or tingling Rapid weight gain Black, bloody or tarry stools Blood in urine or vomit Decreased hearing or ringing in the ears Yellowing of skin and eyes (jaundice) Abdominal cramping, heartburn or indigestion

In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for the following side effects: Swelling or water retention Skin rash or itching

"Flu-like" symptoms Unusual bruising or bleeding Difficulty sleeping (insomnia) Call your doctor as soon as possible if your side effects become severe.

Is it safe to take NSAIDs for a long period of time?


People who take NSAIDs increase their risk for severe bleeding in their stomachs. They may also be at risk for heart attacks and strokes. These risks gets worse if they take higher doses and/or if they take these medicines for a long period of time. Patients who need to take pain medicine for longer than a week should discuss this risk and explore other pain treatment options with their family doctor.

What is a drug interaction?


If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too. Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction." For example, if you're taking a traditional NSAID, drinking alcohol can increase your risk of liver disease or stomach bleeding. Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-thecounter or prescription medicine or use a vitamin or herbal supplement. It's important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using a prescription NSAID.

More Information Seniors


Medicare Part D Blood Pressure Meds Cholesterol-lowering Meds Oral Diabetes Meds Pain Medication After Surgery Understanding Pain Relievers Drug Reactions


Source

Drug-Food Interactions: How Grapefruit Interacts with Certain Drugs Food-Drug Interactions Get the Most from Your Medicine

Written by familydoctor.org editorial staff.


American Academy of Family Physicians Reviewed/Updated: 05/08 Created: 09/04

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Vertebrate steroids Steroid hormones Sex steroids are a subset of sex hormones that produce sex differences or support reproduction. They include androgens, estrogens, and progestagens. Corticosteroids include glucocorticoids and mineralocorticoids. Glucocorticoids regulate many aspects of metabolism and immune function, whereas mineralocorticoids help maintain blood volume and control renal excretion of electrolytes. Most medical 'steroid' drugs are corticosteroids. Anabolic steroids are a class of steroids that interact with androgen
receptors to increase muscle and bone synthesis. There are natural and synthetic anabolic steroids. In popular language, the word "steroids" usually refers to anabolic steroids. Cholesterol, which modulates the fluidity of cell membranes and is the principal constituent of the plaques implicated in atherosclerosis.
http://en.wikipedia.org/wiki/Steroid

Steroidal drugs are often abused and lead to dangerous health conditions.
Prednisone and prednisolone are steroidal antiinflammatory drugs, used to treat a wide variety of conditions such as autoimmune diseases, ulcerative colitis, asthma, dermatological disorders, Crohns disease, tendinitis, bursitis, to prevent organ transplant rejection, and in many chemotherapeutic regimens.

Sodium Steroidal anti-inflammatory drugs cause sodium retention. People taking one of these drugs should talk with their doctor to see if they need to restrict salt intake. Potassium Steroidal anti-inflammatory drugs increase the loss of potassium in urine.1 For most people, this may not cause a significant problem. When potassium is to be increased, it is often best achieved by eating more fruit rather than taking potassium supplements. (Fruit contains higher levels of potassium than that found in the legally mandated supplemental level of a maximum 99 mg per pill). Vitamin D and Calcium Steroidal anti-inflammatory drugs reduce the bodys ability to activate vitamin D.2 3 Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists. If so, activated vitamin D is available by prescription. Regular vitamin D supplements in health food stores are unlikely to have the same effect, although supplementation with 1 gram of calcium per day combined with 500 IU of vitamin D has been reported in one trial to help prevent osteoporosis induced by steroid drugs.4 Protein Steroidal anti-inflammatory drugs cause protein wasting. For this reason, medical doctors sometimes recommend a high-protein diet for people taking these drugs.5 Considering the kidney damage associated with systemic lupus erythematosusone of the conditions steroids are used to treatand the link between kidney damage and high-protein diets, it remains unclear if such advice is appropriate for all patients. Nutrient Depletion Steroidal anti-inflammatory drugs have been found to increase urinary loss of zinc, vitamin K, and vitamin C, although the clinical importance of these losses remains unclear.6

Licorice (Glycyrrhiza glabra) Licorice decreases the livers ability to clear prednisone from the body,7 thus allowing the drug to act for longer periods of time. Human studies have shown that injections of glycyrrhizin from licorice along with prednisolone, a close relative of prednisone, prolongs the duration of time it is active in the body.8 Combining licorice and prednisone demands expert guidance, to ensure that prednisone does not build up to excessive levels. An animal study has shown that glycyrrhizin prevents the immunosuppressive effects of cortisonethe natural hormone most like prednisone.9 Further human research will be necessary to see if this effect is significant in humans. Topical application of glycyrrhetinic acid (a component of licorice) along with various steroids has potentiated the anti-inflammatory effects of these drugs in both humans and animals.10 Aloe (Aloe vera) Applying aloe gel topically along with a form of cortisone has enhanced the hormones anti-inflammatory activity in the skin.11 References: 1. Csaky TZ. Cuttings Handbook of Pharmacology, 6th ed. New York: Appleton-Century-Crofts, 1979, 351. 2. Trovato A et al. Drug-nutrient interactions. Am Family Phys 1991;44:165158 (review). 3. Chesney RW et al. Reduction of serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids. Lancet 1978;ii:112325. 4. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to lowdose corticosteroids in patients with rheumatoid arthritis. Ann Intern Med 1996;125:96168. 5. Trovato A et al. Drug-nutrient interactions. Am Family Phys 1991;44:165158 (review). 6. Buist RA. Drug-nutrient interactionsan overview. Intl Clin Nutr Rev 1984;4(3):114 (review).

7. Tamura Y, Nishikawa T, Yamada K, et al. Effects of glycyrrhetinic acid and its derivatives on delta-4-5-alpha- and 5-beta-reductase in rat liver. Arzneim Forsch 1979;29:64749. 8. Chen MF, Shimada F, Kato H, et al. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate.Endocrinol Japon 1990;37:33141. 9. Kumagai A, Nanaboshi M, Asanuma Y, et al. Effects of glycyrrhizin on thymolytic and immunosupressive action of cortisone. Endocrinol Japon 1967;14:3942. 10. Teelucksingh S, Mackie ADR, Burt D, et al. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet 1990;335:106063. 11. Davis RH, Parker WL, Murdoch DP. Aloe vera as a biologically active vehicle for hydrocortisone acetate. J Am Podiatric Med Assoc 1991;81:19.
http://www.chelationtherapyonline.com/anatomy/p13.htm

Laxatives: OTC Products for Constipation


This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals. What types of OTC products treat constipation?
Over-the-counter (OTC) products are medicines you can buy without a doctors prescription. Many products are advertised to relieve constipation, including bulk-forming laxatives, lubricants, stool softeners, saline laxatives, stimulant laxatives and combinations. .

Laxative Type

Bulk-Forming

Generic Name
Methylcellulose Polycarbophil Psyllium

Brand Name(s)

Citrucel FiberCon Metamucil Glycerin suppository (generic)

Lubricating Glycerin

Mineral oil Mineral oil (generic) Magnesium hydroxide (milk of magnesia) and mineral oil Phillips MO Stool Softeners Docusate sodium Saline Magnesium hydroxide (milk of magnesia) Ex Lax Milk of Magnesia Senna Senokot Stimulant Free Liquid Laxative/Antacid, Phillips Chewable Tablets, Phillips Milk of Magnesia Ex Lax Ultra, Dulcolax Bowel Prep Kit, Gentlax Colace, Dulcolax Stool Softener, Phillips Liqui-Gels

Stimulant Bisacodyl Sodium bicarbonate and potassium bitartrate Sennosides Castor oil Senna Ceo-Two Evacuant Ex Lax Laxative Pills Purge Sennosides

How do laxatives work?


Bulk-forming laxatives add bulk and water to your stools. The larger stools help trigger the bowel to contract and move the stools out. You must use bulk-forming laxatives daily for them to work. Start slowly and drink plenty of fluids. Gradually increase how much you use to reduce the chance of having any side effects. Lubricant laxatives work by coating the surface of the stools. This helps the stools hold in water so they move out of the body more easily. Glycerin suppositories lubricate the inside of the anus (the outside opening to the intestine) to make it easier to pass hard stools. Stool softeners help mix fluid into stools to soften them. This makes stools easier to pass out of the body. Saline laxatives draw fluid into the bowel from nearby tissue. This softens stools and helps the bowel move them out. Stimulant laxatives are the harshest laxatives. They cause the bowel to squeeze or contract to move the stools out. Stimulant laxatives should generally be used only when your doctor recommends them, such as if youre preparing for a bowel exam or if youve just had surgery and shouldnt strain to have a bowel movement.

Should I use a laxative to treat constipation?


Most of the time, constipation doesnt require treatment with laxatives. It will go away on its own or if you make changes in your diet and other habits. For example, you can treat constipation by eating enough fiber, drinking enough fluids and getting enough exercise. SeeConstipation: Keeping Your Bowels Moving Smoothly for more information. Laxatives arent meant for long-term use. Dont use laxatives for longer than 1 week unless youre following your doctors advice. Long-term use or overuse of laxatives can cause health problems. Also, using laxatives too much may hide symptoms that would be important for your doctor to know about. This could delay finding out about problems you have and delay the treatment you need. One exception is bulk-forming laxatives. They can be used on a daily basis to help ease symptoms of irritable bowel syndrome, hemorrhoids and other bowel problems.

Choking Warning
Bulk-forming laxative pills must be taken with enough water to prevent choking. These pills can get caught in your throat or esophagus and swell. If you have problems swallowing, opt for a liquid version of bulk-forming laxative (powder or granules dissolved in water or another drink) instead. Follow the label directions carefully. If you have any chest pain, vomiting, or problems breathing or swallowing after taking the product, get medical help right away.

What are some common side effects of laxatives?


Most laxatives dont have side effects if you use them correctly. Sometimes they can cause cramping, gas, bloating, nausea or diarrhea. Stimulant laxatives are most likely to cause side effects. These can include abdominal discomfort, faintness and cramps. With bulk-forming laxatives, you may notice some bloating, gas or cramping at first. This is more likely if you take too much or increase the amount youre using too quickly. These symptoms should go away in a few weeks or less. If mineral oil is accidentally aspirated (breathed into the lungs), it can cause a type of pneumonia. Older adults or anyone who might have trouble swallowing generally shouldnt use this type of laxative.

Who shouldnt take laxatives?


Dont take laxatives if you have an allergy to any of the ingredients. Some people may be allergic to psyllium, a key ingredient in one type of bulk-forming laxative.

Phenylalanine is another example of an ingredient that can cause a problem for certain people. If you have a condition called phenylketonuria, you shouldnt take a laxative that contains phenylalanine. Other ingredient-related warnings concern your diet while youre taking a laxative. Unless your doctor tells you its OK, dont use products that contain sodium bicarbonate and potassium bitartrate if youre on a low-salt diet. Dont take magnesium hydroxide if youre following a magnesium-restricted diet. Look on the label in the Active Ingredient and Inactive Ingredient sections to find out what ingredients each product contains. If you have any questions, talk to your family doctor or pharmacist.

Could laxatives cause problems with any medicines or supplements I take?


Yes. Laxatives can get in the way of how your body absorbs certain medicines and some nutrients. In general, dont take any other medicines within 2 hours of taking a laxative. If youre taking a prescription medicine of any kind, talk to your doctor before taking a laxative. You also shouldnt mix different types of laxatives. Dont take bisacodyl within 1 hour of taking antacids or drinking milk. While mineral oil and castor oil may have their place as laxatives, they shouldnt be used often. If mineral oil is used often, it can cause deficiencies of vitamins A, D, E and K. Castor oil can also lead to serious problems if its used regularly.

Should I call my doctor for any other reasons?


If you have any of the following symptoms, talk to your doctor before using a laxative: Stomach pain, nausea or vomiting Kidney disease A sudden change in your bowel habits that has gone on for 2 weeks Stop taking laxatives and call your doctor if you have any bleeding from your rectum (the last part of the large intestine) or if you dont have a bowel movement after using a laxative. These could be signs of a more serious problem.

What if I've been using laxatives for a long time?


You may have to retrain your body to go without laxatives if youve been using them for a long time. This means eating plenty of fiber and using a bulk-forming laxative, drinking lots of water, exercising and giving yourself time to have a bowel movement.

If youve used laxatives for a long time, your family doctor may suggest that you wean yourself off of them slowly to give your system a chance to return to normal. Be patientit may take many months for your bowels to get back to normal if you've been using laxatives regularly. Talk with your family doctor about any concerns you have.

What should I look for on the drug label?


When choosing an OTC medicine to treat constipation, check the drug label for possible side effects or interactions with other drugs youre taking. This information will appear in the Warnings section of the label. Be sure to check that youre not taking two medicines that contain the same ingredient. Youll find this information in the Active Ingredient section. Also check the label to make sure the product doesnt contain anything that you might be allergic to. Always read and follow the directions on the label. Be sure you understand what the label says before taking the medicine. If you have any questions, ask your family doctor or pharmacist.

More Information
OTC Guide

Antacids and Acid Reducers Antidiarrheals Antiemetic Medicines Antihistamines Cough Medicine Decongestants Herbal Products and Supplements Pain Relievers Vitamins and Minerals

Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 12/06 Created: 09/05

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Antidiarrheal Medicines: OTC Relief for Diarrhea


This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals.

What types of OTC drugs treat diarrhea?


Over-the-counter (OTC) drugs are medicines you can buy without a prescription from your doctor. Some OTC drugs can help you feel better if you have diarrhea. These are called antidiarrheal drugs. These include loperamide (one brand name: Imodium) and bismuth subsalicylate (brand names: Kaopectate, Pepto-Bismol). Bismuth subsalicylate can also be used for upset stomach and as an antiemetic(a medicine that treats nausea and vomiting). Depending on the cause of your diarrhea, you may also need to take antibiotics prescribed by your doctor. Antibiotics are medicines that kill bacteria. For example, travelers

diarrhea (diarrhea caused by eating food and drinking water that contain germs) may
require antibiotics. If your doctor prescribes an antibiotic for you, its important to talk to your doctor before taking any OTC medicine to relieve your symptoms.

How do antidiarrheal medicines work?


Loperamide works by slowing down the speed of fluids moving through your bowels. Bismuth subsalicylate works by balancing the way fluid moves through your bowels. It also binds toxins (poisons) from bacteria so that they are not harmful and helps kill germs.

Should I treat diarrhea?


Most of the time, diarrhea doesnt require treatment. It most often lasts only a couple of days whether you treat it or not. However, medicine can help you feel better, especially if you also have cramping.

What are some common side effects of antidiarrheal drugs?


Side effects from antidiarrheal drugs arent common for healthy adults. Side effects may be a concern for older adults or people who have health problems. If side effects occur with antidiarrheal medicines, theyre usually very minor. For example, too much loperamide can lead to constipation. Sometimes people who use loperamide have crampy pain. Bismuth subsalicylate can cause your tongue or stool to turn dark. This is a short-term side effect.

Who shouldnt take these drugs?


Dont take loperamide if youve ever had a rash or other signs of an allergic reaction when taking it. Also, dont use loperamide if you have bloody or black stools. These may be signs of a more serious problem, so talk to your doctor. Dont take bismuth subsalicylate if youve ever had an allergy to aspirin or any other product that contains salicylates. Also, dont give bismuth subsalicylate to children who may have the flu or chickenpox because they will have a higher risk of Reyes Syndrome.

Can OTC antidiarrheal drugs cause problems with any other medicines I take?
If certain drugs are taken at the same time, they may interact with each other and change the way your body processes them. This is called a drug interaction. When this happens, the risk of side effects increases. Bismuth subsalicylate may affect some drugs so that they dont work as well. It also may cause side effects if combined with other drugs. If you take any of the following drugs, talk to your doctor before taking bismuth subsalicylate: Blood-thinning drugs Drugs to treat gout Drugs to treat arthritis Drugs for diabetes

Also, check with your doctor before taking bismuth subsalicylate if you take pain

relievers, cold products or some prescription drugs. These medicines may contain aspirin,
which is a salicylate, or they may contain some other type of salicylate. Because bismuth subsalicylate also contains salicylate, you may take more salicylate than you intend if you take more than one of these products. The Know

Whats in the Medicines You Take chart (PDF file: 6 pages / 75 KB. More about PDFs.) can help sort out which drugs contain aspirin so you can avoid
taking too much.

Should I call my doctor for any other reasons?


If you have a fever, mucus or blood in your stools, or a history of liver disease, talk to your doctor before taking an antidiarrheal. Also, if your diarrhea goes on for more than 2 days, call your doctor. Dont keep trying to treat it on your own. Diarrhea that goes on for more than 2 days may be caused by something more than a short-term bug. You may need an antibiotic prescribed by your doctor to help clear it up or it may be a sign of another problem that needs to be checked.

What should I look for on the drug label?


When choosing an OTC medicine to treat diarrhea, check the drug label for possible side effects or interactions with other drugs youre taking. This information will appear in the Warnings section of the label. Be sure to check that youre not taking two medicines that contain the same ingredient. Youll find this information in the Active Ingredient section. Always read and follow the directions on the label. Be sure you understand what the label says before taking the medicine. If you have any questions, ask your family doctor or pharmacist.

Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 12/06 Created: 09/05

http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/855.html

Antacids and Acid Reducers: OTC Relief for Heartburn and Acid Reflux
This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals.

What types of OTC products treat heartburn?


Over-the-counter (OTC) products are medicines you can buy without a doctors prescription. Many OTC products are advertised to relieve heartburn or acid reflux. These include antacids, bismuth subsalicylate, H2 blockers, proton pump inhibitors and combination medicines. Combination medicines may include two or more of the following drugs. Download the PDF below for some examples of these products.

How do antacids and acid reducers work?


Antacids neutralize the acid in your stomach. They can provide fast, short-term relief. Many OTC drugs combine different antacids. H2 blockers reduce the amount of acid your stomach makes. While they dont relieve

symptoms right away, H2 blockers relieve symptoms for a longer period of time than antacids. Some products combine antacids and an H2 blocker. One example combines famotidine, calcium carbonate and magnesium hydroxide (brand name: Pepcid Complete). These combination medicines can relieve symptoms right away and the relief can last for many hours. Bismuth subsalicylate works by balancing the way fluid moves through your bowels. It also binds toxins (poisons) from bacteria so that they are not harmful and helps kill germs. Its also used as an antiemetic (medicine to treat nausea and vomiting) and as an antidiarrheal(medicine to treat diarrhea). Proton pump inhibitors stop your bodys production of acid. This type of drug requires 1 to 4 days to work. Only people who have heartburn oftenat least 2 days a weekshould use this drug. To find out which product is right for you, talk to your doctor.

What problems can OTC antacids and acid reducers help?


These medicines can help relieve heartburn or dyspepsia (pain or an uncomfortable feeling in the upper middle part of your stomach). Heartburn is also called acid reflux disease or gastroesophageal reflux disease (GERD). OTC antacids and acid reducers may also be used as part of a plan to treat ulcers. For treating ulcers, these medicines may be used together and/or combined with antibiotics (drugs that kill bacteria) prescribed by your doctor. If you arent getting enough calcium from your diet, your doctor might suggest that you take additional calcium to help treat or preventosteoporosis. Antacids that contain calcium carbonate can be used with vitamin D to supplement the calcium in your diet.

What are some common side effects of heartburn medicines?


Antacids and acid reducers usually cause only minor side effects that go away on their own. These may include headaches, nausea, constipation or diarrhea. Bismuth subsalicylate can cause your tongue or stool to turn dark. This is a short-term side effect. If side effects make it hard for you to take medicine for heartburn, talk to your family doctor. He or she may suggest a different drug or have ideas about how to make the side effects less of a problem.

Who shouldnt take OTC antacids and acid reducers?


Dont take these drugs if you have an allergy to any of the ingredients. Phenylalanine is an example of an ingredient in some antacids that can cause a problem for certain people. If you have a condition called phenylketonuria, you shouldnt take a medicine that contains

phenylalanine. Dont take bismuth subsalicylate if youve ever had an allergy to aspirin or any other product that contains salicylates. Also dont give bismuth subsalicylate to children who may have the flu or chickenpox because they will have a higher risk of Reyes Syndrome. Other ingredient-related warnings concern your diet while youre taking an antacid or acid reducer. For example, unless your doctor tells you its OK, dont use products that contain sodium bicarbonate or aluminum hydroxide and magnesium carbonate if youre on a low-salt diet. Dont take magnesium hydroxide if youre following a magnesium-restricted diet. If you have kidney disease, you shouldnt use products containing calcium carbonate or aluminum hydroxide and magnesium carbonate without your doctors recommendation.

Can OTC antacids or acid reducers cause problems with any other medicines I take?
If certain drugs are taken at the same time, they can react with each other and change the way your body processes them. This is called a drug interaction. When this happens, the risk of side effects increases. Dont use more than one antacid or acid reducer at a time. Dont mix acid reducers and antacids without first talking to your doctor. If you take any prescription drugs and youre thinking about taking an antacid, H2 blocker or proton pump inhibitor, talk to your doctor first. These drugs can cause problems with other medicines you take. The following drugs may be of special concern for people who are taking H2 blockers or proton pump inhibitors: Theophylline (oral asthma drug) Warfarin (brand name: Coumadin) (blood-thinning drug) Phenytoin (brand name: Dilantin) (seizure drug) Prescription medicine for fungal or yeast problems Diazepam (anxiety drug) Digoxin (heart drug)

Bismuth subsalicylate may affect some drugs so that they dont work as well. It also may cause side effects if combined with other drugs. If you take any of the following drugs, talk to your doctor before taking bismuth subsalicylate: Blood-thinning drugs Drugs to treat gout Drugs to treat arthritis Drugs for diabetes

Also, check with your doctor or pharmacist before taking bismuth subsalicylate if you take pain relievers, cold products or some prescription drugs. These medicines may contain aspirin, which is a salicylate, or they may contain some other type of salicylate. Because bismuth subsalicylate contains salicylate, you may take more salicylate than you intend if you take more than one of these products. The Know

Whats in the Medicines You Take chart (PDF file: 6 pages / 75 KB. More about PDFs.) can help sort out which drugs contain aspirin so you can avoid
taking too much.

Should I call my doctor for any other reasons?


Before taking an antacid or acid reducer, talk to your doctor if you have any of the following symptoms: Trouble or pain when you swallow Bloody vomit Bloody or black stools Ongoing stomach pain Lightheaded, dizzy or sweaty feeling Chest pain, shoulder pain, or pain that spreads to your arms, neck or shoulders with shortness of breath Weight loss for no reason Nausea or vomiting Wheezing (youll hear a squeaky or musical sound in your chest) Heartburn that has lasted more than 3 months

You should stop using antacids or acid reducers and call your doctor if any of the following are true: Your stomach pain doesnt get better when you use the medicine, or it gets worse. You need to take the medicine for more than 14 days. Youre taking Omeprazole (brand name: Prilosec) and feel like you need to take more than 1 course in 4 months. Dont try to treat yourself if you have any of these symptoms. They may be signs that you have an ulcer or a more serious problem that needs to be checked by your doctor.

What should I look for on the drug label?


When choosing an OTC antacid or acid reducer, check the drug label for possible side effects or interactions with other drugs youre taking. This information will appear in the Warnings section of the label. Be sure to check that youre not taking two medicines that contain the same ingredient. Youll find this information in the Active Ingredient section.

Always read and follow the directions on the label. Be sure you understand what the label says before taking the medicine. If you have any questions, ask your family doctor or pharmacist.

Source
Written by familydoctor.org editorial staff.
American Academy of Family Physicians
Reviewed/Updated: 12/06 Created: 09/05

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