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Medications

In December 2007, our guest expert in Le Club's Ask the Expert segment was Dao Le, a pharmacist at Montfort Hospital in Ottawa.

After having studied at the Université Laval in Quebec, Dao received her undergraduate degree in pharmacy (Baccalauréat en pharmacie).  Following graduation, she did a residency in hospital pharmacology at the Université de Montreal.

Dao has worked for several years at the Montfort hospital. She now works as part of the interdisciplinary team in surgery and obstetrics and gynecology. She practices pharmaceutical care, reviewing the drug treatments for patients in those departments. Dao is also working on treatment protocols related to these two disciplines.

Dao is fluent in French and English. She is married and has two children.

Here are Dao’s answers to your questions on Medications:

Q: I was diagnosed with hypothyroidism 23 years ago when I was 40. I take Eltroxin. What’s the difference between taking Eltroxin and Synthroid for this condition?


A: There is no major difference between the two drugs Eltroxin and Synthroid. Both contain the same active ingredient called levothyroxine. The non-active ingredients may vary, but this has no effect on the drugs’ efficacy. Eltroxin is produced by the company GlaxoSmithKline, while Synthroid is made by Abbott.

 


Q: I was diagnosed with celiac disease in 1996, as well as some other disorders (thyroid, osteopenia). I now have fatty liver. I am taking the following medications and supplements: Diovan, Synthroid, vitamin E, selenium, a multivitamin, calcium, zinc and coenzyme Q10. Could any of these contribute to fatty liver?

A: Fatty liver disease is associated with alcoholism, metabolic abnormalities (such as excess body weight, type 1 diabetes and high levels of triglycerides in the blood), toxins, pregnancy and some types of drugs (see below). There is no literature to indicate that the medications you are taking contribute to fatty liver. Risk factors include:

  • Autoimmune disorders such as type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease
  • Abdominal surgery: Any operation that involves removing a significant portion of the digestive tract (small intestine), thus causing serious weight loss, carries a high risk.
  • Medications: including prednisone, hydrocortisone, Premarin, amiodarone, Tamoxifen, methotrexate

Other medical conditions:

  • Family history of metabolic disorders
  • Malnutrition

 



Q: Can long-term use of antidepressants affect a person's memory and/or cognitive abilities?


A: Antidepressants relieve many symptoms of depression, including insomnia, fatigue, lack of energy and a diminished ability to concentrate or think, etc. As a result, antidepressants have a positive impact on memory and cognitive ability. However, improvements in memory and cognitive ability occur later on, generally three or four months after treatment has begun.

 


Q: Some medications must be taken either one hour before or two hours after eating. Why? If you have to eat within 1/2 hour, is it worth taking the medication at all? Does it become less effective or is it dangerous to take?

A: There are several reasons why people are advised to take certain medications on an empty stomach (either one hour before or two hours after a meal) :

  • Food may reduce or slow down absorption of the drug, causing it to become less effective;
  • There is an interaction between your food and the drug in question: the drug attaches itself to various nutrients and prevents the drug from being absorbed. When this occurs, the risk that the drug will become less effective increases;
  • Some medications, including Pantoloc, Losec, Pariet and Prevacid, are more effective when they are taken 30 to 60 minutes before a meal. This allows the drugs to be absorbed into the blood and to travel to the site of action (stomach, duodenum) at the very moment the food is stimulating the production of gastric acid, which is a key cause of abdominal pain. The important thing is to take the drug and to do so at the same time every day if possible.

 


Q: I have been advised to take the antihistamine Aerius daily for my eczema. Are there any health risks or side effects associated with taking antihistamines on a long-term daily basis? 

A: The common side effects of antihistamines such as Aerius are:

  • Headaches: more than 10 percent of patients;
  • Fatigue: 2 to 5 percent of patients;
  • Drowsiness;
  • Dizziness: 2 percent of patients;
  • Dry mouth or dry throat;
  • Muscle pain: 2 to 3 percent of patients;
  • Mood changes;
  • Difficulty concentrating;
  • Nervousness;
  • Nausea;
  • Heart rhythm changes.

If you experience any unusual side effects such as shortness of breath, rapid heartbeat or skin rash, consult your physician. Also, if the side effects persist, call your pharmacist or physician.

In general, the common side effects diminish as your body adjusts to the medication and the drug is well tolerated. Not all patients experience these side effects.

 



Q:
I am currently taking Prometrium 100 mg (two tablets at night and estradial along with Cyclomen. Would any of these medications trigger migraine headaches?  I have always suffered from migraines, but since taking Prometrium I have noticed that I am getting really bad headaches that last for days.

A: Prometrium can cause headaches in 10 to 31 percent of patients. Estradiol can also cause headaches in 3 to 5 percent of patients. Treatment with estradiol can exacerbate migraines.

 


Q: I have been on four different oral contraceptives in the past 2 years (Ortho-Tricyclen Lo, regular Ortho-Tricyclen, Marvelon and Yasmin). Each kind makes me start spotting during the second week of pills, up until my period. My doctor has me taking Premarin throughout my cycle, which he has been shortening by having me take a birth control placebo four days out of seven. I have tried taking 1000 mg of vitamin C to improve absorption. I take my pills at the same time every day and never miss one. Nothing has worked to stop the spotting. I'm 22. I took Ortho-Tricyclen six years ago without a problem, but I think they changed the pill’s composition. Any ideas?


A: The composition of Tricyclen has not changed from when you were initially taking it. Spotting affects 10 to 30 percent of women using oral contraceptives. Spotting occurs during the first three months of use and generally stops over time. This is the number one reason why women stop taking oral contraceptives. A pill that is ill suited to the patient often causes spotting, especially if it contains a high dose of progestins. Progestins cause the uterine lining (endometrium) to become thinner. When the endometrium is thin, it becomes fragile and bleeds at the slightest contraction of the uterus. This is a problem because the uterus is constantly contracting.

It’s possible to decrease spotting by switching to a more estrogen-based pill. As well, NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen reduce uterine contractions.

Other options:

Estrogen supplementation:

  • Premarin: 0.625 mg, once a day for 28 days.
  • Estradiol-17B patch: 50 mcg or 100 mcg, once a day for 25 days.
  • Micronized estradiol 17B tablets: 1 or 2 mg, once a day for 28 days.
  • Low-dose contraceptive pill.

Obviously, there are effective non-hormonal methods available as well.

 


Q: I have been on various pain medications since November 16, 2007, including Tylenol 3, Demerol, Percocet and morphine plus Gravol. I take these as needed for the extreme pain caused by cysts in my ovaries. It hurts to sit, to climb stairs or hills and to bend down to put on my socks. I'm worried about side effects. I live in Bella Bella on the coast of BC, so finding a second opinion is not an option. How long can I be on these types of medications?

A: Demerol, Percocet, Tylenol 3 and morphine are narcotic analgesics (pain killers).

The most frequently reported side effects of narcotics are: nausea, vomiting, drowsiness, dizziness, rash, constipation, dry mouth, confusion, agitation, urinary retention and euphoria. The nausea, vomiting and drowsiness diminish over time.

To avoid constipation, it is generally recommended that a laxative such as Colace or Senokot be taken.

The risk of side effects increases if you take several narcotics at the same time or if you take other medications that affect the central nervous system.

You can use narcotics to relieve pain as long as your pain persists. However, narcotics do not relieve all types of pain. Other drugs, such as NSAIDS (non-steroidal anti-inflammatory drugs such as acetaminophen), can help relieve your pain.


Q: I have to take cortisone at this time for inflammation. I would like to know what the maximum and minimum doses for sinus inflammation are. How is this medication prescribed and how is it taken?

A: I assume you are taking nasal corticosteroids for your sinus inflammation problem.

The minimum dose for relieving symptoms of sinus inflammation depends on their severity; in other words, the dose depends on the degree of inflammation present.

Studies about the use of nasal corticosteroids have shown minimal additional benefits when a dose higher than the usual recommended dose is used.

Nasal corticosteroids available in Canada with their usual dosing schedule:

  • Nasocort: 2 shots of spray once a day.
  • Beconase AQ: 1 spray twice a day.
  • Rhinocort AQ: 2 sprays once a day.
  • Rhinalar: 2 sprays twice a day.
  • Flonase: 2 sprays once a day.
  • Nasonex: 2 sprays once a day.

These dosing schedules relieve most nasal inflammations. Some symptoms disappear after a single day of treatment. Nasal corticosteroids may take a few days or weeks to achieve their maximum effect. For better symptom control, regular use is recommended.

Instructions for using nasal corticosteroids:

  • Shake the bottle well before each use.
  • If you are using your sprayer for the first time, start the pump by pressing down six or seven times until you obtain a fine mist.
  • Blow your nose gently in order to clear out your nostrils.
  • Block one nostril at a time with a finger.
  • Tilt your head slightly forward or hold it straight.
  • Keeping the bottle upright, point the sprayer nozzle towards the inner wall of the nostril and not towards the septum (rigid tissue separating the nostrils).
  • Press down firmly one time.
  • Breathe the mist in slowly and gently while keeping the mouth closed.
  • Repeat this process for the other nostril.

 


Q: My question is: has any woman said anything about a change in the smell of the urine while being on the birth control patch Ortho Evra? I have noticed a distinct off smelling when I go to the bathroom.

A: Hormonal contraceptive patches and birth control pills have similar side effects.

The patch can cause skin reactions such as redness.

The side effects of contraceptive patches and birth control pills include the following: irregular bleeding, breast discomfort, headaches, weight gain and nausea.

In my research, I have not found that the birth control patch causes a change in the odour of urine.

 


Q: I have been on the antidepressant and anti-obsessional medication clomipramine for almost 15 years. I am now 36 and suffering from infertility. As far as I can understand, clomipramine can raise the prolactin level. My doctor has already used Dostinex to help lower my prolactin level but my infertility persists and my doctor does not know why.

The only time I got pregnant was when my clomipramine dosage was very low. Does clomipramine affect infertility in more ways than raising the prolactin level?

A: Clomipramine can indeed cause hyperprolactinemia (increase in prolactin level), which can interfere with ovulation. The drug can also cause menstrual irregularities in women and ejaculation problems in men.

 


Q: I'm experiencing problems with my blood pressure. Although I am taking Diovan and propranolol my blood pressure is 170 over 115. I have a family history of hypertension so it doesn't suprise me!  My question is: do SSRIs, such as Cipralex, contribute to high blood pressure? I've been taking an SSRI for about seven years to help with depression. In that time I've gained a lot of weight and am struggling with high blood pressure. 

A: Yes, Cipralex can contribute to an increase in blood pressure in about 1 percent of patients. Cipralex can also cause weight gain, which in turn contributes to the increase in blood pressure.

 

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