The Pharmacist's Corner

[DEVILsSON]

I got nose bleeds when I took high dosages of fish oil ~12-15 g (1g per pill of standard 180/120 EPA/DHA), especially when I took aspirin for flu. I stopped taking it for a time and reduced the fish oil dosages to <10g and nosebleeds stopped even with occassional aspirin usage.

In all seriousness the questions XM asked as an example are probably the typical questions pharmacists deal with and I'd venture to say that those questions are in Wya's area of expertise.

[wyandotterph]

Originally Posted by XMoker

Food pyramid/AHA nutrition for the sick/recovering and the "average American" or sport nutrition for the performance athlete? That's what it boils down to, I think. Half of that food pyramid and AHA bullshit is counter-intuative to the goals of 99% of the readers here.

Stick to what you know and this will be a better place...

I'll even make up some questions that might apply here to get us started.

1.) Sometimes my codine painkiller makes me itch, why?
2.) How should I store my medications? Is it okay to keep a small bottle in my car during the winter/summer months? What about the fridge or in the bathroom medicine cabinet?
3.) Besides bathing in Purell, are there more reasonable topicals that limit my chances of contracting Staph, Ringworm and other conditions after mat time? Do "Defense Soap" products actually help?
4.) Are there instances of generics not being as effective as name brands? The active ingredients are the same right? What about the fillers? Do sub-par fillers alter the release time causing too fast/slow absorption?
5.) My pills say to take with a meal, is a glass of grapefruit juice or milk good enough?

1. codeine is an opiate, and opiates cause a histamine release from mast cells but its not IgE mediated so its not truly an allergy just the itching/redness part. Benadryl or claritin usually fixes this. Sometimes we switch to a different opiate and that does the job.

2. Medications should always be stored in a cool dry place. Cars and bathrooms are not ideal places for medications. Cars freeze and super heat in their respective months, and bathrooms are too moist. If you have a medication that needs to be refridgerated, do not freeze it.

3. Staph, nothing really except being clean. Ringworm possibly, you can pretreat or postreat yourself the same way I described before for athletes foot. I dont know how comfortable you are rubbing down with lotrimin or spraying down with tinactin all over, but its a possibility.

4. Generic drugs do have the same active ingredients as the brand names however the laws on them allow for a 20% window of Therapeutic equivalencey. So basically there is an 80%-120% window for generic medications to fall into. This may sound scary because lets say that you take 100mg of drug X, drug X now has a generic drug Y. Drug Y comes in 100mg dose as well, but actually you could be getting as little as 80mg or as much as 120mg. Now before people start losing it and demanding brand name medications, you have to remember that the brand name drug also has a window, and you dont get exactly 100mg in every dose. That being said the 20% window that generics have is not detrimental to your health or treatment. The only thing we suggest is that on narrow therapeutic window drugs (these are what we call drugs that have a narrow border between being healthy and toxic or what we call drugs that have a narrow window of effectiveness like seizure medications you are either seizure free on a dose or not there is no real inbetween) we suggest that patients do not abruptly switch. So if you are on drug X, and its a seizure medication, we do not suggest and abrupt change to drug Y. All that being said generic drugs are safe and effective, and are regulated just as stringently as brand name drugs. If we didnt have generic drugs in America, millions of people would go without treatment because of cost.

5. If your pills say take with a meal, then take with a meal. Milk is sometimes a good substitute, and drugs that can be taken with a meal or milk will usually say so. Other drugs that strictly must be taken with food i.e. griseofulvin will indicate that milk may not be enough. Grapefruit juice is not enough for a number of reasons. The first is that grapefruit juice does not offer the calories and fat that mild does, so it doesnt really constitute a meal, furthermore there are a number of drugs that interact with grapefruit/grapefruit juice causing drugs to rise in the body to toxic levels. Orange juice and other citrus juices are ok, just grapefruit juice (there is a specific enzyme in it which causes the interactions).

[wyandotterph]

Originally Posted by stewy37

Actually, these are all relative questions I wouldn't mind seeing an answer to. How about it? Make this thread actually useful.

Here's another. I take 50mg of Trazadone HCL before bed as well as 30mg of Mirtazapine. Most of the time there is no problem. I get 7-8 hours of sleep and than I'm up and about no problem. Sometimes, there are occasions where it seems to hit me extremely hard. Like I'm knocked out for 12 hours and still groggy for hours after waking. I have no idea why this happens, but it's obviously a problem when it does as it gets in the way of school, work, and life in general. Any ideas of what might cause this?

First I need to know why you take these medications, if you dont want your business out there fell free to PM me, but here is some information that might help you.

Food plays a big role with trazodone. If you eat before you take it there may be an increase in the amount of drug absorbed, a decrease in maximum concentration of the drug, the time it takes to reach the maximum concentration increases. The amount of the drug in your system reaches its max at approximately one hour after you take the drug if it is taken on an empty stomach or two hours after dosing when taken with food. So if you eat some days or have a bigger meal some days, the drug will stay in your system longer, making it harder for you to wake up, and giving you that groggy feeling.

As far as the remeron goes (mirtazipine) the half life of this drug is between 20-40 hours, this means that at that time only half the drug is out of your system. This could potentially lead to a build up effect in your blood causing you to be more drowzy on some days and less on others. Furthermore they both interact with seratonin, and both require the CYP450 system for metabolism, you might just need your dosing adjusted, call the doctor that prescribed the medication.

[XTrainer]

Originally Posted by wyandotterph

1. codeine is an opiate, and opiates cause a histamine release from mast cells but its not IgE mediated so its not truly an allergy just the itching/redness part. Benadryl or claritin usually fixes this. Sometimes we switch to a different opiate and that does the job.

2. Medications should always be stored in a cool dry place. Cars and bathrooms are not ideal places for medications. Cars freeze and super heat in their respective months, and bathrooms are too moist. If you have a medication that needs to be refridgerated, do not freeze it.

3. Staph, nothing really except being clean. Ringworm possibly, you can pretreat or postreat yourself the same way I described before for athletes foot. I dont know how comfortable you are rubbing down with lotrimin or spraying down with tinactin all over, but its a possibility.

4. Generic drugs do have the same active ingredients as the brand names however the laws on them allow for a 20% window of Therapeutic equivalencey. So basically there is an 80%-120% window for generic medications to fall into. This may sound scary because lets say that you take 100mg of drug X, drug X now has a generic drug Y. Drug Y comes in 100mg dose as well, but actually you could be getting as little as 80mg or as much as 120mg. Now before people start losing it and demanding brand name medications, you have to remember that the brand name drug also has a window, and you dont get exactly 100mg in every dose. That being said the 20% window that generics have is not detrimental to your health or treatment. The only thing we suggest is that on narrow therapeutic window drugs (these are what we call drugs that have a narrow border between being healthy and toxic or what we call drugs that have a narrow window of effectiveness like seizure medications you are either seizure free on a dose or not there is no real inbetween) we suggest that patients do not abruptly switch. So if you are on drug X, and its a seizure medication, we do not suggest and abrupt change to drug Y. All that being said generic drugs are safe and effective, and are regulated just as stringently as brand name drugs. If we didnt have generic drugs in America, millions of people would go without treatment because of cost.

5. If your pills say take with a meal, then take with a meal. Milk is sometimes a good substitute, and drugs that can be taken with a meal or milk will usually say so. Other drugs that strictly must be taken with food i.e. griseofulvin will indicate that milk may not be enough. Grapefruit juice is not enough for a number of reasons. The first is that grapefruit juice does not offer the calories and fat that mild does, so it doesnt really constitute a meal, furthermore there are a number of drugs that interact with grapefruit/grapefruit juice causing drugs to rise in the body to toxic levels. Orange juice and other citrus juices are ok, just grapefruit juice (there is a specific enzyme in it which causes the interactions).

Originally Posted by wyandotterph

First I need to know why you take these medications, if you dont want your business out there fell free to PM me, but here is some information that might help you.

Food plays a big role with trazodone. If you eat before you take it there may be an increase in the amount of drug absorbed, a decrease in maximum concentration of the drug, the time it takes to reach the maximum concentration increases. The amount of the drug in your system reaches its max at approximately one hour after you take the drug if it is taken on an empty stomach or two hours after dosing when taken with food. So if you eat some days or have a bigger meal some days, the drug will stay in your system longer, making it harder for you to wake up, and giving you that groggy feeling.

As far as the remeron goes (mirtazipine) the half life of this drug is between 20-40 hours, this means that at that time only half the drug is out of your system. This could potentially lead to a build up effect in your blood causing you to be more drowzy on some days and less on others. Furthermore they both interact with seratonin, and both require the CYP450 system for metabolism, you might just need your dosing adjusted, call the doctor that prescribed the medication.

Now THESE strike me as useful posts.

As a follow-up question, see the part highlighted in red. This is a purely speculative question on my part, but in your opinion, are there any potential problems from transdermal absorption if the medication is used like this chronically?

[Sinister]

Hey X...since wyan has been a very good Sport about all this, I propose we close and archive this thread, and re-open a proper "Pharmacist's Corner" thread as a sticky, left open for questions on an on-going basis.

[Stormbringer]

Originally Posted by Sinister

Hey X...since wyan has been a very good Sport about all this,

I agree. There is an incredibly large amount of stuff that can be studied online and read in journals and different papers online and whatnot, but at the same time there is a huge amount of important information that could be gained from having someone with the background of a pharmacist being open to general questions. I think it's a really cool idea myself.

[Sinister]

I'd do it myself, but I'll leave it to X since he and wyan had the most discourse.

[wyandotterph]

Originally Posted by XTrainer

Now THESE strike me as useful posts.

As a follow-up question, see the part highlighted in red. This is a purely speculative question on my part, but in your opinion, are there any potential problems from transdermal absorption if the medication is used like this chronically?

Sure, there are always problems associated with anything. The biggest one that comes to mind with using say topical lotrimin everyday in the same spots for a long period of time is resistance. Although fungus arent as resistant certain forms of bacteria, ie MRSA, they can become resistant to anti fungals. Also if you put antifungal creams on everyday and workout you increase the absorption into your system. Now this may take a long period of time, and consist of many tubes of lotrimin, but it is possible.

[XTrainer]

Originally Posted by Sinister

I'd do it myself, but I'll leave it to X since he and wyan had the most discourse.

I'd be totally for that.