The current options on the market for oral treatment of erectile dysfunction include:

1) Staxyn (vardenafil -oral disintegrating) -10mg 60 minutes before sexual activity.  Don’t chew, crush or break.  Best to take it without liquids; lasts ~4 hours

2) Levitra(vardenafil)-5-20mg 60 minutes before sexual activity; best to take on empty stomach; lasts ~4 hours

3) Viagra(sildenafil) -the original “blue pill”; 25-100mg 60 minutes before sexual activity; best to take on empty stomach; lasts ~4 hours (for some men it may lasts as long as 8-12 hours)

5) Cialis(tadalafil)-10-20mg 60minutes before sexual activity OR 2.5-5mg daily; take without regard to food; lasts ~36 hours

Common side effects for all of the medications: headache, flushing, runny nose, belly ache and back pain.  There are lots of drug interactions so first check with your physician and pharmacist.  They interact with drugs used to treat BPH and all of these meds should not be used if you are being treated with nitrates.

Studies show that they all work equally well and share most of the side effects.  Cost, ease of use, duration and patient preference help you and your physician decide what drug will work best for you.

Finally, what is the whole 4 hour erection thing all about?  Well, it is called priapism(which if you are a True Blood fan, Jason had a case of priapism during the first season).  It is a prolonged, painful erection lasting more then 4 hours without sexual stimulation.  It is due to blood being trapped and unable to drain from the penis.  It can be permanently damaging to the penis if not treated.  Priapism must be treated by a physician immediately.  Fun fact, priapism can also be caused by scorpion bites!

We would love some comments about which medication you feel works best!  So if you have any questions or comments please contact us!

Diabetes Type 2 Overview and Actos and Avandia -What’s the Deal?!

There has been a lot of controversy of benefits versus risks with these medications -especially Avandia.  For a while now, Avandia has been considered unsafe because it is associated with higher risk of heart attacks and strokes and worsened cholesterol levels.   

Well, for those who are still on Avandia, I am sure you will soon notice it is SUPER difficult to get it any longer.  Due to heart concerns, after mid-November, there is a new program that you and your physician will need to be enrolled in -just to be able to get Avandia.  It is the Avandia -Rosiglitazone Medicines Access Program (this link will take you to Avandia.com).  Only patients that are already on Avandia or have no other options will be able to get the medication through the program.  Avandia will no longer be available at your local pharmacy -ONLY through the program which will mail the medication to your home.

On the other hand, we have Actos (pioglitazone), which was considered the “safe” option.  Now, there are some murmurs about increased risk of bladder cancer with use of Actos.   The risk is really quite small, but best to avoid Actos if you have a history of bladder cancer. 

I hope this clears up why there is no Avandia to be found!  If you have any questions about switching to a different diabetes medicine -please leave a comment.  And if you are part of the Avandia program, we would love to hear how that is going for you!

 We received this question in our Submit Your Question page:
Question: I am taking xanax it is really messing with my stomach and am having trouble sleeping and looking for the purest form of benedryl liquid to aid me in sleeping?

Thank you for contacting us!  Xanax can be rough on the belly.  Benadryl is available in multiple forms, including liquid and tablet form.  The actual drug is diphenhydramine.  If you are interested in the liquid form -the “purest” from what is available commercially, would be Children’s Benadryl Dye Free Allergy Liquid.  Although, all liquids It still contains additives and flavoring but is at least free of dye.  It may be “more pure” to take the Dye Free Benadryl gelcaps -they are flavor and color free.

As you probably know, Benadryl (diphenhydramine) is an antihistamine and is used for allergies.  So, it comes along with some side effects, such as dry mouth, dry eyes, possible “hangover” in the morning…  Having said that, up to 90% of Benadryl is used by people to help fall asleep!  If you are new to Benadryl, I would recommend using 12.5mg -25mg 15-30 minutes before bedtime.  You can build from there up to 50mg before bedtime.  Benadryl is not physically addicting.  Take care about the possible “hangover” feeling the next morning and drink lots of extra water!

Can I take Prozac with Coricidin?

Yes and no.  Prozac is okay to take with Coricidin Cold and Flu only.  The rest of the Coricidins contain dextromethorphan which can  interact with Prozac and cause serotonin syndrome.

I ate my Chia Pet’s sprouts on a dare -is that bad?

Not at all!  Actually Chia sprouts and chia seeds are edible and good for your health!  If you want to learn more -please read Chia for Your Health.

Is there a substitute for Xyzal 5mg?

Currently, there is not a generic available for Xyzal 5mg but there are some alternatives.  Xyzal works similarly to Allegra (fexofenadine) which is a prescription antihistamine (available in generic).  OTC generics include Claritin (loratadine) or Zyrtec (cetirizine).  There are also some antihistamine eye drops and nose spray that often are used along with an oral antihistamine.  

A woman asked via email, “I read your article on the Neti Pot.  I’ve always had low blood pressure but just found I am now borderline (140/80). Only change in life is using the Neti Pot daily for 1 year -could that cause it?”

No, there is no known link between use of the Neti Pot and high blood pressure.  Your question does make me wonder what led you to use the Neti Pot daily for the last year -perhaps it is related to the bump in blood pressure…?

Sometimes people are concerned with the “salt water” used in the Neti Pot being able to  raise blood pressure.  This is a false concern because 1.  Very little of the irrigation solution is absorbed into the body and 2. The salt level in the irrigation solution is equal to the body’s salt level so the salt can not pass into the body due to osmotic pressure.

A mom wrote in a recent email, “Can I give my daughter Mucinex for Kids and Children’s Motrin at the same time?”

Yes -it is okay to give the Mucinex and Motrin at the same time.  There are different medications in each.  It is good to ask and be cautious, especially with combination products.

A patient came into the pharmacy this morning and asked, “My doctor told me once I take Nexium for a few weeks, I no longer need to take it on an empty stomach…is that right?”

First, a little background info -Nexium along with Prilosec (omprazole), Aciphex and Prevacid (lansoprazole) -and a couple others- are in a class of drugs called proton pump inhibitor (PPI).  PPIs are used to treat issues related to acid in the stomach (like GERD or heartburn). 

A popular false rumor was started that once a PPI is taken for a few weeks, timing doesn’t matter. 

Untrue!  Just remember,  PPIs are most effective if taken on an empty stomach 30 to 6o minutes before eating.

A dad wrote, “I’ve been surfing (and surfing), looking for an answer to (what I thought) was a simple question, so I’m hoping you can advise: My daughter had an upset stomach (vomiting), so I gave her some Pepto. I then discovered it had expired by about a year. Is there any danger in this? I’ve since thrown it out once I realised, but just wanted some reassurance that there was no serious danger.”

Taking expired Pepto is not known to cause any issues -so I would not worry.  However, Pepto is not good to give to kids under 12 years of age.  Pepto contains bismuth salicylate which is like aspirin.  Aspirin (and Pepto) can cause Reye’s Syndrome in children -it is a very small but serious risk.  There is Children’s Pepto that contains calcium carbonate (like Tums) -and does not have any risk of causing Reye’s.  

If you want some more info on expired meds please read Expired Medications.

To see more random questions and answers, please visit the Question of the Day page.  If you want to ask a random question -please visit our Submit Your Question page.

Metformin was first synthesized back in the 1920s but was not seriously considered for use in treating diabetes until the 1950s.  It took another 40 years for it to be released in the United States for treatment in type 2 diabetes.  It is now first line treatment for diabetes as montherapy or concomitantly with insulin or sulfonylureas. 

Metformin is the only antidiabetic medication still on the market that belongs to the drug class biguanides.  It works by decreasing hepatic glucose production, improving insulin sensitivity and decreasing glucose absorption in the intestines.  This leads to a reduction in fasting glucose levels by 60-70mg/dL, which in turn decreases hemoglobin A1c, a test that measures the average blood glucose over 2-3 months.   Also of interest is that metformin has been evaluated in the treatment of polycystic ovarian syndrome and to help delay early menarche in females.

Metformin is available in an oral solution (Riomet), tablet (Glucophage) and extended release tablet (Fortamet, Glucophage XR, Glumetza).  Metformin tablets and extended release tablets are available in generic. 

The most common side effects during the beginning of treatment are headache, nausea, vomiting and diarrhea.  These are usually transient and will stop after a few weeks of therapy.  Taking doses with meals and starting with a low dose and increasing slowly should help decrease the likelihood of these adverse reactions.  Kids often complain of the “fishy” or “sticky” odor associated with some of the generic tablets.  Additional side effects include flushing, myalgia, rash, sweating and flu-like symptoms.  Sometimes, the outer shell of the extended release tablets may be found in the stool. 

Metformin has a black box warning for lactic acidosis.  It is an extremely rare side effect but if it occurs it is a medical emergency.  Because of this risk metformin should not be used in kids with renal or hepatic insufficiency.  Symptoms of lactic acidosis can include anorexia, nausea, vomiting, belly pain, lethargy and decrease in blood pressure.  The actual incidence is extremely low at around 9 incidences in 100,000 years of therapy.

Metformin can interact with many medications, so it is always best to check with the physician and pharmacist for drug interactions.  Drugs that interact with metformin and are common in kids are cephalexin and corticosteroids. 

Metformin has been approved in kids 10 years and older.  Typical starting dose is 500mg twice daily.  This can be increased to a maximum of 2000mg/day.  Metformin will start working within a few days but maximum effect can take up to two weeks. 

Along with lifestyle changes, metformin is a good option to treat type 2 diabetes in kids.  It has been shown to help with weight loss in patients with diabetes and is one of the few antidiabetic medications that does that regularly cause hypoglycemia.  Metformin is an inexpensive and effective way to help treat type 2 diabetes.  

I LOVE juice -what do I do?  Take the Allegra at night!  It is actually best to take the daily antihistamines (Allegra, Zyrtec, Claritin) at night.  This is because it is best to take the antihistamine 2-5 hours before being exposed to allergens.  And guess when pollen levels are at their worse?  Usually between 5-10 AM!  So, if Allegra is taken at night, you wake up ready to fight off allergens and free to drink as much juice as you want!

Does it hurt me to drink juice and take Allegra at the same time?  No, nothing bad will happen to you if you drink juice and take Allegra at the same time.  However, drinking juice and taking Allegra at same time can actually decrease the amount of Allegra that is absorbed (up to 50% in one study) -this means the Allegra doesn’t work as well.

What about orange juice, cranberry juice, grapefruit juice, grape juice….? Most of the stuidies have been with grapefruit juice, however what causes the interaction is in all fruit juices -so no juice is “safe”.

How long must I separate drinking juice and taking Allegra?  It is best to separate drinking juice and taking Allegra by at least 4 hours.  It is time dependent -so, if you take it together up to 50% won’t be absorbed, if you wait 2 hours 25% won’t be absorbed, if you wait 4 hours mostly all of it will be absorbed.

Can I just take twice the prescribed dose in order to overcome the loss caused by the orange juice? Not a great choice for a couple of reasons.  First, because it is not an exact science of how much Allegra is absorbed so most likely too much Allegra will get into the body.  This increases the risk of side effects.  And because doubling the dose is not very cost effective!

Is it the vitamin C in the juice that causes the interaction? No it is not the vitamin C that causes the interaction.  It is most likely caused by fruit juices inhibiting an organic anion transporting peptide (OATP1A2).  By inhibiting OATP1A2, the absorption of Allegra is reduced.

Why would Zyrtec advertise for Allegra? I really don’t know…

Which is better -Zyrtec, Allegra or Claritin? All three -Zyrtec (cetirizine), Claritin (loratadine) and Allegra (fexofenadine) are now available OTC and all work well.   Studies show that Zyrtec and Claritin are more likely to cause drowsiness then Allegra.  I must admit I am slightly biased because I heart me some Allegra  but others claim Zyrtec or Claritin works better for them.  I would think about cost and what works best with the least side effects for you personally.

If you decide OTC Allegra is for you -go visit their website and get a coupon! 

I hope this clears some questions up!  Thank you for all your comments and questions -please keep them coming!

Question: My father in law  takes a lot of medication and we are concerned that no one is keeping an eye on the big picture to make sure the medicines are all compatible.  The list of what he takes is below.  Are you aware of any possible problems associated with this combination of drugs. 
Glyburide 5mg Take 2 tablets twice a day.   Metformin 500mg Take one tablet twice a day   Simvastatin 40mg take one tablet once a day. Cozaar 50 mg take one tablet daily . Doxazosin 4mg   take one & half tablet at bedtime.
Thanks!

Here is my response:

Hi!  Thanks for contacting us!

Glyburide 5mg -2 tablets twice a day–Diabetes
Metformin 500mg -one tablet twice a day–Diabetes
Simvastatin 40mg -one tablet once a day –Cholesterol
Cozaar 50 mg -one tablet daily –Blood Pressure/kidney protectant
Doxazosin 4mg- one & half tablet at bedtime –BPH/ Blood Pressure

There aren’t any major interactions here.  Use of Cozaar, Doxazosin and Glyburide together can increase risk of blood pressure and blood sugar being too LOW.  This is easily monitored with testing blood pressure and sugar.
Also, he can monitor how he feels -low blood pressure: dizzy, fatigue, light-headed especially upon standing up.  Low blood sugar -light-headed, dizzy, sweating, headache.

He may want to consider adding…
1.  OTC CoEnzyme Q10.  This will help replace the CoQ10 that is decreased from the simvastatin.
2.  OTC B12 (or B-complex).  This will replace the B12 that is decreased from metformin
3.  Talk to physician about adding OTC calcium and vitamin D supplements -for general health and to counteract calcium depletion by Cozaar.

Lastly, are these medications working for him?  Are they controlling his
blood pressure, cholesterol and blood sugar/ A1c?

Hope this helps!  Please contact us with any questions/comments.

There you have it!  Of course, this is quite specific for this patient but if you have questions about your or your family member’s medications -please leave us a comment, submit a question or send an email at nova@getpharmacyadvice.com .

Want to learn more about drug side effects and drug interactions….have any specific questions?  Just drop us an email or comment!

One colleague of mine had an acquaintance who had a false-positive drug test result…she had never taken a recreational drug in her life and somehow ended up testing positive for PCP!  Crazy, right?

Check out this video to see what happened:

Pretty straightforward stuff, yeah?  I guess the moral of the story is to make sure you go over your medication list and do a little investigating if you too end up with a false-positive drug test.  Just a hint: go straight to the source -the pharmaceutical company- they’ll have all the information you need!

Thanks for listening and don’t hesitate to contact me at Cate@getpharmacyadvice.com if you have any questions.  Please false-positive drug test stories by leaving a comment below! 

While you’re at it, watch our video course covering the many ways you can save money on your prescription drugs.  Every penny counts, guys (btw the course if free)!

After reviewing results from the major clinical trial called SEARCH and going over information from other sources (i.e. adverse event reports),  the FDA has issued a warning to the public and healthcare professionals that the highest approved dose of simvastatin, 80mg daily, can cause an increased risk of muscle injury compared to patients taking lower doses of simvastatin or other “statin” medications.

Symptoms of muscle injury you should look out for while taking high-dose simvastatin, or any “statin” for that matter, are muscle pain, weakness, or tenderness.  If your blood is drawn, the test results are likely to show an increase in a particular muscle enzyme, creatine kinase. 

The higher the dose of simvastatin, the higher the risk of muscle injury (aka myopathy)!  There is also an increase risk of muscle injury when simvastatin is taken with certain other medications, escpecially at the increased dose of the cholersterol-lowering medication. 

Follow these dose limitations for simvastatin, and you should be able to decrease your risk of muscle injury (got this list from the FDA’s website):

Do not take simvastatin at all if you are taking:

• Sporanox (itraconazole)
• Ketoconazole
• Erythromycin
• Clarithromycin
• Ketek (telithromycin)
• HIV Protease Inhibitors
• Nefazodone

Do not take more than 10mg of simvastatin if you are taking the following medications:

• Gemfibrozil
• Cyclosporine
• Danazol

Do not take more than 20mg of simvastatin if you also take:

• Amiodarone
• Verapamil

Do not take more than 40mg of simvastatin if your medication list includes:

• Diltiazem

Do not stop taking your simvastatin without first speaking to your physician, but please make sure you contact them as soon as possible if you feel you are experiencing symptoms of muscle injury or if your dose falls outside the abovementioned limitations. 

If I were you and was currently taking simvastatin 80mg once a day, I would make an appointment with my physician to see if they’d be willing to switch your high-dose simvastatin to a lower dose of another more potent “statin” like Lipitor.  With this change, your cholesterol levels will remain under control and your muscles will be happy because they will be at lower risk of injury! 

Ever experienced muscle injury due to high-dose simvastatin?  Confused about whether you should contact your physician based on your simvastatin dose?  Need more clarity on this matter? Leave a comment below and we can help you out. 

Please check out our video course on how to save money on your prescription medications -it will be helpful if your simvastatin is changed to Lipitor.  Plus, it’s available to you at no charge!  Can’t beat that!

Now there is a new rumor out there on the world wide web about taking Bayer Crystals instead of aspirin for the prevention of heart attacks.

I am sure you are now holding your breath to see if the rumor is true or false…..it is….FALSE!

The Bayer Crystals do not work better to prevent heart attacks.  In addition, the Bayer Crystals could be harmful in a person having a heart attack for a couple of reasons:

1.  The Crystals contain 65mg of caffeine and

2. The Crystals contain 850mg of aspirin – much more than the recommended 325mg! (no, more is not better)

***Take care- most aspirin powders (like Goodys and BC) also have high levels of aspirin and caffeine***

If you would like to learn more about aspirin please see …Baby Aspirin Decoded,  Baby Aspirin for the Prevention of Heart Attack and Stroke.

If you would like to learn about how to save some serious dough -please see our *FREE* video course with manual 90 Ways to Save Money on Your Prescription Medications