I am diabetic and i am not bleeding enough to take my blood sugar had to prick my self 6 times to get enough? I had to prick myself 6 times to get enough blood; blood sugar was 437 why was i not bleeding almost nothing.  Please help, Amy

My answer:

What to do now?   There are no other OTC inhaler options.  All other options are prescription only.  Most likely, an albuterol inhaler (by prescription) will be the most appropriate alternative.  Here are some options to help with paying for the inhalers: Proair assitance program, Proventil coupon,  Xopenex coupon and Ventolin assistance program.

HFA inhaler switch: HFA inhalers feel quite different then the old inhalers.  The old (CFC) inhalers had a propellent in them so people could “feel” the drug when using it.  The new HFA inhalers have a finer mist so often patients complain they can’t taste/feel the medicine going in….be assured, the medicine is still being delivered! 

If you think your HFA inhaler is broken -please see the article My HFA Inhaler is Broken

How do you feel about Primatene Mist inhalers being taken off the market?  How do you feel about the new HFA inhalers? We would love to hear from you –please leave a comment!

I have an ingrown toenail. It’s hurting less and the top is white. I do not want to go to a doctor. Is this ok? My mom said that I just have to keep cutting it and it will just work itself out. Is there any way I can prevent this in the future?

 I don’t think I need to get it dug out. I’m not just saying that, it hurts less. I was wondering, can I do the cotton ball thing with an ingrown toenail? My nail is (i think) in the process of growing out

My answer:

Hi Emma,

You’ve heard it before but it bears repeating – there are no stupid questions.  We thought it would be fun to post random questions that we are asked throughout our work days and from this site.  So, if you have any random questions J please leave us a comment or send us an email – nova@getpharmacyadvice.com or cate@getpharmacyadvice.com .  We will talk about whatever you are interested in!

What ever happened with the inhaled insulin?!

Exubera, the inhaled insulin was taken off the market.  It never quite took off because of the issues with correct technique of the patient along with irregular absorption into the lungs.  There is a lot of research going on to find a way to deliver insulin without needles!

I heard there are bloodless glucose meters coming out, is that true? (I hope so!)

Perhaps one day, but not yet   There was one bloodless glucose meter that was close but there were so many issues it is not available.  Good news is that there is a lot of research going on with being able to test blood glucose through skin, breath, tears and saliva…but it is going to be awhile. 

This question was a comment on the article Do all Diuretics Contain Sulfa?:   I have to take Edecrin because I am allergic to all other diuretics but my insurance will not cover it…what can I do?

This is when insurance companies can become super frustrating! The best thing to do, if the insurance co has already said they do not cover it is to:
1) Request letter from your physician about your need for a specific medication and why (with specifics)
2) Contact your insurance company directly on phone, email and letter to request drug to be covered
3) Reach out to your insurance agent and request their help -that is what they are there for

Insurance companies can sometimes be difficult to deal with but the truth is we pay them for coverage. If this is your only option, they should cover it -however to get them to do so can be a long, tedious process.

We received a comment on the article Juice and Allegra:  Why was Allegra taken off the market? 

I don’t believe Allegra (fexofenadine) was taken off the market since its release. However, Seldane (terfenadine) was taken off the market because it interacted with some drugs to cause irregular heart rythmes (that could possibly lead to death). When Seldane was taken orally it was broken down into an active drug, fexofenadine.  Fexofenadine was then released as Allegra. It has all the benefits of Seldane without the negative effects on the heart!

The li'l allergy sufferer

The first time we realized Tater had allergies was because she was scratching her head so hard, her hair started falling out in clumps!  Poor Tater Tot!  She didn’t look a hot mess because she has so much hair you couldn’t even see the bald spots but she was clearly in distress.  We took her to the vet and we walked away with this magical liquid that would treat her allergy symptoms and it only cost $25 for a week’s supply -yikes!  

When we got home and it was time for Tater’s medicine -I pulled out the container and what did I see on the label?  Diphenhydramine (Benadryl’s generic)…my first thought was what?  I just paid $25 for something that would have cost ~$3 in the store!  And now I have a liquid to give to Tater -which is messy and close to impossible!  Frustrating!!  So, I thought why not pass on a little information so others don’t go down this path!

Now, before we go on…the first time this happens it is best to visit the dog’s vet because we don’t want to get allergies confused with more serious issues like kennel cough, ring worm or fleas.  And the vet will okay use of Benadryl, some dogs should NOT receive Benadryl, such as young puppies, dogs with glaucoma or thyroid issues or taking certain medications that may interact.   At this point, if your vet says that Benadryl (diphenhydramine) is okay to use, go ahead and speak up and tell them you will get it at your local pharmacy.  Most vets know that it is much cheaper in the “human” pharmacy and will happily let you save some money by getting it there instead of their office. 

How do we treat allergy symptoms in dogs?  Benadryl (diphenhydramine) works well, is inexpensive and super easy!  It works in dogs just like it does in humans to stop allergy symptoms. 

How do we determine proper dose?  Typically it is dosed at 1mg/lb (so Tater weighs ~12 lbs, I give her 1/2 of a diphenhydramine 25mg tablet).  Most dogs will receive dose every 8 or 12 hours.   

How do I choose which Benadryl (diphenhydramine?)  At the pharmacy, get the Benadryl 25mg (or generic -works just as well and is way cheaper .  You want to pick out the pink tablets that ONLY has diphenhydramine in them.  Make sure to NOT get the other ones like Benadryl Cold & Sinus and such -those other medications are NOT safe for your pup!

How do I give it to my dog?  The tough part   There are those expensive Pill Pockets out there that seem to work well for most.  For Tater Tot and Toshia, we just smear a teeny amount of peanut butter on the tablet and put it on a human finger and they gladly lick and eat the peanut butter and tablet!  Be warned, this will lead to the dogs getting uber excited everytime you open a jar of peanut butter (or actually any sound that may possibly be you opening a jar of peanut butter!)

What are the side effects? Number one side effect is lethargy -your dog may just seem tired and out of it (usually this will go away after a few doses).  Your pup may also have, dry mouth (be sure to keep fresh water out for her), urinate less and possibly (but rare) diarrhea and vomiting.

I hope this helps your doggie fell better and you save some money.  Just so you know, there are other medicines that are available at the “human” pharmacy instead of at the vet’s office -like Flagyl (metronidazole) and Pepcid (famotidine) and amoxicillin.  If you talk with your vet, they can just give you a script for your dog to take to the “human” pharmacy -ie Walgreens, Target, CVS…  Most vets are glad to do this for you.  And yes the script will read for “Tater Tot”

In the past, there have always been two different concentrations of liquid Tylenol on the market -one for children and one for infants.  Now, with the transition in place, there will be only one concentration (160mg/5ml) for all OTC pediatric single-ingredient liquid Tylenol products.

What’s the reason for the change? Simply to decrease the chances for medication errors as parents were at times getting confused between the two infants’ and childrens’ acetaminophen products.

The recommended dose of Tylenol will remain the same at 10-15mg/kg.  The difference is the approriate Tylenol dose is being given in a larger volume of liquid.  Definitely read the label on the box to get the correct amount of Tylenol needed to dose your child!

Be very aware there may be a point in time where both the old and new concentrations of infants’ Tylenol liquid products will be available on store shelves.  Either product is fine to use, just make sure you know which one you have so you can dose your child correctly!

There will be no changes made to childrens’ Tylenol dosing.

Do not hesitate to stop in at your local pharmacy if you’re concerned about dosing issues related to infants’ tylenol products.  Better safe than sorry, right?!

Nova put up a great post last week, “Juice and Allegra.”  It answers the many different questions and comments we received in response to my “Orange Juice with Allegra” piece.  Check it out!

Here’s some extra details on Allegra and its buddies Claritin and Zyrtec. 

Congestion -which OTC allergy medication is the best for this problem? 

Well, studies have shown that Allegra  may have some anti-inflammatory properties (decreases swelling) that may help to relieve nasal congestion.

Apparently Allegra can block the release of  mast cell and basophil inflammatory mediators, resulting in the whole decrease in nasal swelling and congestion.  Neat, huh?

Claritin and Zyrtec do not appear to have these same anti-inflammatory properties, making them not a great choice to help with stuffy nose/sinuses due to allergies. 

Just thought this would be interesting and helpful to those who’s major symptom is nasal congestion! 

In case you’re curious, I suffer from some serious allergies (I think!) here in Charlotte just during the Spring season (end of March to mid-May).  I believe I have found the most effective treatment regimen for myself!  I take Allegra at night (pretty much at bedtime) and fluticasone nasal spray (Flonase) in the morning. 

My very irritating itchy nose, constant sneezing, and nasal/sinus congestion are under control. 

I still notice some post-nasal drip and my eyes are still crazy itchy if I put my contacts in, but I’m at the point where I’m not miserable.  I’m not a fan of wearing my glasses (mostly because I don’t see as well out of them and they make me sleepy), but my eyes seem to hardly itch when I’m not wearing my contacts. 

I’m not sure which medication is doing the best job, and I’m not really up for doing a trial run without one of them to figure it out.  I do know that my symptoms were not well controlled with just Allegra and Sudafed.  When I added fluticasone nasal spray and took off the Sudafed, my quality of life increased dramatically! 

No need to worry, I’ll be posting about my new friend fluticasone nasal spray next. :)

**This is Cate from the future…check out this bit of info about fluticasone nasal spray by clicking here**

Please keep leaving your comments and questions below…it’s fun! 

You can also e-mail me at Cate@getpharmacyadvice.com.

Have a great Sunday!

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!

I find the family of B-vitamins quite confusing.  I think one of the reasons the B vitamins are puzzling is because half of them go by a number (B12) and the rest are known by names (folate)…odd.  So, I thought I’d try to demystify the B-vitamins by reviewing the most used ones. 

In general, vitamin B deficiencies causes anemias, dermatitis, lack of energy and skin lesions.  If you are taking a multivitamin, you are most likely NOT severely deficient in any of the B vitamins.  However, that doesn’t mean a little extra something, won’t help!  I often recommend B-complex to help with energy levels, biotin (B7) to help nail and hair health and folic acid (B9)during pregnancy.

Let’s start at the very beginning (a very good place to start …

1.  B1 (thiamine): It is necessary for carb metabolism; Used to treat Wernicke-Korsakoff syndrome and alcohol withdrawal; It causes the gross “vitamin odor”

2. B2 (riboflavin): Deficiency is marked by lesions in the mouth, lips, tongue and eyes; Can make urine a red-green-orange fluorescence color.

3. B3 (niacin): Deficiency symptoms are dermatitis, diarrhea, dementia and pellagra; Too much can cause belly upset and flushing; Used to treat high cholesterol.

4. B6 (pyridoxine):Levels that are too high or too low can cause convulsions and skin lesions; People taking birth control pills, hydralazine and isoniazid (INH) need higher levels.

5. B7 (biotin) -also called vitamin H: Deficiency can cause dermatitis, depression, lack of energy; Used to help hair and nail health.

6. B9 (folic acid/folate): Deficiency can cause mouth sores, CNS damage and megaloblastic anemia; Very important in pregnancy!

7. B12 (cyanocobalamin): Low levels will cause pernicious anemia, lack of energy and glossitis (tongue swelling); Used to treat deficiency and to increase energy.

Helpful Hint:  Most people know about iron deficiency but less known is folate and  B12 deficiency anemia.  If a patient has anemia but iron levels are normal, it is super important to have B12 and folate levels checked.

I hope this helps clears up the complexity of the vitamin Bs some.  Have any questions or stories?  Love to hear them!  Please leave a comment or send an email -nova@getpharmacyadvice.com