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Overview

Aciphex is used to treat erosive or ulcerative gastrointestinal acid reflux disease (GERD). It's also used to heal duodenal uclers, and in combination with amoxicillin and clarithromycin, it is prescribed to get rid of H. pylori.

People's Pharmacy Perspective

Suppressing acid is big business. Drug companies have made billions on a category of drugs called proton pump inhibitors (PPIs). These are medications such as Aciphex, Nexuium, Prevacid, Prilosec and Protonix. They are prescribed almost like candy because physicians perceive them as highly effective and totally safe.

Patients love such drugs because heartburn hurts. A wonderful meal can turn into a nightmare, especially if reflux wakes you in the middle of the night. And there is concern that repeated reflux (with its corrosive chemicals) can scar the esophagus and increase the risk of cancer. So what’s not to love about acid suppressing drugs?

Have you ever asked yourself why we make acid in the first place? A healthy stomach is incredibly efficient at churning out acid. And it’s not just humans. Most animals also make acid in their stomachs. That’s right, dogs, cats, cows, snakes, sheep and even snails make acid. Scientists suspect that vertebrates have been making acid in their stomachs for at least 300 million years.

Is this just a giant mistake? Did Mother Nature mess up? Well, according to the drug companies that make PPIs it must have all been a cosmic joke, because now that they can stop the acid, all should be well with the universe. But perhaps Mother Nature was on to something and shutting down acid production has some unintended consequences.

For one thing, acid serves as a powerful barrier to bacterial infection. Even with our obsession with cleanliness, there are a lot of nasty bugs out there. We swallow this stuff with our food and we stick our fingers in our mouths and they are loaded with germs. There is growing concern that PPIs are associated with an increased risk of pneumonia (Archives of Internal Medicine, May 14, 2007) and serious digestive tract infections (World Journal of Gastroenterology, Apr 7, 2009).

There are other concerns that have arisen with long-term acid suppression. Absorption of vitamin B12 is best accomplished in an acid stomach environment. Concerns have been raised that PPIs like Aciphex may make it harder for some people to absorb this crucial nutrient from the diet (Basic & Clinical Pharmacology & Toxicology, online, Jan. 2006). Another controversial issue that has the gastroenterology community up in arms is a report in the Journal of the American Medical Association (JAMA, Dec. 27, 2006) linking long-term PPI therapy at high doses to an increased risk of hip fracture. Whether this is due to poor calcium absorption remains unclear (American Journal of Gastroenterology, Mar., 2009.

Stopping PPIs can be quite a challenge. Since the stomach seems to “think” that acid is essential for good health, the cells there try extra hard to make acid even with a PPI on board. When such drugs are discontinued abruptly, the acid-making cells go into hyperdrive. For days, and sometimes weeks (or months), the stomach churns our extra acid. Think about your nose if your overuse a nasal spray. When you stop, there is something called rebound nasal congestion. The blood vessels overcompensate and leave you feeling totally stopped up. So to rebound acid production in the stomach can lead to horrific heartburn. There are very few “official” recommendations about how to get off PPIs without experiencing serious reflux discomfort.

Bottom line: Proton Pump Inhibitors like Aciphex and Nexium are very good at suppressing the production of stomach acid and reducing symptoms of GERD and healing stomach ulcers. Whether the unanticipated adverse effects described above will turn out to be of serious concern remains to be determined. In the meantime, millions pop their PPIs without knowing the long-term consequences. We hope this story turns out well because the stakes are high.

Common Side Effects

• Headache
• Nausea
• Diarrhea
• General abdominal discomform
• Gas 
• Dry mouth and/or sore throat
  

Serious Side Effects

• Blood problems (thrombocytopenia, etc)
• Liver issues
• Serious allergic reactions
• Severe skin reactions
• Irritation of the pancreas (pancreatitis)
• Muscle break down (rhambomyolysis)
• Broken hips (rare and controversial and only linked to long-term use)
  

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9287

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Aciphex 

For Drug Interaction Information check out iGuard:

http://www.iguard.org/

Overview

Accupril is one of a group of drugs that includes Vasotec and Capoten.

These medications are called ACE inhibitors because they affect an enzyme (angiotensin-converting enzyme) important in regulating blood pressure.

Accupril is often used to treat high blood pressure; it may also be prescribed in combination with other drugs to treat some types of heart failure.

Full prescribing information can be found at:

 http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1608

Check out Wikipedia for more user-friendly information:

 http://en.wikipedia.org/wiki/Quinapril

Side Effects and Interactions

ACE inhibitors, including Accupril, can reduce kidney function, particularly in people who already have kidney problems. Regular monitoring is essential.

People on Accupril may experience dizziness, fatigue, a dry persistent cough, nausea or headache.

Other side effects reported include chest pain, palpitations, back pain, drowsiness, constipation, hair loss, dry mouth and impotence.

In rare cases a serious blood disorder has developed. Report any symptoms to your physician promptly.

There are a number of compounds that can interact with Accupril.

In general it is important to avoid potassium supplements, including low-sodium salt substitutes.

Diuretics such as Dyazide, Aldactazide and Moduretic which preserve potassium can also cause dangerous elevations in potassium when taken with Accupril.

Other diuretics may also interact with Accupril. So might the psychiatric drug lithium.

Accupril should not be taken at the same time as tetracycline, since it can reduce absorption of the antibiotic.

Check with your doctor and pharmacist to make sure Accupril is safe in combination with any other drugs you take.

Special Precautions

The first few doses of Accupril you take may cause dizziness or fainting, especially for older people. Be especially careful standing up until your body adjusts.

When you start taking Accupril, be alert for a rare, but serious reaction.

Some people have experienced swelling of the face, lips, tongue and throat which can make breathing difficult if not impossible. This requires immediate emergency treatment.

African-Americans may be somewhat more susceptible to this unusual adverse effect. They are also less likely to get the full expected response to Accupril.

If you are African-American, be sure to discuss benefits and risks with your physician.

Accupril should be avoided during pregnancy, especially second and third trimesters.

Taking the Medicine

Accupril should be taken on an empty stomach, at least one hour before or two hours after a meal.

Do not stop taking Accupril suddenly, as this could lead to complications.

Tri-Sprintec is an oral contraceptive for women. 

GlycoLax is a laxative. 

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Glycolax 

Yaz is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7508

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Drospirenone

Digitek is used to treat heart failure and the control of ventricular response rate in those with chronic atrial fibrillation. 

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Digoxin 

Levoxyl is used to treat hypothyroidism and pituitary TSH suppression. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7937

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Levoxyl 

ProAir HFA is used to treat bronchospasm resulting from asthma and chronic obstructive pulmonary disease (COPD). 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8392

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Proair 

Advair Diskus is used for the long-term maintenance treatment of asthma. It is only for people whose ashtma symptoms are not well-controlled on other asthma medications, as one of its active ingredients (salmeterol) may increase the likelihood of asthma-related death. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8679

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Advair 

Elidel Cream is used as a second-line therapy for the short-term treatment of atopic dermatitis. It is meant for those who are not immunocompromised and who have failed to respond to other topical treatments. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5125

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Elidel 

Arthrotec is used to treat osteoarthritis and rheumatoid arthritis in those who are at a high risk of developing ulcers or other complications from NSAIDs. 

The potential risks should be weighed against the benefits when considering Arthrotec. If Arthrotec is prescribed, it should be used at the lowest dose for the shortest period possible. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8558

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Arthrotec 

Aldara cream is used to treat nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4095

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Imiquimod 

TriLyte with flavor packs is a bowel and colon cleanser taken prior to colonoscopy. 

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Trilyte 

Zovirax is used to treat genital herpes and non-life-threatening mucocutaneous Herpes simplex virus infections in immunocompromised individuals. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4201

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Zovirax 

PrimaCare One is a prenatal vitamin that includes omega-3 fatty acids and folic acid. 

Junel Fe is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4897

Catapres-TTS is a transdermal system used to lower blood pressure. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1890

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Catapres 

Jantoven is used to treat and prevent venous thrombosis and pulmonary embolism. It is also prescribed to treat and prevent thromboembolic complications associated with atrial fibrillation and cardiac valve replacement. Jantoven is indicated for reducing the risk of death, recurrent myocardial infarction, and thromboembolic events like stroke.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6203

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Jantoven 

Enablex is used to treat overactive bladder. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7869

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Enablex 

Rozerem is used to treat insomnia in those who have difficulty falling asleep. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6782

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Rozerem 

Actoplus MET is used to improve glycemic control in those with type 2 diabetes. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9081

EpiPen Auto-Injector is used to treat emergency allergic reactions, including anaphylactic shock caused by stinging and biting insects; allergen immunotherapy; foods; drugs; diagnostic testing substances; other allergens; as well as idiopathic anaphylaxis or exercise-induced anaphylaxis.

The EpiPen is intended for immediate administration in individuals determined to be at risk for anaphylactic shock. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6649

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Epipen 

Sular is used to lower blood pressure. It is an extended-release form of a calcium channel blocker. 

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Sular

Estrostep Fe is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4643

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Estrostep 

Uroxatral is used to treat benign prostatic hyperplasia.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8575

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Uroxatral

NovoLog Mix 70/30 is used to control hyperglycemia in those with diabetes. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8768

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/NovoLog 

Asmanex is used to treat and prevent asthma. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6842

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Asmanex 

Propecia is used to treat hair loss in men (only). 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6926

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Propecia 

Aggrenox is used to reduce the risk of stroke. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4508

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Aggrenox 

AndroGel is used in testosterone replacement therapy, primarily in adult men with conditions that have lead to a deficiency or absence of endogenous testosterone. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6405 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Androgel#Therapeutic_use 

Methylin is a psychostimulant used to treat Attention-Deficit/Hyperactivity Disorder and narcolepsy. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4540

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Methylin 

Relpax is used to treat migraines with or without auras.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6935

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Relpax 

Levora is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4694

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Levora 

Vagifem is a vaginal suppository used to treat atrophic vaginitis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1447

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Vagifem 

Pseudovent 400 is an expectorant used to temporarily relieve symptoms associated with upper respiratory infections, such as congestion, sinusitis, hay fever, and cough.

Differin is a topical medication used to treat acne. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4242

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Differin 

Guaifenex PSE 60 is an expectorant used to treat nasal congestion and cough associated with upper respiratory infections.

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Guaifenex 

Tamiflu is used to treat the flu. It must be taken within two days of the onset of symptoms. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8790

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Tamiflu 

Overview

This is a powerful drug approved for treating schizophrenia. It is also employed for patients with serious bipolar disorder and occasionally as an adjunctive treatment for major depression. There is a black box warning about the danger of giving this medicine to older people with dementia-related psychosis. The drug has not been approved for this use and may increase the risk of death.

Please note that there is also an increased risk of diabetes associated with Abilify. 

People’s Pharmacy Perspective

Abilify is considered an “atypical” antipsychotic. It belongs to a new-generation of mind medicines including Clozaril (clozapine), Risperdal (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine) and Geodon (ziprasidone). When this new group of schizophrenia drugs was introduced in the 1990s they were greeted with a great deal of enthusiasm. Clinicians suggested that such drugs were far more effective and much safer than older antipsychotics. It wouldn’t have taken much to improve on the old-generation of medications that were first introduced in the 1950s.

Drugs like Thorazine (chlorpromazine),  Stelazine (trifluoperazine), Mellaril (thioridazine) and Haldol (haloperidol) come with a long list of side effects including dizziness, slurred speech, seizures, and a variety of movement disorders such as severe neck muscle spasms causing head twitches or uncontrollable rhythmic movements such as sticking out the tongue. People often walk with a zombie-like shuffle. Just a few of the other complications can include urinary retention, constipation and sexual difficulties. It’s hardly surprising such medicines were not that popular with patients.

With the arrival of the atypical antipsychotics, there was hope that patients would be able to return to normal activities or at least resume some semblance of a normal life. Aggressive marketing by the pharmaceutical industry has made these drugs highly successful. More than $13 billion is spent on antipsychotic drugs each year. They are now prescribed for much more than schizophrenia. Many people take these drugs for Alzheimer’s, dementia, bipolar disorder, autism, OCD, ADHD, autism and major depression.

There is also growing concern about both the safety and effectiveness of these new-generation antipsychotics. A study in the New England Journal of Medicine reported that these drugs were no more effective or less likely to cause troublesome side effects than an older antipsychotic medicine (Sept. 22, 2005). There is also a report of an alarming rate of sudden cardiac death linked to the newer drugs (New England Journal of Medicine, Jan. 15, 2009). We now know that many of these medicines can cause dramatic weight gain, diabetes, strokes and irregular heart rhythms. Children and older people may be especially vulnerable to complications.

The bottom line from The People’s Pharmacy is that drugs like Abilify may be very helpful for some patients, but they are not magic bullets. They don’t cure schizophrenia and they come with a long list of side effects.

Common Side Effects

• Headache
• Fatigue and/or tiredness
• Restlessness, agitation or inability to sit still
  
• Anxiety
• Weight gain
• Insomnia
• Nausea, digestive discomfort and/or vomiting 
• Dizziness
• Sedation
• Shaking and/or tremor
• Constipation
• Dry Mouth
• Blurred Vision

Serious Side Effects

• High fever, muscular rigidness, unstable blood pressure, confusion (potentially life threatening!).
  
• Uncontrollable mucle movements and tics
  
• Stroke
• High blood sugar
• Diabetes
• High blood pressure
• Irregular heart rhythms
• Obstruction in the intestines
• Gall bladder attack
• Pancreas irritation
• Muscle pain and weakness
• Suicidal thoughts
• Depression
  

Full prescribing information can be found at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8204

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Aripiprazole

For Drug Interaction Information check out iGuard:

http://www.iguard.org/

Bactroban is an antibiotic ointment. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6013 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Bactroban 

Travatan is an eye solution used to treat intraocular pressure in those with open-angle glaucoma and ocular hypertension who do not respond to other intraoccular pressure lowering medications. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6835

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Travatan 

Avandamet is used to improve glycemic control in adults with type 2 diabetes. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5419

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Avandamet 

Asacol is used to treat ulcerative colitis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8308

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Asacol 

Vesicare is used to treat overactive bladder.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8696

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Vesicare 

BenzaClin is a topical gel used to treat acne. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9296

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Benzaclin 

Fluzone is a flu vaccine for influenza types A and B. 

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Fluzone 

Sprintec is an oral contraceptive for women. 

Arimidex is used to treat breast cancer. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4934

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Arimidex 

Zymar is an eye solution used to treat bacterial conjunctivitis.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1266 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Zymar 

Suboxone is used to treat opioid dependence. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7840

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Suboxone 

Restasis is used to increase tear production in those with ocular conditions that have suppressed tear production. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9154

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Restasis#Restasis 

Ciprodex Otic is a combination of antibiotic and steroid. It is used to treat ear infections. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6698

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Ciprodex 

Prometrium is used to prevent endometrial hyperplasia in menopausal women who have not undergone hysterectomy and who are taking conjugated estrogen. It is also prescribed for secondary amenorrhea. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6971

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Prometrium 

Mirapex is used to treat Parkinson's disease. It is also prescribed to treat Restless Leg Syndrome (RLS). 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8863

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Mirapex 

Oxycontin is a powerful controlled-release pain reliever. 

It is an opioid agonist and a schedule II controlled substance that is subject to abuse. 

Oxycontin tablets are only to be swallowed. If they are taken broken, crushed, or chewed, they become rapid- rather than controlled-release, and the dose may be fatal. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3253

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Oxycontin#OxyContin 

Focalin XR is used to treat Attention-Deficit/Hyperactivity Disorder.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9376

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Focalin

Lovaza is used to lower cholesterol.

Micardis is an angiotensin II receptor antagonist (ARB) used to lower blood pressure. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9096

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Micardis

Geodon is used to treat schizophrenia and bipolar disorder. 

Geodon has a greater capacity to increase QT/QTc interval compared to several other antipsychotics; an increased QT/QTc interval is associated in some other drugs with bringing about a potentially fatal polymorphic ventricular tachycardia, and sudden death. 

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8337

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Geodon 

Cosopt is a solution used to reduce intraocular pressure in those with open-angle glaucoma and ocular hypertension who do not respond to beta-blockers. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8551

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Cosopt 

Atacand is used to treat hypertension and heart failure. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=2154

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Atacand 

Trivora-28 is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4700

Tobradex is a corticosteroid and antibacterial drug for the eye used to treat inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. It is also used for chronic anterior uveitis and corneal injury from burns or other injuries to the eye. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6745

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Tobradex 

Xopenex HFA is an inhaler used to treat asthma and bronchospasm for those with reversible obstructive airway disease.  

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1344

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Xopenex 

Alphagan-P is a solution used to treat intraocular pressure in those with open-angle glaucoma or ocular hypertension. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4544 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Alphagan 

Lumigan is a solution used to treat intraocular pressure in those with open angle glaucoma or ocular hypertension. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3397

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Lumigan 

Trileptal is an anticonvulsant used to treat epilepsy. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7142 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Trileptal 

Provigil is used to promote wakefulness in those with narcolepsy, obstructive sleep apnea/hypopnea syndrome, and shift work sleep disorder. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7205

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Provigil 

Pulmicort Respules is used for the maintenance and prevention of asthma. It is not for the treatment of acute bronchospasm. 

Full prescribing information is available at:

http://dailymed.nlm.niha.gov/dailymed/drugInfo.cfm?id=3270

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Pulmicort 

Byetta is administered as an injection and is used to improve glycemic control in those with type 2 diabetes.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5430

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Byetta

Necon is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9157

Levothroid is used to treat hypothyroidism. 

More information is available at:

http://en.wikipedia.org/wiki/Levothroid 

Loestrin 24 Fe is an oral contraceptive for women. 

Apri is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3570

Vivelle-Dot is a transdermal patch form of estrogen delivery for treating symptoms associated with menopause.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=2113

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Vivelle-dot 

Low-Ogestrel is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4626

Ortho Evra is a transdermal contraceptive patch for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8572

Check out Wikipedia for more user-friendly information:

Levitra is used for treating erectile dysfunction. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7585

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Levitra 

Rhinocort Aqua is a nasal spray used for treating allergies. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3799

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Rhinocort 

Kariva is an oral contraceptive for women. 

More information is available at Wikipedia:

http://en.wikipedia.org/wiki/Kariva 

Januvia is used to improve glycemic control in adults with type 2 diabetes. It should not be used for type 1 diabetes or diabetic ketoacidosis, as it would not be effective. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9347

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Januvia 

Keppra is an anticonvulsant used to control epilepsy. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8964 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Keppra

Avodart is used for men with symptomatic benign prostatic hyperplasia (BPH) to improve symptoms, reduce the risk for need of BPH-related surgery, and to prevent acute urinary retention (AUR). 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8830

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Avodart 

Caduet is used to treat hypertension, coronary artery disease, and angina. It is also used to prevent cardiovascular disease and lower cholesterol.

It combines amlodipine besylate, a calcium channel-blocker, and atorvastatin calcium, a lipid-lowering agent.  

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6355 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Caduet 

Tussionex Pennkinetic is used to treat cough and other upper respiratory symptoms related to allergies or cold. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6948 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Tussionex 

Astelin is a nasal spray used to treat allergies.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1875

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Astelin 

Armour Thyroid is thyroid hormone used to treat hypothyroidism. 

More information is available at Wikipedia:

http://en.wikipedia.org/wiki/Armour_Thyroid

Clarinex is used to treat allergies. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8630

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Clarinex 

Patanol is a solution used to treat allergic conjunctivitis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5993

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Patanol 

Patanol is a solution used to treat allergic conjunctivitis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5993

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Patanol 

Aviane is an oral contraceptive for women. 

Check out Wikipedia for more information:

http://en.wikipedia.org/wiki/Aviane#Monophasic 

Strattera is used to treat Attention-Deficit/Hyperactivity Disorder (ADHD).

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8772

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Strattera 

Lidoderm is a pain reliever for post-herpetic neuralgia. It should only be used on intact skin. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3409

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Lidoderm 

Namenda is used to treat dementia in Alzheimer's patients. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5210

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Namenda

Endocet is a powerful pain reliever. 

Check out Wikipedia for more information on it:

http://en.wikipedia.org/wiki/Endocet 

Vigamox is a solution used to treat bacterial conjunctivitis.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6697

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Vigamox 

Humalog is an insulin analog for the treatment of diabites mellitus and to control hyperglycemia. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5448

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Humalog 

Skelaxin is a muscle relaxant used for the relief of painful, acute musculoskeletal conditions.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4505

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Skelaxin

Nasacort is a nasal spray used to treat allergies. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8500

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Nasacort 

Requip is used to treat the signs and symptoms of Parkinson's disease, as well as to alleviate restless leg syndrome. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=2883

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Requip 

Avalide is used to help lower blood pressure. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9175 

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Avalide 

Avelox is an antibacterial for adults used for treating acute bacterial sinusitis, bronchitis, and pneumonia, and complicated intra-abdominal and skin infections. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9149

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Avelox 

Flovent HFA is an inhaler for the maintenance and prevention of asthma.

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7947

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Flovent

Boniva is used to treat and prevent osteoporosis in postmenopausal women.

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8750

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Ibandronic_acid

Niaspan is used to lower cholesterol. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6144

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Niaspan 

Omnicef is an antibiotic used to treat pneumonia, acute exacerbations of chronic bronchitis, tonsillitis, and skin infections.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8954

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Omnicef

NuvaRing is a vaginal ring used as a contraceptive. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8836

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Nuva_ring 

Combivent is an inhaler used by people with chronic obstructive pulmonary disease (COPD) and asthma. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8799

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Combivent

Cialis is used to treat erectile dysfunction. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8203

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Cialis 

TriNessa is an oral contraceptive for women. 

Detrol LA is used for overactive bladder. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6981

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Detrol_la 

Avapro is a blood pressure medication. It's also used to treat diabetic nephropathy.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5942

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Avapro  

Benicar is used to control blood pressure. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7695

Check out Wikipedia for more user-friendly information at:

http://en.wikipedia.org/wiki/Benicar 

Lunesta is used to treat insomnia. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8923

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Lunesta 

Spiriva is used to treat chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8725

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Spiriva 

Xalatan is an eye solution used to control glaucoma. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=537

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Xalatan

Orhto Tri-Cyclen is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5081

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Ortho_Tri-Cyclen 

Lamictal is an anticonvulsant drug used to treat epilepsy and bipolar disorder. 

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4401 

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Lamictal 

Avandia is used to help improve glycemic control in people with type 2 diabetes. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7972

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Avandia 

Chantix is prescribed to help with smoking cessation. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8135

Check out Wikipedia for more user-friendly information at:

http://en.wikipedia.org/wiki/Chantix 

Topamax is an anticonvulsant medication for children and adults with epilepsy. It is also prescribed for the prevention of migraines. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7412

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Topamax 

Concerta is used to treat Attention Deficit Hyperactivity Disorder in children and adults. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4203

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Concerta 

Lyrica is an anticonvulsant used to manage fibromyalgia, neuropathic pain resulting from diabetic peripheral neuropathy, postherpetic neuralgia, and as adjunctive therapy for those with partial onset seizures. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5166

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Lyrica 

Valtrex is used to treat cold sores and genital herpes. It is also prescribed for chickenpox and shingles. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5757

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Valtrex

Coreg is used to treat congestive heart failure and hypertension. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8113

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Coreg 

Actonel is used to treat and prevent osteoporosis in postmenopausal women. It is also prescribed to increase bone mass in men with osteoporosis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7348

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Actonel

Lotrel is an ACE inhibitor used to lower blood pressure.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=lotrel&x=0&y=0

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Lotrel

Adderall is used to treat Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1362

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Adderall 

Yasmin is an oral contraceptive for women. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=7949

Lantus is injected daily for treatment of adult and pediatric type 1 diabetes. It is also prescribed for adults with type 2 diabetes who need long-acting insulin for the treatment of hyperglycemia. 

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3283

Check out Wikipedia for more user-friendly information at:

http://en.wikipedia.org/wiki/Lantus 

Tricor is a cholesterol-lowering drug in the fibrate class.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8931

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Tricor 

Nasonex is a nasal spray used for treating seasonal allergies and perennial allergic rhinitis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8838

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Nasonex

Seroquel is used in the treatment of bipolar disorder. It is also prescribed to treat schizophrenia. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5606

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Seroquel 

Flomax is used to treat benign prostatic hyperplasia. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=5763

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Flomax 

Celebrex is a non-steroidal, anti-inflammatory drug (NSAID) used to treat osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, menstrual cramps, acute pain, and primary dysmenorrhea. 

Celebrex is also prescribed to reduce the number of colon and rectum polyps in people with familial adenomatous polyposis. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9037

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Celebrex 

Actos is used to improve glycemic control. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9052

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Actos 

Cymbalta is an antidepressant used for treating major depressive disorder and Generalized Anxiety Disorder.

It is also prescribed to manage pain resulting from fibromyalgia, as well as for diabetic peripheral neuropathic pain. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8728

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Cymbalta 

Levaquin is used to treat bacteria resistant to other antibacterial medications. It is prescribed for serious and life-threatening bacterial infections such as pneumonia, acute sinusitis, acute chronic bronchitis, severe skin infections, and urinary tract infections, as well as inhalational anthrax. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8574

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Levaquin

Crestor is one of the statin class of cholesterol-lowering drugs.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6243

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Crestor

ZETIA is a cholesterol-lowering drug that may be prescribed alone or with statins. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9122

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Zetia

Protonix is a proton pump inhibitor used for the short-term treatment and healing of erosive esophagitis resulting from gastrointestinal reflux disorder (GERD). 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9057

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Protonix

Vytorin is a cholesterol-lowering drug composed of both ezetimibe (Zetia) and simvastatin (Zocor).

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9331

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Vytorin

Plavix is used to reduce atherothrombotic events in patients who have recently experienced a stroke, myocardial infarction (MI), or established peripheral arterial disease. 

Full prescribing information is available at: 

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3418

Check out Wikipedia for more user-friendly information: 

http://en.wikipedia.org/wiki/Plavix 

Nexium is used for treating heartburn and other symptoms of gastrointestinal reflux disease (GERD), as well as to reduce the occurrence of gastric ulcers. It is also prescribed to heal erosive esophagitis. 

In combination with amoxicillin and clarithromycin, Nexium is used to treat H. pylori. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=4761

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Nexium

Lexapro is an antidepressant used to treat major depressive disorder and Generalized Anxiety Disorder. 

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9104

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Lexapro 

Overview

 Singulair is used to treat asthma and allergies.

Full prescribing information is available at:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=8034

Check out Wikipedia for more user-friendly information:

http://en.wikipedia.org/wiki/Montelukast

Overview

Sertraline is available as sertraline hydrochloride (Zoloft), an antidepressant, in a tablet form and an oral solution.  Sertraline (Zoloft), like the earlier antidepressant fluoxetine (Prozac), works by enhancing the action of a brain chemical called serotonin. It belongs to the class of antidepressant drugs called serotonin reuptake inhibitors (SSRIs). This medication is prescribed to treat major depression, obsessive-compulsive disorder, panic disorders, social anxiety disorder, post traumatic stress disorder, and premenstrual dysphoric disorder.   

Although the FDA has not specifically approved its use for other purposes, doctors sometimes prescribe sertraline (Zoloft) to treat generalized anxiety, impulse control, and eating disorders.

People’s Pharmacy Perspective

Since the introduction of fluoxetine (Prozac) in 1987, the serotonin reuptake inhibitor (SSRI) class of antidepressants (citalopram-Celexa, escitalopram-Lexapro, fluoxetine- Prozac, fluvoxamine-Luvox, olanzapine plus fluoxetine-Symbyax, paroxetine-Paxil, sertraline-Zoloft) has been wildly popular with physicians, patients, and insurance companies.  Doctors believe SSRIs generally produce fewer side effects than traditional tricyclic antidepressants, though it is not clear whether there are fewer adverse events or just different ones. These drugs are perceived as less costly and time consuming than talk therapy, though a monthly prescription for a brand name SSRI-type antidepressant can cost more than $100.

The FDA now recognizes suicidal thoughts as a potential complication of virtually all antidepressant therapy for children, adolescents, and young adults (18-24 year olds) during the first few months of treatment and whenever there are dosage changes.  Why one would assume that suicidal thoughts would instantly stop at age 25 is a mystery to us. We think that anyone who is put on this type of antidepressant should be aware of the potential for violent, suicidal thoughts. Family members and friends must also be vigilant for any unusual changes and encourage immediate consultation with the prescriber.

When it comes to effectiveness, antidepressants can be helpful for some people, but trial and error may still be the only way to determine whether a given antidepressant is helpful.  There is no clear evidence that any one drug (including duloxetine-Cymbalta or venlafaxine-Effexor) is better than others.(1) There is also no clear data to demonstrate that these antidepressants are substantially better than placebo more than half the time.(2) More significantly, there is little evidence to show that they affect long-term outcomes or suicide rates.(3)

A recent review demonstrated that the medical literature is incomplete with regard to clinical trials. Favorable trials are published more frequently than trials showing no benefit beyond placebo.  As a result, doctors reading the published studies are likely to get a far more favorable impression of an antidepressant than may be warranted.(4)

For many, a long acting medication like fluoxetine (Prozac) is preferred for avoiding withdrawal symptoms (dizziness, nausea, insomnia, headache, sweating) experienced when stopping or switching from other antidepressants.  We have heard from many people that getting off drugs like venlafaxine-Effexor, paroxetine-Paxil or sertraline-Zoloft can be difficult.

The bottom line is that there are no “best choices” when it comes to antidepressants.  Patients must be open to trial and error when starting, be cautious to taper off antidepressants when ending or switching therapies, and constantly be under knowledgeable medical guidance throughout therapy.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention.  Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Special Precautions

There is increased risk of suicidal thoughts in children, adolescents, and young adults with major depressive or other psychiatric disorders especially during the first months of treatment with antidepressants.  Antidepressants are not approved for pediatric patients except for treating obsessive compulsive disorder.

Pregnancy/Breastfeeding:  Consult your prescribing physician and/or obstetrician if you are pregnant or planning a pregnancy, or will be breastfeeding while taking this medication.

Not recommended:  People who have had an allergic reaction to SSRIs, sertraline (Zoloft), or its components or who are taking the MAOI class of antidepressants (isocarboxazid-Marplan, phenelzine-Nardil, tranylcypromine-Parnate, selegiline-EmSam) or drugs with MAOI activity such as pimozide (Orap) or linezolid (Zyvox).  Potentially fatal interactions could occur between MAOI and SSRI antidepressants so MAOIs must be stopped for 14 days prior to beginning SSRI therapy and vice versa.

 Those who are on disulfiram (Antabuse) should avoid liquid sertraline (Zoloft) due to its alcohol content.

 Another potentially fatal drug interaction could result from taking another SSRI with sertraline. This may lead to serotonin syndrome. Patients taking sertraline should avoid other SSRIs such as escitalopram (Lexapro) or a SNRI antidepressant (duloxetine-Cymbalta, venlafaxine-Effexor, Effexor XR), St. John’s wort, tramadol (Ultram), and migraine medications (sumatriptan-Imitrex, Zolmitriptan-Zomig).  The doctor must be notified immediately if there are sudden changes in cognition (confusion, agitation, headache) accompanied by shivering, sweating, fever, increased heart rate, muscle twitching or tremor.

Carefully monitor:  For people who have bipolar disorder and have had an episode of mania, there is a risk that manic symptoms could be triggered by sertraline (Zoloft).  Anyone with a history of seizures or suicide attempts must also be extremely vigilant. Family members and other caregivers should help monitor people on sertraline for suicidal thoughts, self-destructive behaviors, panic attacks, impulsivity, aggressiveness, or other unusual changes in behavior or symptoms of worsening depression or anxiety especially in the early months of treatment and when the dose is adjusted. The doctor must be notified immediately in such cases.

  People with liver problems may need to start on a reduced dose, as they may eliminate Zoloft less efficiently than otherwise healthy people.  Be certain to inform your doctor of any other conditions you may have as it may affect your dose, whether you should even take this medication, or require you to take special tests during treatment.

Taking the Medication

Sertraline (Zoloft) tablets should be taken with a full glass of water roughly at the same time each day (to help you to remember to take it), with or without food.  

Stopping the Medication

It may take up to 4 weeks or longer before effects are felt.  Do not stop or change doses suddenly without first talking with your doctor.  If sertraline (Zoloft) is abruptly discontinued, withdrawal symptoms such as irritability, agitation, dizziness, electric shock sensations, anxiety, headaches, and increased manic episodes may occur.  Discontinuation is usually handled with a gradual reduction in dose.

Common Side Effects

•    Dizziness, drowsiness, nausea
•    Dry mouth, appetite changes
•    Sexual difficulties, changes in sex drive

Serious Side Effects

Call for emergency help if you have these signs of a potential allergic reaction:
•    Difficulty breathing, swelling of the face, throat, lips, or tongue, skin rash or hives.

-Call your doctor promptly if you have any of these serious side effects:  
•    Seizure (convulsions)
•    Serotonin Syndrome (rare, but potentially fatal condition in which serotonin levels are elevated to toxic levels by the action of a single or a combination of medications):
•    Uncontrolled muscle twitching, tremors, stiffness, or shivering
•    Fast heart rate, unusual sweating, fever
•    Agitation, confusion

There may be other side effects not listed here. Talk to your doctor if your condition worsens and about any side effect that seems unusual or is especially bothersome.

Drug Interactions

I.  DO NOT TAKE WITH sertraline (Zoloft):                                       
The following drugs have additive effects to SSRIs, so may increase the risk for serotonin syndrome, a (rare, but potentially fatal condition in which serotonin levels are elevated to toxic levels by the action of a single or a combination of medications):
•    Migraine medications: sumatriptan (Imitrex), zolmitriptan (Zomig), and others
•    Tramadol (Ultram), Lithium
•    All other antidepressant drug classes:  SNRIs (duloxetine-Cymbalta, venlafaxine-Effexor, Effexor XR), SSRIs (escitalopram-Lexapro, fluoxetine-Prozac, etc.), tricyclics (nortriptyline-Pamelor, protriptyline-Vivactil)
•    MAOI antidepressants; drugs with MAOI like activity: Phenelzine (Nardil), isocarboxazid (Marplan),  tranylcypromine (Parnate),  selegiline (EmSam) and linezolid (Zyvox).  These need to be stopped at least two weeks prior to starting sertraline (Zoloft). If sertraline is taken first, two weeks should elapse before starting on one of these other medicines as potentially fatal side effects could occur.
•    Pimozide (Orap):  increases risk of fatal cardiac complications.
•    Sibutramine (Meridia):  not recommended by manufacturer.  Use only under close medical supervision, particularly for signs of serotonin syndrome, since effects are additive to sertraline (Zoloft).
•    Muscle relaxers and cold, pain, anti-seizure, anti-anxiety and antidepressant medicines that could make you sleepy should also be avoided. 
•    Alcohol: increases drowsiness and dizziness 

II. TAKE with CLOSE MEDICAL MONITORING

•    Propafenone (Rythmol):  Certain SSRIs, including sertraline (Zoloft), may increase the level of this drug, so cardiac function should be carefully monitored.  Or, use an alternate antidepressant, such as citalopram (Celexa).

III. DOSE ADJUSTMENT may be required

•    Clozapine, risperidone, cyclosporine, seizure medications (phenytoin-Dilantin, ethotoin-Peganon), propafenone (Rythmol):  The dose of these drugs may need to be adjusted if they are taken with sertraline (Zoloft).
•    Cyproheptadine:  This antihistamine/allergy medication may block the activity of SSRI antidepressants, so its discontinuation may be advised if antidepressant effects seem blunted or the sertraline (Zoloft) dose may need to be adjusted.
•    Carbamazepine (Tegretol): Decreases effectiveness of sertraline (Zoloft), so sertraline dose may need to be adjusted.
•    Aspirin, ibuprofen, naproxen, diclofenac (Voltaren), etodolac (Lodine) warfarin (Coumadin) or other drugs that affect blood clotting:  Drugs that interfere with serotonin reuptake and these agents have been associated with an increased risk of abnormal bleeding, so the dose of these agents may need to be adjusted.

 Other Interactions
•    St. John’s wort (5):     Avoid taking the herb St. John’s wort with sertraline (Zoloft), since the effects are additive and could lead to serotonin syndrome. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John's wort in Hyla Cass's book, St. John's Wort: Nature's Blues Buster).
•    Grapefruit Juice (6):  Avoid taking sertraline (Zoloft) with grapefruit juice as this may result in elevated drug levels in the bloodstream.

There may be other herbal and dietary supplement or food interactions not listed here.  We are concerned for instance, about the potential for bleeding with herbs that may affect coagulation (Ginko biloba, etc).  Check with your doctor and pharmacist before taking any other supplements or over the counter medications to make sure you are aware of the risks the combination may carry.

References
1.  Khan, A. and Schwartz, K.  “Study Designs and Outcomes in Antidepressant Clinical
     Trials.”  Essent. Psychopharmacol.  2005;6:221-226.
2.    Moncrieff, J. and Kirsch, I.  “Efficacy of Antidepressants in Adults.”  BMJ  
2005;331:155-159.
3.    Rubinow, D.R. “Treatment Strategies After SSRI Failure—Good News and Bad News.”  N. Engl. J. Med. 2006;354:1305-1307.
4.    Turner, E. H., et al.  “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy.” N. Engl. J. Med. 2008; 358(3):252-260.
5.  Lantz MS, et al. "St. John's wort and antidepressant drug interactions in the elderly." J
    Geriatr Psychiatry Neurol. 1999;12:7-10. PubMed
6.  Lee AJ, et al. "The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study." Clin Ther. 1999;21:1890-1899.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention.  Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Generic Name is metoprolol tartrate (ma TOE proe lol / TAR trayt) and Brand Name is Lopressor (loe PRES sor)

Generic Name for extended release is metoprolol succinate (ma TOE proe lol / SUK sin ate) and Brand Name is Toprol-XL (TOE prawl ‘X’ ‘L’)

Overview

Metoprolol is available as metoprolol tartrate (Lopressor), an immediate release tablet and metoprolol succinate (Toprol-XL), a long acting, extended release tablet. Metoprolol belongs to the group of heart/blood pressure drugs known as beta-blockers. That means they work partly by blunting the action of adrenaline, the body's natural fight-or-flight chemical. People normally respond to stressful situations with a rapid pulse, a pounding heart and an increase in blood pressure. Metoprolol (Lopressor, Toprol-XL) helps block such reactions by slowing the heart rate and relaxing the blood vessels so the heart does not have to pump as hard.

Metoprolol (Lopressor, Toprol-XL) is usually prescribed for high blood pressure, chest pain, heart attacks, and prevention of a second heart attack. The extended release metoprolol (Toprol-XL) is also used in combination with other medications to treat heart failure. Although the FDA has not specifically approved its use for other purposes, doctors sometimes prescribe metoprolol (Lopressor, Toprol-XL) to treat irregular heart rhythms or tremors, and to prevent migraine headaches.

People’s Pharmacy Perspective

Beta blockers have been around a long time and generally have low cost generics available. One word of caution, however: We have heard from a significant number of people that not all generic Toprol XL (metoprolol succinate) is created equal. Some people have seen their blood pressure skyrocket while others have developed irregular heart rhythms. See their stories.

Beta blockers such as metoprolol should probably not be considered as first-line treatments for high blood pressure (1,2). British hypertension experts reserve beta blockers almost as a last resort, when other blood pressure medicines don’t work (3). Since beta blockers have the potential to cause numerous side effects (and negatively impact blood fats), we agree that they should be used cautiously.

Beta blockers are valuable for managing chest pain and preventing another heart attack after someone has already had one. They may also be valuable when adequate blood pressure control is not achieved with other classes of drugs. You and your physician will need to decide if the benefits outweigh the risks.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention. Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Special Precautions

DO NOT stop taking metoprolol (Lopressor, Toprol-XL) suddenly without first talking to your doctor. Stopping abruptly may trigger potentially fatal heart problems.

Pregnancy/Breastfeeding: Consult your doctor if you are pregnant or planning a pregnancy, or will be breastfeeding while taking this medication.

Metoprolol (Lopressor, Toprol-XL) is not recommended for some people: People who have had an allergic reaction to beta-blockers, metoprolol (Lopressor, Toprol-XL) or its components and people with certain serious heart problems, such as heart rates less than 45 beats per minute (for heart attack patients) or abnormal heart rhythms. The medication could occasionally lead to serious cardiac complications for these individuals. Note that only metoprolol succinate (Toprol-XL), the extended release tablet, is indicated for heart failure. Metoprolol tartrate (Lopressor) is not recommended for people with heart failure.

Some people must be very carefully monitored if they take beta-blockers such as metoprolol (Lopressor, Toprol-XL). In general, people with heart failure must be extremely cautious if prescribed beta blockers because the medicine could lead to cardiac complications. Those prescribed metoprolol succinate (Toprol-XL) are no exception; other medications they are on may need to be adjusted, and most importantly, they must be closely monitored for worsening of their heart condition.

Asthmatics and patients with other respiratory problems are especially vulnerable, as these drugs can make breathing worse. Metoprolol (Lopressor, Toprol-XL) may be a little better than other beta-blockers in this regard, but monitor your breathing carefully. Diabetics should inform their physicians if being prescribed metoprolol (Lopressor, Toprol-XL) since the medication may mask the signs of low blood sugar levels.

People with a history of depression should inform their doctors to ensure both their depression and beta-blocker therapy is well managed. Metoprolol (Lopressor, Toprol-XL) is more likely to affect the nervous system than others in its class and may contribute to depression. People with a thyroid disorder should also be carefully monitored as metoprolol (Lopressor, Toprol-XL) may mask signs of an overly active thyroid. Lastly, people with liver impairments may also need to be very carefully monitored.

Be certain to inform your doctor of any other conditions you may have. This information may affect your dose, whether you should even take this medication, or require you to take special tests during treatment.

Taking the Medicine

Metoprolol (Lopressor, Toprol-XL) is best absorbed when taken with or right after meals. Food may reduce the risk of digestive tract upset and taking the drug at roughly the same time each day allows your body to maintain a constant level of the medication in your blood stream. Metoprolol (Lopressor, Toprol-XL) should be taken with a full glass of water. Avoid alcohol while on metoprolol (Lopressor, Toprol-XL) because it increases drowsiness and dizziness, and do not take calcium supplements or antacids within two hours of metoprolol because they may reduce absorption.

If surgery is scheduled, ask your surgeon and anesthesiologist to see if your beta blocker dose will need to be adjusted. Never stop taking metoprolol (Lopressor, Toprol-XL) suddenly. Your doctor must reduce your dose gradually to prevent serious heart problems.

Common Side Effects

• anxiety, nervousness

• sleep problems (insomnia)

• tired feeling

• vomiting

• decreased sex drive, impotence, or difficulty having an orgasm

• arthritis

The medicine may also have a negative effect on cholesterol and other blood fats, so a lipid test before treatment and periodically thereafter would be prudent.

Serious Side Effects

Obtain emergency medical care if you experience these signs of a potential allergic reaction:

• breathing difficulties

• swelling in your face, lips, tongue, or throat

Call your doctor promptly if you experience any of these serious side effects:

• feeling light-headed, fainting

• worsening depression, memory loss or mood swings

• wheezing, worsening asthma

• feeling short of breath, even with mild exertion

• extra-slow or uneven heartbeats

• stomach upset, low fever, lack of appetite, dark urine, pale-colored stools, jaundice (yellowing of the skin or eyes)

• swelling of your ankles or feet

• cold feeling in your hands and feet

• hives, itchiness, rash

There may be other side effects not listed here. Talk to your doctor if your condition worsens and ask about any side effect that seems unusual or is especially bothersome. Never stop taking any beta blocker medication abruptly unless you are under very close medical supervision. Angina or a heart attack could occur.

Drug Interactions

• Catapres (clonidine): If you are on both blood pressure medications, do not suddenly discontinue either medicine, as the increase in blood pressure could be life threatening.

• Prazosin (Minipress) is more likely to cause fainting problems when combined with Lopressor.

• Hydralazine (Apresoline), propafenone (Rythmol), quinidine, and calcium channel blockers ([verapamil (Calan)], [diltiazem (Cardiem)]): These are also heart/blood pressure medications, which would have increased effects if given together with metoprolol (Lopressor, Toprol-XL). Taking beta-blockers with calcium channel blockers is generally not advised since the combined effects may lead to serious heart problems. If they must be taken together, the dose of one or both medications may need to be reduced and cardiac function should be carefully monitored.

• Propylthiouracil or methimazole (Tapazole), insulins: Beta-blockers may also make treatment of diabetes and thyroid disorders more complicated. Your physician will need to monitor such conditions closely.

• Antacids containing aluminum or calcium and aspirin, ibuprofen: These can reduce absorption and interfere with the effectiveness of metoprolol (Lopressor, Toprol-XL).

• NSAID arthritis drugs such as ibuprofen, naproxen, and high dose aspirin can reduce the effectiveness of metoprolol.

• Cimetidine (Tagamet) and ranitidine (Zantac): Ulcer drugs may increase the effects of metoprolol (Lopressor, Toprol-XL).

• Barbiturates (phenobarbital) and tuberculosis antibiotics (rifampin): These drugs may reduce the effect of beta-blockers.

There may be other drug interactions not listed here. Do not start any new medications or make changes to your treatment without first consulting your prescribing physician.

References

1. Lindholm, L. H., et al. “Should Beta-Blockers Remain First Choice in the Treatment of Primary Hypertension? A Meta-Analysis.” Lancet 2005; 366:1545-1553.

2. Kaplan, N.M., and Opie, L.H. “Controversies in Hypertension.” Lancet 2006; 367:168-176.

3. Beevers, D.G. “The End of Beta-Blockers for Uncomplicated Hypertension?” Lancet 2005; 366:1510-1512.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention. Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Atenolol (Tenormin) is known as a beta-blocker. That means the drug works in part by blunting the action of adrenaline, the body's natural fight-or-flight chemical. People normally respond to stressful situations with a rapid pulse, a pounding heart and an increase in blood pressure. Atenolol (Tenormin) helps block such reactions. This medicine is normally prescribed for high blood pressure, chest pain, or heart attacks.

Although the FDA has not specifically approved its use for other purposes, doctors sometimes prescribe atenolol (Tenormin) to treat irregular heart rhythms, performance anxiety such as stage fright, and to prevent migraine headaches.

People’s Pharmacy Perspective
We suspect that one of the reasons beta-blockers are so popular with insurance companies and HMOs is that they are inexpensive. These drugs have been around a long time and generally have low cost generics available. Current research (1,2) however, suggest that due to their lack of efficacy, beta-blockers such as atenolol (Tenormin) should rarely be the first line of treatment for high blood pressure.

Experts also cast serious doubts about their effectiveness in the prevention of initial heart attacks and strokes for hypertensive patients and have concerns about the multiple side effects beta-blockers could cause (3,4). Beta-blockers are valuable for managing chest pain and especially preventing another heart attack after someone has already had one. Finally, they may also be valuable when adequate control is not achieved with other classes of drugs, but you and your physician will need to decide if the benefits outweigh the risks.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention. Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Special Precautions
Do not stop taking atenolol (Tenormin) suddenly without first talking to your doctor. Stopping abruptly may trigger serious and potentially fatal heart problems.

Atenolol (Tenormin) is not recommended for some people: People who have had an allergic reaction to beta-blockers, atenolol (Tenormin), or its components; people with certain heart problems, abnormal heart rhythms or heart failure, since the medicine could occasionally lead to serious cardiac complications.

Some people must be very carefully monitored if they take beta-blockers such as atenolol (Tenormin): Asthmatics and patients with other respiratory problems are especially vulnerable as these drugs can make breathing worse. Atenolol (Tenormin) is a little better than other beta-blockers in this regard, but monitor your breathing carefully.

Diabetics should inform their physicians if being prescribed atenolol (Tenormin) as the medication may mask the signs of low blood sugar levels. People with a history of depression should inform their doctors to ensure both their depression and beta-blocker therapy is well managed.

While atenolol (Tenormin) is less likely to affect the nervous system than others in its class, beta-blockers have been known to contribute to depression. People with a thyroid disorder should also be carefully monitored as atenolol (Tenormin) may mask signs of an overly active thyroid. People with kidney impairments or who are elderly may need their atenolol (Tenormin) dose adjusted.

Special Precautions
More people who must also be very carefully monitored if they take beta-blockers: Women who plan to become pregnant or breastfeed should not take this medication unless their doctors determine it is appropriate. Atenolol may cause harm to an unborn baby.

Be certain to inform your doctor of any other condition you have, as it may affect whether you should take atenolol (Tenormin), your dose, or require you to take special tests during treatment.

Taking the Medicine
Atenolol (Tenormin) should be taken with a full glass of water and can be taken at meal time or on an empty stomach. If you find this medicine causes digestive tract upset, it may be better tolerated when taken with food.

Atenolol (Tenormin) should not be taken together with orange juice as it may reduce the medication’s effect. (5) Avoid drinking alcohol, which could increase your symptoms of drowsiness and dizziness while you are taking atenolol (Tenormin). Don't take calcium supplements or antacids at the same time as atenolol (Tenormin), as they may reduce its absorption.

You may need to temporarily stop taking atenolol (Tenormin) if you will be undergoing surgery since anesthesia may interact with atenolol (Tenormin) and affect how your heart functions. Be sure to let the surgeon and/or anesthesiologist know well in advance of surgery that you are taking atenolol (Tenormin). Never stop taking atenolol (Tenormin) suddenly. Your doctor must reduce your dose gradually to prevent serious heart problems.

Common Side Effects
Atenolol (Tenormin) can cause a number of side effects. They include a slower heart rate, sexual difficulties, sleep problems, tiredness, anxiety, and nervousness.

This medicine may also have a negative effect on cholesterol and other blood fats, so a lipid test before treatment and periodically thereafter would be prudent.

Although Atenolol (Tenormin) is a little less likely to affect the nervous system than certain other drugs in this class, be alert for the beta-blocker blahs. Symptoms of psychological depression, fatigue, decreased concentration, memory loss and mood swings may come on slowly and insidiously.

Serious Side Effects
Obtain emergency medical care if you experience these signs of a potential allergic reaction: breathing difficulties, hives, or swelling in your face, lips, tongue, or throat. Call your doctor promptly if you experience any of these serious side effects:

• wheezing, worsening asthma;
• slow or uneven heartbeats;
• feeling light-headed, fainting;
• feeling short of breath, even with mild exertion;
• swelling of your ankles or feet;
• nausea, stomach pain, fever, loss of appetite, dark urine, pale stools, yellowing of the skin or eyes;
• depression; or
• cold feeling in your hands and feet.

There may be other side effects not listed here. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Drug Interactions
Atenolol (Tenormin) can interact with a number of other compounds, including the blood pressure medicine Catapres (clonidine). This drug should never be suddenly discontinued by a person on atenolol (Tenormin) or any other beta-blocker, as the sudden increase in blood pressure could be life-threatening.

Calcium channel blockers (verapamil, diltiazem), which are also heart/blood pressure medications, would have increased effects if given together with atenolol (Tenormin).

Taking atenolol (Tenormin) with calcium channel blockers is generally not advised as the combined effects might lead to serious heart problems. If they must be taken together, the dose for both or one medication may need to be reduced and cardiac function should be carefully monitored.

A potentially fatal increase in blood pressure could occur when epinephrine is injected into someone taking a beta-blocker such as atenolol (Tenormin). Epinephrine is often included with a local anesthetic injected for dental work or minor surgery, or may be given if someone has a serious allergic reaction that closes airways.

Many other drugs interact with atenolol (Tenormin), including ampicillin and medicines used to treat anxiety, asthma, blood pressure and heart problems. Arthritis medicine and aspirin may reduce the effectiveness of some beta-blockers. Drugs used to treat migraines, tuberculosis and high cholesterol do not mix well with beta-blockers.

There may be other drugs that interact with atenolol (Tenormin) not listed here. Do not start any new medications or make changes to your treatment without first consulting your doctor.

References
1. Lindholm, L. H., et al. “Should Beta-Blockers Remain First Choice in the Treatment of Primary Hypertension? A Meta-Analysis.” Lancet 2005;366:1545-1553.

2. Kaplan, N.M., and Opie, L.H. “Controversies in Hypertension.” Lancet 2006;367:168-176.

3. Beevers, D.G. “the End of Beta-Blockers for Uncomplicated Hypertension?” Lancet 2005;366:1510-1512.

4. Carlberg, B., et al. “Atenolol in Hypertension: Is It a Wise Choice?” Lancet 2004;364:1684-1689.

5. Lilja JJ, et al. European Journal of Clinical Pharmacology. 2005;61:337.

Overview

Boniva is prescribed to prevent and treat osteoporosis in postmenopausal women. It belongs to the same category as Fosamax.

Bone is constantly being "remodeled," broken down by osteoclasts and rebuilt by osteoblasts. Under normal conditions, these two types of bone cells should work together.

With aging, the osteoblasts often slow down, and more bone is destroyed ("resorbed") than is constructed. Boniva slows the osteoclasts so that bone-building osteoblasts can keep up or get ahead, preventing fractures in the spine.

Side Effects and Interactions

Boniva may occasionally cause achiing joints, flu-like symptoms, high blood pressure, stomach ache, nausea, constipation or diarrhea, headache, or high cholesterol.

Difficulty swallowing, esophageal irritation or even ulcers are unusual but serious side effects.

Death of the jaw bone tissue is a rare but very dangerous reaction, usually associated with dental extractions or other invasive procedures.

Anyone taking Boniva who notices difficulty or pain when swallowing, pain behind the breastbone, or new or more intense heartburn should stop the drug and contact the physician promptly.

Other side effects such as muscle pain, skin reactions and eye inflammation have also been reported.

Boniva will be most effective if the user gets adequate calcium and vitamin D, but supplements should not be taken within 2 hours of the medication.

Aspirin and arthritis pain relievers, both prescription and over-the-counter, can irritate the digestive tract. This may increase the risk of severe esophageal irritation from Boniva. Antacids should be taken at least 2 hours after Boniva. They could interfere with absorption if given at the same time.

Check with your doctor and pharmacist to make sure this medicine is safe in combination with any other drugs you take.

Special Precautions

Boniva can be very irritating to the esophagus. People with any swallowing problems or those who cannot sit or stand for at least one hour after taking the pill should not take Boniva.

People with ulcers or esophageal disease should also avoid Boniva.

Boniva is not recommended for patients with severe kidney disease.

Taking the Medicine

Boniva is not well absorbed, and must be taken exactly according to instructions.

The pill is to be taken first thing in the morning, right after rising, with a full glass of plain tap water.

Mineral water, coffee, and orange juice may all interfere with drug absorption.

The patient must stay upright, sitting up or standing (not lying down), for at least 60 minutes after taking Boniva. Only after that hour has elapsed should she have breakfast, drink coffee or juice, or take other medications.

Boniva may be taken every day or once a month. The same instructions apply to the monthly dose.

Overview

Alprazolam is the most frequently prescribed anti-anxiety agent in the country. It is similar in certain respects to Valium.

Once called minor tranquilizers or sedatives, such drugs are prescribed to calm jittery nerves and relieve excessive tension. Alprazolam is also prescribed for anxiety associated with depression and for panic attacks.

This drug belongs to a class of medications called benzodiazepines. Xanax is a little more rapid in action than many other such compounds and its calming effect lasts for a relatively short period of time.

Side Effects and Interactions

Side effects associated with Xanax include sedation, dizziness, unsteadiness, dry mouth, fatigue and confusion. These may fade after a few days or weeks.

Other possible reactions include depression, visual problems, nausea, menstrual irregularities, slurred speech, increased salivation, rash, itching, change in appetite, altered sex drive, urinary difficulties and reduced blood pressure.

Fainting, racing heart rate or seizures are potentially serious, if uncommon, reactions. Report any symptoms to your physician promptly.

Many drugs can interact with Xanax, including over-the-counter antihistamines, prescription antidepressants, the asthma drug theophylline and the ulcer medicine Tagamet . Anticonvulsants such as Dilantin and the heart medicine Lanoxin do not mix well.

People should not combine the herb kava-kava with drugs such as Xanax. One man who did so actually went into a comalike state.

Oregon grape, which has sedative and anticonvulsant properties, probably should not be combined with Xanax as well.

Prudence suggests that the herb passion flower should not be mixed with Xanax. Also, because of the possibility that the herb affects GABA receptors in much the same way benzodiazepines do, patients should be cautioned not to combine it with drugs such as Xanax.

It is not yet known if the sedative effects of the herb gotu kola are synergistic with those of other agents that promote sleep or reduce anxiety. Nontheless, it would be best not to mix gotu kola with Xanax until this is determined.

Check with your pharmacist and physician to make sure Xanax is safe in combination with any other medicines or herbs you take.

Taking the Medicine

Alprazolam can be taken with food, especially if it upsets your stomach.

Do not drink alcohol or use any other sedative while on this drug, as the combination may lead to dizziness, drowsiness, lack of coordination or confusion.

If you are also taking antacids, take them at least one hour before or after taking alprazolam.

Special Precautions

Do not drive, operate machinery or undertake any activity that requires close attention while you are taking alprazolam. This medicine may make narrow angle glaucoma worse and should not be taken by people diagnosed with this condition.

Regular reliance on alprazolam for many months may lead to dependence. Sudden discontinuation of the drug could trigger withdrawal symptoms including convulsions, nervousness, agitation, difficulty concentrating, insomnia, fatigue, headache and tremor.

Never stop taking Xanax without medical supervision, as the medication may have to be phased out gradually over a period of weeks or months.

Overview

Amitriptyline belongs to an older class of antidepressants. Under the brand name Elavil, it used to be one of the most frequently prescribed antidepressants. It is now prescribed generically more frequently.

It belongs to a class of compounds called TCAs (tricyclic antidepressants) that includes amoxepine (Asendin), clomipramine (Anafranil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil).

The extraordinary popularity of drugs such as Prozac, Paxil, and Zoloft has led to dramatic decline in the TCA class of antidepressants. Yet many people still benefit from such compounds.

Amitriptyline and some of its cousins are also prescribed for anxiety and depression as well as to relieve chronic pain associated with arthritis, fibromyalgia, neuropathy or neuralgia (nerve damage), and migraine headache.

Anafranil is prescribed primarily for obsessive compulsive disorder (OCD)

Side Effects and Interactions

Side effects associated with amitriptyline and many other TCAs include dizziness, drowsiness, constipation, dry mouth, blurred vision, super sensitivity to sunlight, sexual difficulties, urinary retention difficulties, weight gain, heart palpitations, low blood pressure, confusion, forgetfulness, weakness, disorientation, or hallucinations. Some of these adverse effects may disappear over time.

Less common complications to watch out for are changes in blood sugar, anxiety, irritability, sleep disturbances, twitching, tremors, tingling of arms and legs, skin rash, digestive upset, or breast enlargement in men and women. Changes in heart rhythm, stroke or seizures are rare but potentially serious reactions. Report any symptoms to your physician promptly.

Amitriptyline and most other TCAs interact with quite a few other medications.

Combining different categories of antidepressants (TCAs and Prozac-like drugs) can be quite dangerous as TCA blood levels can rise leading to toxicity (confusion, dizziness, delirium, seizures, etc.).

The antidepressants Nardil or Parnate can also become extremely hazardous when taken together with TCAs.

Tagamet (cimetidine) and Tegretol (carbamazepine) may also produce an overdose effect if combined with amitriptyline or other TCAs.

The blood pressure medicine Catapres (clonidine) may lose its effectiveness if taken with amitriptyline or other TCAs. Blood pressure could soar out of control and lead to hypertensive crisis.

There is a concern that ginkgo biloba could possibly make a person more vulnerable to seizures, so it probably should not be taken together with other drugs known to increase the risk of seizures, such as amitriptyline.

Interactions between the herb St.John's wort and amitriptyline are possible. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John's wort in Hyla Cass's book, St. John's Wort: Nature's Blues Buster).

Check with your pharmacist and physician to make sure amitriptyline or any TCA is safe in combination with any other drugs and herbs you take.

Taking the Medicine

Taking TCAs with food may reduce stomach upset.

Because amitriptyline and related compounds can be sedating, physicians frequently prescribe them at bedtime.

Special Precautions

People with a history or risk of seizures may be more vulnerable to attacks while on TCAs.

Other conditions that pose special risks include glaucoma, heart disease, irregular heart rhythms, hyperthyroidism, kidney or liver disease, and urination problems.

Amitriptyline and many other TCAs are quite sedating. This means they can make driving or other tasks dangerous.

Older people may be especially susceptible to complications such as drowsiness, dizziness and confusion.

Sudden discontinuation of amitriptyline or similar antidepressants may cause withdrawal symptoms such as headache, dizziness, nausea, sleeping problems and general feelings of disorientation and discomfort.

Overview

Fosamax is prescribed to prevent or treat osteoporosis in postmenopausal women. Doctors prescribe it to increase bone mass in men with osteoporosis. It is also used to treat a fairly rare condition, Paget's disease of bone.

Bone is constantly being "remodeled," broken down by osteoclasts and rebuilt by osteoblasts. Under normal conditions, these two types of bone cells should work together.

With aging, the osteoblasts often slow down, and more bone is destroyed ("resorbed") than is constructed. Fosamax slows the osteoclasts so that bone-building osteoblasts can keep up or get ahead.

Side Effects and Interactions

Fosamax may occasionally cause stomach ache, nausea, constipation or diarrhea, flatulence, trouble swallowing, and esophageal ulcer.

Although esophageal ulcers are uncommon, they can be extremely serious. Another rare but dangerous reaction that has been reported is osteonecrosis of the jaw--death of the jaw bone tissue. This has generally been linked to tooth extractions or other invasive dental procedures.

Anyone taking Fosamax who notices difficulty or pain when swallowing, pain behind the breastbone, or new or more intense heartburn should stop Fosamax and contact the physician promptly.

Other side effects such as muscle pain, skin reactions and eye inflammation have also been reported.

Fosamax works best when the patient is getting adequate calcium and vitamin D. These should be taken at least one half-hour after taking Fosamax, to avoid interfering with absorption of the drug.

Aspirin and arthritis pain relievers, both prescription and over-the-counter, can irritate the digestive tract. This may increase the risk of severe esophageal irritation from Fosamax. Antacids should be taken at least 2 hours after Fosamax. They could interfere with absorption if given at the same time.

Check with your doctor and pharmacist to make sure this medicine is safe in combination with any other drugs you take.

Special Precautions

Fosamax can be very irritating to the esophagus. People with any swallowing problems or those who cannot sit or stand for at least 30 minutes should not take Fosamax.

People with ulcers or esophageal disease should avoid Fosamax also.

Fosamax is not recommended for patients with severe kidney disease.

Taking the Medicine

Fosamax is not well absorbed, and must be taken exactly according to instructions.

The pill is to be taken first thing in the morning, right after rising, with a full glass of plain tap water.

Mineral water, coffee, and orange juice may all interfere with drug absorption.

The patient must stay upright, sitting up or standing (not lying down), for at least 30 minutes after taking Fosamax. Only after that half hour has elapsed should she have breakfast, drink coffee or juice, or take other medications.

Best absorption of Fosamax occurs if two hours goes by between taking the pill and eating.

Fosamax may be taken every day or once a week. The same instructions apply to the weekly dose.

Overview

Albuterol is one of the more commonly prescribed asthma inhalers in this country.

Although this medicine is also available in tablet form for oral use, the aerosol formulation is less likely to cause general side effects and is more frequently prescribed.

Inhaled albuterol is prescribed for the prevention as well as the treatment of asthma attacks.

It may also be used 15 minutes before vigorous activity to prevent exercise-induced asthma.

Side Effects and Interactions

One advantage of inhaled asthma medicine is that relatively little is absorbed into the body to cause unpleasant side effects.

However, inhaled albuterol can cause palpitations or rapid heart beat in some people.

Other possible side effects include nausea, tremor, nervousness, increased blood pressure, heartburn and dizziness.

There are rare reports of rash, itching, and allergic reactions that interfere with breathing.

In addition, albuterol can precipitate angina, insomnia, headache, unusual taste and irritation of the throat. Report any symptoms to your physician promptly.

Albuterol can interact with several other medications. Do not use a similar kind of bronchodilating inhaler such as Berotec, Brethaire, Alupent, Metaprel or Tornalate simultaneously with albuterol.

Certain antidepressants may also be dangerous in combination with this asthma drug.

Thyroid medication and antihistamines do not mix well with albuterol, and beta blocker medications may counteract its effectiveness.

Check with your pharmacist and physician before using any other medication in combination with this inhaler.

Special Precautions

Although albuterol is very effective, care must be taken not to overuse it.

Because of a relatively short duration of action of 4 to 6 hours, people may tempted to use their inhaler too frequently. This could lead to complications, including increased breathing difficulties or heart problems.

Individuals with preexisting heart conditions, diabetes, seizures, prostate problems or an overactive thyroid gland should use albuterol only under close supervision, if at all.

Ventolin Inhaler needs to be kept at room temperature -- that is, between 59 and 86 degrees. If the aerosol is used at a different temperature, it may not provide an accurate dose.

Taking the Medicine

Use of inhalers is not as easy as it may seem. Make sure your physician provides detailed instructions and demonstrates how to inhale the aerosol so that the medicine ends up in the lungs and not in the back of the throat.

Never try to use the inhaler when you have food, beverage, chewing gum or anything else in your mouth.

Overview Coumadin is known as a blood thinner or anticoagulant. That means it is prescribed to prevent the formation or recurrence of blood clots. People who experience a pulmonary embolism or thrombophlebitis in their legs often receive Coumadin to reduce the risk of more serious complications. When clots are feared, this medicine may lower the likelihood of a heart attack or stroke. Coumadin works by blocking key factors necessary for normal blood coagulation. Vitamin K plays an important role in this process. Getting the right dose can be a very tricky process. Too little Coumadin may not allow for adequate clot protection, but too much could lead to life-threatening hemorrhage. Like Goldilocks and the porridge it may take some experimentation to get things just right. That requires frequent blood tests for prothrombin times, especially in the early phase of treatment. Side Effects and Interactions Side effects of Coumadin therapy are uncommon if the dose is appropriate and the blood is carefully monitored. Some people have occasionally reported hair loss, skin rash, itching, nausea, fever, digestive upset, diarrhea, hepatitis, purple toes, red-orange urine, prolonged, painful erections, and mouth ulcers. Report any symptoms to your physician promptly. A large number of over-the-counter and prescription medications may interact with Coumadin in a dangerous way. Some drugs, including barbiturates and the anticonvulsant Tegretol (carbamazepine), can reduce the effectiveness of Coumadin and increase the risk of blood clots. Others, such as the antibiotics metronidazole (Flagyl) or co-trimoxazole (Bactrim, Septra, etc.), can increase the blood thinning potential of Coumadin and thereby raise the risk of dangerous bleeding. The drugs Nolvadex (tamoxifen) and Danocrine (danazol) can also increase susceptibility to hemorrhage when a woman is taking Coumadin. Because aspirin also acts as an anticoagulant, though it works differently from Coumadin, it should be avoided unless your doctor specifically prescribes it and monitors bleeding time. The heart drug Cordarone (amiodarone), the ulcer drug Tagamet (cimetidine), anabolic steroids such as Anadrol-50 (oxymetholone) and antibiotics such as Biaxin (clarithromycin), erythromycin or tetracycline can also make bleeding more hazardous for people on Coumadin. Some individuals may also be vulnerable to increased bleeding when they take the antidepressants Paxil (paroxetine), Prozac (fluoxetine) or Zoloft (sertraline). Also beware of quinine derivatives prescribed for the heart or for nighttime leg cramps. Patients should be wary of taking thyroid drugs, cholesterol medications and tuberculosis medicines in combination with Coumadin. Vitamins E and K could also be problematic. Consult with the prescribing physician before making any changes in the regimen. Anticoagulants such as Coumadin may pose a hazard when taken with the herb ginkgo biloba. An elderly woman on Coumadin had a hemorrhagic stroke after two months of ginkgo. If the extract of the herb hawthorn is taken together with Coumadin, careful monitoring of bleeding time (through PT and INR) is essential. The anticlotting action of the herb horse chestnut (aesculin) may interact with Coumadin to increase the risk of bleeding. This combination should be avoided. It is possible that juniper berries may interact with Coumadin to increase the risk of bleeding. This possibility remains hypothetical. Licorice binds to serum albumin and may interact with Coumadin. The coumarins in licorice may also potentiate the action of Coumadin, possibly leading to unexpected bleeding. Despite research suggesting that ginseng might reduce platelet aggregation, the only reported interaction with Coumadin resulted in a decreased INR (a measure of blood's propensity to clot). This suggests that ginseng may counteract Coumadin's benefit. A red clover extract containing coumarin derivatives might in theory interact with the anticoagulant Coumadin. Close monitoring of prothrombin time or INR is advisable. Psyllium can affect the absorption of Coumadin. To avoid this, psyllium should be taken at least an hour after Coumadin. In theory garlic could increase the risk of bleeding in people taking anticoagulants such as Coumadin. The herb pau d'arco causes vitamin K-reversible bleeding, strongly suggesting that it would interact with Coumadin to increase the danger of hemorrhage. If the herb arnica were to be taken internally, in addition to serious side effects, it would possibly interact with Coumadin because of the herb's ability to inhibit platelet aggregation. The anticoagulant activity of astragalus may interact with that of Coumadin, increasing the risk of bleeding. This herb capsicum (cayenne) may have the potential to prolong clotting time, so people taking Coumadin should exercise caution before eating quantities of chili peppers. Cayenne also inhibits liver enzymes (CYP1A2) and thus slows the metabolism of Coumadin. In theory the coumarins in the herb chamomile might potentiate Coumadin's effect. Careful monitoring of bleeding time (through PT and INR) are recommended if chamomile is to be used together with Coumadin. One woman was hospitalized with internal bleeding after consuming chamomile tea regularly while taking Coumadin. (CMAJ, Apr. 25, 2006) Also in theory, the herb feverfew could increase the risk of bleeding in people taking Coumadin. Because ginger inhibits prostaglandin synthesis and reduces platelet aggregation, caution should be exercised in combining it with Coumadin. The combination could result in unexpected bleeding. It is not known whether the coumarins in the herb dong quai might interact with Coumadin. To be safe, any woman taking both dong quai and Coumadin should discuss this situation with her doctor and should have bleeding time (PT and INR) checked frequently, especially when starting or stopping the herb. Goldenseal reportedly limits the effectiveness of the Coumadin. As a general rule, do not take any other medication or herbs without first checking with your physician and pharmacist. Taking the Medicine Although the absorption of Coumadin may be slightly slowed by food, the medicine can be taken at meal time, especially if it upsets your stomach. There are, however, certain foods that may reduce the effectiveness of this drug. Because Vitamin K can counteract Coumadin's action, be careful not to overdo on foods that are rich in this nutrient. These include broccoli, cabbage, spinach, collard greens, kale, brussels sprouts and lettuce. This doesn't mean that you must avoid such healthy vegetables, but don't suddenly increase your intake without careful monitoring of prothrombin time. (For a more complete list, see our Guide to Coumadin Interactions.) The same warning would hold if you suddenly dropped one of these from your diet completely. Special Precautions Anyone taking Coumadin must monitor his body carefully. Be alert for any early warning signs of bleeding. Symptoms to watch for include bruising or red spots under the skin, red or dark urine, red, black or tarry stools, nosebleeds, or bleeding around the gums after gentle tooth brushing. Internal hemorrhaging may manifest itself in a variety of ways including pain in joints, chest, stomach or head. Shortness of breath, difficulty breathing or unexplained swelling could indicate bleeding. Alert your physician immediately if you notice any unusual symptoms or signs of spontaneous bleeding.

Overview

Hydrocodone is a semisynthetic analgesic similar in most respects to codeine.

In combination with acetaminophen, it offers excellent relief for moderate pain.

It can ease the discomfort of a bad toothache or the aftermath of minor surgery.


Hydrocodone with acetaminophen is sold under a number of names, including Anexsia 5/500, Anodynos DHC, Bancap, Co-Gesic, Dolacet, Duradyne DHC, Hydrocet, Lortab, Norcet, T-Gesic, and Zydone. Vicodin is the most popular brand name for this medication.

Side Effects and Interactions

Possible side effects to be aware of include weakness, euphoria, loss of appetite, sweating and constipation.

Some people experience shortness of breath, especially if they have asthma.

Other less common reactions include an allergic rash, disorientation, dry mouth and urinary difficulties. Report any such symptoms to your physician promptly.

Acetaminophen may cause liver or kidney problems in large doses or over long periods.

Your physician should evaluate your need for this combination pain reliever periodically.

If you are taking any other medicines, check with a physician or pharmacist.

Alcohol as well as many over-the-counter and prescription drugs can add to the sedative effect of this analgesic.

Antihistamines, antianxiety agents, antidepressants and sleeping pills require extra caution.

Both tricyclic and MAO-type antidepressants may interact with this analgesic to cause greater toxicity, and the anticonvulsant Dilantin may increase the risk of liver damage.

Special Precautions

Like any narcotic, hydrocodone may make you drowsy. Do not drive or attempt any activity that requires coordination and judgment.

Older people may be more susceptible to this reaction, or to lightheadedness or dizziness. Never stand up suddenly as it may make you feel faint.

Long-term use of hydrocodone and acetaminophen has drawbacks. Hydrocodone, like other narcotics, may be habit forming if you take it regularly.

Do not increase the dose on your own in a quest to achieve greater pain relief. But don't play the hero by skipping doses during an acute crisis.

Pain is more easily managed if it can be nipped in the bud instead of trying to play catch up when it has gotten out of control.

Taking the Medicine

Some people react to hydrocodone with nausea or vomiting.

Taking it with food may reduce stomach upset.

Nausea, dizziness and other common reactions may be less troublesome if you lie down for awhile.

Overview

Biaxin is a broad-spectrum antibiotic related to erythromycin.

It is prescribed to fight respiratory tract infections including pneumonia and infections of the skin.

Side Effects and Interactions

The most frequent side effects involve digestive tract upset.

People taking Biaxin report fewer side effects than those on erythromycin, but diarrhea, nausea, abnormal taste, stomachache and upset stomach are potential reactions.

Headache has also been reported. Let your doctor know promptly of any symptoms you experience.
Biaxin interacts with a few other medicines.

It may boost blood levels of the anti-seizure medication Tegretol by 60 percent or more, leading to increased toxicity.

The asthma drug theophylline, the blood thinner Coumadin and the anti-AIDS drug Retrovir (AZT) appear to interact with Biaxin.

It should not be taken by people who are also taking the antihistamines Seldane or Hismanal, as it could lead to a dangerous build-up of these drugs in the body.

Check with your pharmacist and physician to make sure Biaxin is safe in combination with any other drugs you take.

Special Precautions

Because Biaxin, like erythromycin, is eliminated from the body by the liver, this drug should be used very cautiously, if at all, by people with liver problems.

Anyone with a history of allergy to erythromycin-type antibiotics should probably avoid Biaxin. Symptoms of an allergic reaction include hives, rash and itching.

In rare instances allergy may trigger life-threatening anaphylactic shock.

Pregnant women should avoid Biaxin unless the doctor finds no other appropriate therapy. This medication has caused birth defects in animal tests.

Taking the Medicine

Biaxin may be taken with or without food. Doses are usually spaced evenly throughout the day.

Check with your physician or pharmacist for specific instructions, and be sure to complete the full course of medication unless directed otherwise.

Overview

Glucotrol is used together with diet and exercise to control non-insulin-dependent, or Type II, diabetes, which was once called "adult-onset diabetes."

This pill seems to stimulate the pancreas to make more insulin in response to a meal.

Side Effects and Interactions

Episodes of dangerously low blood sugar, or hypoglycemia, are a hazard with Glucotrol as with any oral diabetes drug.

Be alert for symptoms of fatigue, shakiness, headache, cold sweat or confusion, as they could signal this hazardous reaction.

Be sure to discuss the symptoms and treatment of hypoglycemia with your health care provider.

Other possible side effects of this medication include nausea, diarrhea, dizziness, skin rash, drowsiness, stomach ache, changes in liver enzymes, constipation and blood changes.

Fever, sore throat and bruising or bleeding could signal a rare but serious reaction that requires immediate attention. Report any symptoms or suspected side effects without delay.

A number of compounds may interact with Glucotrol.

Alcohol should be avoided if you are on this drug, as it could cause low blood sugar or uncomfortable skin flushing and breathlessness.

Other drugs that could lead to drops in blood sugar include nonsteroidal arthritis medicines like Motrin, aspirin and similar medicines, and antidepressants like Nardil or Parnate.

Many blood pressure pills and heart medicines also interact with Glucotrol, including beta blockers like Tenormin and Corgard as well as calcium channel blockers such as Procardia or Cardizem CD.

So may estrogen or thyroid hormones, corticosteroids, niacin used to lower cholesterol, and the seizure medication Dilantin.

Juniper berries may turn out to lower blood sugar; if so, they would interact with Glucotrol. Close monitoring of blood sugar is advised.

There is a possibility that garlic could interact with drugs that lower blood sugar. Careful monitoring is suggested for anyone combining garlic products with Glucotrol.

Check with your doctor and pharmacist before starting or stopping any other medication or herb.

Special Precautions

Glucotrol must not be taken by people who are allergic to sulfa drugs.

Your doctor will need frequent blood tests to adjust the dose of the medicine when you begin taking it.

Illness or a change in your exercise program may also make it necessary to adjust the dose later on.

Taking the Medicine

For greatest effectiveness, Glucotrol should be taken approximately half an hour before a meal.

Your doctor will tell you if you should take it once or twice a day.

Overview

Zyprexa is the third new medicine to treat schizophrenia, following Clozaril (clozapine) and Risperdal (risperidone).

Unlike older anti-psychotic drugs such as Thorazine (chlorpromazine) and Haldol (haloperidol), which just treated "positive" symptoms such as hallucinations, disorganized thinking, and delusions, the new medications also help against "negative" symptoms. These include apathy, diminished emotion, and social withdrawal.

The goal of the new treatments is to help bring patients back into family life and community activities. While not everyone can benefit, there have been some amazing "awakening-type" success stories.

Side Effects and Interactions

Some people starting on Zyprexa may find that they feel dizzy or faint if they stand up suddenly. They should take care to avoid falling when they first get up.

Zyprexa may cause drowsiness, dizziness, headache, nervousness, agitation, sleeping difficulties, constipation, dry mouth, increased appetite, weight gain, runny nose, tremor, rapid heart rate, and fever.

Less common adverse events include joint pain, fluid retention, personality disorder, involuntary muscle movements, salivation, urinary problems, shortness of breath, and flu-like symptoms. Report any symptoms to your physician promptly.

Zyprexa may interact with other medications, but most of the potential interactions have not yet been carefully studied.

Alcohol should be avoided by patients taking this drug. Blood pressure medicines may increase the trouble with feeling faint upon standing up (orthostatic hypotension). Activated charcoal pills for gas problems prevent normal absorption of Zyprexa and should be avoided.

Tegretol (carbamazepine) appears to alter normal processing of Zyprexa and may require a physician to make a dosage adjustment. Luvox may also interfere with normal metabolism, but more research is called for to resolve this question.

Many drugs affect liver enzymes that process Zyprexa, but this medicine is still so new that there are few if any reports as of this writing.

Capsaicin (cayenne) inhibits liver enzymes (CYP1A2) and thus slows the metabolism of Zyprexa.

Check with your doctor and pharmacist to make sure Zyprexa is safe in combination with any other drugs you take.

Special Precautions

Some people may be more sensitive to Zyprexa. Those over 65 appear to get higher blood levels from standard doses than younger people. Consequently, older people may require lower doses.

Women and people of Japanese heritage may also achieve higher blood levels than Caucasian men.

Drowsiness and incoordination are significant risks associated with Zyprexa. This drug may impair judgment and motor skills and make driving or operating machinery very hazardous.

Dizziness is a potentially serious side effect during early treatment. It can be especially troublesome when someone gets out of bed or stands suddenly. This complication (orthostatic hypotension) could be dangerous for people with underlying heart disease or cardiovascular problems.

Alcohol, sedatives, or blood pressure medications can make this adverse effect more serious. No one should consume alcoholic beverages while taking Zyprexa.

Anyone with a history or susceptibility to seizures may be at increased risk while taking Zyprexa. Therefore the drug should be used very cautiously, if at all, with such patients.

People with liver disease should only receive Zyprexa under carefully monitored conditions. Periodic liver enzyme tests are essential.

Women should not breast feed while taking Zyprexa. People with glaucoma and men with enlarged prostates should only receive Zyprexa under very careful supervision as the drug may make these problems worse.

A rare, but extremely serious complication of antipsychotic drugs is known as NMS (Neuroleptic Malignant Syndrome). If symptoms such as fever, palpitations, rapid pulse, confusion, muscle rigidity, or sweating occur, it is essential that a physician be contacted immediately. This can be a life-threatening condition. Involuntary muscle movements must also be reported promptly.

Taking the Medicine

Zyprexa is usually administered only once a day and may be taken with or without meals.

Overview

Theo-Dur is a commonly prescribed oral asthma medication that helps open the airways.

Theo-Dur is an extended-release formulation that enables patients to control breathing symptoms with one or two daily doses.

Smokers and children may need more frequent doses.

The doctor's instructions on dose and timing should be followed carefully.

Side Effects and Interactions

Side effects of theophylline include nausea, vomiting, loss of appetite, stomach pain, diarrhea, headaches, insomnia, restlessness, nervousness, muscle twitching, heart palpitations, increased urination, hair loss, rash and increased blood sugar.

Less common but more serious adverse reactions include seizures, heart rhythm disturbances, vomiting blood and dehydration. Report any symptoms to your physician promptly.

A blood test is extremely helpful in monitoring treatment and determining proper dose. Blood levels should not be higher than 20 micrograms per milliliter.

Theo-Dur interacts with many other drugs, including caffeine. Large amounts of coffee or cola can exacerbate side effects of theophylline. Be aware that some nonprescription pain relievers may also contain caffeine and exercise appropriate caution.

Although people with asthma may be more susceptible to respiratory tract infections, quinolone antibiotics such as Cipro, Noroxin or Penetrex may be dangerous in combination with Theo-Dur. They may raise blood levels of the drug gradually and insidiously to the point where serious adverse reactions such as convulsions or heart rhythm changes may occur.

A similar and equally dangerous interaction is possible with Tagamet, the ulcer medicine.
Other drugs that may cause increased Theo-Dur toxicity include antibiotics like erythromycin or TAO, the antiseizure medicine Tegretol, and certain beta blockers (Blocadren, Cartrol, Inderal, Levatol, Timoptic and Visken). (People with asthma should avoid beta blockers in the first place, as they often make breathing worse.)

Medications that require extra caution due to potential interactions with Theo-Dur include oral contraceptives, calcium blockers like Calan or Cardizem, the heart drug Mexitil, anticonvulsants like Dilantin or the barbiturates, and tuberculosis medicines.

The herb St. John's wort can speed elimination of theophylline from the body, which could reduce its effectiveness.

Excess nervous stimulation may occur if the herb ma huang is taken together with theophylline. Such a combination may provoke cardiovascular reactions.

Capsaicin (cayenne) inhibits liver enzymes (CYP1A2) and thus slows the metabolism of Theo-Dur.

It's a good idea to check with your pharmacist and physician before using any other medication or herbs in combination with Theo-Dur.

Special Precautions

Some people should not take Theo-Dur. They include those with peptic ulcers and anyone with a history of seizures.

Those with liver problems, heart disease or high blood pressure should be monitored closely if they take Theo-Dur.

An acute asthmatic attack in which a person is having difficulty breathing will not respond adequately to Theo-Dur and requires immediate medical attention. The patient should be taken for emergency treatment.

Taking the Medicine

There is some question about the best way to swallow Theo-Dur. Do not chew or crush the capsule.

The manufacturer suggests that a high-fat breakfast does not interfere with absorption. Because theophylline may upset your stomach, you may wish to take this medicine with food to try and reduce digestive tract disturbances.

With Theo-Dur Sprinkle, the contents of the capsule may be sprinkled on applesauce or other soft food to make it easier for a child or elderly person to swallow. The food should not be chewed.

Overview

Overview

Lanoxin is among the most frequently prescribed drugs in this country.

It is a digitalis heart medicine that to this day is derived from the leaves of a plant related to foxglove. Digitalis has been used medically for over 200 years.

Lanoxin is prescribed for congestive heart failure and certain irregular heart rhythms, or arrhythmias.

People with heart failure often experience fluid retention, sensitivity to cold, fatigue and difficulty breathing after mild exercise, and a nighttime cough, especially when they lie down.

Lanoxin works partly by increasing the pumping power of the heart. It can also help slow an abnormal heart when atrial rhythms gets out of control. But Lanoxin is complex to manage, especially in older people.

This medication requires careful monitoring to prevent an overdose as the therapeutic level is very close to the toxic dose. Periodic blood tests are crucial.

Side Effects and Interactions

Signs of igitalis toxicity include loss of appetite, nausea, diarrhea, vomiting, stomach pain, blurred or disturbed color vision, headache, drowsiness, fatigue, and muscle weakness.

If any of these symptoms occur, contact your physician immediately.

Other adverse reactions may include personality change, depression, confusion, disorientation, apathy, bad dreams and hallucinations. Any side effects should be brought to a doctor's attention promptly.

Lanoxin can interact with a wide range of over-the-counter and prescription medications. Antacids, for example, may diminish the proper absorption of digoxin.

So can certain diarrhea medicines and drugs to control cholesterol like Questran, Cholybar or Colestid.

A number of other medications, such as Cordarone, Rhythmol and quinidine drugs, may make Lanoxin more toxic.

So can Sandimmune, used to prevent transplant rejection.

Calcium-blocking blood pressure medicines like Procardia, Cardizem CD or Calan SR may also increase digoxin levels dangerously.

Diuretics like Lasix are often prescribed in conjunction with Lanoxin. A patient taking both medicines should be monitored carefully, however, as the diuretic may make the body lose too much potassium or magnesium. This could lead to serious changes in heart rhythm.

Potassium-sparing diuretics such as Aldactazide or Moduretic could make monitoring and interpreting tests far more complicated.

One of the trickiest interactions is that of Lanoxin with erythromycin and tetracycline. For reasons that are not well understood, about one person in ten harbors bacteria in the gut that metabolizes digoxin. If this intestinal flora is wiped out with an antibiotic, the person may suddenly be exposed to much more Lanoxin than usual, even though they may still be swallowing the exact same dose.

Because of these possible complications, never add any other prescription or over-the-counter medications to Lanoxin without first checking with your pharmacist and physician.

Extracts of the herb hawthorn may increase the activity (but not necessarily the toxicity) of cardiac tonics such as digitalis.

Hawthorn is not recommended for people who are taking Lanoxin or other digoxin medications.

Licorice can greatly increase potassium loss when taking medicines such as Lanoxin; severe potassium loss greatly increases the risk of heart rhythm irregularities in people taking Lanoxin.

The herb cascara_sagrada taken with Lanoxin also could result in excessive potassium loss with resulting heart rhythm irregularities.

The herb St. John's wort can speed elimination of digoxin from the body, which could reduce its effectiveness.

Psyllium can affect the absorption of Lanoxin; if you take it, it is best to do so at least an hour after taking Lanoxin.

The herb ma huang is incompatible with cardiac glycosides such as Lanoxin; serious disruption of heart rhythm may occur.

Never stop taking Lanoxin or switch to another brand of digoxin unless your physician is monitoring closely. Because the effective dose is so close to the toxic dose, this might be dangerous.

Special Precautions

People with reduced kidney function generally require less Lanoxin. As people age their kidneys may no longer process this medicine as efficiently. This is another reason why periodic blood tests for digoxin levels are essential.

It is also crucial to monitor both potassium and magnesium levels. If these essential minerals become depleted because of diuretic therapy, Lanoxin can become extremely dangerous. Blood tests are the only way to determine electrolyte levels.

Taking the Medicine

It is usually recommended that Lanoxin be taken at the same time and in the same way each day.

For many people the most convenient time is with breakfast. However, food high in bran may reduce the absorption of this drug.

If your breakfast tends to be high in such foods, you might want to schedule your Lanoxin for another time of day.

Overview

Even before Prozac, there was Wellbutrin. It was the first of a new generation of antidepressants and was introduced in 1985, almost two years before Prozac received FDA approval.

The company started shipping Wellbutrin to pharmacies around the country, but before prescriptions could actually be filled, a problem arose. A small study involving 50 women with an eating disorder uncovered an alarming statistic.

Four out of the fifty (8 percent) had suffered a seizure. This unexpected and alarming discovery created consternation at the FDA and the feds had the drug pulled off pharmacy shelves.

The FDA demanded additional tests, but the company resisted, maintaining that the bulimic subjects in the study were not representative of depressed patients. Prior research suggested that the seizure incidence was similar to that for other antidepressants.

For more than a year the company and the FDA argued. Eventually the company capitulated and studied an additional 3,000 patients.

The results redeemed Wellbutrin: The seizure incidence turned out to be 0.4 percent, not that different from other antidepressants and nowhere near the 8 percent seen in the small bulimia study.

Finally, in August 1989, Wellbutrin returned to pharmacy shelves, but it was almost too late. Prozac, introduced in 1987, had become a shooting star. Its incredible popularity made Wellbutrin an also-ran.

Although Wellbutrin works differently from Prozac and similar drugs (Paxil and Zoloft), doctors seemed to remember only the initial concern about seizures.

Despite its initial lack of success in the marketplace, Wellbutrin is roughly comparable to Prozac-like drugs in effectiveness.

Unlike traditional antidepressants, Wellbutrin does not cause weight gain, drowsiness, blurred vision, mental confusion, cardiovascular problems or impaired memory.

And Wellbutrin has one huge advantage over Prozac and other SSRI antidepressants. It does not lower libido, produce impotence or impair orgasms. If anything, Wellbutrin may actually stimulate sexuality for some people.

Side Effects and Interactions

Side effects associated with Wellbutrin include headache, dry mouth, agitation, insomnia, tremor, sweating, skin rash, nausea and constipation.

Other possible side effects include dizziness, nervousness, confusion, weight loss and blurred vision. Report any symptoms to your physician promptly.

Certain other medications may change the metabolism of Wellbutrin: The AIDS drug ritonavir can lead to large increases in the blood levels of the antidepressant, while the antiseizure medicine Tegretol lowers blood concentrations of Wellbutrin.

Taking antipsychotics, antidepressants, theophylline, or oral corticosteroids in combination with Wellbutrin may increase the risk of a seizure. So can sudden discontinuation of anti-anxiety pills like Ativan, Halcion or Xanax.

Other possible interactions may occur in combination with levodopa, phenelzine and tricyclic antidepressants such as amitrityline.

Because of a concern that ginkgo biloba could possibly make a person more vulnerable to seizures, it probably should not be taken together with drugs known to increase the risk of seizures. Antidepressants such as Wellbutrin belong in this category.

Interactions between the herb St. John's wort and Wellbutrin are possible. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John's wort in Hyla Cass's book, St. John's Wort: Nature's Blues Buster).

Animal experiments indicate that compounds that act on dopamine in the brain, such as Wellbutrin, may affect or be affected by the herb chaste tea berry.

Check with your pharmacist and physician to make sure Wellbutrin is safe in combination with any other medicines and herbs you take.

Special Precautions

Even though the seizure risk with Wellbutrin is not as high as originally feared, a 0.4% incidence must not be ignored. The dosing schedule is extremely important in reducing this risk.

The maximum daily dose of 450 mg should not be exceeded. In the case of the sustained release (SR) formulation, the total daily dose should not exceed 400 mg.

Alcohol and certain other drugs (oral decongestants, other antidepressants, theophylline, oral corticosteroids) may potentiate the risk of seizures, so please check with a physician before consuming alcoholic beverages or taking any other medications.

Some drugs, such as Ativan, Halcion or Xanax, should be used cautiously, if at all, with Wellbutrin, because stopping them suddenly may make some people more vulnerable to seizures.

Wellbutrin may cause an exaggerated sun reaction, so people taking this antidepressant should stay out of the sun, wear protective clothing and use a broad spectrum sun block.

Taking the Medicine

Wellbutrin can be somewhat more complicated to take than other medications.

The SR (slow-release) formula is usually given as 150 mg twice a day with at least eight hours between the two doses. If the dose needs to be increased, this must be done gradually with medical supervision.

The SR (slow-release) formulation should not be chewed, crushed or split, as this might alter the absorption of this medicine.

The immediate-release tablets are usually given three times daily. No single dose should exceed 150 mg.

Dosing is usually started at 200 mg a day, given as 100 mg twice a day. This can be gradually increased to a total of 300 mg a day total. The daily dose should not be increased by more than 100 mg in a three-day period.

To minimize insomnia, the last dose of the day should not be taken at bedtime. However, immediate-release tablets should be spaced approximately six hours apart.

Food does not appear to have a significant effect upon Wellbutrin absorption, so it may be taken with or without food.

Overview

Prilosec is the first of a new class of drugs that combat acid secretion by blocking the final step.

This so-called proton pump is prescribed for the short-term treatment of duodenal ulcer and for conditions of abnormal acidity such as serious heartburn (GERD) or the rare Zollinger-Ellison syndrome.

It has a very quick onset and is extremely effective in reducing stomach acid.

Prilosec should not be prescribed as maintenance therapy to keep ulcers from coming back.

Side Effects and Interactions

Prilosec is generally well tolerated. However, headache, diarrhea, stomachache, muscle weakness and rash have been reported.

Other adverse reactions that have been reported less commonly include constipation, cough, fatigue, sore throat and vomiting. Report any symptoms or suspected reactions to your physician promptly.

Prilosec slows the elimination of several drugs that must be processed by the liver, including the anxiety medicine Valium, the anti-epileptic Dilantin and the blood thinner Coumadin.

Blood levels of these drugs may rise and side effects become a problem. If you take both Prilosec and Coumadin, tell your doctor right away if you experience any unusual bruising, bleeding, reddish urine or blackened stools. Prilosec is also reported to blood levels of Sandimmune or Antabuse.

Many other prescription drugs require acidity for absorption. Prilosec can interfere with such medicines, which include Nizoral, ampicillin and iron supplements, among others.

People taking acid-suppressing drugs such as Prilosec should not take enteric-coated peppermint oil. The enteric coating is designed to keep the oil from being absorbed until it reaches the more alkaline lower intestine. But when there is very little stomach acid, the enteric coating may dissolve prematurely, releasing the oil into the stomach.

In older people with too little stomach acid or in patients taking a strong acid suppressor such as Prilosec, vitamin B12 absorption may be impaired. Cranberry juice appears to improve the absorption of this crucial vitamin in such cases.

Be sure to check with your pharmacist and physician about potential interactions before taking any other medication or herb in combination with Prilosec.

Special Precautions

Animal studies have shown that Prilosec is associated with a dose-related increase in stomach cancers. It is not known whether this risk also applies to humans.

In addition, because it is so effective at reducing stomach acid concentrations, patients taking this medicine have higher levels of certain microorganisms in their stomachs than would normally survive there.

Scientists do not yet know whether these bacteria have negative long-term consequences.

Regular supplementation with vitamins C and E might in theory provide protection against nitrosamines produced by the bacteria.

People with liver disease have more trouble metabolizing Prilosec. Older people also remove the drug from circulation more slowly.

Taking the Medicine

Prilosec should be taken before meals.

These delayed-release capsules should not be opened, crushed or chewed, as that might expose them to stomach acid. The medication can be inactivated by acid.

Antacids may be taken with Prilosec if they are needed.

Overview

Klonopin is an anti-anxiety agent, similar in many respects to Valium. It belongs to a class of medications called benzodiazepines.

Once called minor tranquilizers or sedatives, many such drugs are prescribed to calm jittery nerves and relieve excessive tension.

Klonopin is prescribed primarily to control certain types of seizures. It is a relatively long-acting drug.

Side Effects and Interactions

Side effects associated with Ativan include sedation, dizziness, and unsteadiness. These may fade after a few days or weeks.

Do not drive, operate machinery or undertake any activity that requires close attention.

Klonopin may make acute narrow angle glaucoma worse and should not be taken by people diagnosed with this condition.

Other possible reactions include confusion, depression, amnesia, hallucinations, shortness of breath, loss of appetite, coated tongue, dry mouth, constipation, visual problems, rash, hair loss, increased sex drive, urinary difficulties and palpitations. Report any symptoms to your physician promptly.

Do not drink alcohol or use any other sedative while on this drug, as the combination may increase the risk of dizziness, drowsiness, lack of coordination or confusion.

Klonopin can affect blood cell counts and may raise liver enzymes. Periodic tests should be conducted to monitor these.

Many medicines, including narcotics, barbiturates and other sleeping pills, drugs for schizophrenia, anticonvulsants, antidepressants, and MAO inhibitors (Eldepryl, Nardil, Parnate) can interact with Klonopin to increase sedation.

Other possible interactions involve asthma drugs such as theophylline, AIDS drugs like Crixivan and Norvir, beta blockers metoprolol and propranlol, Tagamet, oral contraceptives, Luvox, tuberculosis treatments isoniazid and rifampin, Prilosec and Serzone.

Check with your pharmacist and physician to make sure Klonopin is safe in combination with any other medicines you take.

Special Precautions

The effectiveness of Klonopin may decline after many months on the medication.

Dependence is a possibility with any benzodiazepine. Sudden discontinuation of the drug could trigger status epilepticus in patients taking it as an anticonvulsant.

Other withdrawal symptoms may include nervousness, agitation, difficulty concentrating, insomnia, fatigue, headache and nerve twitching.

Never stop taking Klonopin without medical supervision. This medication may have to be phased out gradually over a period of weeks or months.

Klonopin is not appropriate for those with liver disease. It should not be prescribed for anyone who has had an allergic reaction to another benzodiazepine.

Taking the Medicine

Klonopin is taken three times a day. It may be taken with food, especially if it upsets your stomach.

Carry identification (Medic-Alert) if you are taking Klonopin as an anticonvulsant.

Overview

DiaBeta is used together with diet and exercise to control non-insulin-dependent, or Type II, diabetes.

This condition, formerly called "adult-onset" diabetes, seems to result when the body does not respond adequately to insulin made by the pancreas.

This pill seems to stimulate the pancreas to make more insulin and encourages greater sensitivity to insulin in the body.

Side Effects and Interactions

Episodes of dangerously low blood sugar, or hypoglycemia, are a hazard with DiaBeta as with any oral diabetes drug.

Be alert for symptoms of fatigue, shakiness, headache, cold sweat or confusion, as they could signal this hazardous reaction.

Be sure to discuss the symptoms and treatment of hypoglycemia with your health care provider.

Other possible side effects of this medication include nausea, heartburn, skin rash, changes in liver enzymes, susceptibility to sunburn, ringing in the ears and blood changes.

Fever, sore throat and bruising or bleeding could signal a rare but serious reaction that requires immediate attention.

Report any symptoms or suspected side effects without delay.

A number of compounds may interact with DiaBeta. Alcohol should be avoided if you are on this drug, as it could cause low blood sugar.

Other drugs that might lead to drops in blood sugar include large doses of aspirin, the ulcer drugs Tagamet and Zantac, the cholesterol medicine Lopid and the MAO inhibitor antidepressants Marplan and Nardil.

Be aware that a magnesium-based antacid like Maalox or laxative like Milk of Magnesia could boost the power of DiaBeta and lead to unexpectedly low blood sugar levels.

Many blood pressure pills and heart medicines may also interact with DiaBeta.

Of special concern are the beta blockers such as Inderal LA or Tenormin, because they may mask the warning symptoms of hypoglycemia.

Thiazide diuretics like HydroDIURIL or Lozol can raise blood sugar and may interfere with DiaBeta's effects.

It's possible that juniper berries may turn out to lower blood sugar; if so, they would interact with diabetes medicines such as DiaBeta. Close monitoring of blood sugar is advised.

There is a possibility that garlic could interact with drugs that lower blood sugar. Careful monitoring is suggested for anyone combining garlic products with glyburide.

Check with your doctor and pharmacist to make sure DiaBeta is safe in combination with any other drugs and herbs you take.

Taking the Medicine

DiaBeta may be taken with food, especially if it upsets your stomach.

The manufacturer suggests that it be taken with breakfast or the first meal of the day.

Special Precautions

DiaBeta must not be taken by people who are allergic to sulfa drugs.

Your doctor will need frequent blood tests to adjust the dose of DiaBeta when you begin taking it.

Illness or a change in your exercise program may also make it necessary to adjust the dose later on.

Overview

Daypro is a pain reliever used to treat osteoarthritis and rheumatoid arthritis.

Like other nonsteroidal anti-inflammatory drugs, it reduces swelling and inflammation as well as alleviating pain.

Side Effects and Interactions

The most common side effects of Daypro involve the gastrointestinal tract. They include nausea, indigestion, diarrhea, and constipation.

Some people may develop ulcers and intestinal bleeding while taking Daypro. Occasionally these problems can occur without obvious symptoms and lead to a life-threatening crisis due to perforation of the stomach lining.

Older people appear to be more susceptible to this problem and should be monitored carefully.

Warning signs include weight loss, persistent indigestion, a feeling of fullness after moderate meals, dark or tarry stools, anemia and unusual fatigue.

Home stool tests such as Hemoccult or Fleet Detecatest may provide an early indication of bleeding.

Other side effects to watch for include rash, drowsiness, sleep problems, depression, ringing in the ears, or urinary frequency and pain.

Lightheadedness, difficulty concentrating, and confusion are possible, so do not drive if you become impaired.

Less common reactions may include anaphylaxis (swelling, difficulty breathing, often with rash or hives), which calls for immediate medical attention.

Palpitations, blurred vision, changes in weight and changes in blood pressure have been reported rarely. Report any symptoms to your physician promptly.

Daypro can affect both the kidney and liver, so periodic blood tests to monitor the function of these organs is important.

Some people become sensitive to sunlight while on Daypro, with a severe burn or rash resulting, so use an effective sunscreen, stay covered or avoid the sun.

This medication can interact with certain other drugs, including aspirin and alcohol.

Daypro may blunt the effectiveness of blood pressure medicines such as beta-blockers like Corgard or Tenormin, and possibly ACE inhibitors like Capoten, Vasotec or Zestril.

Because it has the potential to cause GI bleeding, Daypro could be dangerous in combination with the blood thinner Coumadin.

Check with both your doctor and your pharmacist before taking Daypro in combination with any other drugs.

Special Precautions

People who are allergic to aspirin or other anti-inflammatory agents should avoid Daypro.

Signs of allergy include breathing difficulties, rash, fever, or a sudden drop in blood pressure and require immediate medical attention.

Taking the Medicine

Because Daypro can be hard on the digestive tract, it may be taken with food to reduce stomach irritation.

This offers no guarantee of safety, however.

Overview

Thyroid hormones come in a variety of formulations and brand names.

Natural products made of dried thyroid glands from beef and pork are sold as Armour Thyroid, Thyroid Strong and Thyroid USP.

They are generally quite inexpensive, but dosage levels may vary. That is why endocrinologists usually prescribe synthetic products such as Synthroid or Levothroid.

When people develop a sluggish thyroid gland they often feel tired and weak. They may become constipated, sensitive to cold or anemic.

They may also suffer with dry skin and hair, thick brittle fingernails and have shortness of breath when they exercise.

Some people report clumsiness, weight gain, or puffy eyes.

Thyroid problems are diagnosed with blood tests. The best is one that measures thyroid stimulating hormone, or TSH.

This test also helps determine the proper dose of thyroid hormone for treatment.

Side Effects and Interactions

Side effects of thyroid replacement therapy are rare if the dose is appropriate.

Specialists recommend beginning treatment with a low dose and gradually increasing it until symptoms of underactive thyroid disappear and the TSH blood test is normal.

This may initially require blood tests every four to six weeks and good communication with the doctor.

Too much thyroid hormone can lead to complications such as osteoporosis and heart disease.

Signs of overdose include insomnia, heart palpitations, jitteriness, rapid heart beat, increased sweating, higher blood pressure, changes in appetite, and reduced menstrual flow.

Other adverse reactions of excessive thyroid levels include tremor, headache, diarrhea, and weight loss. Report any such symptoms to your physician promptly.

A number of medications may interact with thyroid hormone or alter the tests that detect thyroid problems.

People taking estrogen, asthma medicines, decongestants (including those found in over-the-counter cold or flu remedies), antidepressants, certain cholesterol lowering drugs, blood thinners such as Coumadin or heart medicine like digoxin should check with a physician or pharmacist.

In theory, the herb guggul might counteract thyroid-suppressing drugs or increase the effect of thyroid hormones. Monitoring thyroid function is prudent.

Licorice may alter the required dose of levothyroxine because of its impact on the thyroid gland.

Never stop taking thyroid hormone without first checking with your health care provider.

Special Precautions

Too much thyroid hormone can make a person more susceptible to osteoporosis or weakened bones.

You may wish to discuss with your doctor whether you need tests to monitor bone density.

Thyroid replacement is usually needed for the rest of one's life, and stopping the medicine suddenly could precipitate symptoms of inactive thyroid.

Don't discontinue any thyroid hormone without your doctor's supervision. It is usually best to stick with one formulation rather than switching from one brand to another frequently.

Taking the Medicine

The usual recommendation is to take thyroid hormone before breakfast.

Although this hormone is probably best taken on an empty stomach, it is more important to take it at the same time every day to maintain a constant level in your body.

Do not take this medication with iron pills, as they can interfere with proper absorption.

Overview

Mevacor is prescribed primarily to lower cholesterol.

Heart specialists recognize that coronary artery disease is associated with certain risk factors, including high serum cholesterol, bad LDL cholesterol, elevated triglycerides and reduced levels of protective HDL cholesterol.

Diet, exercise and weight control are usually considered important first-line preventive approaches. When they are insufficient, drugs like Mevacor may be important in reducing the risk of heart disease. This medication has been found to increase good HDL cholesterol while lowering triglycerides and certain other negative blood fats.

Side Effects and Interactions

Mevacor has relatively few side effects and most people tolerate it well. Some adverse reactions that may occur include headache, skin rash, flatulence, constipation, diarrhea, nausea and stomach ache.

Less common complications include muscle pain, blurred vision, dizziness, insomnia, and numbness or tingling of the hands or feet.

Muscle aches or weakness could be a sign of a serious reaction called rhabdomyolysis or myopathy, and call for a test of kidney function.

Kidney failure might be the outcome of untreated myopathy. Report any symptoms to your physician promptly.The danger of rhabdomyolysis or myopathy is increased when Mevacor is combined with certain other drugs.

Troleandomycin or erythromycin antibiotics such as E.E.S., E-Mycin, Erythrocin or PCE have been involved in several cases.

The new antibiotics Biaxin and Zithromax belong to the same class of drugs, but it is not clear if they have a potential for such an interaction.

When Mevacor is combined with other cholesterol-lowering medicines such as Lopid or niacin be alert for muscle pain, weakness, and kidney damage, as rhabdomyolysis is more common in this situation (affecting perhaps 3 or 4 percent of those on Mevacor and Lopid).

The transplant drug Sandimmune increases the risk of this dangerous reaction dramatically, with some reports estimating that around 30 percent of patients on this immunosuppressant together with Mevacor experience myopathy.

Mevacor may also increase the action of the blood thinner Coumadin, with prolonged prothrombin time.

It's possible that flavonoids found in the herb Echinacea affect the enzyme (CYP 3A4) responsible for metabolizing many common drugs. If so, medications such as Mevacor could reach higher levels in the body.

The herb St. John's wort might speed elimination of Mevacor from the body, which could reduce its effectiveness.

There is a remote but untested possibility that peppermint could increase the effects of cholesterol-lowering drugs such as Mevacor. These agents work by inhibiting the enzyme HMG CoA reductase, and menthol has a similar action.

The herb gotu kola may raise cholesterol levels and should not be combined with cholesterol-lowering medications such as Mevacor.


Check with your physician and pharmacist to make sure Mevacor is safe in combination with any other drugs or herbs you may take.

Special Precautions

Anyone with liver problems should probably not take Mevacor.

Liver enzyme changes have been reported in a small proportion of patients using this medicine, and may indicate serious problems.

Liver function should be tested before anyone starts taking Mevacor and every month or so for the first year. Periodic tests are needed thereafter.

Because cholesterol is essential for the developing fetus, pregnant women should not take Mevacor.

Research on animals has also linked Mevacor to liver tumors, but only at relatively high doses. Whether there is a risk for humans remains to be determined.

It is important to see an ophthalmologist before starting on Mevacor. An eye test should also be performed annually to make there is no damage to the lens.

Taking the Medicine

The manufacturer recommends that Mevacor be taken with supper. If you need more than one dose daily, take them with meals.

Overview

*** WARNING: THIS DRUG WAS WITHDRAWN FROM THE MARKET BY THE FDA.

Propulsid promotes good muscle tone in the gastrointestinal tract and in so doing facilitates the proper movement of food through the system.

It is prescribed for nighttime heartburn due to acid splashback from the stomach to the esophagus through the ring of muscle known as the lower esophageal sphincter.

Instead of combating the symptoms of heartburn by neutralizing or reducing the acid produced in the stomach, Propulsid tightens the sphincter to help keep the acid in the stomach where it belongs.

Side Effects and Interactions

Reported side effects of Propulsid include headache, diarrhea, stomachache, constipation, flatulence, runny nose and vision disturbances.

Other reactions, such as insomnia or drowsiness, vaginitis, dry mouth, palpitations, tremor and migraine, are less common.

Many other effects were reported rarely during clinical trials, and some potential side effects of this relatively new drug may not yet have been recorded. Report any symptoms to your physician promptly.

Because Propulsid is prescribed for heartburn, other medicines that work to reduce acid secretion may be prescribed at the same time. Both Tagamet and Zantac are absorbed more rapidly when given with Propulsid.

Tagamet also increases the blood levels of Propulsid.

Other stomach medicines such as Donnatal or Pro-Banthine would work against Propulsid and shouldn't be combined with it.

Besides increasing sphincter pressure, Propulsid hastens stomach emptying. This is generally beneficial but it could interfere with proper absorption of other medicines taken together with Propulsid. Blood levels of such medicines may need to be monitored more frequently.

Propulsid increases the action of blood thinners like Coumadin. Blood clotting time should be checked carefully both when patients on anticoagulants start taking Propulsid and when they stop.

Alcohol and sedative drugs like Halcion, Restoril, Ativan or Xanax produce more impairment in a person who is also taking Propulsid.

Because Propulsid is a relatively new medication, there may be other drug interactions that have not yet been identified.

Do not take any other medication without first asking your physician and pharmacist to check on the potential for interaction with Propulsid.

Special Precautions

Propulsid should not be taken when there is gastrointestinal bleeding, obstruction of the bowel or a possible perforation. Increasing digestive tract movement in such cases could be dangerous.

Although Propulsid doesn't slow reflexes or impair judgment on its own, it may increase the impairment experienced by a person taking an anti-anxiety medicine such as Valium or Xanax.

If Propulsid must be taken together with a benzodiazepine, a prudent person will avoid driving or operating dangerous machinery.

Taking the Medicine

Propulsid is taken four times a day, at least 15 minutes before meals and at bedtime.

Store the pills away from moisture at room temperature (between 59 and 86 degrees F).

Overview

Paxil, like the earlier antidepressant Prozac, apparently works by enhancing the action of a brain chemical called serotonin.

This medication is prescribed to treat major depression, and has been shown to be effective for up to one year.

Like Prozac, Paxil is less likely to cause typical side effects associated with older medications.

Tricyclic antidepressants like Elavil, Tofranil, Sinequan and Pamelor often produce dry mouth, dizziness, weight gain, and a sluggish or lethargic feeling. Paxil may not have these effects, and may have a slight stimulant action.

Side Effects and Interactions

Side effects associated with Paxil include exhaustion, sweating, nausea, decreased appetite, drowsiness, dry mouth, dizziness, insomnia, tremor, problems with ejaculation and anxiety.

Less common adverse reactions include headache, palpitations, constipation, diarrhea, blurred vision and decreased libido.

A wide range of other reactions have been reported but appear to be uncommon. Report any symptoms to your physician promptly.

Paxil can interact with a number of other medications.

Anyone taking other antidepressants, especially drugs such as Nardil, Marplan or Parnate should stop such a medicine at least two weeks before starting on Paxil.

If Paxil is taken first, two weeks should elapse before starting on one of these other medicines.

If the amino acid tryptophan ever becomes available in the U.S. again, it should not be taken with Paxil, as it may increase the potential for adverse reactions.

Tricyclic antidepressants like Elavil, Pamelor or Tofranil could in theory have stronger actions and more pronounced toxicity when they are combined with Paxil.

This may also occur with certain medications prescribed to regulate heart rhythm.

Other compounds that could cause complications in combination with Paxil include Coumadin and possibly Lanoxin.

Tagamet may increase Paxil levels, while phenobarbital or Dilantin can lower them.

Interactions between the herb St. John's wort and Paxil are possible. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John's wort in Hyla Cass's book, St. John's Wort: Nature's Blues Buster).

Check with your pharmacist and physician before taking any other medicines or herbs in combination with Paxil.

Special Precautions

Some people may need very close monitoring if the doctor prescribes Paxil.

For people who have had an episode of mania, there is a risk that manic symptoms could be triggered by Paxil.

Patients who have had seizures also need to followed carefully, since Paxil, like most other antidepressants, may provoke seizures in susceptible individuals.

Because Paxil may cause drowsiness or dizziness, people taking this medicine should not drive or use dangerous machines unless an objective evaluation shows they are not impaired.

Older people and those with kidney disease or liver problems may need to start on a reduced dose, as they may eliminate Paxil less efficiently than otherwise healthy people.

Anyone with a history of suicide attempts must also be extremely vigilant. There have been reports that some people may develop a preoccupation with suicide or violence while taking Prozac.

It is still not certain whether this is caused by the underlying mental condition or is in some way related to the drug. If Prozac were responsible for any of these incidents, there might also be a risk with Paxil.

Family members must help monitor people on Paxil for suicidal thoughts or self-destructive behaviors. The doctor must be notified immediately in such cases.

Taking the Medicine

According to the manufacturer, Paxil should be taken once a day, preferably in the morning.

It may be taken either with or without food.

Overview

This popular antibiotic is a combination of two sulfa drugs, sulfamethoxazole and trimethoprim.

It is frequently prescribed for urinary tract infections, middle ear infections, chronic bronchitis, diarrhea caused by Shigella, and pneumonia due to Pneumocystis carinii.

It is occasionally prescribed for travelers' diarrhea.

Co-trimoxazole is available in single- and double-strength tablets and suspensions for pediatric use.

Side Effects and Interactions

Side effects from co-trimoxazole may include nausea, vomiting, diarrhea, stomach ache, hives, peeling of skin, itching, headache, insomnia, weakness, dizziness, and depression.

Blood disorders and liver damage are unusual but potentially serious. If a rash appears, contact the doctor without delay. Severe skin reactions, while rare, begin with a rash.

Co-trimoxazole can make skin and eyes more sensitive to the sun. It is wise to prevent problems by using sunscreen, protective clothing, a hat, and effective sunglasses.

Remember to report any symptoms or suspected side effects to your physician. Notify the doctor immediately if you develop sore throat, fever, chills, yellowing of skin or eyes, and unusual bleeding or bruising.

Co-trimoxazole may interact with Coumadin, diabetes pills such as Diabinese, Orinase or Tolinase, hydrochlorothiazide or certain other diuretics, Dymelor, methotrexate, cyclosporine, and Dilantin.

Be sure to check with your physician and pharmacist before taking co-trimoxazole together with any other drugs.

Special Precautions

If you are allergic to sulfa drugs, alert your physician immediately.

People who have reacted to other sulfa drugs, including diabetes pills and thiazide blood pressure medicines, should not take co-trimoxazole.

Symptoms such as breathing difficulty, wheezing, sneezing, hives, itching, and skin rash require immediate emergency treatment.

Life-threatening anaphylactic shock may produce an inability to breathe and cardiovascular collapse and can occur within minutes of exposure.

Co-trimoxazole is not prescribed for women at or after 36 weeks of pregnancy, for breastfeeding mothers, or babies less than two months old.

Elderly people may need lower doses, especially if kidneys or liver are not functioning well.


Prolonged use of an antibiotic like co-trimoxazole sometimes leads to an overgrowth of fungus or resistant bacteria known as superinfection. If this occurs, the doctor may need to have you discontinue this drug and take a different medication.

Taking the Medicine

Co-trimoxazole is best swallowed on an empty stomach, at least one hour before or two hours after a meal, with a full glass of water.

If it causes stomach upset, it may be taken at mealtime.

Be sure to finish the entire prescription unless your doctor directs you to stop.

Overview

Hyzaar combines a new kind of blood pressure medicine (prescribed alone as Cozaar) with an old-fashioned diuretic, hydrochlorothiazide (HCTZ).

It is prescribed for high blood pressure, especially if neither drug alone has lowered blood pressure adequately.

Hyzaar may be less effective for African-American patients.

Side Effects and Interactions

People on Hyzaar have experienced dizziness, weakness, insomnia, muscle cramps or pains, nasal congestion and sinusitis.

Other side effects reported include faintness, low blood pressure, diarrhea, vomiting, indigestion, chest pain and impotence.

Unusual but serious reactions to hydrochlorothiazide include rashes which require medical attention, allergic reactions (anaphylaxis) that involve difficulty breathing and shock, changes in blood, increased blood sugar, and disturbances in the balance of electrolytes.

Periodic blood tests are necessary to check on levels of potassium, magnesium, and other electrolytes. Report any symptoms to the physician promptly.

Dizziness or faintness may be worsened by alcohol, barbiturates, narcotic pain medicine, or dehydration through excess sweating, diarrhea or vomiting. Be especially careful when sitting or standing up.

Hyzaar is not appropriate during the second or third trimesters of pregnancy. If a woman taking Hyzaar becomes pregnant, she should consult her doctor as soon as possible.

The dose of diabetes medicine may need to be adjusted.

Questran and Colestid may reduce absorption of HCTZ and should be taken at a different time of day.

Muscle relaxants and cortisone-like drugs also have the potential to interact.

Arthritis drugs, including OTC NSAIDs like Advil or Aleve, may interfere with the effectiveness of HCTZ.

Lithium is not considered compatible with this diuretic and may become more toxic.

Hydrochlorothiazide alone can make the skin more sensitive to the sun. Avoiding sun exposure or using sunscreen and protective clothing are sensible precautions for those taking Hyzaar.

Tagamet may increase the level of Hyzaar slightly, while phenobarbital reduces it.

Interactions with other drugs such as erythromycin, Nizoral, or Sporanox have not been documented but are theoretically possible because losartan is metabolized by CYP 450 enzymes in the liver.

Licorice can greatly increase potassium loss due to medicines such as hydrochlorothiazide.

Check with your doctor and pharmacist to make sure Hyzaar is safe in combination with any other drugs or herbs you take.

Special Precautions

Hyzaar is not recommended for people with liver disease. Serious kidney problems may also interfere with the safe use of Hyzaar.

Hydrochlorothiazide can aggravate lupus (SLE). Make sure your physician is aware of your health history.

Taking the Medicine

Hyzaar may be taken when convenient, with or without food.

It is taken once or twice a day, according to the prescription.

Overview

This medicine makes blood flow more easily through blood capillaries.

It improves red blood cell flexibility so these oxygen-carrying cells can squeeze through small vessels or those that are almost blocked.

Trental is used to treat a leg condition called intermittent claudication, which causes pain upon walking.

Although the FDA has not approved Trental for any other use, doctors sometimes prescribe this medicine for complications of diabetes, sickle cell anemia, Raynaud's syndrome, hearing problems, mountain sickness, stroke and other conditions where blood flow to the brain is compromised.

Side Effects and Interactions

Side effects associated with Trental are relatively infrequent.

Those that have been reported include dizziness, flushing, stomach upset, flatulence, belching, bloating, loss of appetite, nausea, indigestion, and vomiting.

Other adverse reactions to be aware of are headache, blurred vision, constipation, excessive salivation, tremor, confusion, anxiety, nasal congestion, chest pain, brittle fingernails, rash, itching, bad taste in the mouth, swelling, difficulty breathing, thirst and dry mouth.

Report any symptoms to your physician promptly.

Trental does not interact with many other medications.

There have been, however, reports that it may affect blood clotting time, especially in combination with blood thinners such as Coumadin. This could lead to hemorrhaging unless blood is carefully monitored by a test called a prothrombin time.

Blood pressure should also be determined periodically, particularly if you must take antihypertensive medications.

Check with your physician and pharmacist to make sure Trental is safe in combination with any other medicines you may take.

Special Precautions

People who are especially sensitive to caffeine or the closely related asthma drug theophylline may not be able to tolerate Trental.

The doctor should proceed cautiously when prescribing Trental for someone with kidney disease or arteriosclerosis.

Taking the Medicine

Although food may slow the absorption of Trental, it does not reduce the total amount of medicine absorbed into the body.

If this drug upsets your stomach it should be taken with meals.

Overview

Timoptic eye drops are very effective at lowering pressure within the eye and have helped provide an important advance in the treatment of some types of glaucoma.

The active ingredient, timolol, is known as a beta blocker.

Timoptic is normally prescribed alone or with other glaucoma medications to reduce the pressure within the eye.

Side Effects and Interactions

Timoptic can cause eye irritation and some visual disturbances.

It may also provoke headache, dizziness, slow heart rate, heart rhythm disturbances, chest pain, drowsiness, muscle weakness, sexual difficulties, nausea, diarrhea, muscle weakness, rash, hair loss and trouble breathing.

Although Timoptic is less likely to affect the nervous system than oral beta blockers, be alert for the beta blocker blahs. Symptoms of psychological depression, fatigue, confusion, and memory loss may come on slowly and insidiously. Notify your physician promptly of any adverse reactions, especially breathing difficulties, fluid retention in the legs or a night cough.

Timoptic may interact with surgical anesthetics and increase the risk of heart problems in surgery. Check with the doctor ahead of time to see if you should phase off these eye drops gradually before you enter the operating room.

This drug may also interact with a number of other compounds, including several that are used to treat blood pressure or heart problems.

MAO inhibitors for depression (Nardil, Parnate) should not be taken with oral timolol and may pose problems with Timoptic. Dilantin and digoxin may also cause trouble.

Oral contraceptives, estrogen replacement therapy and medicines for arthritis, asthma, migraine headaches, diabetes, and thyroid problems have potential interactions with these eye drops.

Check with your doctor and pharmacist to make sure Timoptic is safe in combination with any other drugs you may take.

Special Precautions

Some people should avoid beta blockers like Timoptic or take them only with great caution.

Asthmatics and patients with other respiratory problems are especially vulnerable, as these drugs can make breathing worse.

People with heart failure should also alert the ophthalmologist, as beta blockers may lead to cardiac complications.

These eye drops can also affect blood lipid levels in a negative manner. A consultation between the eye doctor and the one treating lung or heart problems may be in order.

Taking the Medicine

Timoptic is less likely than oral timolol (Blocadren) to affect the entire body. Nevertheless, some people absorb this medicine through the eye and into the body as a whole.

Absorption can be reduced somewhat with proper application. It helps to pull the lower eyelid away from the eye to make a pouch, look upward, and put the drop in the pouch without touching the dropper to the eye.

As soon as the drops are in, the eyelid should be closed gently for 1 to 2 minutes and pressure applied with a finger to the inside corner of the eye.

Do not stop using Timoptic on your own. Your physician will give you special instructions if you need to discontinue these eye drops or change to another one.

Overview

Ritalin is a mild stimulant prescribed primarily for attention deficit disorder (ADD), with or without hyperactivity.

Ritalin should not be the sole treatment for ADD, which is best managed in an integrated program of educational, psychological and social support.

Diagnosis of the condition requires input on psychological and social factors as well as medical and educational issues. Not all children with ADD respond to Ritalin, but many find it helpful.

Ritalin is also prescribed for narcolepsy, a sleep disorder which results in sudden and unexpected daytime sleepiness.

It has been termed "possibly effective" for mild depression or withdrawn behavior in the elderly.

Side Effects and Interactions

The most common side effects of Ritalin are nervousness and insomnia.

Children often react with stomach ache, loss of appetite, weight loss, trouble sleeping, and rapid heart beat.

Rash is occasionally the first sign of a severe skin reaction. Notify the physician promptly.

Other possible responses include hives; fever; joint pain; nausea; dizziness; palpitations; changes in the pulse or blood pressure; chest pain; hair loss; headache; unusual movements; Tourette's syndrome; and anemia.

Ritalin may impair physical coordination or mask tiredness, making driving and operating machinery more dangerous.

Periodic tests should be conducted to monitor blood cell counts. Report any symptoms or suspected reactions to the physician promptly.

Many medicines, including Coumadin, several anticonvulsants, antidepressants such as amitriptyline or imipramine (Tofranil), and MAO inhibitors (Eldepryl, Nardil, Parnate) can interact with Ritalin.

Other possible interactions include the blood pressure drug guanethidine.

Check with the pharmacist and physician to make sure Ritalin is safe in combination with any other medicines.

Special Precautions

Ritalin is not approved for use in children younger than six.

Long-term safety of Ritalin has not been adequately studied in children. Some reports suggest that growth may be adversely affected.

The doctor may suggest periodic "drug-free days" in which Ritalin is not taken in order to assess whether the child still needs it.

Ritalin is not appropriate for people who are severely depressed or psychotic.

Those with high blood pressure or a history of seizures may aggravate these conditions by taking Ritalin.

Glaucoma or a family history of Tourette's syndrome are also reasons to avoid Ritalin.

Ritalin is considered a controlled substance with a potential for abuse. In the event of abuse, withdrawal must be carefully supervised.

Taking the Medicine

Ritalin is taken two or three times a day, preferably 30 to 45 minutes before meals.

People who experience insomnia in reaction to Ritalin should take the last dose before 6:00 p.m.

Ritalin-SR (slow release) tablets must be swallowed whole, never chewed or crushed.

Overview

The conjugated estrogen formulation is one of the most commonly prescribed medicines in the country, under the brand name Premarin.

The conjugated estrogen formulation is one of the most commonly prescribed medicines in the country, under the brand name Premarin. The hormones are purified from pregnant mares' urine.

Prempro provides a tablet that combines conjugated estrogens with medroxyprogesterone so a woman has to take only one single tablet daily.

Premphase also provides one dose of these estrogens daily. The pills taken on days 15 through 28 of the cycle contain medroxyprogesterone in addition to the conjugated estrogens.

Estrogen replacement therapy is prescribed primarily to relieve menopausal symptoms such as hot flashes.

It has also become a popular measure for preventing osteoporosis and reducing the risk of heart disease in postmenopausal women.

Side Effects and Interactions

Premphase has a number of potential side effects, including breakthrough menstrual bleeding, breast tenderness, bloating, nausea, vomiting, stomach pain, headache, gallbladder problems, liver tumors, depression, jaundice and high blood pressure.

Some women experience an increase in blood sugar and may go on to develop diabetes.

The skin may become more sensitive to the sun, so it is wise to use sunscreen and wear protective clothing (including a hat and sunglasses) if you will be out.

Some kinds of vaginal infections may be more common in women using estrogen. Candida or yeast overgrowth may be a problem.

Other adverse reactions include a change in weight, fluid retention, alteration in sex drive, hair loss, and change in the curvature of the cornea. This may make contact lenses inappropriate.

Report any suspected side effects to the physician promptly.

Your doctor should be notified immediately of any of the following symptoms: pain in the calf or groin, sudden shortness of breath or sharp chest pain, sudden severe headache, blurred vision or speech, weakness or numbness in an arm or leg, yellow skin or eyes or severe abdominal pain.

Let your doctor know if you suspect you may have become pregnant, if you feel seriously depressed, if you notice lumps in your breast, or if vaginal bleeding is abnormal.

Premphase may interact with several other medications, such as theophylline or beta blocker blood pressure pills.

The activity of the anticoagulant Coumadin and that of certain antidepressants may be altered.

Adequate intake of calcium and vitamins B6 and folic acid is important.

Other estrogens interact with alcohol and with grapefruit; it is not known if the conjugated estrogens in Premphase do.

Until the estrogenic activity of hops is further studied, taking this herb in combination with medicines such as oral contraceptives or hormone replacement therapy is an experiment best avoided.

In general, the herb chaste tea berry should not be combined with menopausal hormone replacement therapies.

Saw palmetto berries, which have both estrogenic and antiestrogenic activity, are not recommended for women using female hormones for hormone replacement therapy.

Check with your doctor and pharmacist before taking any other medicine or herbs while taking Premphase.

Special Precautions

There are a number of situations where Premphase may be inappropriate.

Pregnant women should not use this medication, as it could affect the fetus.

Women with a history of breast cancer or other malignant disease susceptible to estrogen are generally advised to avoid this hormone.

Blood clotting disorders such as thrombophlebitis are also a reason to be wary of Prempro.

Prolonged use of postmenopausal estrogen has been controversial because it increases the risk of endometrial carcinoma or cancer of the uterine lining.

Medroxyprogesterone, as supplied in Premphase, counteracts this danger to a large extent.

Vaginal bleeding could be an early warning sign of cancer, however, and requires immediate medical attention.

Medroxyprogesterone does not appear to be protective against the increased risk of breast cancer. Women with a strong family history of breast cancer will want to discuss this issue with their doctor.

Taking the Medicine

Premphase tablets are to be taken once a day.

Overview

Penicillin represents one of the most important drugs ever developed. Its discovery in 1946 permanently changed medicine and set the stage for man's ability to overcome what had previously been life-threatening infections.

Penicillin is effective in fighting infections in many places in the body including the urinary tract, lungs, ears, throat, skin and genital tract.

Penicillin V potassium is prescribed generically or under a variety of brand names including Beepen-VK, Betapen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Robicillin VK, V-Cillin K and Veetids.

Side Effects and Interactions

The most common side effects of penicillin involve digestive tract upset.

Nausea, vomiting and diarrhea can be troublesome for some people. A black hairy tongue, rash, sore mouth, and yeast infections of the mouth, anus or vagina are other potential adverse reactions.

Less common but possibly more serious side effects include anemia and blood disorders.

Report any symptoms to your physician promptly. Long-term treatment with penicillin-type antibiotics requires periodic monitoring by a health professional.

Penicillin VK may interact with aspirin and certain other arthritis medicines.

In addition, oral contraceptives may be less effective in combination with this antibiotic.

Check with your pharmacist and physician before taking any other medicine together with penicillin VK.

Special Precautions

Anyone who is allergic to penicillin-type antibiotics must generally avoid such drugs like the plague.

Symptoms such as breathing difficulty, wheezing, sneezing, hives, itching, and skin rash require immediate emergency treatment.

Life-threatening anaphylactic shock may produce an inability to breathe and cardiovascular collapse and can occur within minutes of exposure.

If you are allergic to penicillin and you ever have to go into the hospital, make sure a sign is placed over the bed alerting hospital personnel to penicillin allergy.

Taking the Medicine

Penicillin VK resists acid breakdown in the stomach so it may be taken with food if it upsets your stomach.

However, for maximum absorption take this antibiotic on an empty stomach. That usually means at least one hour before meals or two hours after eating.

Overview

Zithromax is an antibiotic used to treat respiratory tract infections, infections of the skin, and the sexually transmitted disease Chlamydia trachomatis.

Children may be given Zithromax for ear infections and certain sore throats. It is also prescribed for HIV-positive patients who have developed Mycobacterium avium complex.

Side Effects and Interactions

Very few adverse effects are reported with Zithromax. Diarrhea, nausea and stomach pain are among the possible reactions.

Other side effects that are reported occasionally include indigestion, vaginitis, rash, palpitations and dizziness.

An allergic reaction with swelling of the face and throat and trouble breathing is rare but requires emergency treatment. Report any suspected reactions to the physician promptly.

Aluminum/magnesium antacids can reduce the absorption of Zithromax and should not be taken at the same time.

Check with your physician and pharmacist to make sure Zithromax is safe in combination with any other drug you may take

Special Precautions

Serious allergic reactions have occurred rarely in people taking Zithromax.

Occasionally, when treatment of allergic symptoms is stopped, the symptoms begin again even without the patient taking any more Zithromax. Doctors suspect that this is due to the length of time (days) that the antibiotic lingers in the body.

Zithromax may not be appropriate for people with liver problems. Check with your doctor if you have any questions about this.

This medication makes some people more sensitive to sun damage. Sunscreen, protective clothing and effective sunglasses are recommended.

Taking the Medicine

The manufacturer recommends that Zithromax be taken at least an hour before or two hours following a meal. It should not be taken with food.

Overview

Voltaren is a pain reliever used for arthritis. It belongs to a class of medications commonly called NSAIDs or nonsteroidal anti-inflammatory drugs.

Other medicines in this category include over-the-counter analgesics like aspirin, ibuprofen (Advil, Motrin IB, etc.) and naproxen (Aleve) as well as prescription arthritis pills such as Lodine, Naprosyn or Relafen.

Side Effects and Interactions

Unquestionably the most common side effects of Voltaren involve the gastrointestinal tract. They include nausea, indigestion, heartburn, cramps, gas, constipation, and diarrhea.

Some people may develop ulcers and intestinal bleeding while taking Voltaren. Occasionally these problems can occur without obvious symptoms and lead to a life-threatening crisis due to perforation of the stomach lining.

Older people appear to be more susceptible to this problem and should be monitored carefully.

Warning signs include weight loss, persistent indigestion, a feeling of fullness after moderate meals, dark or tarry stools, anemia and unusual fatigue. Home stool tests such as Hemoccult or Fleet Detecatest may provide an early indication of bleeding.

Other side effects to be alert for include headache, ringing in the ears, rash, itching, and fluid retention.

Drowsiness, dizziness, lightheadedness, difficulty concentrating, and confusion are possible, so do not drive if you become impaired.

Less common adverse reactions include jitteriness, insomnia, difficulty breathing, hair loss, depression, changes in appetite, hearing loss, visual disturbances, sores in the mouth and heart palpitations. Report any symptoms to your physician promptly.

Voltaren can affect both the kidney and liver, so periodic blood tests to monitor the function of these organs are important.

Some people become sensitive to sunlight while on Voltaren, so use an effective sunscreen, stay covered or avoid the sun.

This medication can interact with many other drugs including aspirin, alcohol, certain blood pressure pills, and the ulcer medicine Pepcid.

A person taking a blood thinner like Coumadin may become more vulnerable to a dangerous bleeding ulcer.

All the NSAIDs, including Voltaren, can make methotrexate (Folex, Mexate, Rheumatrex), lithium (Eskalith, Lithobid, etc.) and Lanoxin far more toxic.

When Voltaren is combined with Sandimmune the risk of kidney damage is increased.

Because of a possible risk of hemmorhage, we advise against combining ginkgo biloba extract with this medicine.

Check with your pharmacist and physician to make sure Voltaren is safe in combination with any other drugs you take.

Special Precautions

People who are allergic to aspirin or other anti-inflammatory agents should avoid Voltaren.

Signs of allergy include breathing difficulties, rash, fever, or a sudden drop in blood pressure and require immediate medical attention.

Taking the Medicine

Because Voltaren can be hard on the digestive tract, it may be taken with food to reduce tummy trouble. This does not, however, guarantee that the drug will be safe for the stomach.

Overview

Ibuprofen is a pain reliever used primarily for arthritis.

It may also be prescribed for menstrual cramps, bursitis, tendinitis, sprains, strains and other painful conditions. It belongs to a class of medications commonly called NSAIDs or nonsteroidal anti-inflammatory drugs.

It is now available generically, but previously it was one of the most popular arthritis drugs on the market under the brand name Motrin.

Ibuprofen may be prescribed generically or by brand names such as Children's Advil, Ibu-Tab, Motrin or Rufen. It is also available without prescription under such names as Advil, Bayer Select Pain Relief, Medipren, Nuprin or Motrin IB, among others.

Side Effects and Interactions

Unquestionably the most common side effects of ibuprofen involve the gastrointestinal tract. They include nausea, indigestion, heartburn, cramps, gas, constipation, and diarrhea.

Some people may develop ulcers and intestinal bleeding while taking ibuprofen.

Occasionally these problems can occur without obvious symptoms and lead to a life-threatening crisis due to perforation of the stomach lining.
Older people appear to be more susceptible to this problem and should be monitored carefully.

Warning signs include weight loss, persistent indigestion, a feeling of fullness after moderate meals, dark or tarry stools, anemia and unusual fatigue.

Home stool tests such as Hemoccult or Fleet Detecatest may provide an early indication of bleeding.

Other side effects to be alert for include headache, ringing in the ears, rash, itching, nervousness, fluid retention and loss of appetite.

Drowsiness, dizziness, lightheadedness, and confusion are possible, so do not drive if you become impaired.

Less common adverse reactions include insomnia, heart palpitations, hair loss, depression, tiredness, anemia or other blood changes, fever, visual disturbances, meningitis and sores in the mouth.

Some people might become sensitive to sunlight while on ibuprofen, so use an effective sunscreen or stay well covered. Report any symptoms to your physician promptly.

Ibuprofen can affect both the kidney and liver, so periodic blood tests to monitor the function of these organs are important for anyone on this drug long-term.

This medication can adversely interact with many other drugs. A person taking a blood thinner like Coumadin may become far more vulnerable to a dangerous bleeding ulcer.

Aspirin may reduce the effectiveness of ibuprofen for reducing inflammation.

All the NSAIDs, including ibuprofen, can make methotrexate (Folex, Mexate, Rheumatrex) and lithium (Eskalith, Lithobid, etc.) far more toxic.

Other potentially serious interactions may occur with ibuprofen reducing the effectiveness of ACE inhibitor blood pressure medicines such as Altace, Lotensin or Vasotec, beta-blocker blood pressure drugs like Corgard, Inderal LA or Tenormin, and diuretics such as Bumex, Lasix or Maxzide.

Hemorrhage with the combination of ginko and aspirin has been reported. We advise against combining arthritis medicines such as ibuprofen (Advil, Motrin IB, etc.) with ginkgo biloba extract.