Background information: 15year old female who is not allergic to any medications or taking any medications. She has not tried any acne [...]]]>

Emailed question: Help! I have a date in 2 weeks and need a recommendation for a pimple treatment that can get rid of a pimple overnight! And how did I get these pimples?

Background information: 15year old female who is not allergic to any medications or taking any medications. She has not tried any acne medications (or pimple medications) and has oily skin.

Acne vulgaris or pimple is a common skin condition described as inflamed and/or pus filled skin lesions that are formed as a result of plugged up pores, over-active oil glands and/or presence of skin bacteria, P. acnes. Acne affects mostly teenagers and even some adults, and is generally localized in areas of the face, neck, chest, upper back and shoulders.

Since you are at the age of puberty, your body over-produces hormones that make you more prone to having pimples.

I hate to break the news to you, but there are no treatments that can get rid of a pimple overnight. Most treatments will take at least two to four weeks to see any skin improvement.

My recommendations for pimple treatments are as follow:

(1) Gently cleanse the affected area twice daily with a mild skin cleanser such as Cetaphil cleanser.
(2) At bedtime, apply any over the counter products that contain benzoyl peroxide 5% (Proactive, Neutrogena skinID, Panoxyl, Benzagel, Solugel, Clean & Clear, Clearasil etc), which helps to resurface the skin and has a mild antibacterial effect. These are available in forms of cream, lotion or gel. You should select a gel or alcohol-based product if you have oily skin.
Note: apply on the acne and around the affected areas

You can purchase a “3 Step anti-blemish system” from Proactiv to help get clearer skin. Some benefits of purchasing Proactiv include free online consultation with Dr Katie Rodan & Dr Kathy Fields, many positive testimonials from celebrities, and best of all it has a risk free, 60-days money back guarantee. Please visit www.proactiv.com for more information.

You can also purchase a personalized skin care treatment kit that is “made specifically to your skin type and lifestyle” after completing an interactive online questionnaire at www.skinid.ca. Other benefits of purchasing from Neutrogena skinID: the products are clinically proven to work, with a 100% satisfaction or money-back guarantee and also you may have access to dermatologists support (for more details please visit www.skinid.ca.)

Other over the counter products contain salicylic acid or resorcinol

(3) Try to avoid or minimize use of the following (can cause or worsen pimples):

(1) Medications: coal tar products, hormonal treatments (such as progesterone), phenytoin (Dilantin), corticosterioids (such as prednisone, dexamethasone, etc), and lithium. **Note: please consult your doctor first**
(2) Skin trauma and irritation such as scrubbing and/or picking pimple can cause more inflammation (red and swollen).
(3) Certain cosmetics ingredients can plug up pores such as lanolins, cocoa butter and petroleum bases. You should try to select cosmetics products that are labelled “non-comedogenic” which means the products do not plug up pores or promote pimple formations.
(4) Hormonal fluctuations (eg. during your period) can trigger or worsen acne.
(5) Hot and humid environments may cause pores to be plugged up

Please see your doctor if there are no improvement in a few weeks. Your doctor may prescribe the following topical products:
(1) tretinoin (Retin-A, Stieva-A),
(2) adapalene (Differin),
(3) Tazarotene (Tazorac),
(4) erythromycin (Erysol), Clindamycin (Dalacin T, Cindasol, Clindets) or
(5) combination topical products such as
Benzamycin (benzyol peroxide/erythromycin),
Clindoxyl or Benzaclin (benzyol peroxide/clindamycin) or
Stievamycin (tretinoin and erythromycin).

If you have scarring or severe inflamed acne, your doctor may prescribe oral antibiotics (tetracyclines, erythromycin, sulfamethoxazole, trimethoprim or sulfatrim), oral contraceptives, or isotretinoin (Accutane).

Background information obtained: 23 year old male, allergy, current medication(s) and medical condition: penicillin allergy, Clindamycin 150mg taken four times daily for 7 days (for infection prevention after wisdom teeth extraction, started 1 day ago) and Tylenol #3 [...]]]>

Emailed question: I am experiencing severe heartburn!  What causes heartburn? And can you recommend a heartburn medication?

Background information obtained: 23 year old male, allergy, current medication(s) and medical condition: penicillin allergy, Clindamycin 150mg taken four times daily for 7 days (for infection prevention after wisdom teeth extraction, started 1 day ago) and Tylenol #3 (for pain). He takes his last dose of Clindamycin before bedtime.  There is no family history of heart problems nor does he experience any chest pain such as tightness, pressure or shortness of breath, and pain does not radiate from chest to back, neck, jaw or left arm.

From the information that I have gathered, we can rule out any heart conditions such as heart attack or angina pain.  It appears that the cause of your severe heartburn is most likely due to taking clindamycin.  Clindamycin is an antibiotic that can be used to prevent bacterial infection from dental procedures.  This medication can be very irritating to the esophagus (passageway that leads from your mouth to your stomach).  Your experience of severe heartburn may stem from not taking a full glass of water and lying down after taking your last dose of the day.  Therefore, to prevent this from happening again, you should take this medication with a full glass of water and remain upright for at least 30 minutes before going to sleep.  You should avoid any spicy or irritating foods or drinks such as coffee, cola, acidic beverages such as citrus juices, and chilli-oil or sauce etc., until your esophagus is fully healed. If you prefer taking an over-the-counter medication, then I would recommend an acid reducer,“H2 receptor antagonists”, such as ranitidine (Zantac) 75mg or 150mg and famotidine (Pepcid) 10mg to 20mg (take one tablet up to twice daily).  If there is no improvement in 3 or 4 days, then try a stronger acid reducer, “proton pump inhibitor”, omeprazole (Prilosec) 20mg once daily for 14 days (tablet must be swallowed whole -do not crush or chew).  Please see your doctor if no relief after 14 days.  By taking these medications, along with avoiding eating or drinking spicy or irritating foods or beverages, you can allow the esophagus to heal, thereby reducing the heartburn symptoms.

Medications that can cause heartburn related symptoms (irritation of the esophagus):

• Non-steroidal Anti-inflamatories pain medications: acetylsalicylic acid (Aspirin), naproxen sodium (Aleve), ibuprofen (Advil, Motrin) and etc.

• Bisphosphonates: alendronate (Fosamax), risedronate (Actonel) and etc.

• Antibiotics: clindamycin (Dalacin), tetracycline, minocycline (Minocin), doxycycline (Periostat, Vibramycin)

• Minerals: ferrous (Iron) or potassium (K-Dur, Slow K etc.

For more information, ask a pharmacist at consultpharmacist.com!

The best way to avoid risk is to inform both [...]]]>

There are certain medications which, when used during pregnancy, can pose risk to the growth and development of an unborn baby (fetus). About 2 to 3% of fetal malformations or deformities are caused by medications. This may be a very low percentage, but is preventable.

The best way to avoid risk is to inform both your doctor and pharmacist of your pregnancy, as well as how far along you are in the pregnancy (which trimester), before starting any new medications (prescriptions and/or self-medicated over-the-counter medications). Your health care practitioners should provide you with the following information regarding the benefits and risks of taking various medications during your pregnancy:

1. What are the risk(s) to the unborn baby and the mother if not treated?
2. What are the benefit(s) of being treated?
3. Would delaying the treatment an option?
4. Would treatment be safer in certain trimester?
5. Are there another treatment option(s) that is/are safer?

After you obtain all the answers to the above questions, you can then make a well- informed health decision of whether to initiate the medications.

The following list of medications, not exclusively, are proven to be harmful to an unborn baby based on evidence of human and/or animal studies:

• Cholesterol-lowering medications: “Statin” – example: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor)

• Anti-cancer medications: example: fluorouracil (Efudex), leuprolide (Lupron), methotrexate (Rheumatrex)

• Anti-migraine medications: dihydroergotamine, ergotamine (Cafergot)

• Anti-viral medication: ribavirin (Rebetol)

• Sleeping aids: flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion)

• Skin medications: isotretinoin (Accutane), tazarotene (Tazorac), acitretin (Soriatane),

• Blood thinners: warfarin (Coumadin)

• Hormone related medications: danazol, testosterone, estrogen, clomiphene (Clomid), mestranol, progesterone, norethindrone, norethyndrel, norgestril, leuprolide (Lupron), birth control pills, mifepristone

• Anti-seizure medications: carbamazepine (Tegretol), phenytoin (Dilantin), Valproic acid (Depakene), divalproex (Epival)

• Blood pressure lowering medications: benazepril (Lotensin), captopril (Capoten), cilazapril (Inhibace), enalapril (Vasotec), fosinopril (Prinivil, Zestril), perindopril (Coversyl), quinapril (Accupril), perindopril (Coversyl) ramipril (Altace), trandolapril (Mavik), candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis), valsartan (Diovan), eprosartan (Teveten), olmesartan (Benicar, Olmetec)

• Miscellaneous medications: misoprostol (Cytotec or Arthrotec include diclofenac), leflunomide (Arava), alcohol

For more health advice, visit consultpharmacist.com!

Background information obtained: 35 year old female and current medication(s) and medical condition: Alesse 21 for birth control and Macrobid – 7 days therapy (started 1 day ago).

From [...]]]>

Emailed question: I’ve recently noticed that my urine colour has changed to a brownish-yellow colour. What should I do? Should I see my doctor?

Background information obtained: 35 year old female and current medication(s) and medical condition: Alesse 21 for birth control and Macrobid – 7 days therapy (started 1 day ago).

From the information that I have gathered, it appears that the most likely cause of discoloured urine is Macrobid. Macrobid (nitrofurantoin) is a commonly prescribed antibiotic for treatment of bladder infection. A common undesirable effect from this medication is discolouration of urine. The colour of the urine can range from dark yellowish-brown to brownish-black. Please seek medical attention, if you experience any new symptoms or if the colour of urine does not resume back to normal after you have finished your antibiotic therapy.

The chart below indicates other medications that can discolour urine.

Medications That Can Discoloured Urine

I am not sure if you are aware of this but there is a potential drug interaction between Alesse and Macrobid (nitrofurantoin).  Macrobid (nitrofurantoin) can reduce the effectiveness of your birth control pills (Alesse), putting you at risk of unwanted pregnancy.  The following are options to manage this drug interaction: abstinence or use of a second birth control method such as condoms, for a total of 14 days (during and 7 days after the course of antibiotic therapy).

For more information, ask a pharmacist at consultpharmacist.com!

So, you can also save money by purchasing generic brands instead of brand name medications.  According to Food and Drug Administration [...]]]>

Last week, I discussed how you could save money on your prescriptions by cutting your tablets in half (see previous post for more details), now this week I have another money-saving tip.

So, you can also save money by purchasing generic brands instead of brand name medications.  According to Food and Drug Administration (FDA), a generic drug product (generic brand) is one that is comparable to an innovator drug product (brand name) in dosage form, strength, route of administration, quality, performance characteristics and intended use.”  This means that the generic brand has the same active ingredient, as well as the same amount being absorbed into body in the same amount of time, as the innovator drug product (brand name).  The only slight difference between a generic brand and the brand itself may be the inactive or non-medicinal ingredients, such as binders that make tablets or fillers for capsules etc.

The table below includes the costs of a 90-day supply of the two strengths of the popular cholesterol lowering medication, Zocor (simvastatin) and its generic brand.
Note: Costs for 90-day supply includes $8.60 dispensing fee and are based on Canadian 2010 pharmacy prices

So, from the table above, if your doctor prescribed you Zocor 10mg once daily for 90 days and you ask your pharmacist to dispense the generic version instead of the brand name, then your cost will be $109.53 (instead of $192.26), a significant savings of 43% ($82.73). This means an annual savings of $330.94.

Note: Costs for 90-day supply includes $8.60 dispensing fee and are based on Canadian 2010 pharmacy prices

If you also apply my last health-savings tip and ask your pharmacist to fill the generic 20mg tablet and take half of the tablet (to get 10mg) once daily, then your cost will be $66.67, an additional saving of 39% ($42.86).  This means an annual savings of $171.42.  Overall, by choosing a generic version and cutting your tablets in half, you will save $502.36 ($330.94+$171.42) annually!

Please consult your pharmacist if a generic version of your medication if available and if you can cut the tablets in half.

For more money savings tips, visit consultpharmacist.com!

Many prescription medications come in [...]]]>

Prescription medication prices are rising. Do you have chronic medical conditions that require taking many prescription drugs?  Would you like to save money on your medication expenses? If your answer is YES, then please continue reading.  The following is one way that you can cut your prescription expenses in half.

Many prescription medications come in multiple strengths.  But, here is a secret, many of these medications with multiple strengths cost about the same.  The table below includes the costs of a 90-day supply (and costs per tablet) of the various strengths of the popular cholesterol lowering medication, Lipitor (Atorvastatin).

Note: Costs for 90-day supply includes $8.60 dispensing fee and are based on Canadian 2010 pharmacy prices

So, from the table above, if your doctor prescribed you Lipitor 40mg once daily for 90 days, then the cost will be $233.94 if you were to fill 40mg tablets.  But, if you ask your pharmacist to fill Lipitor 80mg and take half of a tablet once daily, then your cost will be $111.97.  You will still be taking 40mg per day, but with a significant savings of 50%, or $111.97 in this case.  This means an annual savings of $447.88!  You can put that extra money towards that special something you’ve been saving up for!

Note: There are certain medications that you cannot cut in half such as (1) capsules, (2) extended or controlled release formulations (“CD”, “XL”,”XR”, “XC”, “LA”, “CR” or “SR”) and (3) enteric coated formulations (“EC”).  Please consult with your pharmacist if you can cut your medications.  If possible, invest in a pill cutter that can cut your medications accurately in half.

For more money savings tips, visit consultpharmacist.com!

Let’s focus on one of the above component to successful treatment: accurate dosage.

Your child’s weight is important to determine the appropriate dosage. I will elaborate this further. In my [...]]]>

What makes treatment successful? Proper diagnosis, appropriate and accurate dosage of selected medication and patient taking it as directed will provide the successful medical outcome.

Let’s focus on one of the above component to successful treatment: accurate dosage.

Your child’s weight is important to determine the appropriate dosage. I will elaborate this further. In my practice, I have often received children’s prescriptions that doctors have written that can over-dose or under-dose due to improper weight given or estimated. Infants and children belong to a special group of patients that is most often their dosage is determined by weight. If weight is not accurate then the treatment will be either ineffective if weight is underestimated or worst unsafe if the weight is overestimated.
When I receive a child’s prescription, the most important information I have to gather is their weight. However, many parent do not have the child’s current weight. I will either offer my pharmacy’s scale to have the parent weigh their child or have them weigh at home. Then with this important piece of information, I will determine if the dosage is appropriate for the child’s weight.

For example, at my practice, Biaxin (clarithromycin) is a commonly prescribed antibiotic for chest and ear infection for children. The appropriate dosage for Biaxin is 15mg/kg/day in 2 divided doses. If the child weighs 20 kg (or 44 lbs), then the most appropriate dosage is 300mg per day or 150mg twice daily. But, if the doctor or parent underestimated or overestimated the weight of the child, resulting to ineffective treatment of the infection that may lead to bacterial resistance or overdose the child and lead to more undesirable effects such as upset stomach.

If you are a parent, do you have a scale at home?

For more health advice, visit consultpharmacist.com!

Note: you should always read the package insert or read the box for more information [...]]]>

So what can you do when you catch the cold or flu?  For this post we will focus with the common over-the-counter and prescription medications that can help alleviate cough and cold symptoms and/or shorten the duration of viral infections.

Note: you should always read the package insert or read the box for more information regarding dosing (based on age or weight) and caution remarks!

Cold and Flu Symptom Relief: Nasal Symptoms

Runny Nose & Sneezing

Antihistamine (1st generation) are commonly used to treat allergy symptoms such as itchy watery eyes, rash, sneezing and runny nose.  However, these medications are also common in cold and flu products because of “drying” side effect. These medications will help dry up the nasal secretions thereby stopping your leaky faucet nose.  Another beneficial side effect from these medications is the sedative effect, allowing you to get the most needed good night sleep.

The following are two common 1^st generation anti-histamines:

(1) Benadryl (diphenhydramine) and (2) Chlor-Tripolon or Chlor-Trimeton (chlorpheniramine)

You should consult with your health care provider before taking these if you have the following condition(s): glaucoma, lung conditions (asthma, emphysema, bronchitis), seizures, prostate enlargement, certain heart condition and/or on certain anti-depressant medications

Common undesirable effects include drowsiness, dry mouth and constipation

Other related products for runny nose: facial tissues

Stuffy Nose

Decongestants, which help reduce nasal congestion or stuffy nose, are available in oral or nasal formulations.  So, which formulation is better?

Oral formulation is the choice if you (1) do not want to use nasal sprays or (2) anticipate that you will need decongestant effect for more than 5 to 7 days and (3) are aware that you are more likely to experience undesirable effects such as insomnia and nervousness.  You should consult with your health care provider before taking or using decongestants if you have heart condition, hyperthyroidism, diabetes, glaucoma, prostate enlargement, and/or on certain MAOI antidepressants. Sudafed (pseudoephedrine or phenylephrine) is taken orally every 4 to 6 hours.  There are longer acting formulations (Sudafed 12 hour or Eltor), which can be taken orally every 12 hours.

Nasal formulations are most beneficial if you use them for 5-7 days (using any longer can cause more congestion) and want to avoid or to experience fewer undesirable effects.  Oxymetazoline (Afrin) and Xylometazoline (Otrivin), nasal decongestants effect can last up to 12 hours whereas, phenylephrine (Dristan) lasts only 4 hours.

I like to recommend Sudafed 12 hour relief for oral formulation and any nasal sprays with 12-hour relief such as Afrin for nasal formulation because of its longer acting effect.

Oral: Sudafed (phenylephrine or pseudoephedrine)

Nasal: Afrin (oxymetazoline), Otrivin (xylometazoline) and Dristan (phenylephrine)

Other methods of relieving stuffy nose: (1) humidifier, (2) Vicks Vaporub (3) Vicks inhaler (4) or non-medicated Breath-right strips (safe for children, pregnant or breastfeeding female)

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Recommended medications to relieve sore throat
Prescription medications to treat influenza symptoms