Generics Blog|Medical-Care News

Drug Safety Alert!

Do you know what common foods interact with the drugs that you take? You should–a mistake can be fatal

There are times when scarfing down a whole bowl of broccoli may be too much of a good thing. Or when your fresh idea to eat salads for lunch every day can leave behind more than just some spinach in your teeth. Or when an extra glass of wine with dinner could kill you.

Those foods interact with drugs for high blood pressure, thyroid conditions, and diabetes. In some cases, the food can interfere with your treatment, either by making the drug less effective or more powerful.

In other cases, the food/drug mix can trigger unwanted side effects. For example, high-potassium foods such as broccoli can interact with so-called potassium-sparing diuretics used to treat hypertension, causing excess potassium in the body, which, in turn, can cause an irregular heartbeat and palpitations.

In some cases, the mix can be fatal. People with diabetes who drink regularly and are also taking a blood glucose- lowering drug may be putting themselves at increased risk for developing high levels of lactic acid, which, in some cases, can be deadly.

Get Drug-Smart

The chart can help you avoid mixing the most common prescription drugs with foods that can cause problems.

The Trouble with Grapefruit Juice

Drinking grapefruit juice with some drugs can inhibit intestinal enzymes that help your body absorb the drugs. The result? The amount of medication that ultimately enters your system may be more or less than you really need, which could negatively affect your treatment. The best advice: When taking these drugs (see the chart at right), avoid grapefruit juice for at least 2 hours before and after ingesting them, and stick with plain water.

Foods and Drugs That Don’t Mix

Legend for Chart:

A - IF YOU HAVE…
B - ARE YOU TAKING*…
C - THEN STEER CLEAR OF…
D - WHAT COULD HAPPEN

A

B

C

D

Allergies, seasonal

Claritin, Zyrtec, or Allegra (antihistamines)

alcoholic beverages

May increase the drowsiness effect of the drug.

Congestive heart failure or atrial fibrillatien

Lanexin (digoxin)

meals high in bran fiber

Can reduce the amount of the drug that is absorbed.

Tip: Take this drug separately.

Depression

Prozac, Zoloft, or Paxil (selective serotonin reuptake
inhibitor [SSRI] antidepressants)

alcoholic beverages

May increase drowsiness and dizziness, and worsen symptoms.
In general, people who are depressed should avoid alcohol.

Diabetes

Glucophage or Glucotrol XL (to lower blood sugar)
alcoholic beverages

May prolong the risk of abnormally low blood sugar. For
Glucophage, it may also increase the risk of lactic
acidosis (high levels of lactic acid, which, in some
cases, can be fatal).

Erectile dysfunction

Viagra

high-fat meals

May slow the rate at which the drug is absorbed.
Tip: Take this drug separately.

Heart attack, atrial fibrillation, venous thrombosis,
pulmonary embolism, or stroke

Coumadin (an anticoagulant)

varying amounts of foods high in vitamin K such as
turnip greens, broccoli, and green, leafy vegetables,
alcoholic beverages

High amounts of vitamin K decrease the drug’s effect,
whereas low amounts increase the drug’s effect. To keep
this drug working effectively, aim for consistent amounts
of vitamin K. Alcohol can increase the drug’s effect and
put you at risk of excessive bleeding.

Heartburn/gastroesophageal reflux disease (GERD)

Propulsid (a gastrointestinal stimulant)

grapefruit juice, alcoholic beverages

High blood pressure (hypertension) or congestive heart failure

Norvasc, Cardizem, Procardia, or Adalat (calcium channel
blockers) Zestril, Vasotec Accupril, Lotensin, or Prinivil
(ACE inhibitors)

grapefruit juice, salt substitutes containing potassium,
and large amounts of potassium-rich foods such as bananas,
green, leafy vegetables, and oranges

High cholesterol

Lipitor, Zocor, or Pravachol (HMG-CoA reductase
inhibitors or”statins”)

grapefruit juice, alcoholic beverages

Hypothyroidism

Synthroid (levothyroxine)

high-fiber diet; soy products, foods containing large
amounts of iodine, such as spinach, shellfish, saltwater
fish, and iodized salt

Fiber and soy products may decrease the amount of the
drug that is absorbed. Soy products may negatively affect
thyroid function. Iodine can affect thyroid hormone levels.
Tip: Aim for consistent amounts of iodine in your diet.

Insomnia

Ambien

alcoholic beverages

May increase the drowsiness effect of the drug or of
other drugs that help you fall asleep.

Osteoporosis

Fosamax

mineral water, orange juice, coffee, and tea;
high-fiber diet; soy products

These beverages can decrease the drug’s availability.
Tip: Take Fosamax with plain water.

* Prescription drugs are from among the top 60 brand-name prescription drugs sold in 1998. Source: Scott-Levin’s Source Prescription Audit, Newtown, PA. This listing of drugs is not comprehensive. If you are taking a different drug or a generic brand medication for any of these conditions, please see your doctor about possible interactions with foods.

Timing is what’s important. For best results, take Fosamax first thing in the morning, on an empty stomach, with plain water only-not with any other beverage or food. Wait for 30 minutes before consuming anything. For more information about Fosamax, consult your doctor or pharmacist or visit Fosamax’s Web site at www.fosamax.com.

The same food and drug interaction chart also incorrectly lists the seasonal allergy drug Allegra among the medications that increase drowsiness when alcoholic beverages are consumed. There are no drowsiness side effects associated with taking Allegra. If you drink alcohol while taking Allegra, any feelings of drowsiness can be attributed to the alcohol. For more information about Allegra, consult your doctor or pharmacist or visit Allegra’s Web site at www.allegra.com.

Timing is what’s important. For best results, take Fosamax first thing in the morning, on an empty stomach, with plain water only-not with any other beverage or food. Wait for 30 minutes before consuming anything. For more information about Fosamax, consult your doctor or pharmacist or visit Fosamax’s Web site at www.fosamax.com.

The same food and drug interaction chart also incorrectly lists the seasonal allergy drug Allegra among the medications that increase drowsiness when alcoholic beverages are consumed. There are no drowsiness side effects associated with taking Allegra. If you drink alcohol while taking Allegra, any feelings of drowsiness can be attributed to the alcohol. For more information about Allegra, consult your doctor or pharmacist or visit Allegra’s Web site at www.allegra.com.

Can’t find your favorite cold medication at the drugstore? Surprise: Stores nationwide have been pulling Sudafed, Claritin-D, and Advil Cold & Sinus from shelves because an active ingredient, pseudoephedrine, can be used to make an illegal drug, methamphetamine. To get your remedy of choice, you need to go to the pharmacy counter and show your ID.

Also, be aware that drug companies have stocked pharmacy shelves with decongestants that have a different active ingredient — phenylephrine. Don’t be fooled: Pharmacists at the University of Florida say these newer products (labeled “PE”) aren’t nearly as effective at relieving congestion. In fact, several studies show they work no better than a placebo. These experts’ advice? If pseudoephedrine has eased your misery in the past, make the extra effort to get it.

It’s spring, the season of birth and hope, and so once again you perform your vernal ritual. You sneeze. You blow your nose. You rub your eyes. You sneeze. Then you dig out your tried-and true allergy medication, always good for a little relief–but only a little. So for the next few months you sneeze and blow and itch, and your voice sounds like the frogs croaking in the warm spring night.

But it doesn’t have to be that way. Ritual may be good for the soul, but when it comes to the nose, there’s nothing like a solid medical advance. Fortunately, the past few years have brought big improvements in hay fever remedies. A slew of new drugs, of both the prescription and over-the-counter varieties, have become available. On the other hand, some old favorites have been discredited. So if your current regimen leaves you snuffling and snorting, it’s time to sniff out what’s new.

One recent change should make it easier to head off many of your seasonal miseries without so much as a trip to the doctor. Last January the Food and Drug Administration decided to allow the over-the-counter sale of a nasal spray containing cromolyn sodium. Available by prescription for 14 years, Nasalcrom has a spotless safety record; its most serious side effect is that it can make your nose sting. Small potatoes when you consider that in return the drug keeps that organ from becoming itchy, drippy, and sneezy.

When cromolyn sodium hit drugstore aisles in April, it became the first nonprescription allergy preventive. Still, for many people, it won’t solve everything. One problem is inconvenience: You have to-spritz each nostril three or four times a day. “It works best in people who are a little bit obsessive compulsive,” says William Dolen, an allergist at the Medical College of Georgia. And you may have to follow that daily routine for more than a week before you notice any effect. More important, cromolyn doesn’t ease nasal stuffiness or do a thing for allergy-irritated eyes.

To unplug their noses, many allergy-sufferers make heavy use of decongestant; whether nasal spray or pill, they reduce swelling by constricting blood vessels. Big mistake, says allergist James Baraniuk of Georgetown University Medical Center. Use a spray more than a few days and you’ll get a rebound effect. “You’ll end up with congestion worse than when you started,” Baraniuk says. As for oral decongestants, they rev up the nervous system, bringing on jitters or even nightmares.

If you walk on by the decongestants, should you linger at the shelf reserved for antihistamines? They won’t do much more than cromolyn to unclog you–but in other ways these drugs are the foot soldiers of allergy treatment. They can give your smeller a break from sneezing and dripping, your eyes a rest from itching and tearing. And all you have to do is down one or two pills a day.

Just don’t choose this fix too often. Over-thecounter antihistamines have such serious drawbacks that if they were to come under FDA consideration today (rather than having been sanctioned years ago, when guidelines were less rigid), the agency probably wouldn’t approve them for nonprescription use. As anyone with allergies knows, they’re likely to make you sleepy. Even if you don’t feel drowsy, says pharmacologist dames O’Hanlon of Maastricht University in the Netherlands, these medications can leave you dangerously dopey.

O’Hanlon gave nonprescription antihistamines to volunteers, then tested their driving skills. He found that a single dose impaired the motorists as much as a blood alcohol level of .08, which in a number of states can get you slapped in jail for drunk driving. Drivers reacted slowly and tended to drift. “Personally,” says O’Hanlon, “I would never take an over-the-counter antihistamine and do anything that my safety or my family’s safety depended on.”

You can minimize the problem if you take a 24-hour antihistamine at bedtime; that way, the drug should combat allergy symptoms through the next day, but its soporific effect will have waned. If your allergies are so bad that you need antihistamines for months at a time, though, it’s worth seeing a doctor for a prescription antihistamine that doesn’t cause sleepiness. These kinds of drugs have been available for a number of years–but they, too, have improved.

A recent newspaper ad shows how big the changes are. In it, Hoechst Marion Roussel, maker of the well-known antihistamine Seldane, told its millions of satisfied customers to . . . switch to another drug. Granted, the other drug, Allegra, is also a Hoechst product. Still, it’s not the kind of ad one sees every day.

Seldane, of course, was the first nonsedating antihistamine. When it hit the market in 1985, allergy sufferers everywhere, eager for drowse-free relief, rushed to demand a prescription from their doctors. Seldane became the pharmaceutical equivalent of a record gone platinum. But in 1991 researchers discovered that when combined with the common antibiotic erythromycin or one of several other drugs–or when simply washed down with grapefruit juice–Seldane can trigger abnormal heart rhythms. In rare cases such arrhythmia is fatal. The problem received widespread attention, but not everyone got the message. In a study last year, researchers at the Georgetown University Medical Center reported that when presented sham prescriptions for both erythromycin and Seldane, one-third of pharmacists in the Washington, D.C., area provided the drugs without mentioning the danger.

In January the FDA proposed yanking Seldane from the market. Fortunately, newly approved Allegra is Seldane’s good twin. It turns out that Seldane mutes allergy symptoms only after the body has converted the somewhat risky drug into another chemical. Allegra supplies a straight shot of that workhorse compound–which tests show to be free of major side effects. And there are other options: Neither Claritin, introduced a couple of years ago, nor Zyrtec, which came out last year, has the potential for Seldane-style interactions. Of the three, Zyrtec is the strongest, but it makes a small proportion of users drowsy. (Hismanal, the other nonsedating antihistamine on the market, can have the same perilous side effect as Seldane when taken with erythromycin.)

You’ll need to do a little experimenting to find out which of these drugs works best for you. Although researchers don’t know why, one allergy-sufferer may find relief with Claritin but not Allegra, for instance, while another may have the opposite experience.

If your symptoms are really driving you crazy or bringing on problems such as sinus infections, even prescription antihistamines may not be enough. Then it’s time to call in the heavy artillery. Steroid nasal sprays outperform antihistamines in relieving congestion and sneezing. Like cromolyn, though, steroid sprays can take a week to start working and even then may not soothe itchy eyes.

An unlucky minority doesn’t respond to any of these allergy treatments. If you’re truly pollen-impaired, your last resort is to get allergy shots. This approach, known as immunotherapy, has been around for decades. You may remember the routine from childhood: The doctor does a series of skin tests to determine exactly what provokes your allergies, then injects you with small doses of those very irritants–called allergens–to desensitize your immune system. You have to get shots year-round, but over several years, as your body grows accustomed to higher doses of allergen, you need them less frequently. If all goes well, you can eventually end therapy without a return of symptoms.

It’s a regimen that rewards people with thick skin and plenty of patience. For people who lack the latter, allergist Jay Portnoy of Children’s Mercy Hospital in Kansas City, Missouri, recently reported on a technique he calls rush immunotherapy. Patients get their first eight shots in six hours, compressing a few months of treatments into a single day. In a recent trial with 22 allergy-sufferers, patients experienced more side effects- chest tightness, hives, runny noses–on that grueling day than they would have during any single session of standard immunotherapy. Still, Portnoy says the method proved safe.

Less extreme forms of this technique, such as getting four injections in a day, are also under investigation. But many allergists, squeamish about the potential side effects, are approaching the method cautiously. Much more research and doctor education will have to be done if these techniques are to catch on.

If the thought of year-round immunotherapy, whether rushed or leisurely, makes you cringe, keep an eye out for news on a vaccine for the allergy to ragweed, one of the biggest sneeze-drip-itch triggers in the United States. In a study by Immulogic Pharmaceutical Corporation, getting eight shots of the vaccine, called Allervax Ragweed, over about a two-week period before ragweed season left volunteers needing half as much allergy medication as the unfortunates who’d received dummy shots. The vaccine could be on the market in 1999.

But most people needn’t wait for relief. A trip to the drugstore or doctor and a little experimenting with the new remedies may be enough to get you ready for a new spring ritual. Forget the tissues; bury your nose in blossoms instead. And from now on, let the bullfrogs be the only ones who croak.
A Roster of Hay Fever Relievers

Do you buy tissues in bulk? You may not be getting all the allergy relief that’s out there. Here are the pros and cons of the prescription and ovet-the-counter drugs currently available.

Spray decongestants (e.g., AFRIN, 4-WAY, VICKS SINEX) PRO: immediately unclog stuffed nose.

CON: can actually cause stuffiness with prolonged use.

Oral decongestants (e.g., SINUTAB, SUDAFED, TYLENOL SINUS)

PRO: ease nasal stuffiness without producing rebound congestion.

CON: can cause nervousness and insomnia; can raise blood pressure.

Nonprescription antihistamines (e.g., BENADRYL, CHLOR-TRIMETON, TAVIST)

PRO: quickly relieve itchy eyes, runny nose, and sneezing.

CON: can cause drowsiness; don’t unclog nose.

Prescription antihistamines (ALLEGRA, CLARITIN, HISMANAL, ZYRTEC)

PRO: quell symptoms without inducing sleepiness.

CON: can take up to two weeks to bring relief. Hismanal can interact with the antibiotic erythromycin to produce heart-rhythm abnormalities.

Cromolyn nasal spray (NASALCROM)

PRO: prevents sneezing and runny, itchy nose; available over the counter.

CON: must be used four to six times daily; full effect takes up to two weeks; doesn’t lessen nasal stuffiness or soothe itchy, watery eyes.

Steroid nasal sprays (e.g., BECONASE, FLONASE, VANCENASE)

PRO: provide the most effective relief of congested or runny nose, sneezing, and watery, itchy eyes; can also help prevent these symptoms.

CON: bring some relief quickly but take up to a month for full effect.

The results of this study–the first large-scale investigation in North America, and the largest in the world–were presented by Dr. Frederick Foley at the 21st Annual Meeting of the Consortium of Multiple Sclerosis Centers in Washington, DC, last summer. Dr. Foley is the director of Psychosocial Research and Neuropsychology at the MS Center at Holy Name Hospital in Teaneck, New Jersey.

“We surveyed 8,361 people with MS using the Multiple Sclerosis Intimacy and Sexuality Questionnaire, or MSISQ,” Dr. Foley told Momentum. “Of those surveyed, 5,868 responded. Those who completed the survey tended to skew younger, less neurologically impaired, and wealthier–so we believe the results may be conservatively biased,” he explained.

Dr. Foley developed the MSISQ seven years ago with a graduate student, Audrey Sanders, and two small grants from the National MS Society; the questionnaire was subsequently published in Sexuality and Disability (Volume 18, Number 1, 2000).
What the survey said

Nearly 70% of responders (67.2%) said that they had at least one or more MS-related symptom that interfered with sexual activity or satisfaction “always” or “almost always” during the last six months.

Slightly more than half of the men reported difficulty getting or keeping an erection and a third or more said that they felt less confident about their sexuality, were having less pleasurable or intense orgasms, were taking too long to climax, and/or were feeling numbness in their genitals.

Nearly 40% of women said they took too long to orgasm, and more than a third of women felt less intense or pleasurable orgasms, experienced a lack of sexual desire or loss of libido, and/or had inadequate vaginal lubrication. The number who reported loss of feeling or numbness in the genitals was just under one third.

A surprising discovery

“One response we received ran counter to general expectation,” Dr. Foley said. “Nearly a quarter of the men reported feeling that their body is less attractive, while slightly less than one fifth of women responded similarly.

“We’re now analyzing all of the study results to determine what sort of impact these barriers may have on quality of life. And we’ve decided to develop a study into the body image question.”

Dr. Foley’s survey was sponsored by the Consortium of Multiple Sclerosis Centers (CMSC) and conducted through their North American Research Committee on Multiple Sclerosis (NARCOMS) registry. To learn more about the CMSC, NARCOMS, and to register, visit mscare.org/cmsc/CMSC-NARCOMS-Information.html.

Since it came on the market in 1998, Viagra (sildenafil) has changed the manner in which erectile dysfunction (ED) is managed. Over 23 million men throughout the world have tried it, with a modicum of success. Even though it is the best known solution to ED, there are other options as well.

Erectile dysfunction can range from occasional to complete inability to achieve and maintain penile tumescence, or erection. An erection occurs when the nervous system activates increased blood flow to the male reproductive organ: Blood vessels relax and the influx of blood causes the tumescence. Once the sexual excitement comes to fruition, excess blood drains returning the organ to its non-erect state.

Most causes of ED are physical, including diabetes, high blood pressure, cardiovascular disease, and other conditions. It is also due to lifestyle choices such as smoking and lack of exercise. Taken together, any or all of these factors affect the blood flow to the pelvis. Other causes may include low libido and relationship or partner issues. Surgeries to treat cancers–for example, prostate cancer–and injuries to the pelvic area may result in ED. A wide array of pharmaceuticals can also lead to ED.

The three major medications to manage ED–sildenafil, verdanfil (Levitra) and tadalafil (Cialis)–are all inhibitors of an enzyme called phosphodiesterase 5 (PDES). They work by relaxing the smooth muscle cells, which increases the blood flow to the pelvic area and allows tumescence in response to sexual stimulation.

These agents are not free of side effects, however, especially for those with severe heart disease. As such, they are contraindicated for those who have recently suffered a stroke, or who take alpha-blockers for high blood pressure or voiding dysfunction. Importantly, PDE5 inhibitors should not be taken with nitrates (the heart drug nitroglycerine), because the combination can cause a potentially fatal drop in blood pressure. In addition, PDE5 inhibitors have also been linked to a rare form of blindness. All three of these inhibitors share certain side effects, including headache, nasal congestion, facial flushing, gastrointestinal distress, and, less commonly, vision changes.

Among alternatives to these PDE5 inhibitors are injectibles like Alprostadil (caverjet, Edex, MUSE). In addition, vacuum devices are used to trigger the blood flow to the penile tissue. These approaches, however, are marred by their awkwardness of use. It is for this reason that ED sufferers are increasingly turning to safer and natural alternatives. While a number of remedies are touted to be helpful, more often than not the claims fall far short of the promises.

Among the natural choices, the amino acid citrulline is one of the most effective agents to enhance blood flow without any metabolic inhibition, as is the case with PDE5 inhibitors. While PDE5 inhibitors inactivate the enzyme that breaks down nitric oxide (NO), the small molecule that induces vasodilation and increased blood flow, citrulline functions systemically to induce NO and, as a result, flush the pelvic flow with blood. Thus, by boosting the body’s ability to offset any loss in NO, citrulline is an entirely safe and effective long-term alternative for a healthy libido.

AKA: Panax ginseng, Asiatic ginseng, Korean ginseng, Korean red ginseng. Chinese ginseng

PART USED: Root

WHAT IT DOES BEST: Asian ginseng is used for a wide variety of conditions. However, the most scientifically supported uses are for male infertility and erectile dysfunction (ED).

THE BACKGROUND: The Chinese have used Asian ginseng for over 2,000 years as a tonic to improve mental acuity and vitality, enhance physical performance and memory, reduce fatigue and strengthen the immune system.

WHAT’S THE ACTIVE INGREDIENT?

The primary active ingredients are known collectively as ginsenosides. Other actives include panaxans, which may help stabilize blood sugar.

RECENT FINDINGS: According to a report in the November 2002 issue of Urology, Asian ginseng was found to be effective for ED in a double-blind human study. In a related commentary in the January 2003 issue of The Journal of Family Practice, doctors from the University of Virginia Health Sciences Center in Charlouesville noted that Asian ginseng is a safe, suitable alternative to sildenafil (Viagra).

In addition to increasing sex drive, ginseng may help improve male fertility. In a preliminary human study published in the December 1996 issue of Panminerva Medica, 66 men who took Asian ginseng experienced increased sperm count, sperm motility and testosterone levels.

Besides the above, animal studies suggest Asian ginseng may help reduce the effects of stress and fatigue and enhance immune function. Recently, a mice study published in me March 2005 issue of Archives of Pharmacal Research found that ginsenosides derived from Asian ginseng could enhance memory and reduce amnesia.

POSSIBLE SIDE EFFECTS AND PRECAUTIONS: When taken in the recommended dosages, Asian ginseng is considered safe; however, in rare cases it may cause insomnia and headaches and enhance the effects of caffeine. Allergic reactions are possible. Long-term use may contribute to menstrual irregularities and breast pain in some women.

People scheduled for surgery, on blood-thinning medications or with uncontrolled high blood pressure should not take Asian ginseng without first consulting a physician.

Ginseng may affect blood glucose levels; therefore people with diabetes should consult a health care practitioner before use.

IS IT SAFE TO TAKE WHILE PREGNANT OR NURSING?

Asian ginseng is not recommended for pregnant or nursing women.

ARE THERE ANY DRUG INTERACTIONS?

People taking warfarin (Coumadin) or other blood-thinning medications should consult with a physician before taking Asian ginseng.

WHICH TYPE AND HOW MUCH?

The root is dried, powdered and made into capsules, liquid alcohol (tinctures) and dried extracts. Asian ginseng root extract standardized to approximately 4-7 percent ginsenosides is the most researched form.

* For whole powdered root, studies have used 0.5-2g daily.
* For tinctures, 2-3ml three times daily is usually recommended.

Yet another reason for men to exercise caution in the use non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief: These drugs may cause erectile dysfunction (ED).

Finnish researchers surveyed close to 1,100 men between the ages of 50 to 70 about their use of non-steroidal anti-inflammatory drugs, which include most over-the-counter pain relievers, such as aspirin, ibuprofen (generic: Advil, Motrin IB) and naproxen (generic: Aleve). They also asked how often the men had experienced ED, the inability to achieve and sustain penile engorgement.

The men who were taking NSAIDs were twice as likely to have ED as the non-users. This outcome was statistically adjusted to account for various medical conditions that could confound the results.

The researchers speculated that NSAIDs may reduce the body’s release of nitric oxide (NO), a compound that is critical in ensuring optimal blood flow to the penile tissue. In fact, ED drugs on the market–Viagra, Cilais, and Levitra–all work by releasing NO.

This side effect of NSAIDs is in addition to others that have been known for quite some times, such as high blood pressure, heart attacks, stomach bleeding, and potential kidney and liver damage. Even though acetaminophen (generic: Tylenol, Panadol) may be a first choice for mild-to-moderate pain, but it may damage the liver as well.

Men who experience ED should consult their physicians to exclude an underlying disorder that could be causing the problem–for example, diabetes, hypertension or cardiovascular disease.

Here’s a brief look at a few of maca’s healthy attributes — and some reasons you may want to try it.
multitalented

Maca is used primarily for enhancing libido and fertility, and treating erectile dysfunction (ED). The herb is lately being suggested for easing PMS and menopause symptoms, such as night sweats, hot flashes and low libido.

ancient Healer of the Andes

The first recorded use of maca as an herbal medicine dates back to the 17th century in South America, where it was believed to enhance fertility, sexual desire, strength and endurance. Native to the Peruvian Andes, this tuber, related to turnips and radishes, has been consumed by locals for approximately 2,000 years. Maca contains vitamins, minerals, protein, carbohydrates, fiber, amino acids and fatty acids.

Clinically Studied

Preliminary human research suggests maca may enhance both libido and fertility in men without affecting testosterone or other hormone levels.

While there are no human studies on maca and women, animal research suggests that maca has estrogenlike effects, and that it may also enhance female fertility and help prevent menopause problems related to low estrogen, such as osteoporosis. Maca’s ability to mimic estrogen in a positive way may explain its growing popularity as a PMS remedy.

Maca may also be helpful for arthritis. According to a test-tube study on human cartilage, maca promoted nitric oxide (NO) production in cartilage. NO, which results from a natural bodily process, is thought to help decrease inflammation and increase circulation. Researchers theorize that maca improves ED by boosting NO production to the penis.

a Mustard Family Member

Like other members of the mustard family, maca contains glucosinolates, which are responsible for the pungent taste and odor. Glucosinolates, taken in excess along with a low-iodine diet, can lead to the development of goiter, when the thyroid gland is enlarged and thyroid hormone production decreases. However, there are no known reports of maca causing goiter.

Maca’s safety has not been established, although it is considered to have little (if any) toxicity, as it has been a staple in Peru for thousands of years. According to research, maca not only is nontoxic to the liver, but appears to have a liver-protective effect.

THE DOSAGE YOU NEED

A typical dosage for maca is 500-1000mg 3 times daily of the dried root powder. There are no known drug interactions, Avoid if you are pregnant or nursing.

QUICK TIP: Fend off fatigue

Latin American doctors often recommend maca to patients complaining of general fatigue. Tired? Give the herb a try and see if it affects your energy levels.

It’s like your best buddy suddenly turns on you. You’re saying, “Yes!” She’s saying, “Yes!” And the little man below decides he’s going to sit this one out. But even the most bangin’ playas occasionally run into problems in the bedroom. So, jot down these tips from sex and relationship expert Ian Kerner, Ph.D., and keep them by the bed–just in case.

What you call it: “The sprinklers going off before you finish mowing the lawn”

What the doc calls it: Premature ejaculation

What could be causing it: Too much stimulation

What to tell her: “You are just so sexy I couldn’t stop myself. Now, scoot over and let me finish you off too.”

What the expert says: “From a medical state, there’s nothing wrong with a guy who rapidly ejaculates. In fact, nature has, in many ways, designed male sexual anatomy to be as efficient as possible. It’s generally reinforced by a guy’s masturbation habits. So the more the guy masturbates himself quickly to orgasm, the more likely he is to build a neo-path that reinforces that behavior.”

How to avoid it in the future: The easy route is using a thicker condom. However, you can “talk yourself down” with practice. “Unlike women, men reach a point of ejaculatory inevitability where, with or without further stimulation, they’ll orgasm,” says Kerner. “If a guy can recognize that he’s getting close and allow himself to have just one or two of the contractions, it will release muscular tension and blood from the genitals and take him back a little bit in the process of sexual arousal.”

What you call it: “Failure to launch”

What the doc calls it: Impotence or erectile dysfunction

What could be causing it: Maybe the eight vodka shots and four beers you just had. It also might be the result of anxiety or a side effect of medications such as antihypertensives, tranquilizers, or antidepressants.

What to tell her: “I drank too much; I’m an idiot. Give me a second chance and let me take you to dinner,” or, “I’m sorry, baby. With work so crazy, I’m tapped for energy. It’s not that you aren’t smokin’ hot. Let’s go out.”

What the expert says: “If it’s something that happens sporadically, it can be a result of tremendous stress that day or drinking too much alcohol, which numbs the autonomic nervous system. If it’s something that’s happening more regularly, you might be a good candidate for an erectile enhancer like Viagra, Cialis, or Levitra.”

How to avoid it in the future: If moderation at the bar isn’t your thing, make sure getting drunk with the boys isn’t also a pickup night. Or take the emphasis off your penis by pleasuring your partner manually, orally, or with a toy.

What you call it: “Steel rod”

What the doc calls it: Delayed ejaculation

What could be causing it: Being overtired or lack of stimulation.

What to tell her: “This has nothing to do with you, I promise. Sometimes I really just need more time.”

What the expert says: “Delayed ejaculation is a pretty rare phenomenon. Most men who experience the condition either need more direct contact or there is something about the relationship that’s causing them anxiety. Side effects of medications like antidepressants also could play a role. Sometimes a guy can masturbate himself to orgasm but he can’t do it when he’s inside a woman. Very often it’s about his needing a firmer or different kind of stimulation to get over that point of ejaculatory inevitability.”

How to avoid it in the future: If it’s about rest, put down the remote and go to bed–you’ll look better, feel better, and probably be less irritable. If it’s about stimulation, have a wank-’n'-watch session so she can see what you like and how you like it. If it’s just that she’s wearing your mother’s perfume and it’s distracting you, kindly buy her something different. Telling her she smells like your morn should help… or not.

• If you’re about to start a family, think twice before taking an erectile-dysfunction drug. Viagra can harm sperm and reduce your fertility, report British scientists. In a test-tube study, researchers discovered that a typical dosage of the drug doubled premature damage to sperm heads compared to swimmers that weren’t treated. The scientists explain that Viagra, Levitra, and Cialis are part of a class of drugs called PDE inhibitors, which cause the outer layer of the sperm head to break down before it reaches the female egg, preventing penetration. Consult a urologist for an ED therapy that doesn’t affect fertility.

• Nothing says “I love you” like finishing the bathroom tile. Researchers at the University of Nevada at Reno recently determined that following through on promises is the best way to show her how you feel. In the survey of 121 couples, women rated specific actions — for instance, completing home-improvement projects and being on time — as significantly more telling than verbal professions of passion. “Women can see continued small acts of irresponsibility as red flags signaling that you mentally have one foot out the door,” says the study author, Dan Weigel. Ph.D. Another finding: Women rated gift giving at the bottom of the commitment scale.

The singles scene can seem like a minefield. That’s because just kissing can lead to three types of sexually transmitted diseases. Our advice: Get tested for STDs every 3 to 6 months, and ask your partner if she’s been tested, too.

Do you know that more women than men die of heart disease each year? Chances are, neither does your physician. A recent study found that fewer than one in five doctors knew it. This may explain why women are six times less likely to be prescribed Stettins, aspirin, and beta blockers than men are, say Rush University scientists. The meds can have side effects, but the researchers found that the risk of harm is equal for men and women.

• You don’t need to last for hours to please her. Just 8 minutes of sex is enough, states a survey of sex therapists out of Pennsylvania State University. While it was most desirable for intercourse to last between 7 and 13 minutes, making love for 10-plus minutes was often considered too long. “Past that point, the woman may feel inadequate because she can’t make you climax, which decreases her enjoyment,” says Eric Corty, Ph.D., the study author.