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.

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.

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.