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Most Americans Don't Understand Acetaminophen Dangers

Too much of the painkiller in Tylenol, other meds, can cause liver failure, experts say
FRIDAY, Feb. 23 (HealthDay News) - Most Americans aren't aware of the dangers associated with the popular prescription & over-the-counter pain reliever acetaminophen, U.S. researchers report.

Acetaminophen is found in Tylenol, many combination pain & cold medications & a number of prescription drugs, including Vicodin, Darvocet, Tylox, Percocet & Lorcet.

Excessive use of acetaminophen, whether it be a large single dose or long-term overuse, can lead to severe liver damage that may require a liver transplant or cause death.

In fact, acetaminophen overdose is now the most common cause of acute liver failure in the US.

This study, which appears in the January/February issue of the Journal of the American Pharmacists Association, surveyed 104 patients who were visiting a general internal medicine clinic at the University of Michigan Health System.

While a large percentage of the respondents reported using acetaminophen in the past 6 months, almost none could identify the maximum dose of either regular or extra-strength preparations of the drug.

More than 60% of the patients stated that they had never received or weren't sure they had received information about the possible dangers of high doses of acetaminophen.

Over 1/2 of the respondents were unsure what problems might arise as a result of acetaminophen overdosing & just 43% correctly responded that liver damage could be a consequence of acetaminophen overdosing.

The survey respondents also had trouble identifying which medications contain acetaminophen.

According to the study's co-author Janice Stumpf, a clinical associate professor in the College of Pharmacy at the University of Michigan, these findings emphasize the need for better patient education.

"The community pharmacist is in an ideal position to provide education on the safe use of acetaminophen whenever an acetaminophen-containing prescription product is dispensed," she said in a prepared statement.

It's important to read non-prescription drug labels carefully & be aware of the potential hazards of overdosing on a medication. Patients should be aware of which medications contain acetaminophen & avoid taking multiple acetaminophen-containing products together.


Common Painkillers May Cause Hypertension in Men

Acetaminophen, ibuprofen & aspirin might affect chemicals that help blood vessels relax.

By Amanda Gardner
HealthDay Reporter

MONDAY, Feb. 26 (HealthDay News) - Middle-aged men who regularly take the widely used pain pills acetaminophen, ibuprofen or aspirin appear to have an elevated risk of developing high blood pressure.

The 3 drugs are the most commonly used medications in the US, according to a study published in the Feb. 26 issue of Archives of Internal Medicine.

"People should be aware that these drugs have potential adverse effects," said study senior author Dr. Gary Curhan, a researcher at Brigham & Women's Hospital in Boston. "The risk of bleeding is well-known for aspirin & NSAID's. I'd recommend that individuals limit their use of these medications unless they're clearly indicated.

If they have chronic symptoms requiring the use of these drugs, they should discuss alternative treatments with their health-care providers."

Dr. Suzanne Steinbaum, director of the Heart & Vascular Institute at Lenox Hill Hospital in New York City, added: "The thought was that medications like acetaminophen or NSAIDs, or even aspirin, would be safe. This particular study reveals that even these medications when taken regularly (greater than 15 pills per week) can actually increase blood pressure, which may eventually lead to heart disease.

In fact, these classes of medications for pain aren't as safe as we originally thought."

Two large previous studies had suggested that analgesics might be linked with an increased risk of hypertension, or high blood pressure, but those studies involved women.

Another study found that frequent use of painkillers, including nonsteroidal anti-inflammatory drugs, didn't substantially increase a healthy man's risk of developing hypertension.

The new study, however, echoed the findings found in women.

The researchers looked at 16,031 male health professionals without a history of hypertension. The participants provided information about their use of acetaminophen (such as Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen & naproxen) & aspirin.

The men, with an average age of 64.6 years, were followed for 4 years, with 1,968 of them developing hypertension.

Those who used acetaminophen 6 to 7 days a week had a 34% higher risk of hypertension than men who didn't use the drug. Similarly, men who took NSAIDs 6 or 7 days a week had a 38% higher risk of hypertension, while those taking aspirin at this frequency had a 26% higher risk.

And compared with men who took no pills, those who took 15 or more pills each week had a 48% higher risk of hypertension.

All three painkillers may inhibit the effect of chemicals that would normally relax blood vessels & decrease blood pressure, the researchers said.

But more research on the subject needs to be done.

"We have now seen these associations in men & women," Curhan said. "The next steps include finding out if people stop these drugs after years of use, does their blood pressure decrease? Also, not everyone that takes these drugs develops hypertension. We need to identify those at highest risk."


The Dangers of Expired Medications
by Sudesh Samuel
Expired medications are commonplace and inertia notwithstanding, many of us tend to rely on an intuitive sense of their value in continuing to store and use them. Such drugs can be harmful to health in several ways; they can be unpredictable in effectiveness, simply ineffective, or even toxic.

The formal way of classifying a medication as having expired is through it’s labeled expiry date. This date is often set based on a combination of the common properties of the dosage form as well as the stability and expiration studies of the product that have been conducted by the manufacturer. Importantly, this expiry date is contingent on specific storage conditions of the product. Although a medication may pass it’s labeled expiry date, it may not necessarily be any less effective or dangerous to consume depending on the product itself, the storage conditions and the circumstances leading up to expiry.

When most medications pass their expiry date under appropriate storage conditions, they are generally taken to have become so variable in effectiveness as to have become unsuitable for use. This often comes about as a result of the degradation of the active ingredients of the medication with exposure to physical, chemical or microbiological variables like temperature, pressure, humidity, light, bacteria as well as other components of the product known as excipients.

Creams may “crack” once their expiry date is passed, leading to a separation of the components and hence provide a non-uniform delivery of active ingredients. This can lead to the poor control of conditions like eczema or acne. Tablet medications can mechanically “powder” off, change in consistency with exposure to water vapor or even experience the contained drug itself becoming ineffective on prolonged exposure to air as occurs with glyceryl trinitrate, an emergency medicine that can easily become ineffective in relieving acute symptoms of chest pain. With common injections, should the acidity change to fall outside a fairly narrow range, significant pain and tissue damage can result from use. With most eye drops, an expiry date of one month after opening is accepted to minimize the potential for dangerous bacterial contamination.

With any medication, once a specific threshold of remaining active ingredient is passed, the medication can no longer be relied upon to deliver accurate doses. This loss of reliability is often exacerbated by the fact that the active ingredients can degrade into various combinations of active, inactive or toxic breakdown products. The common aspirin is for instance, known to react with moisture to breakdown into salicylic acid, which is active, and acetic acid, which is inactive and can lead to toxicity in excess.

While the expiry date provides a useful gauge of when to stop using a medication, there are also many other factors that can informally accelerate the expiry of a medication and make it dangerous to use, chief among which is how the medication is stored. It is oftentimes not just the medication that is affected by storage conditions but also the storage container. Under inappropriate storage conditions, certain containers can leech material into liquid medication preparations, or medication particles can stick to the container rather than remain separated. On average, a 10 degree rise in temperature doubles the rate of chemical reactions that occur to a medication product and can accelerate the rate of bacterial contamination several fold. Just like an ice cream can simply melt or a loaf of bread becomes mouldy much quicker if not refrigerated, many medication products can easily expire much faster when not stored appropriately.

With oral liquid and topical medications, potentially dangerous changes associated with expiry can at times be detected by color or consistency changes, component separations, altered smell or taste (oral preparations). Should a suspicion of expiry arise, a medication expert should be consulted regardless of whether or not the labeled expiry date has been passed.

“Expiry” should also be understood to occur once a supply of medications is no longer used appropriately for it’s intended purpose. Consultation with a medication expert is always advised to prevent the inappropriate use of existing medication supplies. Inappropriate use can often occur with self-medication and is harmful. An unfinished supply of a previously used antibiotic may be tried to treat a new infection that is actually untreatable by or resistant to that antibiotic. This practice may not only delay recovery but can also encourage the proliferation of “super bugs” that have resistance to many antibiotics. Another incorrect purpose involves sharing medications and this can be especially harmful if another is allergic to the shared medication or a child or pet is medicated with an adult’s medication. Children often require dose adjustments to accommodate their size while many human drugs are often unsuitable for pets. Even a simple food like chocolate that we may enjoy can easily be toxic to a pet dog.

Another mechanism whereby medication expiry is dangerous occurs when an unfinished supply is used despite new information that points to increased precautions associated with the medication or that has led to it’s recall. An example is obtaining pain relief from a previous supply of a painkiller like Vioxx (rofecoxib) or Celebrex (celecoxib) in spite of an existing heart condition that is now known to relate to an increased risk of fatality under those circumstances of consumption.

Expired medications that are kept instead of discarded not only take up space but can actually discourage the appropriate use of new supplies in the treatment of illness. A medication cabinet, if not tended to regularly, could eventually contain more expired medications than viable ones and this can lead to the accidental consumption of an expired medication in place of a viable one. It is definitely advisable to clear the medication cabinet of expired medicaitons at least annually if not more often.

A further danger however, lies in how expired medications are disposed of. Expired medications and pharmaceutical byproducts can be harmful to the environment especially when they end up in our rivers and drinking water supply. Hormonal compounds like estrogen from birth control pills and patches as well as antibiotics have been linked to being flushed by individuals and institutions into sewage, draining largely unchanged and collecting in rivers and streams, then returning in tiny amounts into drinking water. Traces of antibiotics could worsen bacterial resistance while estrogens and other steroids are known to change the reproductive characteristics of fish. Even trace amounts of chemotherapy medications have emerged in tap water and this could be severely detrimental to the unborn babies of pregnant women who drink such water. The long-term impact on human health of medications in our rivers and drinking water is as yet unknown but no one would want to wait to find out. We can all play our part by inquiring on and using pharmacy or state-run programs for the disposal of expired medications instead of sending them down the sink or the toilet bowl.

A pharmacist is the expert of choice to approach in handling medication expiry and should be consulted if in doubt. As a general rule, it is always best to safeguard your own health and that of those around you by expeditiously and appropriately discarding all expired medications.

Author's Bio
Sudesh Samuel is a pharmacist and medical communications specialist with a keen interest in medication management services that make treatments safer, more effective and less costly. He is president of the Institute for Medication Management -


Are Statins the New Gateway Drugs?
by Kerri Knox, RN

So, you go to your doctor’s office and get your cholesterol checked. Standard operating procedure, right?

We have been taught since grade school that low cholesterol levels are the best way to lower your heart disease risk.

So, if you DO happen to have “high cholesterol”, and the definition of “high cholesterol” keeps getting lower and lower all of the time, it’s likely that your doctor will put you on the ‘standard treatment’ to reduce heart disease risk- a statin drug.

If you have a GREAT doctor, hopefully it will be recommended that you do some lifestyle changes: eat better, get some exercise, add Omega 3 fatty acids to your diet, etc. and check your cholesterol level in a few months.

But if you have a “Standard American Doctor”, it’s likely that you will get sent home with a statin the first time you are told that you have “High Cholesterol”.

Statins come by many names: Crestor, Baycol, Atorvastatin, Simvastatin, Lipitor, Zocor, Pravachol, Mevacor, Lescol among others. The intended effect of all of these drugs is to reduce your cholesterol- which they are generally very good at.

But at what PRICE do these drugs lower your cholesterol?

In many cases, statins are just the start of the “drug list” that you end up carrying around in your wallet in case of emergency.

Could statins be the “gateway drug” that makes you NEED all those other drugs in the first place?

There are MANY published studies that show that statins cause many different problems- most of which “require” another drug to “fix”.

The Crestor- CRP study showed a significantly increased rate of diabetes among Crestor users. This obviously requires one or two new drugs: insulin and/or an antidiabetic drug (or two).

Most people who are on two or three different prescription drugs often have heartburn and get a prescription antacid to help with that symptom.

Both prescription antacids as well as diabetic drugs have been shown to cause an INCREASE in fractures among older women.

Aha! Another drug added to the mix- an osteoporosis drug known as a bisphosphenate.

Another study shows a significant increase in depression with the use of statins. Now you “need” an antidepressant, another boon to the pharmaceutical industry. However, a great study shows that men with low cholesterol and who have depression are at much greater risk of dying than other men!!

Great trade off.

Lets not forget that one of the notorious effects of statins is muscle weakness, muscle wastin and a serious condition called Rhabdomyolysis- a life threatening muscle wasting condition that will put you into the ICU for a few days.

Oh, and studies show that prescription antacids ALSO cause muscle weakness, muscle pain and rhabdomyolysis. All of that muscle weakness will probably keep you at home more- increasing your risk of osteoporosis and depression even more!

I forgot that the myositis- another word for muscle pain- will force you to need some pain medication for “non specific” muscle pain. The pain medication will probably make you constipated- with the inevitable drug, a stool softener or the need for laxatives.

If you make it through all of that without cancer or the need for a liver transplant – a couple more of the unfortunate “adverse effects” of statins, then the diabetes has now increased your chance of getting Alzheimers disease- and the need for a few more drugs (that don’t work very well).

Ahhh, but the relief of knowing that you have a 1% less risk of heart disease that COULD have been managed simply with diet, exercise and a few targeted supplements- Priceless!

Kerri Knox,RN
Functional Medicine Practitioner

Author's Bio
Kerri Knox is a Registered Nurse and Functional Medicine Practitioner. She has over 14 years experience working in the health care field.

With a solid grounding in Western Medicine, she bridges the gap between conventional medicine and alternative medicine to help people with chronic illnesses stop "MANAGING" their illnesses and start getting well.

She has a private practice helping people get well who have previously only been managing their illnesses with prescription drugs.

"You CAN overcome chronic illness..."

Her private practice is by telephone consultation ONLY so that she can help YOU wherever you happen to live in the US.
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What is an Adverse Drug Reaction?
by Sudesh Samuel
An adverse drug reaction (ADR) is any unintended, noxious or undesired effect that occurs when a drug is used at accepted doses for preventing, diagnosing or treating a condition.

By this definition from the World Health Organization, ADRs can be further categorized into those that are related to the known mechanisms of the drug (although some may not be) or those that are related to reactions with the immune system.

Most ADRs are considered predictable. One such type of predictable dose-dependent ADR that is due to the known action of a drug is a side effect. An example is the experience of dry mouth from taking an antihistamine. Another such ADR is drug toxicity as seen with the liver toxicity caused by taking the anticancer drug methotrexate. A predictable ADR may occur secondary to a drug’s intended effect as exemplified by diarrhea that is experienced when antibiotics change the gut’s content of microorganisms. A good proportion of drug-drug interactions also lead to predictable ADRs. An example is a seizure experienced due to excess levels of theophylline that result from concurrently taking the antibiotic erythromycin as it inhibits liver enzymes responsible for the breakdown of theophylline.

Unpredictable ADRs make up a smaller proportion and are still mostly not related to immune system reactions. Unpredictable ADRs not related to immune system reactions includes intolerance of aspirin that results in ear ringing after a single small dose. Of the ADRs caused by immune system reactions, these usually come in four types depending on the type of immune system factors involved in the reaction, it’s onset, severity and duration. These have sometimes been termed drug hypersensitivity, a specific subset of which is associated with the immune system’s IgE protein and termed drug allergy. The presence of asthma is often an important predictor of more susceptible individuals to such reactions.

Drug allergy often occurs as quickly as within minutes to hours of drug exposure. Such a reaction can include itching, rashes, airway swelling, vomiting, diarrhea and the experience of shock. This can occur when allergy is experienced with penicillin-based antibiotics in susceptible individuals. In the other types of immune system mediated reactions, the onset is variable and can take as long as 3 weeks from drug exposure to manifest in symptoms. Reactions to anticonvulsants and specific sulphur-based drugs have been known to result in severe and dangerous skin destruction.

When drug hypersensitivity occurs, it is important for the attending doctor or pharmacist to be informed of all medicines or supplements (even foods) that were taken within one month of the symptoms, when they were started and for how long they were taken. The chronology of symptoms also facilitates an accurate diagnosis. In virtually all cases of drug hypersensitivity, the offending drug has to be discontinued. With appropriate treatment and supportive measures based on an accurate diagnosis, symptoms in the majority of cases will usually resolve within 2 weeks.

It is important to keep a list of all the medicines that one is allergic to and to make this list available to all healthcare providers. Drug hypersensitivity relating to immune system reactions often leads to a predictable yet also more serious health risk upon re-exposure to an offending drug or one that shares properties with the previously offending drug. The risk of cross-reactivity between an offending drug and another also is best discussed with an experienced medication expert.

Of value in improving the safety of medication use is the voluntary ADR reporting schemes that are available in various countries. The Yellow Card scheme is used in the United Kingdom while the MedWatch program is available in the United States and the Blue Card reporting form is used in Australia. Such reporting systems constitute pharmacovigilance and this allows for the collection and subsequent publishing of ADR data that encourages greater safety of commercially available drugs.

The increasing presence of ADRs can often be correlated with older-aged adults, increasing numbers of new drugs and self-medication. Consult an experienced drug expert on the probability of ADRs before taking any new drug.

Author's Bio
Sudesh Samuel is a pharmacist and medical communications specialist with a keen interest in medication management services that make treatments safer, more effective and less costly. He is president of the Institute for Medication Management -

Understanding Drug-drug Interactions
by Sudesh Samuel

A drug-drug interaction involves one drug affecting the activity of another usually when both are concurrently administered. Such interactions can result in the reduced or enhanced activity of one or both drugs. While many forms of drug-drug interactions exist, most can be broadly classified into interactions that involve the travel of the drug once administered (pharmacokinetic) or the action of the drug on the body (pharmacodynamic).

Drug-drug interactions that affect the travel of drugs in the body can be further understood as those that affect absorption into the bloodstream, distribution within the body, breakdown into different products or removal from the body.

Absorption interactions can occur when one drug’s particles have a large enough surface area to cause another drug’s particles to stick to them, both drugs may also bind to each other, or one drug alters the acidity of the stomach contents or the rate at which the stomach moves it’s contents. These interactions can alter the ability of one or both drugs to get into the bloodstream. When a drug only reduces the rate of absorption of another, a patient on regular use of both drugs is usually unaffected. However, if one drug reduces the extent of absorption of the other, the patient can be exposed to lower levels of the second drug than required and the second drug may hence be ineffective in treatment.

Distribution interactions may occur when drugs reach the bloodstream and the tissues. Competition between two drugs can arise for binding to the same proteins in the blood or one drug may dislodge another from it’s connection with tissues. It is more common in the second instance when one drug displaces another from the tissues, to find that the displaced drug accumulates in the blood leading to a greater risk of an affected patient experiencing toxicity. An example is when the heart medications quinidine and Lanoxin® (digoxin) are taken concurrently, digoxin blood levels can rise and adversely affect the patient if not monitored appropriately.

While drugs can be broken down at many different sites in the body, the most common site is the liver. Here, a system of enzymes can be up-regulated or down-regulated by one drug to result in the quicker or slower breakdown of the other respectively. Examples of drugs that up-regulate specific enzymes in the liver, include the anti-epileptics Dilantin® (phenytoin) and Tegretol® (carbamazepine). The enzyme up-regulation effect usually takes place gradually with maximal effects observed in 7 to 10 days of starting the drug. It may also take an equal or longer time before normalcy is regained upon discontinuing the drug. Examples of drugs that down-regulate specific enzymes in the liver, include the antibiotics erythromycin and ciprofloxacin. The onset of enzyme down-regulation is usually faster than up-regulation.

The majority of broken down drug products as well as whole drugs are removed from the body through the passing of urine. When one drug affects the pH of the urine, this can affect another drug’s ability to get into the urine depending on how it’s form changes during the filtering process in the kidneys. Transporter molecules in the kidney that facilitate drug removal may also become more or less available to one drug as a result of the presence of another.

Drugs can also interact and exert a net effect by their direct actions on the body. Two drugs with similar effects when administered together can display synergism in action although acting at different sites or receptors in the body. An example is the drowsiness that can be experienced when a sedative like Valium® (diazepam) is taken concurrently with an antihistamine like Polaramine® (dexchlorpheniramine). Conversely when two drugs that have opposing effects are taken concurrently, the response to either or both can be reduced. An example is the opposing wakefulness and drowsiness that can result from consuming a caffeine-based anti-migraine preparation and a sedative.

Another set of action-related drug-drug interactions occurs when two drugs exert toxicity towards the same organ or tissue in the body. Concurrent administration of the two drugs can result in damage to the corresponding organ or tissue despite the individual dose of each drug alone not being enough to result in toxicity under normal circumstances. The common organs that are most often affected by such drug-drug toxicity interactions are the kidneys and the liver. Of note is also that one drug can increase the organ-toxic effect of another even though it does not exert any direct toxicity towards that organ by itself.

Because of the numerous drugs available and the many more that are constantly arriving, drug-drug interactions can be quite common. However, the adverse effects can be minimized through consultation with an experienced medication expert. When such interactions are anticipated early, the most appropriate countermeasures can be readied to maintain well being

Author's Bio
Sudesh Samuel is a pharmacist and medical communications specialist with a keen interest in developing medication management services that help patients achieve less costly, safer and more effective treatments. He is president of the Institute for Medication Management -
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