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Our latest question and answer

Check out our site for the latest question and answer!

Is it possible to delay your period by one week while taking birth control?”

Here is an excerpt of our answer:

While it is possible to skip or delay a period while taking birth control pills, it is more easily achievable on products that are mono-phasic, or pills that only contain one level of hormone throughout the entire pack.

 

Current birth control pills are designed to copy the natural menstrual cycle in women. They are used for both contraceptive purposes as well as for helping women maintain a normal menstrual cycle.  There are many different kinds of oral hormonal contraceptives available, but most options contain 3 weeks of active hormonal pills and one of inactive, or placebo pills. Menses occurs during the week you take the inactive pills with no hormones in them. As soon as you stop taking pills with active hormones in them, that is when you will get your period. For those wishing to extend the time until menses occurs, you would need to keep taking active hormonal pills. Again, stopping active hormonal pills WILL bring on the onset of menses. In fact, delaying menses by one month or more is a common way of dosing and is known as continuous dosing, or continuous cycling. While many patients on continuous cycles simply skip the inactive week in their pills and move on to the next pack, newer products on the market such as Seasonale provide 3 months of active pills followed then by 1 week of inactive pills

Read the rest of our answer on our site!

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The Best OTC Allergy Medicine

Take a look at our newest article: The Best OTC Allergy Medicine!

Read about of each and every one of the over the counter antihistamines on the market. We compare every medication to find you the best over the counter allergy medicine for your symptoms!

Here is an excerpt from our article: 

Best OTC Allergy Medicine

 

 

 

How Do Antihistamines Work?

Antihistamine medications block histamine from binding to receptors that are located all around the body. Histamine plays a central role in the allergic response.  When histamine is released, it has a wide range of effects including:

 

  • Vasodilation (dilation of the blood vessels) – Vasodilation causes the vast majority of the nasal symptoms you experience. Most commonly you become extremely congested but a runny nose is possible as well.

 

  • Cardiac effects – Something we are not usually as aware of when our allergies hit us, but histamine influences both how hard our heart contracts and how fast it pumps.

 

  • Contraction of Smooth Muscle – Smooth muscle is found everywhere in the body including in our airways. Histamine release causes the symptoms of wheezing and coughing.

 

  • Itching – Histamine release also causes itching and redness. The mechanism behind this response is somewhat complicated, but it involves increasing the permeability of small vessels and the separation of skin cells.

 

 

First Generation Over The Counter Antihistamines

     Antihistamines are the most common treatment for allergy symptoms resulting from allergic rhinitis, also known as allergic inflammation of the nasal airways. Allergic rhinitis can affect people either seasonally, known as seasonal allergic rhinitis, or all year round, known as perennial allergic rhinitis. It has been reported that over 30% of adults and over 40% of children will be affected by allergy symptoms. The most common symptoms that patients complain of are sneezing, nasal congestion, runny nose, itchy and watery eyes as well as hives in more severe cases. Although not completely understood why, the symptoms tend to be worse in the evening which can lead to troubled and restless sleep. Antihistamines taken by mouth are considered the best therapy for allergic rhinitis symptoms and are usually very effective. Most antihistamines were at one point available only via a prescription but luckily, a vast majority of them are now available over the counter. In addition in their use for allergy symptoms, antihistamines are a common medication for insomnia. We will discuss each antihistamine in detail, but first, let us simply list all of the available over the counter antihistamines based on their generation. As a general rule of thumb, the first generation antihistamines have been on the market a longest amount of time, last  about 4-6 hours and cause sedation. The second generation over the counter antihistamines are newer, last about 24 hours and cause minimal to no sedation.

Read our full article here:
 

 

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Subutex (Buprenorphine) & Norbuprenorphine Drug Testing Information

Take a look at our newest question and answer regarding Subutex (Buprenorphine)!

Here is an excerpt:

Question:

My question is my daughter, age 28 has been on subutex for 1.5 years (16 mg daily). She is 14 days clean and the subutex is still showing up in her urine. Is this possible or probable? She has not been eating or drinking much since, could that be the problem?

Answer:

 There is no simple answer to your inquiry as many different factors can affect how long a drug is detectable in someones system. Having said that, we can certainly provide you some information that can help you better understand the typical detection times for Subutex (Buprenorphine). Specifically answering your question with all the available information at hand, it is VERY probable that the drug is showing up in the urine, even 15 days after stopping the medication.

 

Subutex (Buprenorphine) is an opioid drug that is structurally similar to morphine. It is most often used for either pain control or opioid dependence/withdrawal. The drug does have some unusual characteristics that vary from many of the other drugs in the opioid class. While most drugs in the class tend to be metabolized and excreted from the body fairly quickly, buprenorphine hangs around for a long time!

 

When talking drug tests, a common measure in determining how long a drug lasts in the body is half life. A half life is the amount of time that it takes for 50% of a drug to be metabolized. For example, if a drug has a half life of 10 hours, 10 hours after that drug is absorbed, only 50% will be remaining in the body. Half lives are used to approximate how long a drug will be detectable via a test. The rule of thumb is that it takes about 5 half lives for a drug to become undetectable. Let’s use the example of the drug with a 10 hour half-life:

 

 

Half Life Time Elapsed (hours) % Drug Remaining
0 0 100
1 10 50
2 20 25
3 30 12.5
4 40 6.25
5 50 3.125

 

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Are You Taking Your Medication Correctly?

Check out our latest article on PharmacistAnswers.com! Here is most of the article but check out the website for pictures and the complete version!

     Most people would be surprised to learn that the effectiveness of many medications is hugely dependent on how exactly they are taken. It sometimes just isn’t enough to take your medication at the same time everyday. Something as simple as dosing at the same time as orange juice can decrease a medications absorption in the body by over 50%! A decrease in absorption by this much can have huge ramifications on how well these medications are working for you. What if this was happening with your blood pressure medication? What about a medication that is supposed to be treating a bad infection? The consequences could be significant. it’s very important to know how to exactly take your medication. This article will list some popular medications that have specific dosing requirements to ensure full effectiveness. Have a question about something you don’t see? Email us and we are happy to answer any questions you may have! 

Timing Is Everything

     While it is important to take your medication at the same time everyday, there are some that should be given at specific times of the day. Taking them at the wrong time can lead to lower effectiveness and possibly side effects.

Proton Pump Inhibitors For Stomach Acid/Acid Reflux

Drugs in this class include Protonix, Prilosec, Nexium, Aciphex and Prevacid. These medications are usually taken once daily but can be dosed twice daily in more severe cases. These medications work best if they are taken 30 minutes before a meal. The reason for this is because these medications only inhibit the acid pumps in the stomach that are active. Stomach acid is stimulated when food is ingested to aid in digestion. Taking the medications 30 minutes before food ensures that there will be peak concentrations of the drug in your body when the acid pumps are most active. It’s important to note that it can take up to 3 or 4 days of daily dosing before they’ll have full benefit. This is because not all proton pumps are inactivated with the first dose.

Blood Pressure Medication

Our blood pressure does not stay consistent throughout the day. In fact, it follows a fairly predictable 24 hour pattern. The most concerning part of the blood pressure pattern is what happens while we are sleeping. During sleep, our blood pressure dips to it’s lowest point of the day. It then later begins to increase around 4 to 6 AM and generally continues to increase throughout the day. There is a significant population (called “non-dippers”) of people whose blood pressure does NOT dip significantly during the evening. It is thought the risk of negative cardiac events is the greatest in the early morning and in those “non-dippers”. Most people take their blood pressure medications in later morning and therefore don’t have the greatest control of blood pressure when it matters most. There is good amount of evidence that suggests that taking blood pressure medications at bedtime not only improves blood pressure numbers, it may reduce the risk of heart attack and stroke! Now, only certain medications have good evidence for night time dosing. These drugs include ACE-Inhibitors (drugs that end in “pril”), ARBs (drugs that end in “sartan”) & calcium channel blockers. Diuretic medications, also known as water pills, should continue to be taken in the morning as they cause fluid loss and could increase the need to use the restroom at night if they are taken before bed.

Statin Cholesterol Medication

The statin medication class is currently the most effective drug class available to treat high cholesterol. The most significant contributing factor to our blood cholesterol levels is in fact not the cholesterol we take in from our diet, but actually the cholesterol that our own body makes. The statin medications reduce the amount of cholesterol that is created by the liver. Most statin medications don’t last very long in the body, certainly not 24 hours. It is therefore usually recommended to take them in the evening, when our body is most actively making cholesterol for peak effect. Two statin medications that don’t follow this recommendation are Lipitor (Atorvastatin) and Crestor (Rosuvastatin) as they last a very long time in the body and the time of dosing therefore does not matter as much.

Levothyroxine For Hypothyroidism

Medications for thyroid replacement come in extremely small dosages. Most medications are measured in milligrams, or 1/1000th of a gram. Levothyroxine is measured in micrograms, or 1/1000 of a milligram! A small change in how the medications is absorbed can cause drastic changes in your thyroid level. For this reason it is extremely important to take levothyroxine consistently. The most common recommendation is to take it first thing in the morning, 30 minutes before food or other medications. Again, the most important thing is to stay consistent in how you take the medication in order to get consistent blood levels!

  

Bisphosphonates For Osteoporosis

Bisphosphonates are a class of medications that are the primary treatment for osteoporosis. They include Fosamax (Alendronate), Boniva (ibandronate), and Actonel (Risedronate). Due to absorption issues, they should be taken first thing in the morning, 30 minutes before other medication or food. The only exception to this is a delayed release form of Actonel known as Atelvia, which should be taken immediately after breakfast.

 
To Eat Or Not To Eat
 

Grapefruit/Citrus Juices

Surprisingly enough, citrus juices can have a major impact on drug absorption in the body. They can significantly INCREASE or DECREASE drug levels, depending on the drug. Grapefruit juice specifically can INCREASE the amount of drug in your body by inhibiting a drug metabolizing enzyme in the liver known as CYP3A4. Drugs that affected by this include:

  •  Certain “Statin” cholesterol medications,
  •  Certain antibiotics such as clarithromycin 
  •  Certain blood pressure medications like amlodipine. 

Increased concentrations of the above medications in the body can possibly cause unwanted and harmful side effects. On the other hand, citrus juices can also inhibit a drug transporter known as OATP (organic anion trasporting polypeptide). This transporter facilitates drug absorption and inhibition leads to less drug being absorbed by the body. Allegra (fexofenadine) is a popular drug that is affected by this interaction. Listen to a commercial for Allegra and you’ll notice it says to avoid fruit juices like orange and grapefruit. Other medications affected by this include:

  • Tekturna
  • Singulair
  • Ciprofloxacin
  • Atenolol

It’s very important to not take grapefruit/citrus juices with these medications as the interactions can be significant.

 

     Most medications can be taken with or without food with no consequence. Many times it can help reduce nauseousness or diarrhea problems. There are certain situations however, where food can be a critical factor in how your medication is absorbed in your body.

Full Vs. Empty Stomach

As mentioned before, food can have alternating effects on medications. Here is a list of drugs that absolutely SHOULD be taken on a full stomach to enhance absorption of medication:

  • Lovastatin
  • Augmentin (Amoxicillin/Clavulanic Acid) Extended Release
  • Nitrofurantoin
  • Cefuroxime

Here is a list of medication that should be taken on an empty stomach to enhance absorption:

  • Proton Pump Inhibitors (Prilosec, Prevacid etc.)
  • Ampicillin
  • Clarithromycin
  • Penicillin
  • Rifampin
  • Levaquin
  • Tetracycline
  • Voriconazole
 

Calcium, Magnesium, Aluminum and Zinc

A common warning sticker you may see on your prescription bottle states that you should not take your medication with calcium or magnesium salts. This warning sticker is on medications that actually bind to what is know as cations, or positively charged ions. Calcium (Ca 2+), Magnesium (Mg 2+), Aluminum (Al 3+) and zinc (Zn 2+) are all positively charged cations which bind to certain medications, drastically reducing their absorption and effectiveness. It is important to avoid cation consumption with medications that interact. Calcium is commonly found in dairy products, antacids (TUMS) and multivitamins. Below is a partial list of medications that interact:

  • Tetracycline
  • Minocycline
  • Doxycycline
  • Bisphosphonates
  • Iron Products
  • CellCept (mycophenolate)
  • Gabapentin
  • Crestor
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Birth Control Side Effect Wizard!

We have been spending a lot of time creating a comprehensive guide to birth control.

One thing we were really passionate about was creating a guide for women who were having side effects on their birth control. We didn’t want to be too wordy in an effort to make the information as easy as possible to understand.

What we came up with was a Birth Control Side Effect Wizard! All you have to do is click on a side effect you are experiencing, and the wizard will give possible suggestions!

We really love where it is headed! We are just piloting it now, so we would like some feedback!

Let us know!

Thanks As Always!

PharmacistAnswers

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