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Common Painkillers Tied to Kidney Risks for Children: Study

Children taking the common painkillers known as nonsteroidal anti-inflammatory drugs may be at risk for acute kidney damage, particularly when the kids are dehydrated, a new study finds.

Nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), such as ibuprofen (brand names Advil and Motrin), naproxen (Aleve) and ketorolac (Toradol) are used to relieve pain and fever.

“The one thing we did see that seemed to be connected to kidney damage was dehydration,” said lead researcher Dr. Jason Misurac, a nephrologist at Indiana University School of Medicine in Indianapolis.

For the study, which was published in the Jan. 25 online edition of the Journal of Pediatrics, Misurac’s team looked at the medical records of children admitted to Riley Hospital for Children in Indianapolis from 1999 through mid-2010. Over that time, they identified more than 1,000 cases of children being treated for kidney damage.

In nearly 3 percent of the cases, the damage was related to NSAIDs, the study found. Most kids were teens, but four were under 5 years old. All of them had been given NSAIDs before being hospitalized. Since many other cases involved several causes of kidney damage, it is possible some of those also were related to NSAIDs, the researchers said.

Most children who developed kidney damage had been given the recommended dose and had not been taking NSAIDs for more than a week.

In adults, taking NSAIDs regularly for several years has been tied to kidney problems, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Cases involving children have previously been reported but only rarely.

Misurac noted that most of the children in the study hadn’t been drinking well and also were vomiting and had diarrhea, all of which can lead to dehydration. When someone is dehydrated the kidneys have a way of protecting themselves, which NSAIDs block, resulting in the damage, Misurac explained.

“Certainly in the way NSAIDs affect the kidneys, it’s reasonable to think that dehydration plus an NSAID has more of an effect than just an NSAID by itself,” he said.

Often the signs of kidney problems aren’t apparent, Misurac said. One sign is a decrease in urine; another is stomach pain. “But most kids who have episodes of acute kidney injury have nonspecific symptoms and there’s no one way to tell,” he said.

“If kids are dehydrated and not drinking well, then parents should think twice about using NSAIDs,” Misurac said. Tylenol (acetaminophen), which acts differently than NSAIDs, might be a better choice for children, he said.

For many of the children in the study, the kidney damage was reversed, Misurac said. The damage, however, was permanent for seven patients and they will probably need ongoing monitoring and treatment for declining kidney function, he said.

All the children under age 5 had to undergo dialysis and were more likely to be treated in an intensive-care unit, the researchers said. They also stayed in the hospital longer.

Although the study showed an association between taking NSAIDs and kidney problems in children, it didn’t establish a cause-and-effect relationship.

One expert agreed that NSAIDs can damage the kidneys.

“This is well known. Unfortunately, it is better known among doctors; the public is not as educated regarding this problem,” said Dr. Felix Ramirez-Seijas, director of pediatric nephrology at Miami Children’s Hospital.

Ramirez-Seijas said NSAIDs are “overused and abused, both by doctors and patients.”

For children, most fevers should not be treated; fever is how the body fights infection, he said. “There is a fear of fever that leads to overtreatment,” Ramirez-Seijas said.

In addition, children who take NSAIDs for aches after vigorous exercise also are at risk, because they may be dehydrated, Ramirez-Seijas said.

His advice to parents is to be sure children are well hydrated if they are going take NSAIDs. In addition, he believes that even these over-the-counter drugs should only be used with the advice of a doctor.

“Most people see taking a couple of Advil like taking a sip of water, but it’s not,” Ramirez-Seijas said.

By Steven Reinberg     HealthDay    Jan. 25




Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

What are NSAIDs and how do they work?

Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation that is necessary for healing, but also results in pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.

Prostaglandins are produced within the body’s cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.

What NSAIDs are approved in the United States?

The following list is an example of NSAIDs available:

  • aspirin
  • celecoxib (Celebrex)
  • diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
  • diflunisal (Dolobid – discontinued brand)
  • etodolac (Lodine – discontinued brand)
  • ibuprofen (Motrin, Advil)
  • indomethacin (Indocin)
  • ketoprofen (Active-Ketoprofen [Orudis – discontinued brand])
  • ketorolac (Toradol – discontinued brand)
  • nabumetone (Relafen – discontinued brand)
  • naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • salsalate (Disalsate [Amigesic – discontinued brand])
  • sulindac (Clinoril – discontinued brand)
  • tolmetin (Tolectin – discontinued brand)

What are the side effects of NSAIDs?

NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.

Common side effects are

  • nausea,
  • vomiting,
  • diarrhea,
  • constipation,
  • decreased appetite,
  • rash,
  • dizziness,
  • headache, and
  • drowsiness.

Other important side effects are:

  • kidney failure (primarily with chronic use),
  • liver failure,
  • ulcers, and
  • prolonged bleeding after injury or surgery.

NSAIDs can cause fluid retention which can lead to edema, which is most commonly manifested by swelling of the ankles.

WARNING: Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.

Use of aspirin in children and teenagers with chickenpox or influenza has been associated with the development of Reye’s syndrome, a serious and sometimes fatal liver disease. Therefore, aspirin and non-aspirin salicylates (for example, salsalate [Amigesic]) should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.

NSAIDs increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

For what conditions are NSAIDs used?

NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever.

Specific uses include the treatment of:

  • headaches,
  • arthritis,
  • ankylosing spondylitis,
  • sports injuries, and
  • menstrual cramps.
  • Ketorolac (Toradol) is only used for short-term treatment of moderately severe acute pain that otherwise would be treated with narcotics.

Aspirin (also an NSAID) is used to inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk for strokes and heart attacks.

NSAIDs also are included in many cold and allergy preparations.

Celecoxib (Celebrex) is used for treating familial adenomatous polyposis (FAP) to prevent the formation and growth of colon polyps.

With which drugs do NSAIDs interact?

NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics (“water pills”) and decrease the elimination of lithium (Eskalith, Lithobid) and methotrexate (Rheumatrex, Trexall). As a result, the blood levels of these drugs may increase as may their side effects.

NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase bleeding (for example, warfarin [Coumadin]), there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged use of NSAIDs.

NSAIDs also may increase blood pressure in patients with hypertension (high blood pressure) and therefore antagonize the action of drugs that are used to treat hypertension.

NSAIDs increase the negative effect of cyclosporine on kidney function.

Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.


Medical and Pharmacy Editor: Jay W. Marks, MD  
Pharmacy Author: Omudhome Ogbru, PharmD 

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This Mineral Fights Depression — And It Is Cheaper And Safer Than Drugs

The supplement starts to take effect after only two weeks, the researchers found.

Over-the-counter magnesium is a safe and effective way to treat mild to moderate depression, a new study suggests.

The mineral magnesium has already been linked to lower inflammation and improvements in depression.

Now a new randomised controlled trial has tested the effects of magnesium chloride supplements compared with no treatment.

For the research, half of 126 people with mild to moderate depression were given 248 mg of magnesium chloride per day for six weeks.

After just two weeks, some positive effects of the supplement could be seen.

Those taking magnesium had clinically significant improvements over the six weeks.

People did not have any problems taking magnesium and there were no differences based on sex, age, whether people were also taking antidepressants, or other factors.

More than half of the people in the study said they would continue to take magnesium to help them with their depression.

Ms Emily Tarleton, the study’s first author, said:

“This is the first randomized clinical trial looking at the effect of magnesium supplementation on symptoms of depression in U.S. adults.
The results are very encouraging, given the great need for additional treatment options for depression, and our finding that magnesium supplementation provides a safe, fast and inexpensive approach to controlling depressive symptoms.”

Ms Tarleton says that the next stage is to move on to larger populations to see if the results can be replicated.

While many more studies have investigated antidepressant medications, there is also much evidence of their side-effects.

A survey of people taking antidepressants has found higher than expected levels of emotional numbness, sexual problems and even suicidal thoughts associated with the medication.

Of the 20 adverse effects to antidepressants that people were questioned about:

  • 62% said they had ‘sexual difficulties’,
  • 52% said they ‘didn’t feel like themselves’,
  • 42% noticed a ‘reduction in positive feelings’,
  • 39% found themselves ‘caring less about others’,
  • and 55% reported ‘withdrawal effects’.

The study was published in the journal PLOS ONE (Tarleton et al., 2017).

JULY 12, 2017
source: PsyBlog

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The Simple Treatment That Beats Antidepressants

Two-thirds of people with major depression were no longer depressed after this treatment.

A brisk walk three times a week can actually beat antidepressant medication in treating major depression, research finds.

The results come from a study on three groups of elderly people with major depressive disorder.

One group were given the exercise, another given antidepressant medication and the third both.

The results showed that all three groups improved the same amount.

Professor James Blumenthal, the study’s first author, said:

“One of the conclusions we can draw from this is that exercise may be just as effective as medication and may be a better alternative for certain patients.”

The results showed that after exercise almost two-thirds of participants were no longer depressed after 16 weeks.

One of the problems with exercise is that it may take a little longer to take effect.

Professor Blumenthal said:

“While we don’t know why exercise confers such a benefit, this study shows that exercise should be considered as a credible form of treatment for these patients.
Almost one-third of depressed patients in general do not respond to medications, and for others, the medications can cause unwanted side effects.
Exercise should be considered a viable option.”

Exercise could be particularly beneficial because people are taking an active role, rather than passively taking a pill, Professor Blumenthal said:

“Simply taking a pill is very passive.
Patients who exercised may have felt a greater sense of mastery over their condition and gained a greater sense of accomplishment.
They felt more self-confident and had better self-esteem because they were able to do it themselves, and attributed their improvement to their ability to exercise.
These findings could change the way some depressed patients are treated, especially those who are not interested in taking anti-depressants.
While these medications have been proven to be effective, many people want to avoid the side effects or are looking for a more ‘natural’ way of feeling better.”

The antidepressant tested in the study was sertraline, which is marketed as Zoloft.

The study was published in the journal Archives of Internal Medicine (Blumenthal et al., 1999).

 source: PsyBlog

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Common Painkillers Linked To Increased Risk Of Heart Attack, Study Says

Story highlights
A new study links common painkillers called to increased risk of heart attacks
Researchers urge doctors and patients to weight the risks and benefits
The drugs are not proved to be a a direct cause of heart attacks

(CNN)Taking even over-the-counter doses of common painkillers known as NSAIDs – nonsteroidal anti-inflammatory drugs – has been linked to an increased risk of heart attack in a new study.

The likelihood of experiencing a heart attack was calculated to increase by an average of 20% to 50%, compared with someone not taking the drugs, regardless of the dosage and amount of time the medications are taken.

The findings are observational and based on an association, however, with the drugs not proved to be a a direct cause of heart attack.

This group of drugs includes ibuprofen, diclofenac, celecoxib and naproxen, which are available over the counter or by prescription for higher doses, to relieve pain or fever resulting from a range of causes, including flu, headaches, back pain and menstrual cramps. Their range of uses also means they are often taken as needed, for short periods of time.

The level of risk increased as early as one week into the use of any drug in this category and at any dose, and the risk associated with taking higher doses was greatest within the first month.
“We found that all common NSAIDs shared a heightened risk of heart attack,” said Dr. Michèle Bally, an epidemiologist at the University of Montreal Hospital Research Center, who led the research. “There is a perception that naproxen has the lowest cardiovascular risk (among the NSAIDs), but that’s not true.”

Researchers’ overall finding was that taking any dosage of these drugs for one week, one month or longer was linked to an increased risk of a heart attack. The risk appeared to decline when these painkillers were no longer taken, with a slight decline one to 30 days after use and a greater decline, falling below 11%, between 30 days and one year after use.

Based on the paper, published Tuesday in the BMJ, Bally’s team suggests that doctors and patients weigh the potential harms and benefits before relying on the drugs as a treatment option.

“People minimize the risks because drugs are over the counter and they don’t read labels,” Bally said. “Why not consider all treatment options? … Every therapeutic decision is a balance of benefits and risk.”

Building on previous research

Cardiovascular diseases are the No. 1 cause of death globally, according to the World Health Organization, with 80% of all deaths in this category due to heart attacks and strokes. Each year, it’s estimated that 735,000 people in the United States have a heart attack. In the United Kingdom, more than 200,000 hospital visits each year are due to a heart attack.

Previous research has showed that this class of painkillers could increase the risk of having a heart attack, known as myocardial infarction. In 2015, the US Food and Drug Administration called on drugmakers to update their warnings labels to identify an increased risk of a heart attack or stroke.

But the specifics in terms of timing, dosage and treatment durations were less clear.

Bally and her team reviewed all available studies in this area from Canadian and European databases, analyzing the findings from 446,763 people, with 61,460 of them having had a heart attack. Their goal was to calculate the risk, determinants and time course of heart attacks associated with the use of NSAIDs under typical circumstances.

The team looked at very short-term use and at any dose, said Bally. “In real life, people use drugs at low doses and use them on and off,” she said, adding that this is not reflected in many clinical trials, for example, in which people have often been monitored during prolonged use of these drugs.

When using them for one week, the greatest risk was associated with rofecoxib, followed by diclofenac, ibuprofen and then celecoxib, respectively, though all except celecoxib had similar levels of risk, hovering around 50% increased odds of a heart attack, at any dose.

At higher doses, typically needing a prescription, some drugs had an even greater risk of heart attack between one week and one month of use. For example, naproxen showed a 75% increased likelihood of a heart attack within one month with doses of 1200 milligrams per day or more, and naproxen showed an 83% increased likelihood of a heart attack with doses greater than 750 milligrams per day when taken for one week to one month.

But the level of risk declined, on average, when the drugs were used for longer than one month.

“This is relative to not taking these drugs, your baseline risk,” Bally said. “The risk is not 75%. It’s an increase (maybe) from a tiny baseline risk that they have.”
Millions of these pills are sold every year, Bally said. “Therefore the risk, no matter how small or relative, is important to note from a population viewpoint.”
“We already know that these drugs increase your risk of having a heart attack,” said Dr. Mike Knapton, associate medical director at the British Heart Foundation, in a statement. “However this large-scale study worryingly highlights just how quickly you become at risk of having a heart attack after starting NSAIDs.” Knapton was not involved in the research.

Knapton further added that people must be made aware of the risk and that alternative medication or treatment should be considered where appropriate. For example, physical therapy or yoga could be used to alleviate pain from an injury.

nonsteroidal anti-inflammatory drugs
nonsteroidal anti-inflammatory drugs

Association, not causation

The researchers stress that the findings are purely observational, as they used readily available data about certain populations. Not all potentially influential factors could be taken into account, they say.

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine, commented that a number of lifestyle factors, such as smoking and body mass index, are not available in the data about the study participants. “It leads to uncertainty,” he said.

Tobacco use, unhealthy diet, obesity, alcohol abuse and hypertension are just a few of many factors that can cause a heart attack.

“This is the largest study of its kind, but it is still observational data based on prescription or dispensing information, rather than whether people were actually taking their medication,” said Dr. Amitava Banerjee, senior clinical lecturer in clinical data science at UCL in the UK. “Although these data reflect real-world use of NSAIDs, it is impossible to control for all the factors which may lead to confounding or bias.”

This uncertainty combined with the overall observational nature of the findings means the cause of the increased risk shown in the analysis cannot be explained, nor can the drugs be directly stated as a cause of heart attacks.

Bally thinks a cause could be changes in blood pressure or effects on kidney function, as these areas are poorly studied. But she stresses that all five drugs studied have individual behaviors. “It will be hard to point to one factor,” she said.

Relative, not absolute risk

“The paper has good evidence that there is some risk of a heart attack for all NSAIDs and suggests that the risk starts immediately on starting them, but is only expressed in relative terms,” said Evans, who was not involved in the research. “There is no clear description of the absolute risk.”

The findings are based on the chances of a heart attack occurring in people taking these drugs, compared with those not taking them. If risk was already low in a person, a 20% to 50% increased risk is not that much cause for concern.

“The risks are relatively small, and for most people who are not at high risk of a heart attack, these findings have minimal implications,” Evans said.

It’s also possible that people taking these drugs are, on average, already at higher risk than people not taking the drugs, he said, commenting that the study did not account for these factors in their calculations. For example, the reason someone is prescribed an NSAID, such as for severe pain, may also be the reason they have a heart attack soon after. So while the study shows that risk of a heart attack increases as soon as a few days into taking NSAIDs, the links may not be as clear as suggested, Evans said.

“The most likely mechanisms for action of the drugs would be expected to show a low risk at the start and only have an effect on heart attacks after longer usage. That this wasn’t the case casts some doubt on the findings of an immediate increase in risk,” he said.
“All effective medicines have unwanted effects, and NSAIDs, although easily available, are not without some risks, but this study is no reason to induce anxiety in most users of these drugs,” he said.

But while waiting for more clarity on the true level of risk and its cause, experts still advise caution when prescribing or taking these painkillers.

“The increased risk of heart attack with NSAIDs, regardless of which one, means that both health professionals and the public should weigh up the harm and the benefit when prescribing these medications, especially for more than a day or two,” Banerjee said.
“Despite the over-the-counter availability of the traditional NSAIDs, this caution is still required. The mechanism of this increased risk of heart attack is not at all clear from existing studies.”

By Meera Senthilingam, CNN         May 9, 2017
 source: www.cnn.com

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 Your Doctor Wishes You Would do These 8 Things

We polled family doctors from across the country, and they laid down the law on eight things they wish we’d do—or stop doing.

According to our panel of general practitioners, Canadians aren’t always doing what they should to make the most of doctor visits—and skipping out on these crucial tactics could lead to a delay in diagnosing serious conditions. Here’s what our experts say you should add to your patient checklist.

1. Stop feeling shy

Many of us hesitate to talk to our physicians about sensitive issues (think substance abuse or sexual health—or even gender identity). But honesty and openness are important, both for fostering a good doctor-patient relationship and for ensuring that you get the best care, says Dr. Laura Pripstein, medical director of the Sherbourne Health Centre in Toronto and a staff physician on the family health team. That’s why it’s OK to try out a doc before committing. Dr. Pripstein recommends booking an initial visit to see if your potential doctor is a good fit. “You want to see if this person seems like someone you can talk to, someone you feel comfortable with,” she says. And if you don’t think your doctor understands or respects your concerns, don’t be afraid to find someone new. “If you feel you can’t ask questions that might be embarrassing, you don’t have the right provider,” says Dr. Pripstein.

2. Don’t come to your appointments unprepared

Get the most out of your time—and your doc’s—by arriving at your appointment with a clear plan for what you want to discuss, says Dr. David Ross, an associate professor of family medicine at the University of Alberta in Edmonton. “It’s good to have patients think about their problems from when the issue began, then look at it chronologically to the present,” says Dr. Ross. Making a prioritized point-form list in advance helps ensure that you don’t forget anything or mix up the order of events, he says. Then, work with your doctor to address the most serious issues first.

3. Choose your family doc over the walk-in clinic whenever you can

Yes, a clinic is convenient, but what we gain in easy access, we lose in familiarity. “I think it’s really valuable if people can connect with a family physician who they’ll be able to see long term, rather than just looking for the quickest way to access care,” says Dr. Maurianne Reade, a physician with the Manitoulin Central Family Health Team in Mindemoya and M’Chigeeng First Nation, Ont. A family doctor will know your medical history and will keep it in mind when suggesting treatment—so, for example, if you’ve recently taken several courses of antibiotics for a UTI, your physician will likely look for a different course of action if you come in with another infection. According to the most recent statistics, about 4.5 million Canadians don’t have a regular family doctor. If that’s you, contact your provincial College of Physicians and Surgeons, or check to see if your region has an online registry (Ontario has Health Care Connect, while Quebec launched a web-based family doctor finder last year). “It’s important to know that we doctors are privileged to share in your stories and to help you through difficult times,” says Dr. Reade.

4. Share what’s happening in your life

There’s a reason your doctor wants to know where you’re working, if you’re dating and how the kids are—and it’s not just because she likes you. (Though she does, we’re sure.) Physicians need a picture of their patients’ lives beyond their specific health symptoms and conditions, especially when they’re first getting to know you, says Dr. Stephen Wetmore, the family medicine chair at the Schulich School of Medicine & Dentistry at Western University in London, Ont. “Doctors need to know these things to understand how your lifestyle and habits may be influencing your health,” he says. So when you’re talking about your exercise habits, your health history and whether you smoke, drink or use drugs, mention your employment status, family obligations and intimate relationships, too, says Dr. Wetmore.


5. Be a better googler

Doctors know you do it (hello, late-night web searches), but they would prefer you to ask about good sources of information, rather than going rogue online. They also want you to be honest about your fears if you’ve read something particularly upsetting. Physicians can’t address your concerns or point you in the right direction if they don’t know what your fingertips have been up to. “The thing we want our patients to do is ask us for the most reliable Canadian websites to go to as resources,” says Dr. Heather Waters, an assistant professor of family medicine at McMaster University in Hamilton.

6. Don’t think your symptoms are “no big deal”

If you’ve noticed you are having more headaches than usual or are sleeping more or are eating less, you might not think to tell your doctor—but you should. There’s no set of rules for determining which symptoms are worthy of investigation or discussion, says Dr. Wetmore, but make a note to mention anything that is new or has changed since your last appointment. “You should bring up things like sudden weight loss or fatigue that seems excessive,” he says. “It could be a sign of a larger problem, or the cause of a developing problem.” Evenif it doesn’t end up being serious, seeing your doctor will help ease any anxiety you might be feeling, and that’s worth the visit, too.

7. Talk about what you’re taking

Tell your physician about any herbal medications and alternative treatments you take, says Dr. Mel Borins, a University of Toronto associate professor and author of A Doctor’s Guide to Alternative Medicine: What Works, What Doesn’t, and Why. It’s important for patients to share what’s working for them and for doctors to be open-minded about therapies outside their own practice or traditions, he says. This is also a concern when it comes to conventional meds, especially if you’re pregnant; there are only 23 medications specifically approved for use during pregnancy— yes, out of every available drug—which can leave women feeling anxious about taking prescription or over-the-counter drugs when they’re expecting, says Dr. Robyn MacQuarrie, an obstetrician-gynecologist in Bridgewater, N.S. But don’t stop taking your meds as soon as your pregnancy test comes back positive. “It’s really important to talk to your doctor instead of stopping cold turkey,” says Dr. MacQuarrie. Physicians can help you determine the risks and benefits of using different drugs, and they can let you know when the effects of not taking a medication while pregnant may be worse than taking it— which is the case with some antidepressants.

8. Avoid diagnosing yourself

You know doctors don’t like it when you come in prepared with a diagnosis you’ve made thanks to the aforementioned Dr. Google. But do you know why? It’s not because they think you’re encroaching on their territory! Rather, they worry that a serious medical problem might get missed or you’ll cause yourself unnecessary anxiety over something not serious. That’s because not everyone has the most common symptoms of a particular condition. Plus, men, women and different ethnicities can have varying symptoms for the same problem. For instance, Dr. Reade’s community has a large proportion of people with diabetes, which can affect the warning signs of cardiac disease, a major killer in Canada. Instead of the usual pain or pressure on the left side of the chest or arm, men and women with diabetes may instead have spells of profuse sweating with weakness. And, of course, women who don’t have diabetes can have differing symptoms, too; sometimes, a heart attack can feel like acid reflux or come with sudden nausea, vomiting and lightheadedness. So always tell your physician if your symptoms are surprising or strange—like a headache that feels different than usual, for example. And if you’re worried about a specific diagnosis, be sure to bring that up, too.


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Why Kids Younger Than 12 Don’t Need OTC Cough And Cold Remedies

The common cold season is here, and if you have children, you will likely feel their suffering from these annoying upper respiratory tract viral infections. Children experience more colds, about six to 10 annually, than adults. With each cold producing symptoms of nasal congestion, runny nose, cough and mild fever lasting up to seven to 10 days, it may seem that children are nearly continuously sick.

Parents certainly want their ill children to feel better, and they, naturally, want to help. A frequent solution is over-the-counter (OTC) drugs, which are heavily advertised to treat many maladies, including colds. A stroll down your local pharmacy OTC drug aisle will highlight the numerous OTC drug products available for adults and children.

It is tempting to buy one or more of these products to help your child. However, for children younger than 12 years of age, it is best not to use commonly advertised OTC cough and cold drug products. These products lack supportive clinical study efficacy and safety data, an issue I’ve studied as a professor of pharmacy practice.

Children are not just small adults

When treating children with OTC or prescription drugs, it is important to understand that young children differ significantly from the adult population with respect to drug efficacy and adverse effects.

Over the past 30 years, we have learned much more about pediatric pharmacology and drug action and behavior, known as pharmacokinetics, and differences compared to adults. Prior to this, and even today to some extent, health care professionals assumed that drugs functioned and behaved similarly in children as in adults.

Based on this assumption, health practitioners often only reduced the amount of a drug to a child based on a proportion of the child’s body weight to an adult. For example, a provider would prescribe 50 percent of an adult drug dose for a child with 50 percent body weight of an adult. The efficacy of OTC cough and cold product active ingredient, as demonstrated in adult studies, was assumed to be similar in children.

However, we have learned, and are continuing to learn, that this strategy is not accurate and can be dangerous. Most drugs are not specifically studied and evaluated in children prior to their labeling by the FDA and availability to the public.

A safe and effective drug dose and dose schedule (how often a drug dose is given) is derived from these formal studies and evaluations. But without these formal studies, pediatric-specific drug pharmacology is not accurately evaluated and determined. In addition, a physician can legally prescribe any drug for a child, even if there aren’t data supporting its efficacy and safety in children.

OTC drugs regulated differently than Rx drugs

FDA regulation of OTC drug products differs from prescription drug regulation. Active ingredients in OTC drug products are evaluated and approved by therapeutic category, such as the cough and cold therapeutic category. In a major undertaking begun in 1972, the FDA has been reviewing OTC drug product categories for safety and efficacy, and it continues to do so.

Pediatric OTC cough and cold products have seen significant regulatory changes in recent years. In 2007, several health care experts petitioned the FDA to carefully review pediatric efficacy and safety data of OTC cough and cold products, requesting that these products be specifically labeled not for use in children younger than six years of age.


In 2008, the FDA recommended that OTC cough and cold products not be given to children younger than two years old. The trade group representing OTC drug product manufacturers, the Consumer Healthcare Products Association, additionally announced that these products would be labeled “not for use” in children younger than four years old. The FDA agreed, and this remains the current status of pediatric age labeling for OTC cough and cold products.

In addition, reviews of the medical literature indicates that OTC drug ingredients are actually ineffective in reducing cold symptoms in children. OTC cough and cold products can be dangerous to use as well, with more than 100 deaths of infants and young children described in published reports where these products were the sole cause or important contributive causes.

Although several doses of pediatric OTC cough/cold products are unlikely to be toxic, these reports have described scenarios where the products were used inappropriately, by administration of doses too large, doses given too frequently, measurement of liquid doses inaccurately (too much) or administration of similar active ingredient drugs given from numerous OTC products resulting in accumulative large doses.

These mistakes were easily made by parents, considering the difficulty in accurately measuring out small liquid doses and a desire for the drugs to help (more is better).

A word of caution regarding codeine

Recent studies and recommendations have significantly altered our use of another drug historically used to treat cough in children – codeine. It is an opioid, and it is still available over the counter in some cough medicines in some states. It is available in all states as prescription products.

We have learned in recent years that codeine is metabolized differently from subject to subject. Codeine alone has very little useful pharmacologic activity, but the liver chemically alters it into its active form, morphine, and another chemical. Morphine is dangerous, as it suppresses breathing. It must be used cautiously even in adults.

For many years, codeine has been used for treating pain and cough in children and adults. Recent evaluations, however, have determined that its clinical efficacy for these uses is inferior to other available drugs. We have learned that the amount of morphine produced from codeine liver metabolism can vary widely from person to person, a result of genetic differences.

Some individuals may convert codeine to a lot of morphine, while others may convert codeine to much less morphine. Evidence has accumulated over the past 10 years demonstrating that codeine can produce a significant decrease in breathing in some infants and children.

More than 20 cases of fatal respiratory depression have been documented in infants and children. In 2016, the American Academy of Pediatrics published a warning on the dangers of administering codeine to infants and children, recommending that its use for all purposes in children, including cough and pain, be limited or stopped.

Try these remedies instead

When your child next suffers from a cold, instead of reaching for an OTC cough and cold product, use an OTC nasal saline drop or spray product to help with nasal congestion. You can also run a cold air humidifier in his or her room at night to additionally help loosen nasal congestion. Acetaminophen or ibuprofen can be given as needed for fever.

If your child is coughing enough to be uncomfortable or to prevent nighttime sleep, try giving honey, so long as he or she is one or older. Honey has been recently shown by several clinical studies to be an effective cough suppressant, and is likely to be much safer than codeine and OTC cough and cold products.

These therapies have been endorsed by the American Academy of Pediatrics. When using these treatments in infants and young children, it is always wise to speak with your child’s pediatrician first, as several more serious illnesses may initially produce symptoms similar to those of a common cold.

November 23, 2016     Edward Bell       Professor of Pharmacy Practice, Drake University




Research Reveals How A Single Choice Affects Mental Health More Than Medications

“We need to get serious
about the critical role played by nutrition.”

– Julia Rucklidge, Clinical Psychologist

We pretty much all agree that good nutritional habits are vital to good physical health, yes? But what about mental health? Do good nutritional habits translate to a healthier mental state? On the surface, it would make sense. After all, the food that we eat contains nutrients – and these nutrients are transported throughout our entire body via our bloodstream. We already know that the brain requires nutrients to operate effectively…so, yeah, it makes sense.

But is eating right more important to mental health than prescription medicine?

Ah, this is a bit trickier. After all, pharmaceuticals are research-intensive and science-based products that have undergone extensive trial and error, often over a period of multiple years. These same products have earned the coveted “seal of approval” from the Food and Drug Administration (FDA)…no easy task to say the least.
But, then again, hasn’t food undergone “testing” too? We’ve been “studying” the effects of food for much, much longer than medicine, haven’t we?

Scientists seem to have a pretty good grasp as to what foods are healthy and unhealthy, so why haven’t there been many hypotheses focused on the mental health/nutrition link? Going back to the underlying question, we could attempt to subjectively rationalize a “yes” or “no” answer, and we may come up with an acceptable (maybe even a good) explanation. Or we could call upon that same scientific method to help us out a bit.

What does the science say?

First, we should get this one out of the way: good nutrition is essential for our mental health, and a myriad of mental health conditions can be affected by nutritional habits. This is THE most important lesson of the entire article. Yes, it is interesting that eating healthy may be more impactful than medication; but understanding that food has a direct impact on our mental health is even more crucial.

The Mental Health Foundation – a preeminent, science-based mental health organization, based in the UK – states:

“One of the most obvious, yet under-recognized factors in the development of major trends in mental health is the role of nutrition…the body of evidence linking diet and mental health is growing at a rapid pace, as well as its impact on short and long-term mental health.”

Just as interesting is the following, again quoting from the Mental Health Foundation:

“…the evidence indicates that food plays an important contributing role in the development, management and prevention of specific mental health problems such as depression, schizophrenia, attention deficit hyperactivity disorder, and Alzheimer’s Disease.”


So, what do we know, then? Two important things:

  1.  An overwhelming amount of evidence exists proving that food does have a direct effect on our overall mental health.
  2.  That the food we take in can directly contribute – in ways both good and bad – to both potential and existing mental health conditions.


Most rational people accept the notion that medication (e.g. prescription medications, vaccines, etc.) plays an important role – and a positive one – in the prevention and treatment of many different health conditions.

One area that is much more contentious is the impact of pharmaceuticals on mental health. More specifically, whether or not pharmaceuticals simply “mask” symptoms rather than cure the underlying condition – as is the case with many patients suffering from anxiety and/or depression, for example.

Dr. Julia Rucklidge, professor of Clinical Psychology at the University of Canterbury, is among the advocates for treating mental health disorders with adequate nutrition, despite having her initial doubts. The research that she has undertaken over years, however, has ultimately led her to a simple, profound conclusion: that “nutrition is a safe and viable way to avoid, treat, and lessen mental illness.”

To emphasize her point, Dr. Rucklidge cites her now-well-known study of ADHD patients. The adult participants were split into two groups: one group received micro-nutrients (i.e. vitamins and minerals), and the second group received a placebo (an inactive ingredient used as a basis of measurement.)

Here’s what she found:

– In eight weeks, twice the number of participants responded favorably in the micro-nutrient group than the placebo group.
– Participants that continued with the micro-nutrient regimen realized positive mental health benefits; the alleviation of symptoms.
– Participants that discontinued the micro-nutrient regimen and reverted back to medication realized worsening symptoms.

Dr. Rucklidge didn’t cease experimental efforts with ADHD patients, and continued testing the impact of micro-nutrients on patients with depression, schizophrenia, bi-polar disorder, and others. Similar to the ADHD study, patients responded favorably to the micro-nutrient regimen.
What does this mean?

It simply means that nutrition is a vital component to not only physical health, but overall mental health. Commonsensical? We’ll let you be the judge of that.

But, if Dr. Rucklidge and her colleagues are correct – and many indicators seemingly point in this direction – it may indeed alter how mental illness is both viewed and treated.

SEPTEMBER 22, 2016