Tag Archives: medicine

When Benadryl is Dangerous (Insert scary movie music here)

benadryl funny pic

The A,B,Cs and Zs of Antihistamines

A is for Allegra or fexofenadine, B is for Benadryl or diphenhydramine, C is for Claritin or loratadine and Z is for Zyrtec or cetirizine.

First and foremost, Benadryl can be dangerous. Everyone knows it causes sedation in most people but some of you still contend, “It doesn’t bother me!” Here is some data to the contrary. A well known study on antihistamines was written by an author named Weiler and published in 2000 in the Annals of Internal Medicine. Using a driving simulator, he compared the effects of Benadryl, Allegra, alcohol and placebo. He measured how well subjects could follow another vehicle at a set distance, how many times they got out of their lane and reaction times when responding to an obstacle put in their path. The subjects taking Benadryl had the worst performance—worse than alcohol! They also divided up the Benadryl takers inquiring which ones felt subjectively unaffected by the drug. The study found that those people still objectively had slower reaction times. So even if you think your immune to the effects of Benadryl, studies show that to be false.  The Allegra arm of the study showed no effect on cognition. A lot of UPS pilots reside here in Louisville, and this study is often cited to allow UPS pilots to take Allegra while in the air.

Benadryl can also be an issue for our children. Michael Blaiss, past president of the American College of Allergy, Asthma and Immunology, wrote a review in Clinical Therapeutics in 2004 about antihistamine prescribing strategies in school age children. He cites the detrimental effects of older sedating antihistamines on their “physical, social, and psychological well-being and academic performance.”

The take-home message is Benadryl should not be used routinely during the day. Newer agents such as Allegra, Zyrtec and Claritin have much better side effect profiles. Even Zyrtec cannot be called “non-sedating.” It’s also associated with sedation in some people and is therefore called “less sedating.” This becomes an issue if you operate heavy machinery or fly an airplane.

Hopefully you are still awake. Stay tuned for a blog on the ever-changing OTC nasal steroid market. Be sure to “like” my facebook page www.facebook.com/drdamin and share with other allergy sufferers.

 

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

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Two Inhalers to be Removed from Market by Year End

hourglassThe last of the CFC (Chlorofluorocarbon) containing inhalers will be removed from the market at the end of 2013.

History
Dating back to the 1980s, many countries signed an agreement to phase out CFC propellants in products to keep from further damaging the ozone layer in the atmosphere which protects us from the sun’s radiation. Most inhaler manufacturers were given a deadline of 2008 to remove the CFC propellant. The white generic albuterol inhalers made by Wallace or Warrick were no longer available as they contained the CFC propellant rather than the newer HFA (Hydroflouroalkane) propellant. I have seen patients who still carry these inhalers in their purses although they expired years ago!

Products Affected
Two inhalers were given an additional five years to remove the CFC propellant: Combivent and Maxair. Combivent because it was unique formulation that contained both albuterol and ipratroprium and Maxair because it was a unique breath actuated device.

Options
Users of the old Combivent inhaler already have an alternative. Combivent Respimat was approved by the FDA in 2011 and has been available since mid 2012. The new Combivent is only one puff per dose rather than two. Maxair will no longer be manufactured or sold after December 31, 2013. If you use Maxair, talk with your health care professional about your options. Further information about Maxair can be found here.

CFC FDA Consumer Update full version

List of non-CFC inhalers

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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

Nasal Congestion? Medicine not helping?

Are you or a family member struggling with one of allergy’s most aggravating symptoms? Sometimes our noses work too well. If it doesn’t like what you’re breathing, it does its best to protect you. A congested, runny nose is a body’s way of trying to block out or rinse out the particle/offender. The following is a list of treatments that help with the aggravating symptom of congestion:

  1. Nasal steroids-Nasal steroids are one of the most effective treatments when it comes to congestion. They all require a prescription, and their peak effect comes with several weeks of use. The safety profile is excellent with appropriate use. There can be side effects, though. Nose bleeds and nasal irritation can occur. On rare occasion, someone can develop a perforated septum which is a hole in the tissue dividing the two sides. They can also affect the pressure inside the eye which can be an issue for someone with glaucoma. Remember, they are steroids but  are delivered in microgram quantities and are not likely to cause long term issues the way milligram doses of oral steroids can.
  2. Nasal antihistamines-Nasal antihistamines also are effective for nasal congestion. Most nasal antihistamine studies show a noticeable benefit in congestion in as little as 30 minutes. They can also have an additional benefit when added to nasal steroids.  Like nasal steroids, these are also available only by prescription. They are not as likely to cause nose bleeds compared with nasal steroids and do not affect the pressures inside the eye.
  3. Oral decongestants-Oral decongestants like pseudoephedrine and phenylephrine are effective in treating nasal congestion. Pseudoephedrine is available behind the pharmacy counter without a prescription. For adults, it comes in short-acting 30mg pills as well as longer acting formulations that have up to 240mg in them. They can be found in a tablet by themselves or in combination with antihistamines or guaifenesin. The main issue with oral decongestants is their side effects, as they are stimulants that can raise blood pressure, increase heart rate and cause insomnia.
  4. Nasal spray decongestants-Nasal decongestants are the payday lender of nasal sprays. You can get quick relief but you’ll pay for it later with continued use. They constrict blood vessels in the nose and can provide a rapid improvement in congestion. If used more than three days, rebound congestion develops when the medicine wears off that can be worse than the initial congestion. These sprays can be addictive and lead to damage to your nasal tissue. It’s called rhinitis medicamentosa and occasionally needs steroids to help break the cycle. I have a bottle in my medicine cabinet. When I have a cold and wake up congested in the middle of the night, I’ll go for the rapid relief so I can get right back to sleep.
  5. Hypertonic nasal saline-Hypertonic nasal saline has a greater salt concentration than isotonic saline. It can have a very mild effect on nasal congestion.
  6. Surgery-If you’ve exhausted all the options above or have medical issues that narrow your choices, you may want to consider looking into an anatomical issue. For some a deviated septum or severely swollen nasal turbinates despite medicines will require an evaluation with an ENT. A septoplasty or a turbinectomy may be the answer rather than medicine. For kids, the blockage may not be the front portion of the nose but swollen adenoid tissue in the back of the nose.

You may ask, “What about oral antihistamines?” They are not on this list. By themselves, oral antihistamines do not treat congestion. That is why most are sold in combination with pseudoephedrine as a “D” option.

Spring is here. Talk with your doctor about what you should take to keep congestion from slowing you down.

Be sure to “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page with other allergy sufferers.

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

It’s Not Allergies

Its Not Allergies Pic

In keeping with the winter theme, I want to discuss things that cause allergy symptoms but are not really allergies. Many people are often shocked when their skin testing is negative, and I tell them they are not allergic. I run the risk of losing my credibility if I don’t hurry up and explain myself since they came in complaining of a profusely runny nose and nasal congestion. The explanation lies in the difference between allergies and irritants.

The word “allergy” implies the body saw a substance and made an immune response to that substance where the body is now primed with allergic antibodies waiting for the next exposure. That next exposure causes the release of histamine and other inflammatory chemicals that cause the sneezing, itching and the running of our nose.

Irritants, however, are all about air quality. Common irritants are cigarette smoke, pollution, dust (not to be confused with dust mites), perfumes/scents, cleaning fumes and changes in air pressure or temperature. A common trigger is the dramatic change in air pressure we experience during such activities such as flying in an airplane or driving up the Smoky Mountains. No one comes in after shoveling snow or scraping the ice off car windows and states, “I am so allergic to cold air,” but we often blow our noses once we are back inside.

So why is discriminating between the two important? The answer is in how they are treated. Allergies are treated with antihistamines, nasal sprays, decongestants, avoidance measures and allergy shots. Irritant symptoms don’t usually respond to newer antihistamines but can be treated with prescription nasal sprays, decongestants, nasal saline and air purifiers. Allergy testing can help separate the two or identify areas of overlap.

So if you recently walked through the mall (especially in front of Abercrombie & Fitch) and had to rummage through your pockets or purse looking for a tissue, rather than say “It’s allergies,” say “It’s NOT allergies,” instead.

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

Tis the Season for Nose Bleeds

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Tis the season for nose bleeds or in medical jargon, epistaxis. Here are a few thoughts on the subject. This week, Mother Nature is giving us a reprieve from the lower temperatures that cause us to run our heaters and dry out the air in our homes. That process leads to nasal irritation that can range from a small amount of blood in the tissue to all out running to the bathroom to hold pressure on the nose. In addition to the dry air, blood thinners, childhood “picking” and steroid nasal sprays can also aggravate the situation. Stopping steroid nasal sprays for a couple of days and moisturizing your nasal passageways are recommended. Humidifiers, nasal saline, a nasal saline gel and/or petroleum jelly will help moisturize your nose. All of which can be obtained at retailers such as Walgreen’s, Target or Wal-mart. A costlier fix is the whole house humidifier an HVAC company can install. If you notice that the nosebleeds always come from the same side, you may have an anatomical issue where a blood vessel is too close to the surface and easily irritated. This might warrant a trip to your ear, nose and throat (ENT) surgeon to consider silver nitrate cauterization, which in a recent Cochrane review achieved complete resolution in 88% of patients. For more profuse bleeding, use of a nasal decongestant like Afrin can constrict the blood vessels. Caution! Nasal decongestants can be addictive and cause rebound congestion if used longer than 2-3 days.  Another cautionary note, I am always reluctant to recommend humidifiers unless patients agree to be diligent in their cleaning of the humidifier to prevent mold build up. And finally, distilled or boiled water is recommended for those who use Neti-Pots and other rinse aids. Although extremely rare, a brain-eating amoeba called Naegleria fowleri can be contracted from infected water sources. Yuck! I hope these tips help get you through the winter! Feel free to share this post, especially with other parents… and those tap water Neti-Pot users!

Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.