The Saturday Evening Post » Cara Acklin, Pharm. D.

What’s in Your Medicine Cabinet?

Cara Acklin, Pharm. D. — Thu, 02 May 2013 12:00:22 +0000

It’s easy to take way too much of certain active ingredients—and put your health at risk—by mixing and matching over-the-counter remedies to soothe cold, cough, or allergy symptoms. Experts recently reduced the daily dose of acetaminophen (aka Tylenol) that’s considered safe for adults. Additionally, people often don’t realize that it and other medicines such as pseudoephedrine (a decongestant) and dextromethorphan (a cough suppressant) are found in hundreds of different pills, capsules, syrups, and lozenges. To avoid “double-dipping” and to stay safe, take only one product containing the same ingredient when possible, and monitor your daily dose using the following chart.

Check Your Meds

Active Ingredient	Typical Daily Dose*	Daily Limit	Danger of Higher Doses
Acetaminophen (extra-strength, 500 mg)	3 pills	6 pills	Liver damage, death
Aspirin (regular, 325 mg)	4 pills	12 pills	Stomach ulcers, bleeding
Dextromethorphan (15 mg/teaspoon, for coughs)	6 teaspoons	8 teaspoons	Seizures, coma, death
Pseudoephedrine (regular, 60 mg, for congestion)	2-4 pills	4 pills	Seizures, trouble breathing

*Always consult your pharmacist and physician for personal recommendations. Dozens of other seemingly harmless medicine cabinet drugs have dangerous side effects that are amplified when mixed with other medicines. You can compare any meds you are thinking of taking together at nlm.nih.gov/medlineplus/druginformation.html.

What’s in Your Medicine Cabinet? The Saturday Evening Post

Call First, Act Later

Cara Acklin, Pharm. D. — Thu, 29 Jul 2010 13:24:46 +0000

One of the most rewarding parts of my work as a  pharmacist is answering questions people have about their medicines. It is also one of my most frustrating jobs, especially when people call with a question about a medication that they have already taken. At that point, I’m unable to help them avoid potential drug interactions and side effects. If you have a question about a drug, no matter how inconsequential it may seem, please call your pharmacist before taking it. Then, you can make the best decisions about your medications.

Call First, Act Later The Saturday Evening Post

Be Careful with Coumadin

Cara Acklin, Pharm. D. — Thu, 29 Jul 2010 13:24:13 +0000

Warfarin (Coumadin), a prescription drug used to  prevent blood clots, saves countless lives. However, many drugs and supplements (even common pain  medicines like aspirin and ibuprofen) can intensify its anti-clotting effect and put patients at risk of excessive bleeding. When Coumadin therapy is indicated, give your doctor—and your pharmacist—a comprehensive list of your prescription drugs, over-the-counter medicines, and herbal and dietary supplements, including vitamins. At each medical and dental visit, be certain the health care provider is aware that you are on Coumadin. As an extra precaution, also ask the pharmacist to double-check for any drug interactions when filling new  prescriptions or picking up refills. Never stop taking  Coumadin without first talking to your doctor.

Be Careful with Coumadin The Saturday Evening Post

Water Pill Basics

Cara Acklin, Pharm. D. — Wed, 02 Jun 2010 19:11:13 +0000

Water pills (called diuretics) get rid of extra fluid in the body, making it easier for the heart to pump, and help reduce blood pressure.

Common diuretics: hydrochlorothiazide (Microzide and others) and furosemide (Lasix).

When to take: in the morning to limit nighttime  bathroom trips.

What to watch for: Some people suffer leg cramps when taking water pills. To combat the problem,  consider getting extra potassium from foods such  as bananas and orange juice. Before making drastic changes in your diet, however, please consult a  pharmacist or doctor for specific advice. Too much  potassium may cause other problems. Do not take  potassium supplements when taking water pills.

Water Pill Basics The Saturday Evening Post

Shingles Solutions

Cara Acklin, Pharm. D. — Wed, 02 Jun 2010 19:11:13 +0000

An attack of shingles (caused by the reactivated  chickenpox virus, which usually stays dormant in  people who had the disease) is typified by burning pain and sensitive skin, followed by a blistering rash that takes weeks to resolve. The antiviral drugs acyclovir, valacyclovir, and famciclovir may reduce symptoms  if started within three days of getting the rash. Pain  relievers such as gabapentin (Neurontin), pregabalin (Lyrica), and a combination of acetaminophen and  hydrocodone (Vicodin) may also be prescribed,  especially when severe pain lingers after the rash clears. Qutenza, a new prescription patch for nerve pain, is applied by a doctor and delivers a synthetic form of capsaicin, the chemical found in chili peppers. To prevent shingles, the Zostavax vaccine is recommended for those over 60 who have had chickenpox. When an unvaccinated person develops shingles, the shot may be given after the rash heals to prevent a  recurrence. If you suspect shingles, see a doctor.

Shingles Solutions The Saturday Evening Post

Allergy Relief

Cara Acklin, Pharm. D. — Wed, 02 Jun 2010 19:11:13 +0000

Don’t suffer needlessly from springtime allergy  symptoms. Taken once or twice daily, over-the-counter (OTC) products that contain the active ingredient  loratadine (Claritin) or cetirizine (Zyrtec) help treat runny nose, sneezing, and itchy and watery eyes. These drugs, which may be used in combination  with OTC pseudoephedrine (Sudafed) to relieve congestion, sometimes cause a dry mouth. Diphenhydramine (Benadryl) is another effective option for allergy relief. The OTC product is taken every eight hours and may cause drowsiness.

Allergy Relief The Saturday Evening Post

Gout: New Therapy Guidelines

Cara Acklin, Pharm. D. — Mon, 01 Mar 2010 05:00:50 +0000

Recent medical findings show that  lower doses of prescription colchicine treat gout just as well as the higher amounts used in past years—and with fewer side effects. Instead of 10 tablets per day, doctors now recommend taking two tablets at the first signs of an  attack, followed by one tablet an hour later, if needed. Colchicine interacts with a number of medications, notably the antibiotic clarithromycin (Biaxin). Ask your pharmacist or doctor about  possible drug interactions before  starting colchicine treatment.

Gout: New Therapy Guidelines The Saturday Evening Post

What Happened to Armour Thyroid?

Cara Acklin, Pharm. D. — Mon, 01 Mar 2010 05:00:15 +0000

Armour thyroid, a natural hormone  replacement for those suffering from  hypothyroidism, is currently unavailable because of a shortage of its active  ingredient (dried pig tissue that contains the T3 and T4 thyroid hormones). Until the backlog is resolved, people who  prefer the combination of pig hormones may talk to their doctors about taking prescription Cytomel (synthetic T3)  plus Synthroid (synthetic T4). Some pharmacies are equipped to mix or “compound” a prescription product  from powder that contains both pig  hormones—and in customized doses. Ask your pharmacist for a compounding pharmacy in your area.

What Happened to Armour Thyroid? The Saturday Evening Post

Treating and Preventing Skin Ulcers

Cara Acklin, Pharm. D. — Mon, 01 Mar 2010 05:00:12 +0000

Need help for chronic leg ulcers or sores? A prescription ointment containing papain and urea may help. Regular use of the product helps break down dead skin or tissue in wounds, a process known as debridement. This allows dead cells to  be more easily removed and promotes healing. A doctor who specializes in wound care can help develop treatment plans to decrease the severity of chronic leg skin ulcers, a problem that is caused by poor circulation in the veins that carry blood from the legs to the heart.

Treating and Preventing Skin Ulcers The Saturday Evening Post

Heartburn Relief

Cara Acklin, Pharm. D. — Mon, 16 Nov 2009 19:06:21 +0000

To A.S., Rice Lake, Wisconsin:

Long-term use of drugs called proton pump inhibitors (such as Aciphex) for acid reflux is seen by most as a safe choice that is made on a case-by-case basis. There is some evidence that the decrease in acid in the stomach increases a person’s risk of pneumonia. The lower level of stomach acid may also decrease the body’s ability to absorb calcium and vitamin B12, nutrients that are important for bone health, energy, and metabolism. Ask your doctor whether monitoring these key compounds might be indicated.

Heartburn Relief The Saturday Evening Post

Metformin and Glucose Levels

Cara Acklin, Pharm. D. — Mon, 16 Nov 2009 19:03:07 +0000

To E.W., Arley, Alabama:

The hemoglobin A1c level indicates a person’s average blood glucose over the prior three months. It is a better measure of glucose control than a finger stick test that measures glucose at one specific time. In general, taking metformin lowers one’s A1c level. A desirable A1c reading is less than 7 percent. An A1c of 9 percent indicates the average blood sugar level is 240 Side effects of metformin may include GI upset, headache, and weakness. Patients with kidney, liver, or heart problems may experience a rare but serious condition called lactic acidosis.

Controlling your blood sugar is important. I would not recommend stopping your medication without further conversation with your doctor.

Metformin and Glucose Levels The Saturday Evening Post

Tylenol: Beware of Overuse

Cara Acklin, Pharm. D. — Mon, 16 Nov 2009 18:57:07 +0000

Check labels of cold and flu medicines for acetaminophen (the active ingredient in Tylenol). Used correctly, acetaminophen is safe and effective with a lower risk of stomach upset than other over-the-counter pain relievers. However, taking multiple products that contain the compound can be dangerous. Acetaminophen overuse is the most common cause of liver failure in the United States. Acetaminophen is found in Excedrin, NyQuil, and a number of multisymptom cold medicines. Prescribed pain medicines may contain it, too. Your pharmacist can recommend the daily maximum amount of acetaminophen-containing medications that is safe.

Tylenol: Beware of Overuse The Saturday Evening Post

Heartburn Relief

Cara Acklin, Pharm. D. — Mon, 24 Aug 2009 14:00:42 +0000

To A.S.: Long-term use of drugs called proton pump inhibitors (such as Aciphex) for acid reflux is seen by most as a safe choice that is made on a case-by-case basis. There is some evidence that the decrease in acid in the stomach increases a person’s risk of pneumonia. The lower level of stomach acid may also decrease the body’s ability to absorb calcium and vitamin B12, nutrients that are important for bone health, energy, and metabolism. Ask your doctor whether monitoring these key compounds might be indicated.

Heartburn Relief The Saturday Evening Post

Tylenol: Use as Directed

Cara Acklin, Pharm. D. — Mon, 24 Aug 2009 14:00:40 +0000

When used correctly, acetaminophen (the active ingredient in Tylenol) is safe and effective with a lower risk of stomach upset than other over-the-counter pain relievers. However, acetaminophen overuse is also the most common cause of liver failure in the United States. Many people are unaware that acetaminophen is found in many over-the-counter and prescription drugs. Some examples include Excedrin, NyQuil, cough and cold medicines, Vicodin, Percocet, and Fioricet. It is very important to read the active ingredients in all over-the-counter drugs and to ask if your prescription pain medications contain acetaminophen. Your local pharmacist can recommend the maximum amount of these medications that can safely be taken daily.

Tylenol: Use as Directed The Saturday Evening Post

Metformin and Glucose Levels

Cara Acklin, Pharm. D. — Mon, 24 Aug 2009 14:00:32 +0000

To E.W.: The hemoglobin A1c level indicates a person’s average blood glucose over the prior three months. It is a better measure of glucose control than a finger stick test that measures glucose at one specific time. In general, taking metformin lowers one’s A1c level. Side effects of metformin may include GI upset, headache, and weakness. Patients with kidney, liver, or heart problems may experience a rare but serious condition called lactic acidosis. Controlling your blood sugar is important. I would not recommend stopping your medication without further conversation with your doctor.

Metformin and Glucose Levels The Saturday Evening Post