Tuesday, May 25, 2010
Newly Designed Website
Family Medicine of Southern Indiana has a newly designed website at http://carriebrowne.com. Be sure to come see our new improvements including online access to new patient forms, new family Medicine merchandise, and more pictures coming soon!
Medication Side Effects
Cholesterol medicines—Zocor/simvastatin, Pravachol/pravastatin, Lipitor/atorvastatin, Crestor:
Can cause mild achiness, but usually this is symmetric i.e. both legs or arms. This does not mean muscles are breaking down. Sometimes a sensation of weakness. If this occurs, tell the patient to call us, stop the medicine for two weeks and see if the symptoms resolve. Usually these symptoms are dose-dependent, meaning it occurs more often at higher doses. The symptoms are thought to be due to depletion of Coenzyme-Q10, a factor present in the body. Coenzyme Q10 supplements can be bought over the counter, and sometimes if a patient has had myalgias with all of the statin drugs, a low dose of the statin with the supplement CoQ10, can prevent the aches. If one drug causes the achiness, it does not necessarily mean the others would.
Usually when first starting the drug, the liver functions should be checked every three months for the first year, then once or twice a year. If the lab levels of the liver functions rise, this may not be a problem. Usually it is due to what’s called fatty liver, a condition of the liver in which fat deposits there, related to weight and high cholesterol or triglycerides. If the liver enzymes go up, it is invariably reversible, because it is due to overload of the liver, not liver failure! The guidelines are that if they rise less than twice of normal, it is okay to continue the medicine.
Glucophage (for diabetes or insulin resistance):
Start slow. Take one pill with the largest meal daily for a few days to a week. It is not uncommon to initially get diarrhea. This usually resolves as the body adjusts to the medicine. After it resolves, add another pill to go up to twice a day. The same symptoms may occur again, so go slow. Ideally, a patient should get up to 1000 mg twice a day, but go as slow as needed. Some patients are able only to tolerate 500mg twice daily. Always take with food.
Blood pressure pills:
Most should have no side effects other than feeling a little more tired initially as the person adjusts to lower blood pressure. However, beta-blockers (ziac/bisoprolol, metoprolol/Toprol, Bystolic) can sometimes cause more fatigue initially so should take at bedtime. Ace inhibitors (lisinopril, zestril, vasotec/enalapril, Altace) can cause a tickling cough in about 10% of people. If this happens, need to switch the medicine. Any other side effects, let me know.
Antidepressants:
SSRIS—Lexapro, Celexa/citalopram, Zoloft/sertraline, Paxil/paroxetine, Luvox, Prozac/fluoxetine can cause initial nausea and sleepiness for the first week as the body adjusts to the neurotransmitters. After the first week, this should improve.
SNRIs—Effexor/venlafaxine, Cymbalta, Pristiq: can cause initial headache, jitteriness, or “head cold” sensation for the first 3-7 days, and this should resolve as the body adjusts.
Can cause mild achiness, but usually this is symmetric i.e. both legs or arms. This does not mean muscles are breaking down. Sometimes a sensation of weakness. If this occurs, tell the patient to call us, stop the medicine for two weeks and see if the symptoms resolve. Usually these symptoms are dose-dependent, meaning it occurs more often at higher doses. The symptoms are thought to be due to depletion of Coenzyme-Q10, a factor present in the body. Coenzyme Q10 supplements can be bought over the counter, and sometimes if a patient has had myalgias with all of the statin drugs, a low dose of the statin with the supplement CoQ10, can prevent the aches. If one drug causes the achiness, it does not necessarily mean the others would.
Usually when first starting the drug, the liver functions should be checked every three months for the first year, then once or twice a year. If the lab levels of the liver functions rise, this may not be a problem. Usually it is due to what’s called fatty liver, a condition of the liver in which fat deposits there, related to weight and high cholesterol or triglycerides. If the liver enzymes go up, it is invariably reversible, because it is due to overload of the liver, not liver failure! The guidelines are that if they rise less than twice of normal, it is okay to continue the medicine.
Glucophage (for diabetes or insulin resistance):
Start slow. Take one pill with the largest meal daily for a few days to a week. It is not uncommon to initially get diarrhea. This usually resolves as the body adjusts to the medicine. After it resolves, add another pill to go up to twice a day. The same symptoms may occur again, so go slow. Ideally, a patient should get up to 1000 mg twice a day, but go as slow as needed. Some patients are able only to tolerate 500mg twice daily. Always take with food.
Blood pressure pills:
Most should have no side effects other than feeling a little more tired initially as the person adjusts to lower blood pressure. However, beta-blockers (ziac/bisoprolol, metoprolol/Toprol, Bystolic) can sometimes cause more fatigue initially so should take at bedtime. Ace inhibitors (lisinopril, zestril, vasotec/enalapril, Altace) can cause a tickling cough in about 10% of people. If this happens, need to switch the medicine. Any other side effects, let me know.
Antidepressants:
SSRIS—Lexapro, Celexa/citalopram, Zoloft/sertraline, Paxil/paroxetine, Luvox, Prozac/fluoxetine can cause initial nausea and sleepiness for the first week as the body adjusts to the neurotransmitters. After the first week, this should improve.
SNRIs—Effexor/venlafaxine, Cymbalta, Pristiq: can cause initial headache, jitteriness, or “head cold” sensation for the first 3-7 days, and this should resolve as the body adjusts.
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