It’s Not Just Us

There’s a chapter in my book entitled, “Other Medical Issues While A CKD Patient.”  One of the items discussed in this chapter is medication and how it interacts with the kidneys.  I keep harping about reading the labels of any medications you might need to take. Not only do you need to know what’s in the medication and how it may interact with other medications you may be taking, but you need to know if the dosage prescribed has been changed, if there’s a change in the formulation, and – most importantly – if this medication may be a danger to Chronic Kidney Disease patients.

Now it turns out that we are not the only ones who need to be so careful. has some interesting information for all of us:

Read the drug labels, avoid dangerous side effects

By Mary Brophy Marcus, USA TODAY

Updated 08/03/2011 8:11 PM

When Johnson & Johnson announced plans last week to lower the maximum dose for Extra Strength Tylenol, the news made some people rethink how often they take the drug and other over-the-counter medicines.

In  an effort to reduce the risk of liver damage resulting from overuse of acetaminophen — the active ingredient in Tylenol  — the drugmaker’s McNeil division will soon cap the product’s daily dose recommendation at 3,000 milligrams (a total of six 500-milligram pills a day) instead of the current 4,000 (eight pills a day).

Some experts say they also worry about overuse of other  medications that consumers can purchase off pharmacy shelves without a prescription, such as the pain reliever ibuprofen, Theraflu for colds, and the antihistamine Benadryl.

“It’s important for the public to realize all drugs have side effects. It doesn’t matter if they’re prescription, over-the-counter, herbals or nutritional supplements. If they have active ingredients, they have side effects and can interfere with normal body functions,” says Brian Strom, director of the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania.

He says Tylenol is an “extraordinarily” safe drug at proper doses, even though its overuse is a leading cause for liver transplants in patients with acute liver failure. But, he says, “It has a narrow therapeutic ratio. The toxic dose and the therapeutic dose are very close.”

Other drugs also contain acetaminophen, such as over-the-counter cold remedies (Nyquil, Dayquil) and prescription Percocet and Vicodin. But many people aren’t aware of this, and it can lead to overdoses.

“People don’t really read labels,” Strom says. Changing the daily dose recommendation “was a good move, but it was not enough.” He says manufacturers need to make it harder to overdo it with over-the-counter drugs that pose greater overdose risks, for example by packing drugs such as Tylenol in smaller quantities and doing away with “extra-strength” versions.

Other common, and commonly overused, over-the-counter drugs that concern experts include nonsteroidal anti-inflammatories (NSAIDS) such as naproxen (Aleve) and ibuprofen (Advil and Motrin), says Winston Parris, professor of anaesthesiology and division chief for Pain Management at Duke University Medical Center.

“You can have GI (gastrointestinal) problems, especially if you have a history of ulcers and bleeding,” Parris says.

Overdosing on NSAIDs also can damage kidneys, says transplant pharmacist Lisa McDevitt, a clinical specialist in organ transplantation at Tufts Medical Center.

“We’ve seen patients come for kidney transplants who ended up with renal failure because of daily around-the-clock use of naproxen. It’s not as common as Tylenol
toxicity, though,” she says.  (e.g. I’ve highlighted this section since it deals specifically wit us.)

Overdoing it on Benadryl, used for allergies, is not uncommon either, says Sarah Anderson, an assistant professor of clinical pharmacy at the University
of Colorado School of Pharmacy.

Though it won’t cause organ failure in amounts higher than the daily recommended dose, Anderson says, “the big danger is its sedating side effects. That’s dangerous from a driving standpoint or certain lines of work where heavy machinery is used, for example.”

“People play loose and free with Benadryl,” says Ausim Azizi, chair of the department of neurology at Temple University School of Medicine. “There are a lot of side effects. One is loss of memory in the immediate period after taking it, and disorientation in older people,” he says.

Overuse can also cause serious drying side effects, especially in some with other health issues, says Anderson. “People with glaucoma and urinary retention, and men with prostate issues, can have more problems,” she says.

Anderson says over-the-counter herbals stocked in drugstores are of concern, too, especially what she calls the “G” herbals. Ginkgo biloba and garlic supplements can put a person at risk for increased bleeding, she says, and many people don’t realize the herbal drug Saint-John’s-wort, used by some to self-treat depression,  can decrease the effectiveness of oral contraceptives.

“Herbals are troublesome — there’s no quality control,” says Strom. “If we’re lucky, they’re placebos.”

If you have a medical condition or you’re on other drugs, Anderson says, you need to be vigilant. “Read labels and check things out with your
physician and pharmacist,” she says.

“All drugs do harm,” says Strom. “We’ve decided for some, though, the toxicity is worth it.”

Commonly used over-the-counter medications may carry risks, say experts.

Acetaminophen (Extra Strength Tylenol). For headaches, joint and muscle pain, fever.

Overuse risks: Liver damage or failure. May cause liver problems at lower doses in alcohol users, or in those who take other drugs containing acetaminophen.

Ibuprofen (Advil, Motrin), a nonsteroidal anti-inflammatory drug (NSAID). Reduces pain and swelling related to arthritis. Relieves headache, fever, menstrual cramps.

Overuse risks: Gastrointestinal pain, bleeding. Kidney damage.

Diphenhydramine (Benadryl), antihistamine used to prevent, reduce hayfever and other allergy symptoms.

Overuse risks: Memory loss and disorientation, especially in elderly. Drowsiness, dryness.

Loratadine (Claritin), antihistimine used to relieve hayfever, other allergy symptoms.

Overuse risks: Sleepiness, fast heart rate. May lose effectiveness over time. Claritin-D includes an additional active ingredient, pseudoephedrine sulfate, which may cause insomnia or restlessness. Pseudoephedrine should not to be taken with certain medications for Parkinsons, depression, psychiatric or other emotional conditions.

Dextromethorphan, a cough suppressant, and Doxylamine succinate, an antihistamine (NyQuil Cough).

Overuse risks: Can cause drowsiness, especially when mixed with sleeping medications and alcohol. Not to be taken with certain medications for Parkinsons, depression, psychiatric or other emotional conditions.

Ranitidine (Zantac), an acid reducer, treats ulcers and gastroesophageal reflux disease (GERD).

Overuse risks: May lose effectiveness over time. Long-term acid suppressor use could lead to poor absorption of some forms of calcium.

Sources: Brian Strom, Perelman School of Medicine at the University of Pennsylvania; Winston Parris, Duke University Medical Center; Lisa McDevitt, Tufts Medical Center; Sarah Anderson, University of Colorado School of Pharmacy; Ausim Azizi, Temple University School of Medicine.

Posted 08/03/2011 7:00 PM | Updated 08/03/2011 8:11 PM
Okay, so it’s annoying and the print on the package is small, but take the time to read it.  It’s another way to prolong your life.
Until Tuesday,
Keep living yor life!

Published in: on August 12, 2011 at 5:36 pm  Leave a Comment  

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