rtb2008-02

Blood Pressure Medicines

 

How is high blood pressure treated?

High blood pressure medicines (also called antihypertensive medicines) can help lower your blood pressure. The goal of treatment is to reduce your blood pressure to normal levels with medicine that is easy to take and has few, if any, side effects. Your doctor may also talk to you about the benefits of lifestyle changes, such as eating a healthy diet, being physically active, and losing weight if you're overweight.

What are some common medicines to treat high blood pressure?

There are 8 types of medicine used to treat high blood pressure. Your doctor will decide which type of medicine is right for you.

Diuretics
(water pills) help your body get rid of extra sodium (salt) and water so your blood vessels don't have to hold so much fluid. Some examples of diuretics include chlorthalidone (brand name: Thalitone), furosemide (brand name: Lasix), hydrochlorothiazide (brand name: Esidrix) and indapamide (brand name: Lozol). Your doctor may also prescribe a combination of diuretics, such as hydrochlorothiazide combined with triamterene (brand names: Dyazide, Maxzide).

Beta-blockers make the heart beat slower so that blood passes through your blood vessels with less force. Some examples of beta-blockers include acebutolol (brand name: Sectral), atenolol (brand name: Tenormin), carvedilol (brand name: Coreg), metoprolol (brand names: Lopressor, Toprol XL), nadolol (brand name: Corgard), propranolol (brand name: Inderal) and timolol (brand name: Blocadren).

Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) keep your body from making angiotensin II, a hormone that causes blood vessels to narrow. Some examples of ACE inhibitors include benazepril (brand name: Lotensin), enalapril (brand name: Vasotec), lisinopril (brand names: Prinivil, Zestril), quinapril (brand name: Accupril), ramipril (brand name: Altace) and trandolapril (brand name: Mavik).

Angiotensin II receptor blockers
(also called ARBs) protect your blood vessels from the effects of angiotensin II, a hormone that causes blood vessels to narrow. Some examples of ARBs include candesartan (brand name: Atacand), irbesartan (brand name: Avapro), losartan (brand name: Cozaar), olmesartan (brand name: Benicar), telmisartan (brand name: Micardis) and valsartan (brand name: Diovan).

Calcium channel blockers (also called CCBs) help keep your blood vessels from constricting (becoming narrow) by blocking calcium from entering your cells. Some examples of CCBs include amlodipine (brand name: Norvasc), diltiazem (brand names: Cardizem, Cartia, Dilacor, Tiazac), felodipine (brand name: Plendil), nicardipine (brand name: Cardene), nifedipine (brand names: Adalat, Procardia) and verapamil (some brand names: Calan, Covera, Isoptin, Verelan).

Alpha-blockers help relax your blood vessels by reducing nerve impulses. This allows your blood to pass through more easily. Some examples of alpha-blockers include doxazosin (brand name: Cardura), prazosin (brand name: Minipress) and terazosin (brand name: Hytrin).

Centrally acting drugs
affect your brain and central nervous system to reduce the nerve impulses that can cause your blood vessels to narrow. Some examples of centrally acting drugs include clonidine (brand name: Catapres) and methyldopa.

Direct vasodilators
relax the muscles in the blood vessel walls. This causes the blood vessels to widen. Some examples of vasodilators include hydralazine (brand name: Apresoline) and minoxidil (brand name: Loniten).

 

Do these medicines have any side effects?

Like most medicines, high blood pressure drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often. Some common side effects of high blood pressure medicines include the following:

 
  • Headache
  • Dizziness or lightheadedness
  • Nausea and/or vomiting
  • Extreme tiredness, weakness, drowsiness or lethargy (lack of energy)
  • Diarrhea or constipation
  • Weight loss or weight gain
  • Nervousness or increased anxiety
  • Chest pain, heart palpitations (the feeling that your heart is racing) or arrhythmia (irregular heartbeat)
  • Cough, fever, congestion, upper respiratory tract infection or "flu-like" symptoms
  • Skin rash
 
Tell your doctor as soon as possible if your side effects become severe or bothersome.
 

What is a drug interaction?

If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction." For example, people taking certain CCBs may need to avoid having grapefruit or grapefruit juice.

Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking.

Also, ask your doctor whether you need to avoid any foods or drinks while using your blood pressure medicine.

 

Cholesterol-lowering Medicines

 

Why did my doctor prescribe cholesterol-lowering medicine for me?

Lowering your "bad" cholesterol (also called LDL, or low-density lipoprotein) can reduce your risk of having a heart attack or stroke. A number of lifestyle changes can help you improve your cholesterol level (see the box below). However, if these lifestyle changes don't help after about 6 months to 1 year, your doctor may suggest medicine to lower your cholesterol.

Even if you take cholesterol-lowering medicine, it's important to keep up with your lifestyle changes. Eating a healthy diet and being physically active can make your medicine more effective. Your doctor can give you tips on how to make healthy food choices and include physical activity in your daily routine.

 

Lifestyle changes

  • Avoid smoking cigarettes or using any other tobacco product.
  • Get regular physical activity.
  • Eat a healthy low-fat diet that includes lots of fruits and vegetables.
  • Limit how much alcohol you drink.

What are some common cholesterol-lowering medicines?

Several types of medicine are used to treat high cholesterol levels. Your doctor will decide which type of medicine is right for you. He or she may prescribe more than 1 of these drugs at a time because combinations of these medicines can be more effective.

Statins (also called HMG-CoA reductase inhibitors) slow down your body's production of cholesterol. These drugs also remove cholesterol buildup from your arteries (blood vessels). Examples of statins include atorvastatin (brand name: Lipitor), fluvastatin (brand name: Lescol), lovastatin (brand names: Altocor, Mevacor), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor) and simvastatin (brand name: Zocor).

Resins (also called bile acid sequestrants) help lower your LDL cholesterol level. Some examples of bile acid sequestrants include cholestyramine (brand names: Prevalite, Questran), colesevelam (brand name: Welchol) and colestipol (brand name: Colestid).

Fibrates (also called fibric acid derivatives) help lower your cholesterol by reducing the amount of triglycerides (fats) in your body and by increasing your level of "good" cholesterol (also called HDL, or high-density lipoprotein). Some examples of fibrates include fenofibrate (brand names: Antara, Lofibra, Tricor) and gemfibrozil (brand name: Lopid).

Niacin (also called nicotinic acid) is a B vitamin. When given in large doses, it can lower your levels of triglycerides and LDL cholesterol, and increase your HDL cholesterol level. Even though you can buy niacin without a prescription, you should not take it to lower your cholesterol unless your doctor prescribes it for you. It can cause serious side effects.

Cholesterol absorption inhibitors help lower your cholesterol by reducing the amount that is absorbed by your intestines. Ezetimibe (brand name: Zetia) is a cholesterol absorption inhibitor. This type of medicine is often given in combination with a statin. The combination of ezetimibe and simvastatin (brand name: Vytorin) is an example.

Do cholesterol-lowering medicines have any side effects?
Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often.

Common side effects of cholesterol-lowering drugs include the following:

 
  • Diarrhea or constipation
  • Abdominal pain, cramps, bloating or gas
  • Nausea and/or vomiting
  • Headache
  • Drowsiness or dizziness
  • Muscle aches or weakness
  • Flushing (skin turning red and warm)
  • Sleep problems
 
Tell your doctor as soon as possible if your side effects become severe.

 

What is a drug interaction?

If you take 2 or more medicines at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction."

Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine, or use a vitamin or herbal supplement.

It's important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using your cholesterol-lowering medicine.

 

Oral Diabetes Medicines

 

Why did my doctor prescribe oral diabetes medicine for me?

If you have type 2 diabetes, your body's tissues do not get enough insulin. This results in high blood sugar levels. Some people who have type 2 diabetes don't make enough insulin. Other people make enough insulin but their bodies are not able to use it properly.

Some people who have type 2 diabetes need to take insulin in shots to help control their blood sugar levels. Most take pills by mouth (oral medicine) to help control their diabetes. Some people take insulin and oral medicines.

 

What are some common oral diabetes medicines?

There are 5 types of oral diabetes medicines. Your doctor will decide which type of medicine is right for you.

Sulfonylureas help your body make more insulin. These are the most common type of oral diabetes medicine. Some examples of sulfonylureas include acetohexamide (brand name: Dymelor), chlorpropamide (brand name: Diabinese), glipizide (brand name: Glucotrol) and glyburide (brand names: DiaBeta, Glynase, Micronase).

Metformin (brand name: Glucophage) helps control blood sugar in a couple of ways. It helps your body use insulin better. It also helps your body make less sugar and reduces the amount of sugar your body absorbs from food. It almost never causes hypoglycemia (low blood sugar).

Meglitinides help your body make more insulin. Examples include nateglinide (brand name: Starlix) and repaglinide (brand name: Prandin). These pills are usually taken with meals.

Thiazolidinediones help your body use insulin better. They also help your body make less sugar. There are 2 thiazolidinediones: pioglitazone (brand name: Actos) and rosiglitazone (brand name: Avandia).

Alpha-glucosidase inhibitors help your body absorb sugar more slowly to keep your blood sugar lower. This type of medicine is taken every time you eat a meal. There are 2 alphaglucosidase inhibitors: acarbose (brand name: Precose) and miglitol (brand name: Glyset).

Sometimes two kinds of medicines are given together. For example, glyburide combined with metformin (brand name: Glucovance), glipizide combined with metformin (brand name: Metaglip) and rosiglitazone combined with metformin (brand name: Avandamet).

 

Do these medicines have any side effects?

Like most medicines, these drugs can cause side effects. Your doctor may want to see you or want you to have tests (like liver tests) to check for problems. However, the side effects usually are not severe and are not common. Side effects of oral diabetes medicines may include the following:

 
  • Nausea and vomiting
  • Diarrhea
  • Gas and bloating
  • Decreased appetite
  • Headache and/or muscle aches
  • Flu- or cold-like symptoms
 
Talk to your doctor about any side effects you may be having.
 

Will a diabetic drug interact with my other medicines?

If you take 2 or more drugs at the same time, how the drug works can change. When this happens, the risk of side effects increases. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

Drug-drug interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine or use a vitamin or herbal supplement.

Certain foods or drinks can also keep your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction." For example, if you’re taking an oral diabetes medicine, drinking alcohol can increase your risk of low blood sugar.

Ask your doctor whether you need to avoid any foods or drinks while using your oral diabetes medicine. And take medicines exactly as your doctor tells you to.

 
 

Know the signs

People who have diabetes need to know the signs of hyperglycemia (high blood sugar ) and hypoglycemia (low blood sugar). Make sure your family members, friends and coworkers know how to help you in an emergency situation.

Signs of low blood sugar:
 
  • Shakiness
  • Drowsiness
  • Cold sweats and pale, cool skin
  • Headache
  • Confusion
  • Fast heartbeat
  • Extreme hunger
  • Diarrhea or gas
 

Exercising more than usual can sometimes cause low blood sugar. Keep candy, juice or glucose tablets on hand to treat low blood sugar. Call your doctor if your symptoms become severe or bothersome.

Signs of high blood sugar:

 
  • Increased hunger
  • Increased thirst
  • Increased urination
 

Eating more than you usually do, forgetting to take your diabetes medicine, or taking another medicine that you don't usually take can all cause high blood sugar. Call your doctor if any of the above symptoms become severe.
 

Prescription Nonsteroidal Anti-Inflammatory Medicines

 

How do prescription nonsteroidal anti-inflammatory drugs work?

Nonsteroidal anti-inflammatory drugs (also called NSAIDs) stop cyclooxygenase enzymes (also called COX enzymes) in your body from working. COX enzymes speed up your body's production of hormone-like substances called prostaglandins. Prostaglandins cause the feeling of pain by irritating your nerve endings. They are also part of the system that helps your body control its temperature.

By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis. They also help reduce inflammation (swelling), lower fevers and prevent blood from clotting.

 

What are some common prescription NSAIDs?

There are 2 classes of prescription NSAIDs.

Traditional NSAIDs include the following:

 
  • Diclofenac (brand names: Cataflam, Voltaren)
  • Etodolac (brand name: Lodine)
  • Fenoprofen (brand name: Nalfon)
  • Flurbiprofen (brand name: Ansaid)
  • Ibuprofen (2 brand name: Advil, Motrin)
  • Indomethacin (brand name: Indocin)
  • Ketoprofen (brand names: Orudis, Oruvail)
  • Meclofenamate
  • Meloxicam (brand name: Mobic)
  • Nabumetone (brand name: Relafen)
  • Naproxen (brand names: Anaprox, Naprelan, Naprosyn)
  • Oxaprozin (brand name: Daypro)
  • Piroxicam (brand name: Feldene)
  • Sulindac (brand name: Clinoril)
  • Tolmetin (brand name: Tolectin)
 
COX-2 inhibitors include celecoxib (brand name: Celebrex).

If you need to take a prescription NSAID, your doctor will help you find one that is right for you.

 

What's the main difference between traditional NSAIDs and COX-2 inhibitors?

You have 2 types of COX enzymes in your body: COX-1 and COX-2. Researchers believe that one of the jobs of COX-1 enzymes is to help protect your stomach lining. The COX-2 enzyme doesn't play a role in protecting your stomach.

Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX-1 enzymes are blocked, pain and inflammation is reduced, but the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers and bleeding in your stomach and intestines.

COX-2 inhibitors only stop COX-2 enzymes from working. Since the COX-2 enzyme doesn't help to protect your stomach, COX-2 inhibitors may be less likely to irritate your stomach or intestines.

 

Do prescription NSAIDs have any side effects?

Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often.

Common side effects of prescription NSAIDs may include the following:
 
  • Dizziness or headache
  • Nausea, excess gas, diarrhea or constipation
  • Extreme tiredness or weakness
  • Dry mouth
 
Serious side effects of prescription NSAIDs may include the following:

 
  • Allergic reaction, such as difficulty breathing, hives, swelling of the lips, tongue or face
  • Muscle cramps, numbness or tingling
  • Rapid weight gain
  • Black, bloody or tarry stools
  • Blood in urine or vomit
  • Decreased hearing or ringing in the ears
  • Yellowing of skin and eyes (jaundice)
  • Abdominal cramping, heartburn or indigestion
 
In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for the following side effects:

 
  • Swelling or water retention
  • Skin rash or itching
  • "Flu-like" symptoms
  • Unusual bruising or bleeding
  • Difficulty sleeping (insomnia)
 
Call your doctor as soon as possible if your side effects become severe.

 

Is it safe to take NSAIDs for a long period of time?

People who take NSAIDs increase their risk for severe bleeding in their stomachs. They may also be at risk for heart attacks and strokes. These risks gets worse if they take higher doses and/or if they take these medicines for a long period of time. Patients who need to take pain medicine for longer than a week should discuss this risk and explore other pain treatment options with their family doctor.

What is a drug interaction?

If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction." For example, if you're taking a traditional NSAID, drinking alcohol can increase your risk of liver disease or stomach bleeding.

Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine or use a vitamin or herbal supplement.

It's important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using a prescription NSAID.

 

Pain Control After Surgery: Pain Medicines

 

What are the benefits of taking pain medicine after surgery?

People used to think they just had to put up with severe pain after surgery. Today, your nurses and doctors can do many things before and after surgery to prevent or relieve your pain. Treatment of pain can help you in the following ways:
  • You can feel more comfortable, which will help your body heal.
  • You can get well faster. If you feel less pain, you can start walking and get your strength back more quickly. You may even leave the hospital sooner.
  • You may have fewer complications after surgery. People whose pain is well-controlled seem to do better after surgery. For example, they don't have as many problems such as pneumonia and blood clots.
 
Many types of medicines are available to help control pain. Some of these include nonsteroidal anti-inflammatory drugs (called NSAIDs), opioids and local anesthetics.

When are NSAIDs used?

For mild pain after surgery, you might be given NSAIDs. These medicines reduce swelling and soreness, and relieve mild to moderate pain. Some examples of these medicines are aspirin and ibuprofen (one brand name: Motrin).

What are the benefits of NSAIDs?

You won't get addicted to these medicines. Depending on how much pain you have, these medicines can take it away or at least lessen your need to take a stronger medicine, such as morphine.

What are the problems with NSAIDs?

Most NSAIDs get in the way of blood clotting. They may also cause nausea, stomach bleeding or kidney problems. If your pain is strong, you will usually also have to take an opioid.

When are opioids used?

Opioids such as morphine and codeine are the medicines most often used for acute pain, such as short-term pain after surgery.

What are the benefits of opioids?

Opioids work well for severe pain. They don't cause bleeding in the stomach or other parts of the body. It's rare to become addicted to opioids after surgery if it's used as prescribed by your doctor.

What are the problems with opioids?

Opioids may cause drowsiness, nausea, constipation or itching. They can also interfere with breathing or urination.

What about local anesthetics?

Local anesthetics, such as bupivacaine, can be given in a shot near your incision or through a small tube in your back. These medicines block the nerves that send pain signals to your brain.

What are the benefits of local anesthetics?

Local anesthetics, or shots at the incision, will block pain only at that area of the body. There is little or no risk of drowsiness, constipation or breathing problems when you use a local anesthetic. Local anesthetics reduce your need for opioids.

What are the problems with local anesthetics?

Several shots are needed to keep the pain relief going, but too much of a local anesthetic can cause problems. Even average doses may cause you to feel dizzy or make your legs feel weak.

How is pain medicine given?

Medicines can be given by mouth (liquid or pill) or through the rectum (suppository), or they can be injected into the skin, a muscle or a vein.

What are the benefits and problems of oral medicines?

Aspirin, ibuprofen or codeine can be taken by mouth. Pills and liquids cause less discomfort than shots into a muscle or the skin. They can work just as well as shots. They are inexpensive and easy for you to take when you go home from the hospital. On the other hand, these medicines can't be used if you aren't supposed to take anything by mouth or if you're nauseated or vomiting. (Some of these medicines also come in a rectal suppository, so you can take them even if you're nauseated.) There may be a delay in pain relief with oral medicines, because you have to ask for the medicine and wait for it to be brought to you.

What are the benefits and problems of injected medicines?

Medicines given in shots into the skin or a muscle can work even if you're nauseated or vomiting. However, the injection site usually hurts for a short time.

Pain relief medicines can be injected into a vein through a small tube called an intravenous (IV) catheter. The tip of the tube stays in your vein all the time that the medicine is being used. Medicine given this way goes through your body fast, so it starts to work quickly. This method of pain relief works well for brief pain.

With a patient-controlled analgesia (PCA) pump, you can control your own doses of pain medicine. When you begin to feel pain, you push a button to inject medicine into your vein; a small tube must first be put into your vein. If you use the PCA pump, you have to learn how to use it and when to use it.

Pain medicine can also be put into your back through a small tube called an epidural catheter. This method works well when you're having surgery on your chest or your stomach. It takes a specially trained doctor, called an anesthesiologist, to put the small tube in your back. This person also watches you for problems that can happen several hours after the pain medicine is given.

 

Pain Relievers: Understanding Your OTC Options

 
This information was developed as part of an educational program made possible by an unrestricted educational grant from McNeil Consumer & Specialty Pharmaceuticals.
 

What types of OTC pain relievers are available?

Over-the-counter (OTC) pain relievers are medicines that you can buy without a prescription from your doctor. Two main types of OTC pain relievers are available. One type is acetaminophen (brand name: Tylenol). The second type is nonsteroidal anti-inflammatory drugs (also called NSAIDs). NSAIDs include the following:

 
  • Aspirin (two brand names: Bayer, St. Joseph)
  • Ibuprofen (two brand names: Advil, Motrin)
  • Ketoprofen (one brand name: Orudis KT)
  • Naproxen (one brand name: Aleve)
 
Some products contain both acetaminophen and aspirin (brand names: Excedrin Extra Strength, Excedrin Migraine, Vanquish).

 
 

How do pain relievers work?

Acetaminophen seems to relieve pain and reduce fever by working on the parts of the brain that receive pain messages and control the body’s temperature.

NSAIDs relieve pain and fever by reducing the level of hormone-like substances (called prostaglandins) that your body makes. These substances cause the feeling of pain by irritating your nerve endings. They also are part of the system that helps your body control its temperature.

 
 

What types of problems can OTC pain relievers help?

Acetaminophen and NSAIDs relieve pain caused by muscle aches and stiffness, and reduce fever. NSAIDs can also reduce inflammation (redness and swelling).

OTC pain relievers can be helpful in treating many types of pain, such as pain from arthritis, earaches, back pain, and pain after surgery. They can also treat pain from the flu (influenza) or a cold, sinusitis, strep throat or a sore throat. Children who may have the flu or chickenpox should not take aspirin because they are at higher risk to develop a condition called Reye’s Syndrome.

Acetaminophen can be a good choice for relieving headaches and other common aches and pains. It can be used safely by most people on a long-term basis for arthritis and other chronic painful conditions if pain is improved. Make sure you tell your doctor about any OTC medications you take regularly.

Ibuprofen is helpful for menstrual cramps and pain from inflammation (such as muscle sprains). If ibuprofen doesn’t work for you, naproxen and ketoprofen may be options.

 

Will an OTC pain reliever work as well as a prescription one?

For most people, OTC drugs are all they need to relieve pain or reduce fever. If an OTC drug doesn’t help your pain or fever, or if you’ve been taking an OTC drug for more than 10 days for pain or 3 days for fever, call your doctor. These may be signs that you have a more serious problem or need a prescription medicine.
 

What are some common side effects of OTC pain relievers?

Side effects from OTC pain relievers aren’t common for healthy adults who only use pain relievers once in a while. However, side effects can be a concern for people who use pain relievers often or who have health problems. If you have health problems or use pain relievers often, talk to your doctor.

Acetaminophen can be used safely by most people. It can cause liver damage in people who take very high doses or who already have abnormal liver function . To reduce your risk of liver problems, never take more than the recommended dose of acetaminophen. For adults and children older than 12, this means a maximum of 8 extra-strength or 12 regular-strength pills a day.

With long-term use, NSAIDs can cause gastrointestinal (GI) problems. These problems range from upset stomach to ulcers to GI bleeding. For minor stomach upset, eating some food or drinking some milk before you take an NSAID may help. Your risk of GI problems from NSAIDs goes up the higher the dose you take and the longer you take them. Drinking alcohol may increase this risk. Acetaminophen is much less likely than NSAIDs to cause GI problems.

NSAIDs may also make high blood pressure worse. If NSAIDs are used regularly for many years, they can also hurt your kidneys. Your doctor can check for this problem with a blood test.

If you have questions about the side effects of OTC pain relievers, talk to your doctor.

 

Allergic Reactions

It’s rare, but some people are allergic to certain drugs. If you’ve ever had a bad reaction to a pain reliever, ask your doctor before taking anything for pain. Signs of an allergic reaction include itching, hives and trouble breathing. Call your doctor right away if you think you’re having an allergic reaction.
 

Who shouldn’t take acetaminophen?

You generally shouldn’t take acetaminophen if you are already taking another product containing acetaminophen. If you have severe kidney or liver disease, or if you have 3 or more drinks that contain alcohol every day, you should talk to your doctor before taking acetaminophen.
 

Who shouldn’t take NSAIDs?

You shouldn’t take NSAIDs if you are allergic to aspirin or other pain relievers. Talk to your doctor or before you take an NSAID, especially aspirin, if you:
 
  • Take blood-thinning medicine or have a bleeding disorder
  • Have bleeding in the stomach or intestines, or have peptic (stomach) ulcers
  • Have liver or kidney disease
  • Have 3 or more drinks that contain alcohol every day

Can OTC pain relievers cause problems with any other medicines I take?

If certain drugs are taken at the same time, they can interact with each other and change the way your body processes them. This is called a drug interaction. When this happens, the risk of side effects increases.

For example, if someone who takes high blood pressure medicine also takes an NSAID, the high blood pressure medicine may not work as well as it should.

Many OTC drugs contain the same pain reliever or contain ingredients found in prescription drugs. By combining OTC medicines or taking a prescription drug with an OTC drug, you may be getting more than the recommended dose of the active ingredient (the substance in the medicine that works to relieve your symptoms). For example, many OTC cold medicines contain acetaminophen. If you were to take one of these products and also take acetaminophen separately, you would be taking much more acetaminophen than you intended.

What should I look for on the drug label?
When choosing an OTC pain reliever, check the drug label for possible side effects or interactions with other drugs you are taking. This information will appear in the “Warnings” section of the label.

Be sure to check that you are not taking two medicines that contain the same active ingredient. You will find this information in the “Active Ingredient” section.

Always read and follow the directions on the label. Be sure you understand the label information before taking the medicine. If you have any questions, ask your family doctor or pharmacist.
 

 

Drug Reactions

 

What is an adverse drug reaction?

Medicines can treat or prevent illness and disease. However, sometimes medicines can cause problems. These problems are called adverse drug reactions. You should know what to do if you think that you or someone you take care of is having an adverse drug reaction.

 

Can adverse drug reactions happen to everyone?

Yes. Anybody can have an adverse drug reaction. However, people who take more than 3 or 4 medicines every day are more likely to have an adverse drug reaction. One medicine might cause an adverse reaction if its taken with another medicine.

One way to reduce your chances of having adverse drug reactions is to work with your doctor to limit the number of medicines you take. Tell your doctor about all of the medicines you're taking, even if you take something for only a short time. You may also want to use only one drugstore so your pharmacists get to know you and the medicines you take. Pharmacists are trained to look at the medicines you're taking to see whether they might cause an adverse drug reaction.

 

Are prescription medicines the only cause of adverse reactions?

No. Even medicines that don't need a prescription (called over-the-counter medicines) can interact with each other or with prescription drugs and cause problems. Supplements, herbal products in teas or tablets, or vitamins may also cause adverse reactions when taken with certain drugs. Be sure to tell your doctor and pharmacist if you're using any of these products.

Some types of food may also cause adverse drug reactions. For example, grapefruit and grapefruit juice, as well as alcohol and caffeine, may affect how drugs work. Every time your doctor prescribes a new drug, ask about possible interactions with any foods or beverages.

 

What about medicines I've used in the past?

You might be tempted to save money by taking old medicines that you've used before. However, it's likely that you are taking different medicines now than you were when you were taking the old drug. Even though you didn't have an adverse reaction with the old medicine before, you might have a bad reaction when you take it with the medicines you're taking now.

 

Is it safe to use a friend or relative's medicine?

No. Using medicines that were prescribed for a friend or relative can cause problems and might lead to adverse drug reactions because:

 
  • Your doctor prescribes medicine according to your size, gender and age. The wrong amount of medicine may cause adverse reactions.
  • The medicines you're taking are probably different from the medicines the other person takes. This different combination of drugs may also cause an adverse reaction.
  • You might react differently to the medicine than the other person did.
 
To be safe, never share medicines with anybody.

 

How will I know I'm having an adverse drug reaction?

When you're taking any medicine, it's important to be aware of any change in your body. Tell your doctor if something unusual happens.

It may be hard to know if an adverse reaction is caused by your illness or by your medicine. Tell your doctor when your symptoms started and whether they are different from other symptoms you have had from an illness. Be sure to remind your doctor of all the medicines you are taking. The following are some adverse drug reactions that you might notice:

 
  • Skin rash
  • Easy bruising
  • Bleeding
  • Severe nausea and vomiting
  • Diarrhea
  • Constipation
  • Confusion
  • Breathing difficulties
 
The following are some adverse reactions your doctor might notice during a check-up:
  • Changes in lab test results
  • Abnormal heartbeat

 

 

What will my doctor do if I have an adverse drug reaction?

Your doctor might tell you to stop taking the medicine so the adverse reaction will go away by itself. Or your doctor might have you take another medicine to treat the reaction. If your adverse reaction is serious, you might have to go to a hospital. Never stop taking a medicine on your own; always talk with your doctor first.

 

Drug-Food Interactions: How Grapefruit Interacts with Certain Drugs

 

What is a drug-food interaction?

A drug-food interaction happens when the food you eat or drink affects the ingredients in a medicine you are taking so the medicine can't work the way it should.

Drug-food interactions can happen with both prescription and over-the-counter medicines, including antacids, vitamins and iron pills.

 
 

How does grapefruit interact with medicines?

Eating grapefruit or drinking grapefruit juice can cause higher levels of some medicines in your body, making it more likely that you will have side effects from the medicine.

Interactions can happen up to 3 days after eating or drinking grapefruit. This means you cannot drink grapefruit juice in the morning and take your medications later in the day to stop possible medicine interactions.

 

Do all medicines interact with grapefruit?

Only some medicines interact with grapefruit. Examples include medicines for:

 
  • High cholesterol: atorvastatin (one brand: Lipitor) and simvastatin (one brand: Zocor)
  • High blood pressure: felodipine (one brand: Plendil), nifedipine (one brand: Procardia), and nisoldipine (one brand: Sular)
  • Heart arrhythmia (when your heartbeat isn't normal): amiodarone (one brand: Cordarone) and disopyramide (one brand: Norpace)
 
If you don't know if the medicine you are taking interacts with grapefruit, ask your doctor or pharmacist. Your doctor usually can prescribe another medicine that doesn't interact with grapefruit.
 
 

Do all fruit juices interact with medicines?

All other fruit juices, even other citrus juices, are safe to drink when taking medicine. There is no proof that these other juices interact with medicines.

 

What if I take a medicine that interacts with grapefruit?

An interaction can occur even if you eat or drink a small amount of grapefruit. However, if you like grapefruit and want to continue to enjoy it, ask your doctor if there is a different medicine for you that doesn't interact with grapefruit.

 

Food-Drug Interactions

 

What is a drug-food interaction?

A drug-food interaction happens when the food you eat affects the ingredients in a medicine you are taking so the medicine cannot work the way it should.

Drug-food interactions can happen with both prescription and over-the-counter medicines, including antacids, vitamins and iron pills.

 

Are all medicines affected by food?

Not all medicines are affected by food, but many medicines can be affected by what you eat and when you eat it. For example, taking some medicines at the same time that you eat may interfere with the way your stomach and intestines absorb the medicine. The food may delay or decrease the absorption of the drug. This is why some medicines should be taken on an empty stomach (1 hour before eating or 2 hours after eating).

On the other hand, some medicines are easier to tolerate when taken with food. Ask your doctor or your pharmacist whether it's okay to take your medicine with a snack or a meal or whether it should be taken on an empty stomach.

 

Facts to remember about drug-food interactions

  • Read the prescription label on the container. If you don't understand something, ask your doctor or pharmacist.
  • Read all directions, warnings and interaction precautions printed on medicine labels and packages. Even over-the-counter medicines can cause problems.
  • Take medicine with a full glass of water, unless your doctor tells you differently.
  • Don't stir medicine into your food or take capsules apart (unless your doctor tells you to) because this may change the way the drug works.
  • Don't take vitamin pills at the same time you take medicine because vitamins and minerals can cause problems if taken with some drugs.
  • Don't mix medicine into hot drinks because the heat may keep the drug from working.
  • Never take medicine with alcoholic drinks.

 

 

How to Get the Most from Your Medicine

 

What do I need to know?

Medicines can help you feel better. But if medicines are taken incorrectly, they can actually make you feel worse. To use prescription medicines and medicines you can buy "over-the-counter" (without a prescription) correctly, follow the guidelines below.

 

What questions should I ask my doctor about my medicines?

If there is something you don't understand about a medicine you're taking, ask your doctor. If you still don't understand, ask your doctor to explain things more clearly. If you are taking more than one medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems when they are taken together (called a drug interaction).

Below is a list of questions you can ask your doctor to learn how to use each medicine correctly and safely:

 
  • What does the medicine do?
  • When and how should I take the medicine?
  • What side effects (reactions your body may have to the medicine) could I have?
  • Will the medicine react to any other medicines, foods or drinks?
  • Should I avoid any activities while I'm taking the medicine?
  • What should I do if I forget to take the medicine?
  • How will I know whether the medicine is working?

Things to know about each medicine you take

  • Name (generic name and brand name)
  • Reason for taking it
  • How much to take and how often to take it
  • Possible side effects and what to do if you have them
  • How long to continue taking it
  • Special instructions (taking it at bedtime or with meals, etc.)
 

How can I remind myself to take my medicine?

Make your medicine part of your daily routine by taking it at the same time (or times) every day, such as when you wake up or with meals. Keep the medicine bottle(s) in a place you see often, such as on the kitchen counter. (Make sure that medicines are in childproof containers and kept out of the reach of children.)
 
 

Should I avoid any foods, drinks or activities while I'm taking medicine?

Talk to your doctor about things to avoid while you are taking a prescription medicine. Some foods can cause side effects, such as stomach upset, if you are taking medicine. Drinking alcohol is generally not a good idea while you are taking medicine. Some medicines cause reactions such as sun sensitivity (getting a sunburn or sun rash), so you may have to limit your outdoor activities or protect your skin from the sun.

If you are taking an over-the-counter medicine, read the label to see what to avoid while you are taking it. Follow the instructions just as you would with a prescription medicine. If you have questions, ask your doctor or pharmacist.

 

Medicine do's and don'ts

  • Do read the label carefully.
  • Do take your medicine exactly as your doctor tells you to.
  • Do make sure that each of your doctors (if you see more than one) has a list of all of the medicines you're taking
  • Do ask your doctor to help you make a schedule (if you are taking more than one medicine) so you know what medicines to take at what times of the day.
  • Do consider using one pharmacy for all your prescriptions. The pharmacist can help you keep track of what you're taking.
  • Do make sure everyone you live with knows what medicine you're taking and when you're supposed to take it.
  • Don't combine prescription medicines and over-the-counter medicines unless your doctor says it's OK.
  • Don't stop taking a medicine or change how much you take or how often you take it without first talking to your doctor.
  • Don't take someone else's medicine.
  • Don't use medicine after its expiration date.
  • Don't crush, break or chew tablets or capsules unless your doctor tells you to. Some medicines won't work correctly unless they are swallowed whole.
 

What's the difference between generic and brand name medicines?

Just like foods, some medicines come in both brand names and generics. Generic medicines are generally cheaper. Ask your doctor or pharmacist if a generic form of your prescription medicine will work for you.

Over-the-counter (OTC) medicines also come in generics. Compare the lists of ingredients. If the generic has the same ingredients as the brand name, you may want to consider using it. But be careful: The generic may contain different amounts of certain medicines. Ask your doctor or pharmacist if you have questions about which medicine to choose.

 

Tips for choosing OTC medicines

  • If you have questions, ask your doctor or pharmacist.
  • Although it can seem overwhelming, take the time to look at all the choices.
  • Read the label carefully, and note what symptoms the medicine will treat.
  • Look for a medicine that will treat only the symptoms you have. For example, if you have only a runny nose, don't pick a medicine that also treats coughs and headaches.
  • Note how much medicine you should take and what side effects it may cause.
  • Note what medicines or foods you should not take with the medicine.
  • Check to see if the medicine causes problems for people with certain health problems (such as asthma or high blood pressure).
 

What if I don't feel better even though I'm taking my medicine?

Any medicine needs time to work. When you are given a prescription, ask your doctor how long it should take for the medicine to make you feel better. It might take time to find the correct medicine for you and the correct amount of it. Call your doctor if you have concerns about what you're taking or if you don't feel better after taking your medicine as prescribed.
If you're trying to treat yourself with an over-the-counter medicine and it doesn't seem to be working, call your doctor. Your sickness can get much worse if you wait too long to get treated by your doctor.