OTC advice and Q&A from Pharmacist to Pittsburgh (home, rain)

[guylocke]

I also wanted to point out something. No matter what myself or anybody else for that matter posts on this thread, we are not your primary care physician. We do not know what other co-morbidities or conditions you may have or special circumstances you may require. You should always use extreme caution when using medicine of any sort.

[WVUPharm2007]

So, what's your opinion on the DPP-IV inhibitor Januvia? It's shown great efficacy towards increasing insulin production and simultaneously not causing hypoglycemia. However, it was released rather hastily without an extensive battery of long term trials. DPP-IV has other biochemical uses in the body outside of the metabolism of incretins, such as metabolism of polypeptide Y and activation of T-Cells. Keeping in mind both t-cells and polypeptide-y, trials have shown Januvia to increase incidence of upper respiratory tract infection and cause weight loss. This leads me to believe that the inhibition of DPP-IV may wind up causing some unwanted secondary effects. Do you think Januvia will show to cause clinically relevant problems in patients who are immunosuppressed (HIV patients, cancer patients) or otherwise have shaky immune systems (say..the elderly) after future retrospective studies come out?

This is a good idea...it's hard to find medical professionals willing to converse on the internet...

[outofsc]

Quick question -

If you are someone like me who experiences an opposite reaction to caffeine (it puts me to sleep - esp. Diet Mt. Dew) will you get hyper on Benydryl and sleepy on Sudafed?

[WVUPharm2007]

Maybe, but not always. Are you bipolar, have anxiety disorders, or suffer from any other mental disorder stemming from neurotransmitter dysfunction? It's more common in those folks. It's really patient specific and tough to predict. The only way to really find out is to take Saturday and down a couple of Benadryl. Don't drive or anything.

I doubt Sudafed would cause drowsiness. If it did, then you would probably get drowsy every time you were frightened or had an adrenaline rush. But when you deal with the brain, the only thing we do know is that we know very little, so anything is possible, honestly.

[outofsc]

No- I don't have any bipolar, anxiety, or other mental disorders - unless being a bit flaky counts. :-) I just can drink tons of caffeine and then go straight to sleep if I choose. I don't usually drink sodas, however, and never touch coffee - just personal preference. However, I do have a high tolerance for pain and a little medicine goes a long way with me. I felt some of the effects from my spinal block for at least 8 weeks after my surgery. Thanks for answering - I was just a little curious.

[Katarina Witt]

I have heard of others who are not bothered by caffiene. I am not one of them. Would love to drink coffee at night, but can't. Even de-caf, with its small amt of caffiene.

[DonOrkoskey]

Have you ever though about a OTC blog? My wife is a P4 at Pitt and feels the same way you do, (and I do too), about OTCs.

If you were interested in blogging I'd be happy to help set up a site for you. I am a web designer. I'd be willing to do it free of charge because I feel this info should be out there.

Contact me through www.simpledon.com if you are interested.

Cheers!

[guylocke]

DPP-IV inhibitor Januvia?

The jury is still out. I, too, have read some pretty incredible things about its efficacy. I HOPE the things you mentioned are not seen, but your reasoning is sound and I wouldn't be surprised if you did see it with immunosuppressed patiets. It was definitely rushed to market and I can't imagine there won't be some negative effect found post-market in the future.

My mum is still ticked about Zelnorm. It was the only thing to give her relief. Poor gal

[guylocke]

I doubt Sudafed would cause drowsiness

Well, like others have talked about on this thread, she might not have ever grown out of that paradoxical effect that many children experience.

It is not terribly uncommon for children to have a paradoxical effect towards Sudafed to make them drowsy, but the majority of people grow out of it (we don't even truly know why it happens). Some adults retain this paradoxical effect - so it's certainly possible.

[WVUPharm2007]

This new Avandia scare is cracking me up, too. The media is out scaring everybody to death...again. You can check out the study on nejm.org for free. Many of the findings are insignificant and the risk is still very low on the significant findings.

I'm not saying it's not true, it is. Anything that increases LDL is bound to increase incidence of MI, but way too much of a deal is being made out of this, IMO. An increase in MI from 0.36% to 0.43% was seen in Avandia vs. not-Avandia in the smaller, pooled together studies. Are the benefits from Avandia better than the risks? I'd say yes. Of course, you can always cop out and say "just use Actos" as Actos actually helps with LDL.