Conventional Drugs / Information

Parkinson's Disease / Risk

Conventional medical treatment relies heavily on l-dopa (levo-dihydroxy-phenylalanine), a dopamine precursor that can cross the blood-brain barrier and is converted to dopamine in the brain. L-dopa is now rarely used by itself, but rather in combination with carbidopa (Sinemet) or benserazide (Madopar) that protects it from breaking down before it reaches the brain tissue. As l-dopa must compete with other amino acids in crossing both from the gut to the blood stream and from the blood stream to the brain it is usually recommended that it be taken between meals rather than with meals.

Although l-dopa medications can bring significant relief from Parkinson’s disease symptoms they become less effective with time. After four or five years of increasing dosages their effect becomes sporadic and unpredictable (the “on-off syndrome”) and patients become increasingly helpless and depressed. There is also evidence that the use of l-dopa medications may lead to a deficiency of B-vitamins, especially niacin and vitamin B-6. Most Parkinson’s disease experts now recommend that l-dopa therapy be started as late as possible after diagnosis of Parkinson’s disease so as to postpone the day when it no longer works and to limit its many serious adverse effects.

Selegiline (Deprenyl, Eldepryl) is another drug used in Parkinson’s disease therapy. It works by blocking the breakdown of dopamine in the brain. Trials have shown that starting Parkinson’s disease patients on selegiline can extend the time period before they need l-dopa by about nine months. Combinations of l-dopa medications and selegiline have also been tried in early stage Parkinson’s disease patients, but were found to have no advantage. A study concluded that the combination therapy increased mortality by about 50% when compared to Parkinson’s disease patients treated with l-dopa medications alone.

However, a subsequent study found that Eldepryl (Selegiline, Deprenyl) can slow Parkinson’s Disease safely. In patients with early Parkinson’s disease, selegiline and other drugs in a class called monoamine oxidase type B inhibitors are cheap and effective treatments that reduce disability and the need for levodopa, researchers reported in the British Medical Journal. Their study findings also show that the drugs are not associated with increased mortality, as had been reported in an earlier study. [British Medical Journal, August 14, 2004]

Anticholinergenic drugs work by reducing the amount of acetylcholine produced in the brain and thereby redressing the imbalance between dopamine and acetylcholine. They are no longer recommended for older patients as they have serious neuropsychiatric side-effects.

2009 (Ames, Iowa) – Anumantha Kanthasamy and W. Eugene and Linda R. Lloyd, researchers at Iowa State University, have reportedly found an essential key to possibly cure Parkinson’s disease.

Kanthasamy discovered that the protein kinase-C (specifically PKCd) is killing the dopamine-producing cells which Parkinson’s sufferers lack and he, and his research staff, discovered a compound that neutralizes the cell-killing kinase-C and allows the dopamine-producing cells to survive and function.

As reported in an Iowa State University publication, Kanthasamy’s group is now looking for additional compounds that also can serve to neutralize protein kinase-C. By identifying more compounds that perform the function of neutralizing kinase-C, notes the report, researchers are more likely to locate one that works well and has few side effects.

According to the report, the discovery is expected to provide new treatment options to stop the progression of the disease or even cure it.

Alzheimer's Disease

Researchers found that clioquinol can almost stop the progression of Alzheimer’s disease. They believed that by absorbing the copper and zinc atoms that concentrate in the brains of Alzheimer’s sufferers, clioquinol could stop the onset of dementia before it starts.

The finding came from a study conducted on 26 Alzheimer’s sufferers; half were given clioquinol while the other 13 were given a placebo. Researchers studied all 26 patients over a nine-month period of time and found that patients given the clioquinol retained more mental capacity than those who received the placebo. Research also showed patients who were given clioquinol had a 1.4 percent decrease in their mental capacity, whereas patients who were given the placebo had an 8.9 percent decrease in their mental capacity.

The study suggests that before dementia sets in in the brains of Alzheimer’s sufferers, clioquinol could prevent zinc from building up on the surface of the brain by absorbing the mineral’s atoms. The results of the study show that clioquinol could treat patients with Alzheimer’s twice as well as the latest Alzheimer’s drugs that are available.

Clioquinol has been around for 100 years and is currently used to treat athlete’s foot, ear infections and indigestion. [Archives of Neurology December, 2003;60(12):pp.1685-91]

In October 2003, the FDA finally approved memantine for the treatment of moderate to severe Alzheimer’s disease. Memantine is marketed in the US by Forest Laboratories under the trade name Namenda.

Memantine is an N-methyl- D-aspartate (NMDA) receptor antagonist that is neuroprotective by blocking glutamate, which can cause overstimulation of the nerves and become toxic to the nervous system. Memantine may benefit individuals with Alzheimer’s disease by improving cognition and overall functioning.

Jan 10, 2008. Newsmax reports that an “extraordinary new scientific study, which for the first time documents marked improvement in Alzheimer’s disease within minutes of administration of a therapeutic molecule, has just been published in the Journal of Neuroinflammation.”

Known as anti-TNF therapeutics, the drug used in the study is called Etanercept (trade name Enbrel) which is given by an injection into the spine. Improvement was said to have come came within minutes of the injection.

Sue Griffin, Ph.D., director of research at the Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences (UAMS) in Little Rock and at the Geriatric Research and Clinical Center at the VA Hospital in Little Rock, said: “It is unprecedented that we can see cognitive and behavioral improvement in a patient with established dementia within minutes of therapeutic intervention.”

To date other patients with mild to severe Alzheimer’s have reportedly received the treatment and “all have shown sustained and marked improvement.”

July 29, 2008 – For the first time, an experimental drug shows promise for halting the progression of Alzheimer’s disease by taking a new approach: breaking up the protein tangles that clog victims’ brains. The encouraging results from the drug called Rember, reported at a medical conference in Chicago, electrified a field battered by recent setbacks. The drug was developed by Singapore-based TauRx Therapeutics.

Even if bigger, more rigorous studies show it works, Rember is still several years away from being available, and experts warned against overexuberance. But they were excited. “These are the first very positive results I’ve seen” for stopping mental decline, said Marcelle Morrison-Bogorad, director of Alzheimer’s research at the National Institute on Aging. “It’s just fantastic.”

The federal agency funded early research into the tangles, which are made of a protein called tau and develop inside nerve cells. For decades, scientists have focused on a different protein – beta-amyloid, which forms sticky clumps outside of the cells – but have yet to get a workable treatment.

Premature/Signs of Aging

Study results show that an 80-year-old drug most commonly used as a topical antifungal agent may have the potential to slow down the aging process.

Clioquinol is best known as an antifungal and antiprotozoal drug; however its use as an antiporotozoal drug ended when it was withdrawn from the market after being blamed for an outbreak of subacute myelo-optic neuropathy (SMON) in Japan in the 1960s, although some researchers contest that clioquinol was the true cause of the outbreak.

Despite being associated with neurotoxicity, research in the last few years has suggested that clioquinol may be able to reverse the progression of Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. These findings have left scientists puzzled as to how one drug could have similar effects on three very different neurodegenerative diseases. However, scientists are McGill University believe that they may have solved this puzzle.

Dr. Siegfried Hekimi and colleagues found that clioquinol is a “very powerful inhibitor” of a protein called CLK-1, or clock-1, which is linked to aging. “Because clock-1 affects longevity in invertebrates and mice, and because we’re talking about three age-dependent neurodegenerative diseases, we hypothesize that clioquinol affects them by slowing down the rate of aging,” says Dr Hekimi. Exactly how clioquinol inhibits CLK-1 remains uncertain, however suspects that metals may play a role because the drug is a metal chelators.

Dr Hekimi conclude: “The implication is that we can change the rate of aging. This might be why clioquinol is able to work on this diversity of diseases that are all age-dependent.” [McGill University January 8th 2009]

Allergic Rhinitis / Hay Fever

Prescription Drugs
Nonsedating antihistamines may cause life-threatening irregular heartbeat and should not be taken with other drugs or if you have other liver or heart problems. Oral decongestants may have systemic side effects. Nasal corticosteroid sprays are effective if used properly; improvement takes 1 to 2 weeks. Systemic steroids are prescribed only for severe allergic rhinitis; generally prescribed for short amounts of time because of their many side effects. Leukotriene receptor antagonists are a newer class of medications for treating hay fever. In addition, they also treat asthma, which can occur alongside hay fever. They are considered a highly effective medication and are also long-lasting drugs. Two commonly prescribed leukotriene receptor antagonists include Montelukast and Zafirlukast.

Over-the-Counter
Antihistamines may cause drowsiness. Alpha-adrenergic topical sprays reduce congestion but there is a rebound effect if used for more than a few days. Cromolyn sodium is the only preventative drug choice; works as well as antihistamines but does not cause drowsiness; take continuously or it will not work effectively; it is virtually without side-effects.

The FDA (Food and Drug Administration, USA) has approved an allergy drug, Zyrtec-D (cetirizine HCl 5 mg and pseudoephedrine HCl 120 mg), for non-prescription use in children aged 12 and more and adults (Nov 2007). In other words, Zyrtec-D is now an OTC (over-the-counter) drug.

Zyrtec-D has been on the market since 2001, but only as a prescription medication. The latest approval applies to OTC status for the relief of hay fever and other upper-respiratory allergies, such as sneezing, itchy/watery eyes, runny nose, itchy nose, itchy throat, and nasal congestion. Zyrtec-D is also indicated for nasal passage swelling, sinus congestion/pressure relief, and for restoring freer breathing through the nose.

NOTE: Extended use of antihistamines or nasal sprays can make your allergic rhinitis worse.

Post Nasal Drip

Allergy medications: Histamines are naturally occurring chemicals released in response to an exposure to an allergen, and they are responsible for the congestion, sneezing, and runny nose typical of an allergic reaction. Antihistamines are drugs that block the histamine reaction. These medications work best when given prior to exposure. Antihistamines can be divided into two groups: 1) Sedating (Benadryl, ChlorTrimetron, Tavist), 2) Non- Sedating (Claritin, Hismanal). Sedating antihistamines should be avoided in those patients who need to drive or use dangerous equipment. Non-sedating antihistamines can have serious drug interactions.

Decongestants: These drugs temporarily reduce swelling of sinus and nasal tissues leading to an improvement of breathing and a decrease in obstruction. They may also stimulate the heart and raise the blood pressure and should therefore be avoided by patients who have high blood pressure, heart irregularity, glaucoma, thyroid problems, or difficulty in urination. The most common decongestant is pseudoephedrine (Sudafed).

Combinations: These drugs are made up of one or more anti-allergy medications. They are usually a combination of an antihistamine and a decongestant. Other common combinations include mucus thinning agents, anti-cough agents, aspirin, Advil, or tylenol. They help to simplify dosing and often will work either together for even more benefit or have side-effects that cancel each other out.

Allergy Shots (Immunotherapy): Allergy shots interfere with the allergic response. After identification of an allergen, small amounts of it is given back to the sensitive patient. Overtime the patient will develop blocking antibodies to the allergen, and they become less sensitive.

Steroids: These drugs (prednisone, medrol, hydrocortisone) are highly effective in allergic patients, however there is a potential for serious side effects when used over time. They are best used for the short term management of allergic problems, and must always be monitored by a physician.

Steroid nasal sprays: (Vancenase, Beconase, Flonase, Nasacort, Rhinocort) They reduce allergic or inflammatory inflammation, but do not have the side-effects of oral (systemic) steroids.

Nasalcrom: This spray helps to stabilize allergy cells (mast cells) by preventing release of allergy mediators, like histamine.

Decongestant sprays: (Afrin, Neosynpherine) They quickly reduce swelling of nasal tissues by shrinking the blood vessels. They will improve breathing and drainage over the short term, unfortunately if they are used for more than a few days they can become highly addictive (rhinitis metamentosa). Long term use can lead to serious damage.

Antihistamine sprays: It works like oral antihistamines but applied topically to the nasal membranes (Astelin).

Atrovent: It helps to control nasal drainage mediated by neural pathways. It will not treat an allergy, but it does decrease nasal drainage.

Mucus thinning agents: Mucus thinning agents are utilized to make secretions more thin and less sticky. They help to prevent pooling of secretions in the back of the nose and throat where they often cause choking. The thinner secretions pass more easily. Guaifenesin (Humibid, Fenesin) and organic Iodine (Organidin) are commonly used formulations. If a rash develops or there is swelling of the salivary glands they should be discontinued.

Allergy / Intolerance to Foods (Hidden)

Thirty-five children with atopic dermatitis were proven to be allergic to various foods by dietary elimination and challenge, radio-allergosorbent test (RAST) and human basophil degranulation test (HBDT). Oral sodium cromoglycate improved skin lesions in these patients and protected them from the effects of challenge with food allergens. This protective effect of oral sodium cromoglycate may be explained by the blocking of the immune response in the gut wall and of antigen entry. [Ann Allergy. 1981 Sep;47(3): pp.173-5] The initial dose was 100mg per day and was progressively raised to 200-600mg per day, depending on the response.

Addison's Disease

If you receive an early diagnosis of Addison’s disease, treatment may involve taking prescription corticosteroids. Because your body isn’t producing sufficient steroid hormones, your doctor may have you take one or more hormones to replace the deficiency. Cortisol is replaced using hydrocortisone (Cortef), prednisone (Deltasone) or cortisone. Fludrocortisone (Florinef) replaces aldosterone, which controls your body’s sodium and potassium needs and keeps your blood pressure normal.

You take these hormones orally in daily doses that mimic the amount your body normally would make, thereby minimizing side effects. If you’re facing a stressful situation such as an operation, an infection or a minor illness, your doctor may suggest a temporary increase in your dosages.

Hyperthyroidism

Because of the importance of controlling hyperthyroidism and preventing it’s effects (on bone loss, for example), the use of conventional drugs to accomplish this should be considered strongly. In some cases, when using thyroid medication to support a poorly function thyroid, the only necessary action would be to lower the dose in order to prevent hyperthyroid symptoms.

Myasthenia Gravis

Conventional medicine can control myasthenia gravis. Some medications improve neuromuscular transmission and increase muscle strength, and some suppress the production of abnormal antibodies. These medications must be used with careful medical supervision because they may cause major side effects.

Autoimmune Tendency

Natural compounds derived from a sea anemone extract and a shrub plant have been found to block the autoimmune disease response in type-1 diabetes and rheumatoid arthritis, according to University of California, Irvine researchers.

The study shows both in human and animal tests how these compounds work to deter the effect of autoimmune T-cells, white blood cells that attack the body. The goal, according to UCI researchers, is to develop new treatments from these compounds that will target these destructive T-cells while allowing other white blood cells to fight disease and infection.

The study, led by UC Irvine School of Medicine researchers George Chandy and Christine Beeton, identifies how these compounds work against a type of white blood cells called effector memory T lymphocytes, which play a major role in autoimmunity. Both compounds block an ion channel in these cells that prevents the cells from proliferating and producing chemicals called cytokines that attack the body during autoimmune disease states.

“Autoimmune diseases affect millions of Americans, and any new therapies that can aid them will have great significance,” Chandy said. “What’s promising about this study is that we identified a protein target on the T-cells that promote autoimmune activity and the compounds that can selectively block the target and shut down the destructive cells.”

White blood cells patrol the body to fight against cancer and infections, but if some of these cells turn against the body they are meant to protect, they cause autoimmune diseases. Millions of people worldwide are afflicted with disabling autoimmune disorders. Two examples of this large class of diseases are type 1 diabetes, in which white blood cells attack the pancreas, and rheumatoid arthritis, in which the joints are attacked.

In their study, the UCI researchers used modified compounds derived from the rue plant (PAP-1) and a Cuban sea anemone extract (SL5), both of which block the ion channel in the destructive T-cells. [Early Online Edition of the Proceedings of the National Academy of Sciences. Nov 6-10, 2006

Multiple Sclerosis / Risk

A form of bacteria seems to be the organic cause of multiple sclerosis, claims a Dr. Hoekstra, MD. Its tentative name – not yet widely accepted by other microbiologists – is Borrelia mylophora, so named because its characteristics seem to resemble those of Borrelia burgdorferi, the bacteria believed responsible for Lyme disease. In cases of multiple sclerosis, the myelin sheath covering the nerves gets eaten away by the immune system, explains Dr. Hoekstra. “That is exactly like the hunters’ torches setting fire to the forest. Most of the destruction of the myelin sheath takes place from actions of the white blood cells and their antibodies. But their primary target is not the myelin sheath at all. It’s the Borrelia mylophora bacteria, running around in the nervous system. B. mylophora has an extremely high affinity for the myelin sheath. It loves it.”

The successful use of doxycycline against B. mylophora was first verified by a physician in South Dakota who reasoned that the symptoms of MS (which he had) were suggestively similar to those of Lyme disease, which responds fairly well to doxycycline. After dosing himself for three months with the antibiotic, he was symptom free. However, the long-term use of antibiotics has many drawbacks, cautions Dr. Hoekstra. It seriously damages the ecology of intestinal microflora and can lead to a condition of microbial imbalance called dysbiosis. This in turn can be the foundation for numerous diseases. It can also facilitate the growth of more cell wall deficient forms. To counteract this, probiotic replacement is required.

Researchers from the Medical University of South Carolina have produced the first clinical evidence that statins can help in multiple sclerosis in an article in The Lancet (May 2004).

A group of 30 patients with MS given 80mg a day of Zocor, or simvastatin, had a 44 percent reduction in brain lesions after three months of treatment, their study showed. Brain lesions are areas of inflammation, and are markers of the progression and severity of MS — a debilitating disease in which nerve cells lose their insulating sheath, leading to muscle weakness, fatigue, bladder problems and impaired vision.

Professor Chris Polman, an MS expert at the VU Medical Center in Amsterdam said more research was needed, including a large placebo-controlled clinical trial.

Tysabri was withdrawn in 2005 by Biogen Idec Inc. and Elan Corp. PLC, only months after it had been approved. The Food and Drug Administration has allowed testing to resume after the company said no more cases of the brain disease had emerged.

The new studies found that Tysabri alone or with standard interferon treatment cut the rate of relapse by as much as two-thirds after two years and reduced the number of people whose MS got worse, compared to those on a dummy treatment or interferon alone.

Tysabri was highly anticipated because it works in a different way than existing drugs, which offer only modest help. It blocks destructive immune cells from leaving the bloodstream and entering the brain to inflame and damage nerve tissue.

The studies “confirm that this drug is a significant advance for MS treatment,” said Dr. Allan H. Ropper of Boston’s Caritas St. Elizabeth’s Medical Center, who wrote an editorial in the journal. [NEJM March 1, 2006]

An useful pair of studies in the journal Neurology show that the sleep disorder drug called Provigil (modafinil) is not helpful to MS patients suffering from fatigue, while the common pain-reliever aspirin might be. While two earlier pilot studies had shown modest positive benefit from Provigil, this 56-person study showed the effect on fatigue to be indistinguishable from placebo. Meanwhile, a 30-person trial showed that aspirin did reduce fatigue compared to placebo.

Drs. Steven R. Schwid of the University of Rochester, New York, and T. Jock Murray of Dalhousie University in Halifax, Nova Scotia, observe that “until we make progress in distinguishing fatigue from other MS symptoms, in identifying its mechanisms and in measuring it accurately, we will not make substantial progress in treating this disabling symptom.”

In a crossover study, a daily dose of 1,300mg of aspirin was tested against a placebo in 30 patients. The effects were evaluated using the Modified Fatigue Impact Scale (MFIS), which is a self-reported measure of fatigue using interviews with patients about fatigue levels and impact of fatigue on daily activities. People taking the aspirin scored significantly better on the MFIS than those on placebo. The mechanism for aspirin in reducing fatigue is unknown.

According to Dr. Wingerchuk, one of the lead investigators, the results of aspirin treatment for fatigue were similar to those achieved by Symmetrel, which is about 40% effective in relieving MS fatigue in some studies.

Patients must be monitored for GI bleeding at this elevated dose of aspirin.

Ulcerative Colitis

Mild symptoms of UC may respond to antidiarrheal medications and dietary changes. Prescription medications may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease. Once inflammation is under control, aminosalicylates (such as sulfasalazine or mesalamine) can be used to maintain remission.

Moderate to severe symptoms of UC usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that necessary to treat mild colitis.

Canasa Rectal Suppositories contains 500mg of mesalamine. Sulfasalazine has been used in the treatment of ulcerative colitis for over 55 years. It is split by bacterial action in the colon into sulfapyridine (SP) and mesalamine (5-ASA). It is thought that the mesalamine component only is therapeutically active in ulcerative colitis.

Immunomodulator medications, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medications suppress the body’s immune system to prevent inflammation, and may be needed to avoid the long-term use of steroids.

Using an epidermal growth factor (EGF) enema with oral medication is effective in treating the ulcers and inflammation that ulcerative colitis causes, a study shows. EGF is known to stimulate the healing process. The research shows that the stimulating properties in an EGF enema can help speed up the healing process of the ulcers, improve symptoms, and lead to more remissions.

To determine EGF’s effectiveness, researchers split 24 volunteers into two groups and evaluated them at two-, four-, and 12-week intervals. Half of the patients were men. Each participant gave himself or herself an enema and retained the solution for more than 45 minutes per day for 14 days. One group had enemas containing EGF, but the comparison group did not. All of the volunteers also combined their treatment with the ulcerative colitis drug mesalamine, which was taken orally. At the start, all of them had common symptoms of ulcerative colitis, including: fatigue, weight loss, loss of appetite, rectal bleeding, and loss of body fluids and nutrients

At two weeks, the group taking the EGF enemas showed significant decreases in symptoms, and 10 out of 12 went into remission, compared with 1 out of 12 in the comparison group. Eight of the 12 in the EGF group remained in remission after 12 weeks.

Two patients in the comparison group left the study by the second week because their symptoms got worse. [NEJM, July 24, 2003]

Crohn’s disease (CD) and ulcerative colitis (UC) are chronic-relapsing diseases, the clinical courses of which are characterized by periods of remission and periods of acute flare up, determining clinical symptoms which have a strong impact on the quality of life for patients. For many years, corticosteroids have represented the cornerstone of therapy for induction of remission in Inflammatory Bowel Disease (IBD); however, the side-effects emerging with long-term use exceeded the clinical benefits. Recently, Infliximab (IFX) has become an alternative choice in the treatment strategies for CD and UC. Some safety issues are associated with IFX use, mostly related to the development of adverse events (e.g. opportunistic infections, autoimmune disorders and infusion reactions). Major concerns are related to the reactivation of latent tuberculosis and development of malignancy, even if there is no clear evidence the use of IFX increases the incidence of solid cancers. The research published in issue 39 of World Journal of Gastroenterology and led by Renato Caviglia at University Campus Biomedico in Italy aimed to retrospectively evaluate the safety and efficacy of long-term therapy with IFX, reviewing the medical charts of 41 IBD patients who received, after a loading dose of 3 IFX infusions, scheduled retreatment every 8 weeks as maintenance protocol.

Centocor, Inc., Schering-Plough Corporation, and Mitsubishi Tanabe Pharma Corporation have announced (2007) that an estimated one million patients have now been treated with REMICADE (infliximab), the leading anti-tumor necrosis factor (TNF)-alpha therapy worldwide. In fact, REMICADE has been used to treat more patients worldwide than all other anti-TNF-alpha agents combined. REMICADE was the first anti-TNF-alpha treatment approved by the U.S. Food and Drug Administration (FDA), when it was indicated for the treatment of acute moderate to severe Crohn’s disease in 1998. The indication for Crohn’s disease was quickly followed by additional indications, such as rheumatoid arthritis.

REMICADE has been studied in more than 37 clinical trials, evaluating its use in a wide variety of diseases of the immune system and is approved for use in 88 countries.

Lupus, SLE (Systemic Lupus Erythromatosis) / Risk

Hydroxychloroquine (Plaquenil) is one of a number of drugs, like chloroquine or quinacrine, which have been used for many years in the treatment of malaria. It was discovered that these drugs often are helpful in the treatment of various rheumatic diseases, particularly systemic lupus erythematosus (SLE) and rheumatoid arthritis. Although chloroquine is sometimes used, the preferred antimalarial drug is hydroxychloroquine due to its greater safety. These can be used in combination also, sometimes with better success.

Microscopic Colitis (Collagenous Colitis / Lymphocytic Colitis)

Conventional treatment is often started with sulfasalazine. Patients may improve with sulfasalazine, but they are not necessarily cured. For the many that don’t tolerate sulfasalazine, Asacol (one brand of mesalamine or 5-aminosalicylic acid) is typically prescribed. These medicines are thought to act as anti-inflammatory agents in the intestine.

Anti-diarrheal medications such as Imodium and Lomotil are used for temporary relief, but tend to merely delay the diarrhea.

Studies done with prednisone (a corticosteroid) do not sound very promising for long-term use. Most patients do respond quickly to this agent, so it can be useful to stop a severe attack. However, the diarrhea routinely returns when prednisone is discontinued. Long-term use of prednisone is discouraged because the side effects (formation of cataracts, bone degeneration, high blood pressure, and a tendency toward diabetes) which can eventually be worse than the benefits.

Some people report excellent short-term results with certain antibiotics; however, the results generally are not long lasting.

A cholesterol-lowering drug called cholestyramine is helpful to some. Fiber in the form of psyllium hydrophilic mucilloid (like Metamucil) also helps some patients, but not others.

Low dose tricyclic antidepressants (such as Doxepin or Elavil) can sometimes help with the joint and muscle pain.

Ankylosing Spondylitis

Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into two products: 5-aminosalicylic acid (5ASA), and sulfapyridine. There is some controversy as to which of these two products are responsible for the activity of azulfidine. Whereas it is known that 5ASA has therapeutic benefit, it is not clear whether sulfapyridine adds any further benefit. In the colon, the products created by the breakdown of sulfasalazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulfasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immune-suppressant effect as well. Following oral administration, 33% of the sulfasalazine is absorbed, all of the sulfapyridine is absorbed, and about 33% of the 5ASA is absorbed. Sulfasalazine was approved by the FDA in 1950.

Through a long line of firsts in the biotechnology industry, the history of REMICADE includes 15 FDA indications spanning across inflammatory diseases that include Crohn’s disease (adult and pediatric), ulcerative colitis, rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis and psoriasis. (2007)

Cerebral Palsy

There are many different drugs that can be and are commonly used for muscle relaxation in CP.

Congestive Heart Failure

Prescription drugs are part of a program used to treat CHF. Such a program should consider:

Chronic Venous Insufficiency (CVI)

Daflon 500mg is an oral phlebotropic drug indicated in the treatment of venous disease, ie, chronic venous insufficiency (CVI) and hemorrhoidal disease (HD). It contains naturally occurring substances, but one of them has been modified for better absorption.

Daflon 500mg, micronized, purified flavonoid fraction (MPFF), is a semisynthetic phlebotropic drug whose active ingredients are micronized diosmin (90%) and hesperidin (10%). Hesperidin is extracted from a species of Rutaceae aurantieae of the citrus genus, a type of immature small orange harvested and dried in Spain, North Africa, and China. Diosmin, a member of the flavonoid family, is synthesized starting from this raw material.

Daflon is challenging to find in the USA, but can be ordered from some foreign pharmacies, including India and Malaysia. Some locations seem to be charging too much, so please shop around. Two capsules a day should cost around one US dollar.

Lymphatic Congestion

DAFLON 500 mg improves lymphatic drainage by increasing the frequency and intensity of lymphatic contractions, and by increasing the total number of functional lymphatic capillaries. Furthermore, DAFLON 500 mg decreases the diameter of lymphatic capillaries and the intralymphatic pressure. [Phlebology. 1994;(suppl 1): p.23-25, Lymphology. 1998;31(suppl): pp.12-16]

Varicose Veins

DAFLON 500 mg has a comprehensive and rigorously demonstrated mode of action, which enables it to fight simultaneously all the pathophysiological aspects of venous disease, affecting the veins, lymphatics, and microcirculation.

It prolongs the vasoconstrictor effect of noradrenaline on the vein wall, even under warm and acidotic conditions, increasing venous tone, and therefore reducing venous capacitance, distensibility, and stasis. This increases the venous return and reduces venous hyperpressure present in patients suffering from chronic venous insufficiency (CVI).

Daflon is challenging to find in the USA, but can be ordered from some foreign pharmacies, including India and Malaysia. Some locations seem to be charging too much, so please shop around. Two capsules a day should cost around one US dollar.

Arrhythmias/Dysrhythmias

In atrial fibrillation, medications are available to restore and maintain a normal heart rhythm. Additionally, blood thinning agents, such as Coumadin (warfarin), are prescribed to reduce the risk of clots forming or stroke. The results of a study were announced showing that an experimental orally administered anticoagulant, Ximelagatran (Exanta™, Exanta™, AstraZeneca) has been shown to be a highly effective alternative to well-controlled warfarin for stroke prevention in patients with non-valvular Atrial fibrillation, not only resulting in a greater reduction of strokes and systemic embolic events in these individuals, but also caused less bleeding while providing a safer, easier-to-administer agent without the need for monitoring. [Halperin JL., Am Heart J. September 2003;146(3): pp.431-8]

For PVCs, unless there is structural heart damage, no action may be required. If symptoms are troubling, a mild anxiolytic drugs or beta-adrenergic blockers may be helpful. Long-term treatment of ventricular tachycardia may require the use of oral anti-arrhythmic medications (such as procainamide, amiodarone, or sotalol). Anti-arrhythmic medications, however, may have severe side effects, and their use is currently decreasing in favor of other treatments.

Many types of tachycardias respond well to anti-arrhythmic medications. Although not a cure, they can reduce episodes of tachycardia or slow down the heart when an episode occurs. These medications include:

Phlebitis / Thrombophlebitis

Subcutaneous (beneath the skin) injection of the original and less expensive form of the anticoagulant medication heparin is as effective and safe as subcutaneous administration of the newer and more expensive low-molecular-weight heparin for treatment of venous thromboembolism.

“We conclude that fixed-dose subcutaneous unfractionated heparin is as effective and safe as low-molecular-weight heparin for initial treatment of patients with venous thromboembolism and is suitable for treatment at home,” they write. “In addition, the results of this study question the value of APTT monitoring in patients who are treated with currently recommended doses of unfractionated heparin.” [JAMA. 2006;296: pp.935-942]

Increased Risk of Stroke

You can increase the chance of getting the preventive effects and decrease the chance of side effects effects of any medicine by choosing and using it wisely. When it comes to using aspirin to lower the risk of heart attack and stroke, choosing and using wisely means knowing the facts and working with your health professional.

There are many reasons to believe that the drug dipyridamole (300mg per day) will be far more effective in the prevention of heart attacks and strokes than aspirin. Moreover, dipyridamole has none of the harmful side effects of aspirin.

Dipyridamole, like aspirin, inhibits platelet adhesion, and thus tends to prevent the vascular thrombosis of heart attacks and strokes. In a trial referencing the poor response to aspirin, Dipyridamole was added to the treatment protocol and the results were outstanding. Over a two-year period, stroke deaths were decreased by 50%, deaths from myocardial infarction decreased by 38% and deaths from cancer by 25%. [ European Stroke Prevention Study, Lancet, December 12, 1987; pp. 1,371-4]

Hypotension

If simple measures don’t alleviate the problem, you may need conventional medication. Although a wide range of drugs (including phenylpropanolamine, ephedrine and the nonsteroidal antiinflammatory drugs indomethacin and ibuprofen) have been used to treat hypotension, many of them are not consistently effective.

The following medications have proven effective in treating postural hypotension:
Fludrocortisone. Fludrocortisone is a mineralocorticosteroid that appears to be effective for most types of postural hypotension. It works by promoting sodium retention by the kidney, thereby causing fluid retention and some swelling, which is necessary to improve blood pressure. Its sparing effect on sodium is done at the expense of a concurrent loss of potassium. Therefore, when taking fludrocortisone, it’s important to also take adequate amounts of potassium each day. Fludrocortisone has none of the anti-inflammatory properties of cortisone or prednisone and it is not a muscle-building agent.

Midodrine. Midodrine activates receptors on the arterioles and veins to produce an increase in blood pressure. Studies show that it is effective in improving standing blood pressure in those with postural hypotension related to nervous system dysfunction, such as in patients with Shy-Drager syndrome.

Pericarditis

In a study of nine patients with recurrent pericarditis resistant to traditional therapy it was found that all had a positive response with colchicine at a dose of one mg/day. These patients had experienced relapses despite treatment with indomethocin, acetylsalicylic acid, or prednisone. With colchicine treatment prednisone was discontinued in all patients between 2 to 6 weeks. The colchicine was continued. A mean follow-up of 24.3 months showed no recurrences in

any patient. These results are encouraging but due to the small sample in this study larger trials are warranted. [Circulation, 1990;82: pp.1117-1120]

Sickle Cell Trait / Disease

GenoMed, the Next Generation Disease Management company whose business is public healt, announced today that it has submitted a case report of a sickle cell patient whose pain disappeared with GenoMed’s treatment approach, only to recur when GenoMed’s treatment was stopped.

The patient is a middle-aged African American woman who for years required multiple pain pills every day to tolerate the pain of her sickle cell disease. Since beginning GenoMed’s trial on Dec. 22, 2005, she experienced no pain until her trial medication ran out on February 6, 2006. Said her physician, who is lead author on the case report, “Prior to this experiment, for over two years, there has not been more than a day, at least during the winter months, when she has not required some Vicodin.” [medicalnewstoday.com, 16, Sep 2006]

Constipation

Research has found that a medication, tegaserod, is effective in treating nearly all symptoms associated with chronic constipation (CC), a common disorder of the gastrointestinal tract that affects approximately 15% of the Western population at any one time. Tegaserod is currently the only drug aside from laxatives found to be effective at treating such a wide variety of symptoms.

“Chronic constipation is a complex medical disorder and several bodily mechanisms are involved in its development,” says Stefan Muller-Lissner, M.D., lead author of the study. “The positive results we have found from tegaserod treatment in relieving this array of symptoms could potentially benefit millions.”

The long-term safety, efficacy and tolerability of tegaserod have been proven. Patients show no serious side-effects from long-term usage and maximal improvements were observed after approximately 6 months of further treatment and were sustained thereafter. [The American Journal of Gastroenterology, 27 Nov 2006]

Well, another drug bites the dust. The Food and Drug Administration (FDA) has requested that Novartis Pharmaceuticals Corporation of East Hanover, New Jersey, voluntarily discontinue marketing of Zelnorm (tegaserod) based on the recently identified finding of an increased risk of serious cardiovascular adverse events (heart problems) associated with use of the drug. Novartis has agreed to voluntarily suspend marketing of the drug in the United States.

Zelnorm is a prescription medicine approved in July 2002 for short-term treatment of women with irritable bowel syndrome whose primary symptom is constipation. It was subsequently approved in August 2004 for treatment of chronic constipation for men and women under age 65. Zelnorm is marketed in 55 countries.

FDA is currently advising patients who are using Zelnorm to contact their health care providers to discuss treatment alternatives. Patients who are taking Zelnorm should seek emergency medical care if they experience severe chest pain, shortness of breath, dizziness, sudden onset of weakness or difficulty walking or talking, or other symptoms of a heart attack or stroke.

“This decision reflects the FDA’s commitment to continuously monitor approved drugs throughout their marketing life, and take action when we believe the risks exceed the benefits,” said Dr. Douglas Throckmorton, Deputy Director for the Center for Drug Evaluation and Research. “Here, a potential risk of very serious harm to patients who have this non-life-threatening condition was recently identified, making this action necessary.”

Throughout February and March 2007, Novartis reported to FDA the results of a new analysis of 29 short-term (1 – 3 months) randomized, controlled clinical trials of Zelnorm. FDA has concluded, based on these data that for most patients the benefits of this drug no longer outweigh the risks.

Hemorrhoids

In acute hemorrhoidal attacks, DAFLON 500mg is highly effective, right from the second day of treatment, in improving all signs and symptoms, such as bleeding, pain, discharge, tenesmus, and proctitis, thereby reducing the consumption of oral analgesics.

The efficacy of DAFLON 500 mg associated with fiber supplement has been superior to fiber supplement alone and equivalent to rubber-band ligation plus fiber supplement in stopping anal bleeding due to hemorrhoids.

DAFLON 500 mg combined with hemorrhoidectomy significantly reduces the risk of postoperative bleeding.

In long-term treatment for chronic hemorrhoidal disease, DAFLON 500mg has been proven to significantly reduce recurrence, duration, number, and severity of hemorrhoidal attacks. [Dis Col Rectum.2000;43: pp.66-69, Phlebology. 1992;7(suppl 2): pp.61-63]

IBS (Irritable Bowel Syndrome)

Please see the link between IBS and Antibiotics.

Nausea, Vomiting

Until recently, symptoms of nausea almost always were treated with promethazine (Phenergan) suppositories. Today’s technology offers more choices, both commercially and through compounding.

A few OTC treatments are available that can be helpful in relieving nausea, vomiting, and dizziness. Dimenhydrinate (Dramamine) and meclizine (Bonine) are perennial favorites for treating symptoms associated with motion sickness. Emetrol (consisting of dextrose, fructose, and phosphoric acid), can be effective in treating nausea.

When OTC treatments fail to provide the needed relief, a prescription medication may be more appropriate. Commercially available options include dopamine-2 antagonists such as promethazine and prochlorperazine (Compazine), as well as 5-hydroxytryptamine-3 antagonists such as ondansetron (Zofran) and granisetron (Kytril). For motion sickness, scopolamine is a highly effective anticholinergic agent. Additional options include metoclopramide, chlorpromazine, and haloperidol.

Please keep in mind that other conventionally used medications you may be taking for other purposes can cause nausea and vomiting.

Heartburn / GERD

If you are currently taking a proton pump inhibitor like Prilosec or Nexium you should not stop these drugs suddenly. That is one of their main dangers, in that while they relieve your symptoms they actually make the underlying condition worse and cause you to be dependent on them. Transition to an H2 receptor antagonist like Zantac at bedtime and then gradually wean off the Zantac. Zantac is much safer than these proton pump inhibitors.

Prescription Drug Side-Effects

As with so many things, the benefits of a medication must be balanced against any side effects. Some consequences require that the medication be discontinued.

Morgellons Disease

Many dermatologists refute the suggestion that this is an actual disease but instead indicate that many of these patients have psychological problems or other common skin disorders. Many psychiatirsts recommend antipsychotic drugs, as they consider the condition an imaginary parasitosis.

Hypothyroidism

Please see the link between Hypothyroidism and Thyroid Medications.

Hyperprolactinemia

Medications such as some blood pressure medications, anti-nausea drugs or antipsychotics may cause elevated prolactin levels.Here is a page where many men and women describe how much Dostinex has helped them.

When no symptoms are present, monitoring may be all that needs to be done. When symptoms are present, the dopamine agonist, bromocriptine mesylate, is often the initial drug of choice. It lowers the prolactin level in 70-100% of patients. Agents other than bromocriptine have been used (eg, cabergoline, quinagolide). Cabergoline, in particular, probably is more effective and causes fewer adverse effects than bromocriptine. However, it is much more expensive. Cabergoline is often used in patients who cannot tolerate the adverse effects of bromocriptine or in those who do not respond to bromocriptine.

Elevated SHBG

SHBG’s may be lowered by two of the artificially generated progesterones, norgestrel and norethisterone.

Hirsutism

If you have seen a medical doctor about hirsutism, you’re probably taking birth control pills, possibly in combination with one or more other drugs. Drugs to retard hirsutism fall into three broad categories:

1. Androgen receptor blockers: Cyproterone, flutamide (Eulexin), and spironolactone (Aldactone).

2. Androgen-suppressing agents: GnRH agonists (Lupron), estroprogestins (birth control pills), corticosteroids, and insulin-sensitizing agents (metformin/Glucophage).

3. 5 alpha-reductase inhibitors: Finasteride (Proscar), eflornithine hydrochloride (Vaniqa).

All of these drugs work to some extent. They have helped some women see measurable reductions in androgen levels and unwanted hair growth. Most have side effects. All are recommended in conjunction with birth control pills, partly to control the side effects of these medications.

Low HGH (Human Growth Hormone)

Adding the medication mestinon (30-60 milligrams before exercise) may restore the normal rise in growth hormone release during exercise in fibromyalgia.

Low Testosterone Level

The most commonly used aromatase inhibitor in bodybuilding is aminoglutethimide (Cytadren). This drug also inhibits an enzyme (desmolase) necessary for synthesis of cortisol, but fortunately, aromatase can be inhibited with levels of drug that cause only limited inhibition of desmolase.

For an average male, a dose of 250mg per day (one tablet) appears optimal. The half-life is 8 hours, so the drug is better taken in divided doses. The best plan seems to be to take half a tablet on arising, and quarter tabs six and twelve hours later. This keeps levels generally fairly constant, but allows a small drop in the hours shortly before arising, which is then compensated for by the higher dose on arising. With this scheme, inhibition of cortisol production is generally too low to be noticed, and generally there is no rebound effect on discontinuance. However it is not a bad idea nonetheless to taper off, first omitting the midday quarter tab dose for a few days, then omitting both quarter tab doses, then reducing the initial dose to one quarter tab, and then ending completely. A week is sufficient for the taper.

Some people suffer a degree of lethargy or sedation from aminoglutethimide, even at this low dose, but most do not. Anastrozole (Arimidex) is a superior aromatase inhibitor which does not have these side effects. It is, however, very expensive. With moderate doses of testosterone it seems that 1mg per day is sufficient, and some have claimed half a tab to be sufficient.

Aromatization is the process of converting testosterone to estrogens. This process increases with age. Aromatase blockers include prescription medication such as Arimidex (anastrozole), Aromasin (exemestane), Femara (letrozole), Nolvadex (tamoxifen), and Faslodex (fulvestrant). Nonprescription items such as Chrysin, Tribulus, DHEA, and Vitamin D can reduce estrogen levels and enhance testosterone levels. If these fail to increase free testosterone and lower excess estradiol, then ask your doctor to prescribe the potent aromatase inhibiting drug Arimidex (anastrozole) in the very low dose of 0.5mg, twice per week. Arimidex reduced estradiol by approximately 70% within 24 hours and by approximately 80% after 14 days of daily use.

Low Adrenal Function / Adrenal Insufficiency

The use of hydrocortisol to supplement low cortisol output by weak or failing adrenal glands is essential.

Elevated DHEA

Aldactone (spironolactone) decreases androgens like DHEA and testosterone and thus helps to decrease excess hair growth and acne.

Low SHBG

Selection of an OC formulation that maintains increases in SHBG may be important in minimizing androgenic effects in general, and especially important in hyperandrogenic women, who may benefit most from reductions in levels of free testosterone.

SHBG’s may be lowered by two of the artificially generated progesterones, norgestrel and norethisterone. If you are a woman who may be susceptible to androgenetic alopecia, that is, hereditary hair loss (female pattern baldness), or you have a naturally low SHBG level, you should avoid any contraceptive pills or hormone replacement therapy that contains synthetic progesterone.

Cushing's Syndrome / Hypercortisolism

Please see the link between Cushing’s and Surgery.

Elevated Testosterone Level, Female

Troglitazone and metformin lower biologically available testosterone levels by approximately 25% in women with PCOS. This testosterone lowering correlates with the reduction in insulin levels. Resumption of ovulation has been reported in women receiving these agents alone or in combination with clomiphene citrate (Clomid).

Elevated Insulin Levels

Metformin makes the body’s tissues more sensitive to insulin and is one of the most common OHAs, or oral hypoglycemic agent, on the market. Its use can make weight loss easier too.

Low Sex Drive

The most common medications that put a damper on sex include antidepressants, which inhibit arousal and orgasm; anti-inflammatories, which also hamper orgasm; ulcer medications, which lessen desire; and birth control pills, which limit desire and decrease lubrication. Diuretics and anti-anxiety drugs may have this side-effect also.

AIDS / Risk

Prednisone must be used cautiously by HIV-positive individuals because it is immunosuppressive and can increase the risk of getting opportunistic infections.

ATRIPLA contains 3 medicines, SUSTIVA (efavirenz), EMTRIVA (emtricitabine) and VIREAD (tenofovir disoproxil fumarate also called tenofovir DF) combined in one pill. EMTRIVA and VIREAD are HIV (human immunodeficiency virus) nucleoside analog reverse transcriptase inhibitors (NRTIs) and SUSTIVA is an HIV non-nucleoside analog reverse transcriptase inhibitor (NNRTI). VIREAD and EMTRIVA are the components of TRUVADA. ATRIPLA can be used alone as a complete regimen, or in combination with other anti-HIV medicines to treat people with HIV infection. ATRIPLA is for adults age 18 and over.

Chronic Fatigue / Fibromyalgia Syndrome

If prescriptions medications are needed to maximize sleep, Ambien, Desyrel, and Klonopin are more helpful than other sleep medications when CFS / Fibromyalgia is present.

Parasite Infection

When parasites are present and identified, conventional drugs should be considered for their elimination. These may include:

Albendazole (Albenza), Diethylcarbamazine (Hetrazan), Ivermectin (Stromectol), Mebendazole (Vermox), Oxamniquine (Vansil), Praziquantel (Biltricide), Pyrantel (Antiminth, Pin-Rid) and Thiabendazole (Mintezol).

Cystitis, Bacterial Bladder Infection

While natural means may prevent as well as treat cystitis, there are times when the judicious use of antibiotics is the best treatment choice. Natural means alone will often prevent recurrence and in some cases resolve bladder infections that have resisted antibiotic treatment.

MRSA

Vancomycin is one of the few antibiotics still effective against hospital strains of MRSA infection, although the drug is no longer effective in every case. Several drugs continue to work against CA-MRSA, but CA-MRSA is a rapidly evolving bacterium, and it may be a matter of time before it, too, becomes resistant to most antibiotics.

HPV (Human Papilloma Virus)

A conventional MD may offer you one of several ways to treat genital warts.

Sinusitis

Please see the link between Sinusitis and Antibiotics.

Shingles (Herpes Zoster)

In a double-blind, randomized, crossover study, 58 patients with postherpetic neuralgia received 6-week courses of amitriptyline, 12.5 to 150 mg/d; lorazepam, 0.5 to 6 mg/d; or lactose placebo. Doses were titrated to the maximum level tolerated. Patients rated pain in a diary, using lists of verbal descriptors. Forty-seven percent of patients reported moderate or greater relief with amitriptyline, 16% with placebo, and 15% with lorazepam. Mean amitriptyline dose was 65 mg/d. Greater relief was associated with higher amitriptyline doses, up to the maxiumum dose of 150 mg/d, and with higher serum tricyclic levels. Lorazepam did not relieve pain and was associated with severe depressive reactions in four patients. [NEUROLOGY 1988;38:1427]

Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia.

Lyme Disease

Please see the link between Lyme Disease and Antibiotics.

Parasite, Eosinophilic Meningitis / Rat lung worm

In severe cases steroids may help to reduce inflammation and symptoms. The worms generally die without treatment after a few weeks. Giving a patient anti-worm treatment can make their condition much worse by killing all worms present at the same time which results in even greater brain inflammation.

Parasite, Pinworm Infection

Pin-X (pinworm treatment containing pyrantel pamoate) is available over-the-counter as a single dose remedy. If you have side-effects after taking pyrantel, get advice from your health care provider before you take it again, especially if a skin rash occurs.

Periodontal Disease - Gingivitis

Some drugs, such as oral contraceptives, anti-depressants and certain heart medicines, can affect your oral health.

Chronic Inflammation

Although they are sometimes necessary, long-term use of the more dangerous antiinflammatory drugs, such as prednisone, can cause diabetes, osteoporosis, or even death.

Metformin is a drug used to treat type II diabetes. It functions via different mechanisms to restore youthful metabolic-glucose metabolism. Metformin’s ability to lower elevated blood insulin levels helps explain why it has been shown to significantly lower C-reactive protein levels in human studies, which reduces inflammation.

November 20, 2002 — Preliminary data suggest that the commonly used antibiotic doxycycline (Periostat), which is widely used to treat gum disease, reduces C-reactive protein (CRP) levels by nearly 50% in patients recently hospitalized for an acute coronary syndrome.

The results are drawn from the Metalloproteinase Inhibition with Low-Dose Doxycycline to Prevent Acute Coronary Syndromes (MIDAS) pilot trial.

For the investigation, 50 patients with recent acute coronary syndromes were randomized to low-dose doxycycline (20 mg BID) or placebo. The 20 mg tablet, taken twice daily, provides a sub-antimicrobial dose of the antibiotic.

At enrollment, the two treatment arms had similar demographic and clinical characteristics, including age, sex, and frequency of hypertension, diabetes, smoking, prior cardiac history, extent of coronary disease, presentation with acute myocardial infarction or unstable angina, and need for a percutaneous coronary intervention.

At six-month follow-up, sub-antimicrobial dose doxycyline significantly reduced CRP levels by 45.8 percent compared to baseline values (p<0.05). The drug was also associated with a 33.5 percent reduction in interleukin-6 and a 50 percent reduction in metalloproteinase (MMP)-9 activity (p<0.05).

There was no difference between the low-dose doxycycline and placebo groups in the composite end point of cardiovascular death, myocardial infarction, or troponin-positive unstable angina. Dr. Brown emphasized, however, that the study was too short to permit assessment of a significant difference between the two groups with respect to this end point.

Low-dose doxycycline was safe with no discontinuations due to treatment-related side effects. Two patients in the placebo group discontinued treatment prematurely. Both developed drug rashes that were probably due to another drug they had started at the same time, Dr. Brown said.

“The findings are exciting, since research is now showing that CRP is both a key marker of inflammation leading to future acute coronary events, but also that CRP itself may contribute to the initiation and progression of atherosclerosis,” he noted.

Heel Pain

Cortisone injections should be avoided in the initial treatment of plantar fasciitis; they should be suggested only as supplemental treatment in patients who have resistant chronic plantar fasciitis after achieving adequate biomechanical control. These injections may provide only temporary relief and can cause a loss of the plantar fat pad if used injudiciously.

Tendonitis

Cortisone shots may reduce the pain and assist in recovery, but will not regrow damaged tissue. Some doctors have made the claim, now supported by evidence, that cortisone shots can in fact weaken the structures being treated, and do not recommend them in spite of the temporary relief they may offer. (Care must be taken when injecting cortisone near any ligament or tendon: they must not be injected into.)

While the use of anti-inflammatories may reduce the swelling and pain, they also may hinder permanent recovery. Inflammation is part of the process for normal tendon regrowth. The chronic use of anti-inflammatories should be approached with caution.

Low Platelet Count

Attacking a platelet-depleting autoimmune disease in a whole new way, an experimental drug is helping patients with immune thrombocytopenic purpura (ITP) once again produce healthy amounts of platelets — with no major side effects.

That’s the conclusion of a new, multicenter study led by Dr. James B. Bussel, professor of pediatrics at Weill Cornell Medical College, attending pediatrician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and director of the Hospital’s Program for Platelet Disorders.

His team’s findings appear in The New England Journal of Medicine, November 19, 2006.

The new drug, a novel protein called AMG 531, successfully boosted platelet production in patents with chronic ITP, a serious autoimmune disorder that affects more than 16,000 adult Americans, and perhaps as many children, each year.

Elevated Total Cholesterol

Kilmer S. McCully, M.D.

Chief, Pathology and Laboratory Medicine Service

West Roxbury Veterans Affairs Medical Center

The longest running study of cardiovascular disease in a population was initiated in Framingham, Massachusetts in 1948 and continues to this day. This important longitudinal study identified important major risks for disease, especially smoking, lack of exercise, age, male gender, and elevated cholesterol levels in younger men.

In spite of the great emphasis on cholesterol levels, the Framingham study made several critical observations that refute the “diet-heart” hypothesis. In the first place, dietary cholesterol has no relation to cholesterol levels in the blood, and dietary cholesterol has no relation to the risk of developing cardiovascular disease.

This observation was confirmed by multiple large studies from Chicago, Puerto Rico, Honolulu, Netherlands, Ireland, and the massive Lipid Research Clinics study of US citizens. The next astounding finding is that elevated cholesterol is not a risk factor for women of any age or for men over age 47.

Furthermore, both total mortality and cardiovascular mortality in Framingham participants increases in those with LOW cholesterol levels. This finding has been confirmed by multiple studies from Canada, Sweden, Russia, and New Zealand. These contradictory findings have been ignored, distorted, and incorrectly reported by supporters of the “diet-heart” hypothesis.

The massive Multiple Risk Factor Intervention Trial (MRFIT) screened 360,000 men to find those with the highest risk of developing cardiovascular disease. Approximately 12,000 overweight, hypertensive, smokers with elevated cholesterol levels were recruited for this 7 year trial, involving consuming a low fat diet, smoking cessation, exercise and anti-hypertensive drugs.

At the end of the trial, blood pressure was down, smoking decreased, and average cholesterol levels were down 7%. When the results of this $100M trial were analyzed, 115 in the treatment group had died of heart disease, compared with 124 in the control group, an insignificant difference. Looking at mortality from all causes, there were 265 deaths in the treatment group, compared with 260 in the control group. In looking at the failure of this massive and expensive $100M trial, the investigators found minor benefits of smoking cessation, no benefit of lowering blood pressure, and no effect of lowering cholesterol levels by 2% compared with the control group.

In the even more massive Lipid Research Clinics (LRC) trial, 4000 participants with very high cholesterol levels were selected from almost half a million men. After significant lowering of cholesterol levels for 7 years by the resin cholestyramine, 190 men had suffered nonfatal heart attacks in the treatment group, compared with 212 in the treated group. As for fatal heart attacks, the figures were 1.7% compared with 2.3%, a difference of 0.6%, or 12 individuals. The investigators expressed these differences as relative risk reductions of 19% and 30% by throwing out the denominators of their fractions.

In the later trials with statin drugs that lower cholesterol levels more effectively than the unpleasant resin cholestyramine, a similar statistical approach was taken to increasing the apparent effect on reducing cardiovascular mortality and adverse events.

In an analysis of 6 major statin trials (EXCEL, 4S, WOSCOPS, CARE, AFCAPS, LIPID), the reduction of cardiovascular mortality ranged from -19% to -41% when expressed as relative risk reduction, but from -0.12% to -3.5% when expressed as absolute risk reduction. This statistical manipulation to make the results more impressive illustrates Mark Twain’s aphorism: There are lies, damn lies, and statistics. Thus a multi-billion dollar drug industry depends upon using misleading interpretations of statistics showing trivial differences between treated and control groups.

The gigantic MONICA study, sponsored by the World Health Organization, analyzed the relation between cardiovascular mortality and blood cholesterol in 27 countries, in much the same way as the Seven Countries Study. The results are similar, showing that countries like Japan and China have low mortality and low cholesterol levels, and countries like Finland have high mortality and high cholesterol levels.

Yet countries like France, Germany, Switzerland, and Luxembourg have a low mortality rate and yet a high blood cholesterol value. This so-called “French paradox” is not a paradox at all, when examination of the data reveals great disparities in mortality between different regions with the same cholesterol levels.

Similarly the residents of Corfu have a 5 fold greater mortality than residents of Crete, despite identical dietary practices and identical cholesterol levels. Residents of the North Karelia regions of Finland have mortality rate of 493/100,000 and those in Fribourg France have mortality rate of 102/100,000, yet the cholesterol levels are identical at 245 mg/dl in both regions.

The National Cholesterol Education Program is a quasi-governmental body sponsored by members of the National Institutes of Health, American Heart Association, and other supporters of the “diet-heart” hypothesis. This body recommends a low fat, high carbohydrate diet to prevent heart disease, in spite of the increasing incidence of diabetes, obesity, and hypertension that is linked to consumers of this diet.

They consistently advocate programs of extreme lowering of cholesterol levels by drug therapy, in spite of evidence of increased risk of mortality from heart failure, cancer, cirrhosis, and other diseases in older subjects with low cholesterol levels. They also recently recommended lowering the acceptable level of Low Density Lipoprotein (LDL) in the population by statin therapy, in spite of the fact that 8 of the 9 members of the advisory panel had a direct conflict of interest by accepting payments from the drug industry.

This body has popularized the concept that LDL is “bad cholesterol” and HDL is “good cholesterol” in spite of the marginal and sometimes contradictory data distinguishing these fractions from total blood cholesterol. This body also advocates “aggressive cholesterol lowering” in the population in spite of the fact that no cholesterol lowering trials have demonstrated reduced mortality or sudden death from such treatments in the otherwise normal population.

Kilmer S. McCully, M.D.

Chief, Pathology and Laboratory Medicine Service

West Roxbury Veterans Affairs Medical Center

Low White Count

DMSA (used for removing heavy metals) can cause bone marrow suppression and is potentially hepatotoxic. There have been no reports yet of permanent bone marrow suppression or liver damage, but the literature has many case reports of significant neutropenia and thrombocytopenia during therapy with DMSA.

Anticoagulant Use

Continued anticoagulant use is recommended, although the dose may need to be reduced or even eliminated when taking natural anticoagulants. Lab test monitoring is necessary to make sure that the blood is not overly thinned.

Bipolar Disorder, Manic-Depressive

People with this condition generally require life-long treatment with lithium or other drugs to control manic episodes, sometimes with antidepressants to control the depression, although it improves both depression and mania. In fact, the occurrence of depression in a person who has been taking lithium is often an indication that a higher dose is needed. For lithium to reach its maximum effectiveness, 2 or even 3 weeks is often required.

Some of the brand names under which lithium is sold are Lithane, Eskalith, Lithobid and Cibalith. Lithium is effective only for about half the people with bipolar disorder.

Some doctors believe that a significant bipolar disorder will not respond sufficiently to alternative interventions alone.

Doctors and patients should be aware that some will develop kidney problems when taking lithium, and that kidney function should be monitered. “A … safety alarm was triggered by reports of kidney damage in the late 1970s. Subsequent reports have questioned the significance of anatomical findings, and functional impairment and relationship to lithium treatment. Recent findings support the conclusion that progressive impairment of glomerular and tubular function in patients during lithium maintenance is the exception rather than the rule and is related more to lithium intoxication, maintenance plasma lithium levels, concurrent medications, somatic illness, and age than on time on lithium.”[Neuropsychopharmacology (1998) 19 200-205.10.1038/sj.npp.1395203]

There aren’t many studies with Seroquel (quetiapine fumarate) as the only medication used to treat bipolar disorder. As far as the anecdotal evidence goes, people are reasonably satisfied with this medication when it does work for bipolar mania. It does do a good job at boosting an antidepressant’s effect on the depression side of things and often can work as a stand-alone mood stabilizer, dealing with both mania and depression, despite being approved to treat only mania.

Anxiety

Anxiety is a condition that results from not dealing successfully with the core issues of life. Anxiety is something that man was not meant to experience, but because of wrong choices, can become a reality. If this symptom can not be dealt with at its cause, then one can look at chemical solutions, keeping in mind that is only palliative.

HealthCentral has a list of many of the common drugs used to treat anxiety.

Attention Deficit Disorder (ADD / ADHD)

Results of a study found that an extended-release form of methylphenidate – sold as CONCERTA (methylphenidate HCl in the OROS delivery system) may be associated with a lower likelihood of abuse than immediate-release methylphenidate (sold as Ritalin). – Nov 3, 2006.

“The abuse of prescription stimulant medications is a growing concern among physicians who prescribe these medications to treat Attention Deficit Hyperactivity Disorder (ADHD) and parents of children and teens who rely on these treatments to restore normal function,” said Edward Sellers, M.D., Ph.D., an investigator on this study and professor of Pharmacology, Medicine and Psychiatry at the University of Toronto. “Our study suggests that slowing the rate of drug delivery through the extended-release OROS technology may decrease the likelihood of abuse.”

Here are some side effects reported from drugs commonly used to treat this condition.

Adderall – The most common side effects are restlessness or tremor; anxiety or nervousness; headache or dizziness; insomnia; dryness of the mouth or an unpleasant taste in the mouth; diarrhea or constipation; or impotence or changes in sex drive.

Concerta Side Effects – In the clinical studies with patients using CONCERTA, the most common side effects were headache, stomach pain, sleeplessness, and decreased appetite. Other side effects seen with methylphenidate, the active ingredient in CONCERTA, include nausea, vomiting, dizziness, nervousness, tics, allergic reactions, increased blood pressure and psychosis (abnormal thinking or hallucinations).

Ritalin Side Effects – Nervousness and insomnia are the most common adverse reactions but are usually controlled by reducing dosage and omitting the drug in the afternoon or evening.

Other reactions include hypersensitivity (including skin rash, urticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vasculitis, and thrombocytopenic purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia; drowsiness; blood pressure and pulse changes, both up and down; tachycardia; angina; cardiac arrhythmia; abdominal pain; weight loss during prolonged therapy.

Autism

A new scientific study has uncovered evidence suggesting a link between low levels of anti-depressants and other psychoactive drugs in drinking water supplies and the triggering of Autism.

The New Scientist [PLoS One, DOI: 10.1371/journal.pone.0032917 (June 2012)] reports that a study, undertaken by professor of evolutionary biology Michael Thomas of Idaho State University in Pocatello, found that just traces of selective serotonin uptake inhibitors (SSRIs) such as prozac, a common anti-depressant medication, had significant effects on the neurological activity of fish.

Thomas exposed fathead minnows to the drugs for a period of just under three weeks in doses comparable with the highest estimated environmental levels, and found that the exact same genes turned on in people with autism were also triggered in the fish after exposure.

“While others have envisioned a causal role for psychotropic drugs in idiopathic autism, we were astonished to find evidence that this might occur at very low dosages, such as those found in aquatic systems.” Thomas said. Thomas notes that his findings could indicate that residues of psychiatric medications found in the drinking supply may be a cause of autism in humans.

The study notes that its findings dovetail with previous research indicating that pregnant women who take SSRIs are more likely to have autistic children. It also adds weight to research that has previously found a link between Psychiatric drugs and autism-like symptoms in rats exposed to the medicines. []

Hypersomnolence

Ritalin or other stimulant drugs have been used successfully in controlling the need to sleep during the day. One such is Provigil, a wake-promoting drug which improves wakefulness in patients with excessive daytime sleepiness (EDS) associated with narcolepsy or hypersomnia, without affecting nighttime sleep.

Idiopathic hypersomnia is usually treated with stimulant medications such as amphetamine, methylphenidate, and modafinil. These drugs may not work as well for this condition as they do for narcolepsy.

Meniere's Disease

Your doctor may prescribe medications to be taken during an episode of vertigo to lessen the severity of an attack:

There are several classes of medications that may help.

Motion sickness medications, such as meclizine (Antivert) or diazepam (Valium), may reduce the spinning sensation of vertigo and help control nausea and vomiting.

Anti-nausea medications, such as prochlorperazine, may control nausea and vomiting during an episode of vertigo.

Long-term medication use can reduce fluid retention (diuretic), such as the drug combination triamterene and hydrochlorothiazide (Dyazide, Maxzide). Reducing the amount of fluid your body retains may help regulate the fluid volume and pressure in your inner ear. For some people a diuretic helps control the severity and frequency of Meniere’s disease symptoms.

Bulimic Tendency

Research has lead to the development of selective serotonin reuptake inhibitors (SSRIs) to regulate serotonin in the body while suppressing food craving and promoting weight loss. Fluoxetine (Prozac) and fluvoxamine (Luvox) are two such inhibitors. To date, fluoxetine is the only drug approved by the FDA.

One study has shown that there is little difference between groups that incorporate the use of fluoxetine and psychotherapy and groups with psychotherapy alone (who were given a placebo). Both groups showed tremendous improvement in eating behaviors. The only observable difference was significant weight loss with the group receiving the fluoxetine. However, other studies have shown that when no psychotherapy is used, groups receiving fluoxetine produce dramatically different results than do groups receiving a placebo. Those receiving fluoxetine displayed improved eating behaviors and mood, while those receiving a placebo did not.

Edema (Water Retention)

There is no single, accepted gold standard treatment for idiopathic cyclic edema. Several different treatments have been reported. An agent used for treating high blood pressure called Captopril has also been used with success. It works against the kidney hormone aldosterone which is elevated in this condition and causes excess salt and water retention.

Sometimes a mild diuretic will help reduce fluid retention but can worsen the edema of idiopathic cyclic edema. While one would think that taking a “water pill” or diuretic would improve this edematous condition, it turns out that in most cases this is the wrong long term treatment. In fact, chronic diuretic use will increase the secretion of aldosterone which in turn produces more edema. If the chronic use of diuretics is discontinued, the cyclical swelling disappears in most cases within about 3 weeks.

Patients experiencing a disturbance in their ability to normally excrete salt may need to either be placed on a diet limited in salt and/or given diuretic medications. In the past, patients with diseases associated with edema were placed on diets that were very restricted in salt intake. With the development of new and very potent diuretic agents (water pills), this marked restriction in dietary salt intake is generally no longer necessary. These diuretics work by blocking the reabsorption and retention of salt by the kidneys, thereby increasing the amount of salt and water that is eliminated in the urine.

Nephrotic Syndrome (NS)

People with NS may be at risk for developing a blood clot in the legs or in the renal veins that transport blood from the kidney. Some patients take blood thinners to prevent this complication.

Controlling hypertension is essential in reducing proteinuria in NS. This is accomplished with angiotensin converting enzyme (ACE-1) inhibitors. ACE-1 inhibitors are the preferred blood pressure lowering medication because they provided added protection to the kidneys.

ACE-1 inhibitors cause a dry cough in approximately 8% of patients who take them. ACE-1 inhibitors are given in the highest dose tolerable to ensure kidney protection. If a patient develops a cough, a new class of drugs may be used, known as angiotensin receptor blockers (ARB). ARBs work by blocking angiotensin receptors, which blocks the effects of angiotensin after it is produced. They offer the same kidney protection as ACE-1 inhibitors without causing cough. If tolerable, ARBs may be combined with an ACE-1 inhibitor for added benefit.

Acute, Intermittent Porphoria

Medications and drugs are often the worst triggers. The following drugs can percipitate an attack of AIP and should be AVOIDED:

Metabolic Syndrome (Syndrome X)

ACTOS is a once-a-day prescription medication for type 2 diabetes that, along with healthy eating and physical activity, helps your body control blood sugar (glucose) levels. ACTOS makes the cells in your body more sensitive to insulin, a hormone produced by the pancreas that allows the cells in your body to use blood sugar for energy.

ACTOS can be used by itself or in combination with certain other diabetes medications (sulfonylureas, metformin, or insulin) when your necessary efforts at healthy eating and physical activity do not control your blood sugar levels.

ACTOS is a member of the type of oral diabetes medications called thiazolidinediones.

Headaches, Cluster

Subcutaneously injected sumatriptan (6mg in 0.5ml) (Imitrex in the US) is the most effective, reliable, and rapid abortive therapy for cluster headache attacks. An injection (easily given by the patient) eliminates or markedly diminishes cluster headaches within 15 minutes in essentially all patients at every attack. Some patients have had headaches eliminated in as little as 7 minutes. This effect does not lessen with continued use. Some patients have had satisfactorily rapid results with sumatriptan nasal spray. The oral triptans are less effective, but some especially good responders with relatively milder and slower-developing headaches may prefer this route of administration.

Insomnia

Use of benzodiazepine medications for sleep disorders has become more and more common, and is implicated in a long list of side effects and difficult withdrawal symptoms. Benzodiazepines are often found under the following names, Xanax (Alprazolam), Valium (Diazepam), Ativan, Alzapam (Lorazepam), Halcion (Triazolam), Klonopin (Clonazepam), and Restoril, among others. Patients often find it very difficult to withdraw from these medications, and at the same time long-term medication with these drugs is often discouraged due to the addictive nature of the drugs and the accompanying side effects.

HOWEVER, restorative sleep is so important, if natural methods do not provide the deep sleep needed, a prescription drug may be worth trying.

Americans spent $2.1 billion on prescription sleeping pills in 2004, and bought 600 million over-the-counter ones. But many of these medicines, including antihistamines and antidepressants, haven’t been proven safe and effective for the problem. And almost none of them have been approved for long-term use by the Food and Drug Administration (FDA), yet they are often taken for months or years. [USA Today July 27, 2005]

Since 1998, my colleagues and I found gabapentin (Neurontin) to fit the above description of the ideal pharmacotherapy for insomnia among alcoholics and substance users (Karam-Hage and Brower, 2000). To date, we have yet to observe any abuse or subjective effects reported by patients. In 2000, we reported an open-label study of 15 successfully treated cases. Gabapentin was started at 300 mg hs, the dose was increased to response by 300 mg/day to reach a maximum of 1800 hs (average dose=900 mg) with follow-up at one month. [Psychiatric Times, February 2004, Vol. XXI, Issue 2]

Headaches, Migraine/Tension

The regular and frequent use of conventional drugs should be avoided when possible. While pain killers may provide relief, they don’t deal with the cause of the problem. Pain medications, though apparently effective, may even aggravate the problems they attempt to solve. The use of medication, even in quantities as low as ten aspirin tablets per week, can be the cause of a chronic daily headache syndrome. One medical study found that stopping all treatments and pain medication actually decreased headache frequency and intensity in the subjects by more than 50%. The best thing to do when tolerable and circumstances allow is to avoid taking medication and assist the body’s detoxification process.

Gout / Hyperuricemia

Medications such as NSAIDs, corticosteroids and allopurinol are commonly used against gout.

Since the 1800s, colchicine has been the standard treatment for acute gout. While colchicine is very effective, it often causes nausea, vomiting and diarrhea. These side-effects are uncommon when this drug is given intravenously, but because of their unpleasant nature, non-steroidal anti-inflammatory drugs (NSAIDs) have become the treatment of choice for most acute attacks of gout. The NSAID that is most widely used to treat acute gout is indomethacin. NSAIDs may also have significant toxicity, but if used for the short-term, are generally well tolerated. Aspirin and aspirin-containing products should be avoided during acute attacks because they will further elevate uric acid levels.

Therapy directed at normalizing uric acid levels in the blood should be considered for patients who have had multiple gout attacks or have developed tophi or kidney stones. Several drugs that help the kidneys eliminate uric acid are available, such as probenecid, and a drug that blocks production of uric acid by the body, such as allopurinol. The choice between these two types of drugs depends on the amount of uric acid in the urine. With correct treatment, gout should be well controlled in almost all cases.

Rheumatoid Arthritis

Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into two products: 5-aminosalicylic acid (5ASA), and sulfapyridine. There is some controversy as to which of these two products are responsible for the activity of azulfidine. Whereas it is known that 5ASA has therapeutic benefit, it is not clear whether sulfapyridine adds any further benefit. In the colon, the products created by the breakdown of sulfasalazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulfasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immune-suppressant effect as well. Following oral administration, 33% of the sulfasalazine is absorbed, all of the sulfapyridine is absorbed, and about 33% of the 5ASA is absorbed. Sulfasalazine was approved by the FDA in 1950.

Plaquenil may be used for short or long-term rheumatoid arthritis treatment. In treating rheumatoid arthritis, Plaquenil may slow down the substances which harm the joints.

Centocor, Inc., Schering-Plough Corporation, and Mitsubishi Tanabe Pharma Corporation have announced that an estimated one million patients have now been treated with REMICADE® (infliximab), the leading anti-tumor necrosis factor (TNF)-alpha therapy worldwide (2007). In fact, REMICADE has been used to treat more patients worldwide than all other anti-TNF-alpha agents combined. REMICADE was the first anti-TNF-alpha treatment approved by the U.S. Food and Drug Administration (FDA), when it was indicated for the treatment of acute moderate to severe Crohn’s disease in 1998. The indication for Crohn’s disease was quickly followed by additional indications, such as rheumatoid arthritis.

“Rheumatoid arthritis derailed my life,” said Ellen Shmueli, RA patient. “Simple tasks like lifting my child or holding a pen were nearly impossible. It’s hard to put into words what REMICADE has meant to me.”

Through a long line of firsts in the biotechnology industry, the history of REMICADE includes 15 FDA indications spanning across inflammatory diseases that include Crohn’s disease (adult and pediatric), ulcerative colitis, rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis and psoriasis.

“This significant milestone was achieved as a result of nearly three decades of expanding and improving access for people living with life-altering inflammatory diseases,” said Neal Fowler, President, Centocor, Inc. “In partnership with Centocor R&D, we will continue our pledge of bringing the promise of biomedicine to physicians and patients through continued research and development, REMICADE and our promising pipeline portfolio.”

REMICADE has been studied in more than 37 clinical trials, evaluating its use in a wide variety of diseases of the immune system and is approved for use in 88 countries.

Osteoarthritis

First US approval for a prescription NSAID (non-steroidal anti-inflammatory drug) treatment that can be applied directly to site of osteoarthritis pain (October 2007). Voltaren Gel is the only prescription topical medication proven to significantly reduce osteoarthritis pain in both the knees and the joints of the hands.

Voltaren Gel offers highly effective pain relief with minimal drug absorption throughout the body – shown to be 94% less than comparable oral diclofenac treatment. Voltaren Gel (diclofenac sodium topical gel) 1% has received US regulatory approval as the first topical prescription treatment that patients can apply directly to sites of pain associated with osteoarthritis.

Juvenile Rheumatoid Arthritis

The U.S. Food and Drug Administration (FDA) approved Celebrex (celecoxib) for a new use – the relief of the signs and symptoms of Juvenile Rheumatoid Arthritis (JRA) in patients two years of age and older. This approval follows the November 29 meeting of FDA’s Arthritis Advisory Committee, in which the committee voted 15 to 1 in favor of approval of this product. [29 Dec 2006]

Peyronie's Disease

The most favorable nonsurgical treatment for Peyronie’s involves injecting medication directly into the plaque in the attempt to soften the hardened tissue and decrease the pain and curvature. Injection medications include steroids, collagenase, verapamil and interferon. It is not yet clear which of these substances works best, although collagenase and verapamil appear the most promising at this time.

Osteoporosis / Risk

Servier, a leading independent French research-based pharmaceutical company, discovered and developed Protelos. Protelos has been recently licensed across Europe in the treatment of postmenopausal osteoporosis to reduce the risk of vertebral and hip fractures. It is the first agent of its kind with a dual action on bone metabolism, simultaneously increasing bone formation and decreasing bone resorption. This action rebalances bone turnover in favour of the formation of new and strong bone.

The results of two large-scale phase III clinical trials have shown that Protelos is effective at reducing the risk of vertebral and hip fractures in postmenopausal osteoporotic women. Results published in the New England Journal of Medicine from the first major clinical trial show that in women with existing vertebral fractures the risk of new vertebral fractures is halved within a year and in the longer-term. This efficacy has also been confirmed in patients without fracture at baseline. Recent results from the second major clinical study show that Protelos also significantly reduces the risk of hip fracture in postmenopausal osteoporotic patients . These results show the efficacy of Protelos whatever the severity of the disease and the site of fracture. Throughout its development Protelos was shown to be safe and well tolerated. Protelos is easy for patients to take; one sachet daily diluted in water taken at bed time.

Although Evista is frequently recommended for osteoporosis, a study indicated that calcium and vitamin D alone may produce the same benefit.

Two years of treatment with calcium at 500mg per day and vitamin D3 at 400-600IU per day plus placebo increased iliac crest bone mineral density similarly to calcium and vitamin D3 plus raloxifene (Evista; 60 mg/d or 120 mg/d) in a randomized, three-arm study of 54 postmenopausal women with osteoporosis. Compared to baseline, all treatments shifted the mean degree of bone mineralization to closely resemble that of premenopausal bone. [ J Clin Endocrinol Metab 2003;88(9):4199-4205]

A long-term study of the most widely used osteoporosis drug has found that many women can discontinue the drug after five years without increasing their fracture risk for as long as five more years.

The study on alendronate (fosamax) was led by researchers at the University of California, San Francisco, and findings are published in the December 27, 2006 issue of the “Journal of the American Medical Association.” The research also showed that women at very high risk of painful spine fractures might be better-off continuing treatment.

“This has important implications as it has not been known whether treatment of osteoporosis should be continued indefinitely,” said lead author Dennis Black, PhD, professor in the UCSF Department of Epidemiology and Biostatistics. “Because women with osteoporosis, particularly older post-menopausal women, often need to take multiple drugs, this would be welcome news for this group.”

Fosamax Once Weekly (alendronate sodium) increased bone mineral density (BMD) more than Actonel Once-a-Week (risedronate) with similar tolerability, according to results of the Fosamax Actonel Comparison Trial (FACT). This is the first U.S. head-to-head study comparing FDA approved once weekly osteoporosis treatments in postmenopausal women with osteoporosis. In this study, Fosamax provided greater increases in BMD at all sites measured as early as six months, and lowered levels of biochemical markers of bone turnover further within the normal pre-menopausal range than Actonel within three months. Reducing and stabilizing bone turnover, which leads to increased bone density, are important factors in improving bone strength in patients with osteoporosis.

However, Merck, maker of osteoporosis drug Fosamax, may have “seriously under reported” the risks of “jawbone death” related to the drug, according to the American Association of Oral and Maxillofacial Surgeons. A class-action lawsuit has been filed claiming that Merck knew about the risk of jawbone death but hid it from the public.

“Jawbone death” is associated with the use of a bisphosphonate class of drugs (to which Fosamax belongs). Also known as Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ), is a serious side effect that destroys the bone in the jaw, and is difficult to treat.

BRONJ was reported by oral surgeons, who noticed the condition among patients treated with intravenous forms of bisphosphonates in 2003. A broader warning of BRONJ was issued for the entire class of drugs in 2005.

Fosamax is prescribed to about 10 million men and women — mostly postmenopausal women — each year to help increase bone density, with annual sales of $3 billion. Over 190 million prescriptions for oral bisphosphonate drugs have been dispensed worldwide. [LawyersAndSettlements.com July 19, 2007]

Restless Leg Syndrome (RLS) / Periodic Limb Movement Disorder (PLMD)

Apart from the use of drugs to treat RLS, components used in the manufacture of drugs or supplements may be causing or aggravating the problem. If you can remember having started taking a new medication or supplement shortly before the onset of symptoms, consider stopping it for a time to see if symptoms improve. You may also wish to consider stopping all ‘unnecessary’ supplements to see if any of those may be causing the problem.

Gabapentin was effective for restless leg syndrome (RLS), according to the results of a double-blind crossover study published in the Nov. 26, 2002 issue of Neurology. Longer studies will be needed to confirm long-term tolerability of this drug.

“Gabapentin may be a potent agent for treatment of even severe RLS, without the disadvantages of long-term complications of previously favored treatments,” study author Diego Garcia-Borreguero, MD, from the Fundacion Jimenez Díaz in Madrid, Spain, says in a news release.

Generally, there are three classes of drugs that are used to treat PLMD and RLS. These are benzodiazepines, Parkinson drugs, and narcotics. Medical treatment of PLMD and RLS often significantly reduces or eliminates the symptoms of these disorders, though not always. There is no cure for PLMD or RLS, and medical treatment must be continued to provide potential relief.

Clonazepam is the most commonly employed benzodiazepine treatment. It is effective in many cases, but not all, and it usually causes drowsiness or sedation. Sometimes, clonazepam allows the patient a better, more restful night’s sleep without affecting the occurrence of limb movement. Patients with PLMD may have other sleep disorders, such as obstructive sleep apnea, which the use of clonazepam could worsen.

The drugs used to treat Parkinson’s disease are also very effective against PLMD and RLS. These include, L-dopa/carbidopa, bromocriptine (which suppresses the excretion of prolactin), pergolide, and selegiline. If either benzodiazepines or Parkinson’s medications do not relieve symptoms, then narcotics, such as codeine, oxycodone, methadone, and propoxyphene are sometimes employed.

In May of 2005, ropinirole HCl (Requip®), which also is used to treat Parkinson’s disease, was approved by the Food and Drug Administration (FDA) to treat moderate-to-severe (i.e., 15 or more episodes per month) restless legs syndrome. This medication may result in extreme drowsiness and may cause patients to fall asleep during daily activities (e.g., driving). Other side effects include dizziness, nausea and vomitting, sweating upon standing

Knee Pain

Please see the link between Knee Pain and Hyaluronic Acid.

Costochondritis

Cortisone shots are one way of reducing the inflammation of costochondritis but repeated injections are not recommended as they are said to weaken the cartilage after extended periods of use.

Muscle Cramps / Twitching

Medications such as diuretics or water pills can lead to cramping due to loss of sodium and potassium.

Bell's Palsy

If you do decide to use conventional medications that may help relieve the compression, such as prednisone and antivirals, they should be started as quickly as possible. The “window of opportunity” for starting these medications is thought to be 7 days from the onset of Bell’s palsy.

Seizure Disorder

Many anti-epileptic drugs inhibit glutamine synthase, which may partly explain their toxic side effects.

Tremors

The following drugs, medications, substances or toxins are some of the possible causes of Tremors as a symptom.

This list is incomplete and various other drugs or substances may cause your symptoms.

* Alcohol

* Amphetamine intoxication – in high doses.

* Ancobon

* Blanex

* Caffeine

* Certain asthma medications

* Certain epileptic medications

* Chlorofon-F

* Chlorphenesin Carbamate

* Cocaine

* Compazine

* Dilantin

* Enoxacin

* Enoxin

* Flexaphen

* Flucytosine

* Illicit drugs

* Lobac

* Maolate

* Miflex

* Mus-Lac

* Paraflex

* Parafon Forte DSC

* Pargen Fortified

* Polyflex

* Skelex

* Theophylline

* Valproic acid (Depakote)

Neuritis/Neuropathy

Atenolol, a beta-blocker, is one of any number of drugs that can have side effects. Fatigue is a common side-effect and paraesthesia, peripheral neuropathy and myopathies have been reported.

Diabetes Type II

Many diabetics are able to control their blood sugar levels by natural means alone. When, for whatever reason, this is not possible, insulin use may be needed. The type of insulin and dose will need to be worked out carefully under your doctor’s supervision.

The pharmacokinetics of insulin absorption are influenced by the insulin species, the dose, exercise of the injection site and the interaction of various modified insulin preparations. Human insulin is absorbed more rapidly than animal insulins, however when considering basal insulin requirements, beef and pork insulins have a longer duration of action and for most purposes can be considered peakless when compared with human insulin. Many reports have indicated an increased frequency of hypoglycemia unawareness with human insulin when patients are switched from beef/pork insulins

Metformin (not a type of insulin) is the generic version of Glucophage. Even though it should be chemically identical, many who have tried both find they have less side-effects on the patented form.

If essential fatty acid metabolism is badly broken and the supplementation of GLA (gamma-linolenic acid) will not produce the necessary products in the quantities needed, then also the drug pentoxifylline can be used. Pentoxifylline has a more immediate effect, while EPO (evening primrose oil) is slower, but has a more complete spectrum of effects in managing the fatty acid deficiencies that diabetics suffer from. EPO and pentoxifylline used over a longer time (4 months to 1 year) cause the blood to become thinner – which is not a bad thing for diabetics – but is a bad thing if it is excessive which can lead to bruising and slower wound-healing. Getting the correct balance might require some attention.

2009. Clinical studies demonstrate that SYMLIN, a self-administered injection given prior to meals, helps patients achieve lower blood glucose (sugar) after meals, leading to less fluctuation during the day, and better long-term glucose control (A1C) compared to patients taking insulin alone. In these studies, patients used less mealtime insulin and also had a reduction in body weight compared to patients taking insulin alone. SYMLIN was studied in over 5300 individuals in the clinical program that led to approval by the FDA.

Diabetes is an example of a condition that primarily results from chronically consuming processed foods – the Standard American Diet (SAD). We consume sugars in excess, and because nothing bad happens immediately, think that everything is fine. Insulin resistance, weight gain, and diabetes develop slowly. Even when one generation escapes the consequences, thenext generation will harvest them.

Just like with finances. When spending is out of control, and we spend what we don’t have, we are in effect borrowing from the future. The consequences are only being delayed.

As Moses said, “Be sure your sins will find you out.” And so it is with the insulin-related conditions. The chickens are coming home to roost.

Not only is our uncontrolled desire for sweets driving this, but food manufacturers, competing for our food dollars, want people to chose their product over others, even to the point of promoting addiction. When it is all about profit and pleasure, there are sure to be unwanted consequences.

The medical and pharmaceutical community is also profit motivated. Very often, the ‘solution’ to the problem has nothing to with the cause. This becomes reinforced when we desire a quick fix and aren’t willing to break free from our pattern of poor choices. Thus we have new drugs to solve problems, without addressing the cause.

As an example, look at all the research being done to discover new marketable drugs to solve the problem of insulin resistance. Here is an article from http://www.diabetesselfmanagement.com/Articles/Diabetes-Definitions/incretin-hormone/.

The solution isn’t chemistry, it is choices. Bad choices will always produce bad fruit and good choices will always produce good fruit – eventually.

“A hormone that stimulates insulin secretion in response to meals. The two most important incretin hormones are called glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Understanding how these hormones work is helping to yield new treatments for Type 1 and Type 2 diabetes.

Other experimental drugs called DPP-IV inhibitors also affect incretin hormone levels. Dipeptidyl peptidase IV (or DPP-IV) is an enzyme that normally breaks down GLP-1 and GIP. A number of pharmaceutical companies are working on DPP-IV inhibitors, which block the action of this enzyme and therefore leave more of the bodyís own GLP-1 and GIP in circulation. DPP-IV inhibitors have been shown to improve blood glucose control, enhance the insulin secretory response, and increase insulin sensitivity in animal and human studies. In rats with chemically induced diabetes (a model of Type 1 diabetes), DPP-IV inhibitors increased the number of pancreatic islets and beta cells. More, longer-term studies of DPP-IV inhibitors in humans are now under way.”

Uveitis

Many uveitis specialists treat intermediate uveitis according to the method outlined by Kaplan. Patients whose visual acuity is better than 20/40 are generally not treated, unless they have CME, extensive neovascularization of the peripheral retina, extensive vasculitis, or if they complain of severe floaters. Patients whose visual acuity is 20/40 or worse usually are treated. As with most forms of uveitis, corticosteroids are the mainstay of therapy.

Topical therapy with prednisolone acetate 1% or prednisolone sodium phosphate 1% is only helpful in the treatment of the anterior segment inflammation. The intravitreal concentration of drugs administered topically is too low to be efficacious in the face of moderate-to-severe vitritis, especially in the phakic patient.

Periocular injections of corticosteroids are preferentially given in unilateral cases and occasionally in bilateral cases. Triamcinolone acetonide can be administered superotemporally into the sub-Tenon space or through the inferior eyelid into the retroseptal space. If the disease is not controlled after 2-3 injections given over an 8-week period, systemic prednisone should be considered. Some authorities advocate the use of a combination of betamethasone and depot methylprednisolone in an effort to achieve early onset and prolonged duration of action.

Oral prednisone may be the preferred treatment in patients with bilateral intermediate uveitis or in cases resistant to topical or periocular steroids. A purified protein derivative (PPD) test is imperative prior to starting any patient on systemic corticosteroids if there are any risk factors for TB. Once the inflammation stabilizes, the oral dose is tapered according to disease activity. An H2 blocker (Tagamet or Zantac) or a proton pump inhibitor (Prilosec or Prevacid) can be prescribed adjunctively to oral steroids.

Finally, intravitreal triamcinolone acetonide injections have been used to treat CME. In a small series by Androudi et al of 16 patients (20 eyes) with noninfectious uveitis and CME, of which 3 had intermediate uveitis, visual acuity improved in 11 eyes and improved but returned to baseline levels in another 5 eyes, respectively.

For recalcitrant cases with high corticosteroid requirements to control the inflammation, the surgical implantation of a device releasing fluocinolone acetonide in the vitreous can be considered (see Surgical Care).

In the event that corticosteroids cannot control the intermediate uveitis or in those whose disease invariably flares when steroids are discontinued, immunosuppressive therapy often is attempted. Immunosuppression or immune-modulation is also used as part of the concept of steroid-sparing therapy in an effort to reduce the patient’s requirement for systemic corticosteroids and, therefore, to diminish the adverse effects of systemic corticosteroid therapy.

Cyclosporine, tacrolimus, azathioprine, and methotrexate are the most commonly used agents with documented efficacy in many uveitic conditions. Chlorambucil can be considered for intractable cases. They can be used concurrently with corticosteroids as steroid sparing agents or alone.

Murphy et al prospectively evaluated the efficacy and the safety of cyclosporine and tacrolimus in patients with posterior and intermediate uveitis. The 2 agents did show a similar response rate (approximately 67%), but cyclosporine was associated with a higher incidence of adverse effects.

The use of infliximab, an anti-tumor necrosis factor (anti-TNF) monoclonal antibody, has been shown to be effective in improving macular thickness and visual acuity in patients with uveitic refractory CME due to intermediate uveitis or other noninfectious uveitis. Initial successful reports by Markomichelakis et al were duplicated by Rajaraman et al in a pediatric population in which infliximab achieved reduction in intraocular inflammation with concurrent elimination or decrease in steroid requirements.

More recently, daclizumab, an interleukin-2 receptor blocking antibody, has been shown to be effective in noninfectious uveitis in a multicenter nonrandomized interventional case series. It allowed control of ocular inflammation with stability in visual acuity with reduction of concomitant immunosuppression by at least 50%.

Finally, interferon-beta (INF-beta), which has an established value in the treatment of MS, appears to have a positive effect in terms of visual acuity, CME, and aqueous and vitreous inflammation in intermediate uveitis associated with MS. This information was taken from emedicine.com.

Gallbladder Disease

Oral dissolution therapy with ursodiol (Actigall) and chenodiol (Chenix) works best for small, cholesterol gallstones. These medicines are made from the acid naturally found in bile. They most often are used in individuals who cannot tolerate surgery. Treatment may be required for months to years before gallstones are dissolved.

Mild diarrhea is a side effect of both drugs; chenodiol may also temporarily elevate the liver enzyme transaminase and mildly elevate blood cholesterol levels.

Glaucoma/Risk

Nearly all the medications for glaucoma are aimed at reducing eye pressure. Lowering IOP is even proving to be beneficial for about two-thirds of patients with normal pressure glaucoma.

Often, glaucoma is treated first with medication or laser therapy is tried. If these treatments fail or are thought likely to fail, filtration surgery is offered. However, in certain situations (especially when medication cannot be tolerated) filtration surgery may be used initially.

With new glaucoma drugs, such as topical alpha2-selective adrenergic agonists, topical carbonic anhydrase inhibitors, and topical prostaglandin analogs, medical therapy is slowly changing.

Pancreatectomy

Blood sugar should be monitored regularly if insulin production is reduced due to limited pancreatic output. Insulin replacement may be necessary.

Pancreatitis

In one study on acute pancreatitis, PTX (Pentoxifylline) was shown to reduce pancreatic inflammation and attenuate the depletion of pancreatic glutathione. PTX also inhibited the expected increase in TNF-a levels and prevented mitochondrial damage. Mitochondria are the power plants within all of our cells. The scientists suggested that PTX be considered as an adjuvant treatment of acute pancreatitis. [Gomez-Cambronero et al. 2000]

Enlarged Prostate

Finasteride (Proscar or Propecia) is a medication that helps shrink the prostate in many men. This can lead to improvement of symptoms.

Hepatitis

A news release in April, 2003 suggested that a new generation of drugs restores the immune response blocked by the hepatitis C virus, reducing the virus to nearly undetectable levels in a matter of days. This is according to researchers at UT Southwestern Medical Center at Dallas and UT Medical Branch at Galveston.

“We found that the new protease inhibitors could actually prevent the virus from blocking this immune response and basically restore the innate antiviral response in human cells,” said Dr. Michael Gale, assistant professor of microbiology at UT Southwestern and senior author of the study, published online today in Science Express. “Our conclusion is that these new drugs will have a dual efficacy.”

Protease inhibitors, which are already undergoing clinical trials as therapies to treat chronic hepatitis C infections, target the enzymatic activity of the viral protease. Protease, an enzyme that can split a protein into component peptides, is required to process viral proteins into their functional forms.

November 02, 2006 – Saint Louis University Liver Center scientists are presenting research today on a more effective way to treat hepatitis C patients who have been unresponsive to current drug therapies.

They have shown that a cocktail of ribavirin and Infergen, a highly potent Interferon, is nearly twice as effective at controlling hepatitis C than standard treatments. They are sharing their findings at the annual American Association for the Study of Liver Diseases meeting in Boston.

“The results are promising,” says Bruce R. Bacon, M.D., principal investigator and director of the division of gastroenterology and hepatology at Saint Louis University School of Medicine. “This group of non-responders is a very challenging population to treat, and we found that patients who followed through with the therapy had a response nearly twice that of previous trials looking at this population.”

Saint Louis University Liver Center researchers led a study of more than 500 patients with hepatitis C at 40 sites, 77 percent of whom had advanced fibrosis. Fourteen percent of patients taking 9mcg of Infergen daily and 20 percent taking 15 mcg were virus negative after six months.

A quarter of the non-cirrhotic patients receiving Infergen were also virus negative after 24 weeks. The optimal response to antiviral therapy is for the hepatitis C viral RNA to become undetectable on treatment and to remain undetectable for at least another six months off therapy; this is referred to as a sustained virologic response, essentially a cure of the disease. Rates of sustained virologic response are still to be determined in this ongoing study.

Myocarditis

Hypersensitivity myocarditis has been associated with the use of methyldopa, hydrochlorothiazide, ampicillin, furosemide, digoxin, tetracycline, aminophylline, phenytoin, benzodiazepines and tricyclic antidepressants. [Archives of

Pathology and Laboratory Medicine, August, 1991;115: pp.764-769]

Low Back Pain / Problems

Colchicine has been regarded by some as the most powerful anti-inflammatory agent known to man. The beneficial effects of colchicine in the treatment of gout are apparently secondary to its ability to inhibit both the metabolic and phagocytic activity and migration of granulocytes. Colchicine’s inhibition of the release of histamine containing granules from mast cells is also believed secondary to its interference with granule transportation by the microtubular system. While beneficial in the treatment of the crystal-induced inflammation observed in gout and pseudogout, colchicine is only occasionally effective in the treatment of other types of arthritides (arthritis).

Over the past 30 years, Rask has treated thousands of patients with resistant disc disorders with oral and intravenous colchicine and has noted a 90-95% improvement rate. Since 1979, he has published the results of his uncontrolled studies, some involving up to 500 patients, who have suggested significant therapeutic benefits from colchicine therapy with fewer adverse effects than typically associated with the use of aspirin.

In a 1985 double blind study of 39 patients with low back pain of at least two months duration, Meek compared combined intravenous and oral colchicine treatment with placebo. Patients in the treatment group received colchicine .6-mg orally b.i.d. (twice a day) for 14 days and one-mg IV (intravenous) on days one, four and eight of the 14 day study period.

Adverse Effects

While no real effect from placebo administration was observed, the treatment group demonstrated significant improvements in pain, weakness, leg raising limitations, and muscle spasm. Adverse effects from colchicine administration were documented in only one patient in the form of a burn at the IV site. In a double blind study of oral colchicine in the treatment of low back pain, Schnebel and Simmons compared oral colchicine with placebo in 34 patients with low back symptoms of less than three months duration. Over the 12-week study period, both groups of patients continued in a comprehensive physical therapy program and were administered NSAIDs and muscle relaxants. No significant differences in therapeutic response were noted between the treatment and placebo groups, but an increased number of adverse effects, mainly diarrhea and vomiting, were observed in the colchicine group. This study has several limitations, including a small sample size, multiple etiologies of low back pain, poor patient compliance, and the use of concomitant treatments.

Contraindications

Colchicine use is contraindicated those patients with serious gastrointestinal, renal, hepatic or cardiac disease. Colchicine can also harm the fetus when used during pregnancy. When administered intravenously for the treatment of an acute gouty attack, the total dosage over the first 24-hours should not exceed four milligrams, as greater cumulative dosages have been associated with multiple organ failure and death.

Abdominal pain, nausea, vomiting, and diarrhea, are typically the earliest and most common adverse effects associated with colchicine over dosage.

Pulmonary Fibrosis / Interstitial Lung Disease

Prednisone is the most common drug given to patients with idiopathic pulmonary fibrosis. About 30% of all patients respond favorably to this medicine. It is not understood why some patients do well on prednisone while others do not. Prednisone is taken orally mouth every morning, starting with a high dose for the first 4 – 8 weeks. As improvement occurs, the dose is gradually lowered. Changes in mood are one of the more common side effects. Most patients can handle these changes (anxiety, depression, or sleeplessness) when they know what is causing the problem. Less common side effects include a rise in blood-sugar levels, osteoporosis, high blood pressure, cataracts, and increased susceptibility to infection.

Pentoxifylline (Trental) will help to suppress pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-a), which is a dangerous chemical messenger that incites the immune system to attack healthy tissues throughout the body. Elevated TNF-a causes a systemic inflammatory cascade throughout the body.

Captopril has shown protective effects on radiation-induced pulmonary injury. This drug was effective in protecting the lung parenchyma from inflammatory response and subsequent fibrosis. [Int. J. Radiat. Biol 2000 Apr:76(4): pp.523-32] ] The recommended dose is 400mgs per day for a week, then increased to 400mg BID.

Increased Risk of Prostate Cancer

Research suggests that an ingredient used in cough medicines for more than half a century may be an effective treatment for prostate cancer.

Dr Israel Barken, Moshe Rogosnitzky, and Dr Jack Geller tested the cough suppressant noscapine, a non-addictive derivative of opium, on mouse models of prostate cancer. Results showed that noscapine reduced tumor growth by 60% and limited the spread of tumors by 65%, all without causing harmful side effects.

This is not the first time that noscapine has been studied as a treatment for cancer. It has previously been studied as a treatment for breast, ovarian, colon, lung, and brain cancers, and for various lymphomas, chronic lymphocytic leukemia, and melanoma. However, because noscapine is a naturally-occurring substance it is non-patentable and thus finding financial backing for clinical trials has proven difficult.

Mosche Rogonsnitzky, of MedInsight Research Institute, a nonprofit organization committed to making doctors aware of commercially unsponsored medications, off-label (secondary) uses for approved medicines, long-lost therapies, and specialized tests that enable treatment to be tailored to the individual, said of the discovery: “Noscapine is effective without the unpleasant side effects associated with other common prostate cancer treatments. Because noscapine has been used as a cough-suppressant for nearly half a century, it already has an extensive safety record. This pre-clinical study shows that the dose used to effectively treat prostate cancer in the animal model was also safe.”

News release: New study shows that a cough medicine ingredient could effectively treat prostate cancer MedInsight Research Institute. December 18th 2008.

Cancer / Risk - General Measures

February 2008. Researchers from the University of Oklahoma have tested a chemical compound known as SHetA2, or Flex-Hets—a derivative of Vitamin A—that successfully prevents cancer from forming and spreading. The compound was reportedly effective against 12 types of cancer, including kidney and ovarian cancer, even when caught in later stages.

As reported in The Oklahoman, while clinical trials are still needed, the researchers hope to develop a pill that could be taken daily, like a multivitamin, to prevent cancer.

“These are exciting times when we’re working on a substance that prevents cancer from occurring or spreading,” said Dr. Robert Mannel, director of the University of Oklahoma Cancer Institute.

“This could dramatically and significantly improve our ability to successfully prevent and treat cancer,” said Dr. Mark Clanton.

COX-2 inhibitor drugs, so-called because they block an enzyme called cyclooxygenase-2 (COX-2), are used to treat the pain and inflammation. There is now compelling evidence that they may also protect against cancer. Mitch Gaynor, M.D., director of medical oncology at the Strang Cancer Prevention Center in New York, notes that suppressing COX-2 may be beneficial because, “the COX-2 enzyme helps make carcinogens much more active once they get into your body. The enzyme also allows cancerous cells to grow new blood vessels.”

There may be drug-free alternatives to the synthetic COX-2 inhibitors as close as your spice shelf. Although they do not have as powerful an action, it appears that certain foods are natural inhibitors of the COX-2 enzyme. By incorporating these foods in your diet, you can obtain some of the potential cancer-preventing benefits of the COX-2 inhibitors naturally.

Dipyridamole tends to prevent the attachment of cancer cells flowing in the blood circulation to the endothelium and thus tends to prevent the formation of metastases. Dr. Betty Rhodes (retired) has been disappointed that there has been no followup on this most hopeful indication that she has demonstrated of dipyridamole in treating melanoma. She feels that dipyridamole may be just as effective in treating many other forms of solid malignant tumors.

In a trial referencing the poor response to aspirin ine heart disease and stroke, dipyridamole was added to the treatment protocol and the results were outstanding. Over a two-year period, stroke deaths were decreased by 50%, deaths from myocardial infarction decreased by 38% and deaths from cancer by 25%. [ European Stroke Prevention Study, Lancet, December 12, 1987; pp. 1,371-4]

(Philadelphia)—Scientists at the University of Pennsylvania School of Medicine have found that a commonly prescribed diabetes drug kills tumor cells that lack a key regulatory gene called p53. Results from current studies in mice may result in new therapies for a subset of human cancers that tend to be aggressive and resistant to existing treatments. Additionally, the findings open up a new avenue for targeting cancers whose hallmark is the absence of this regulatory gene.

The Penn team reported their findings last month (July 2007) in Cancer Research.

“This is the first time you can show that tumor growth is impaired by a diabetes drug,” says senior author Craig B. Thompson, MD, Director of the Abramson Cancer Center and Chairman and Professor of Cancer Biology and Medicine. “It is specific for tumors that lack p53, which is the most common mutation in human cancer.”

More than half of all human cancers have lost the p53 gene. Yet even in an era of molecularly targeted therapies scientists have had trouble figuring out how to compensate for the absence of a gene. Unlike a genetic mutation that changes the function or activity of a gene, which can be inhibited by a well-tailored drug, loss of a gene leaves nothing for the drug to target.

Thompson and his team, however, have been accumulating evidence over the last several years that p53, best known as a regulator of cell division, controls several metabolic pathways in cells. For potential cancer therapies, that means a drug that affects pathways controlled by p53 could help control p53-deficient tumors.

Significantly, the regulation of metabolic pathways by p53 is also influenced by Metformin, the most widely used diabetes drug. Metformin activates the metabolic enzyme AMPK (AMP activated protein kinase), which exerts changes on cellular metabolism by affecting p53 function. Two observational studies already show that diabetic patients who take Metformin have a lower rate of cancer diagnosis and mortality than other diabetics.

Thompson’s group hypothesized that Metformin may specifically slow the growth of cancers that lack p53. To find out, they injected human colon cancer cells that have normal p53 function into one side of mice and colon cancer cells that lack p53 into the other side. Four days later they started treating the animals with a daily injection of either a saline control solution or with Metformin, using a dose comparable to diabetic treatment in humans.

Four weeks later, the p53-deficient tumors in mice treated with Metformin were half the size of the p53 deficient tumors in control mice. There was no difference in the size of the p53 normal tumors between the animals treated with Metformin or saline. They concluded that Metformin slowed the growth of the colon cancer cells that lack a normal p53 function.

Increased Risk of Alzheimer's / Dementia

Researchers found that clioquinol can almost stop the progression of Alzheimer’s disease. They believed that by absorbing the copper and zinc atoms that concentrate in the brains of Alzheimer’s sufferers, clioquinol could stop the onset of dementia before it starts. That could mean that this drug might be of use by a physician who is concerned about Alzheimer’s developing in a high risk patient. [Archives of Neurology December, 2003;60(12):pp.1685-91]

Please also see the link between Alzheimer’s and Conventional Drugs for a report regarding Rember.

Increased Risk of Pancreatic Cancer

A common asthma drug reduced pancreatic cancer cell growth in laboratory experiments and animal tests, a new study reports.

A protein called S100P is found in excess amounts in some cancers and is important for pancreatic cancer cell growth and survival. This protein also activates a cell surface protein receptor called RAGE that plays a role in Alzheimer disease, diabetes, and cancer.

A drug called cromolyn, an allergy and asthma treatment, has been shown to bind to proteins similar to S100P. To test cromolyn’s effects on S100P in pancreatic cancer cells, Thiruvengadam Arumugam, Ph.D., Vijaya Ramachandran, Ph.D., and Craig D. Logsdon, Ph.D., of the University of Texas M. D. Anderson Cancer Center in Houston, conducted experiments with the drug in tissue cultures and in mice with implanted pancreatic cancer.

They found that cromolyn bound to S100P, halted the activation of RAGE, and slowed cancer cell growth and survival in cell lines. In mice, the drug slowed pancreatic tumor growth and improved the effectiveness of gemcitabine, a chemotherapy drug used to treat pancreatic cancer.

“Together, these data support the further investigation of cromolyn as a possible treatment for pancreatic cancer,” the authors write. [JNCI December 20, 2006]

Increased Risk of Melanoma

Doctors in Surrey, England for the previous 11 years had been maintaining melanoma patients with Clark’s level IV and III disease on dipyridamole, 300mg a day. Thirty of these patients were maintained on this dose of dipyridamole. Of them, 26 had level IV disease and 4 had level III disease. At five years, the survival of the level IV patients was 74%. The five-year survival for the total of the 30 of level IV and III disease was 77%. None of the level III patients died. Reference was given that the expected five-year survival for level IV melanoma is 32%. In the case of melanoma, 100% of deaths are caused by distant metastases.[Lancet, March 23, 1985; p.693]

Increased Risk of Coronary Disease / Heart Attack

There are many reasons to believe that dipyridamole at 300mg a day will be far more effective in the prevention of heart attacks and strokes than aspirin. Moreover, dipyridamole has none of the harmful side effects of aspirin.

In patients at sufficient cardiovascular risk for myocardial infarction, the benefits for using aspirin do outweight the risks. [Cardiovascular Reviews and Reports, April 2004]

Dandruff

Nizoral is the only shampoo containing a patented active ingredient known as ketoconazole. This ingredient is proven to be effective against P. ovale and acts directly to inhibit growth of the fungus. This product is the number one choice of doctors and pharmacists, when recommending an anti-dandruff shampoo. The effects of Nizoral can last several days, making daily use unnecessary.

When using Head and Shoulders or Selsun Blue, go ahead and leave the shampoo on all night under a shower cap. This increases the killing time for the active ingredients, zinc and selenium.

Scabies / Mites

Doctors treat scabies by prescribing a medicated cream or lotion to kill the mites. The cream will need to be applied to the skin all over the body, not just the area with the rash, and usually must remain on the skin for 8 to 12 hours before it can be washed off. After applying it, don’t wash your hands – scabies mites love the area between the fingers! You may want to apply the medication before your child goes to bed, then wash it off in the morning.

Most often, the treatment needs to be repeated in 1 week.

Direct physical contact – like holding hands – is the most common way to transmit scabies, but because the mites that cause scabies can live as long as 2 to 3 days in clothing, bedding, or dust, it’s possible for your child to catch scabies from another person who shares the same infected bed, linens, or towels.

If someone in your family is being treated for scabies, all other members of the household should be treated, too. Clothing, sheets, and towels should be washed in hot water. Each room in the house should be vacuumed, and the vacuum cleaner bag should then be thrown away.

Eczema

Apollo Pharmaceuticals has conducted research to characterize the Pharmacological profile of Relieva, a topical preparation containing Psorberine in Novasome, a proprietary liposome formulation. The in vitro studies to specifically determine the immunoregulatory effects of Psorberine, a natural product, show that: it is a potent anti-inflammatory compound.

Because the clear anti-inflammatory profile of psorberine (in psoriasis) suggests that it might also be effective in atopic dermatitis, we decided to determine the efficacy and tolerability of Relieva in adult patients with Atopic Dermatitis (eczema) and an open label study was conducted in the USA. Forty two patients were enrolled in the 12 week trial carried out by Global Clinicals Inc. Efficacy and safety was assessed using EASI scores and a Subject Reported Questionnaire.

Study results showed significant improvements with respect to EASI scores by comparison to subject’s baseline scores. In addition, subjects responding to a post treatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching and appearance as a result of using the study preparation. September 2007.

“Relieva has exceeded our expectations in treating eczema because it was originally formulated to treat psoriasis but the new result for treating eczema and Atopic Dermatitis are amazing. These recent clinical trial and laboratory studies have been a pleasant surprise.” — D.J. Weiland

Male Hair Loss

A 5-year clinical study demonstrated that 9 of 10 men on Propecia had visible results (either regrowth of hair (48%), or no further hair loss (42%) compared to 25% on placebo, according to an assessment of photographs by an independent panel of dermatologists.

2 of 3 men on regrew hair, as measured by hair count. All the men in the study who were not taking Propecia lost hair.

A majority of men on Propecia were rated as improved by doctors – 77% vs 15% with placebo.

A majority of men on Propecia reported their bald spot getting smaller, their hair loss slowing down, and the appearence of their hair improving.

In the first year of the study, 86% of men on Propecia maintained hair or increased the number of visible hairs vs 42% on placebo.

Less than 2% of men experienced less desire for sex, difficulty in achieving an erection, and a decrease in the amount of semen. When the men who had these side effects stopped taking Propecia, the side effects went away.

Keep in mind that hundreds of different prescription drugs have been linked to hair loss!

Hyperhidrosis

Conservative medical treatments such as Drysol, Drionics or oral medications may be helpful for mild and moderate cases of hyperhidrosis, but are usually ineffective in cases of severe hyperhidrosis.

Erythema Nodosum

Treatments for erythema nodosum include antiinflammatory drugs, and cortisone by mouth or injection. Colchicine is sometime used effectively to reduce inflammation. Treatment must be customized for the particular patient and conditions present. It is important to note that erythema nodosum, while annoying and often painful, does not threaten internal organs and the long-term outlook is generally very good.

Seborrheic Dermatitis

Please see the link between Seborrheic Dermatitis and Topical Applications.

Concern Over Wrinkled Skin

Lotions such as Retin-A, alpha hydroxy or Renova help to exfoliate dead cells from the skin making it smoother. Retina-A and Renova contain a chemical that can cause cell production, which has been mutated by the sun, to return towards normal.

Pruritus Ani

The OTC medication Lotrimin cream mixed with hydrocortisone 1% cream can be applied daily. A mild alphahydroxyacid cream can help, as can plain vaseline applied each day to the anal area.

Hives

For many patients with hives of unknown cause, treatment with antihistamines is effective. This is because in people with hives, histamine is being released by mast cells in the tissues which in turn initiaties the irritation and accumulations of fluid. Other inflammatory white blood cells, including lymphocytes and polymorphonuclear cells, have also been implicated. Antihistamines inhibit this inflammatory process.

On occasion and especially with pressure hives, antihistamines are ineffective, probably because of the nature of the molecular mediators operating in this condition. If antihistamines do not help, then several second-line treatments are used. The most effective are corticosteroids. Others include doxepin, dapsone, attenuated androgens, calcium antagonists, antimalarials, gold and methotrexate.

Female Hair Loss

Hundreds of different drugs have been linked to hair loss. Anesthetics, chemotherapy, bromocriptine – used to inhibit lactation, beta blockers, ACE inhibitors, amphetamines and anticholesterol agents are examples.

Rosacea

Never apply a topical steroid like cortisone to rosacea unless directed to do so by your doctor for a specific reason. Cortisone treatments can worsen rosacea over the long term and make it even more resistant to treatment.

Cold Hands and Feet

Atenolol, a beta-blocker, is one of any number of drugs that can have the side effect of producing cold hands and feet. The most serious side-effects include heart failure, heart block and bronchospasm. Other side-effects include fatigue and coldness of the extremities.

Fibroids

Doctors may prescribe / recommend drugs of various types.

GnRH agonists. Gonadotropin-releasing hormone agonists can be used to treat fibroids. Most fibroids shrink by one-third to one-half of their original size after two to three months of treatment with these drugs. Smaller fibroids may cause fewer problems and they are often easier to remove surgically. Women should not take GnRH agonists for more than six months. After that, the drugs can cause rapid bone loss, leading to osteoporosis. Fibroids generally start to grow again once drug treatment stops. Most women stop having menstrual periods while they are taking GnRH agonists.

OCs. Oral contraceptives are sometimes used to control the heavy menstrual bleeding associated with fibroids, but they do not help prevent fibroid growth. Newer types of continuous-dosing OCs reduce or eliminate the number of periods a woman has per year.

IUDs Intrauterine devices that release progestin can be very beneficial for reducing heavy bleeding. Specifically, the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena), has shown excellent results. Many doctors now recommend the LNG-IUS as a first-line treatment for heavy menstrual bleeding, particularly for women who may face hysterectomy (removal of uterus).

NSAIDS. For fibroid pain relief only, women can use nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil) or naproxen (Aleve).

Nasal Polyps

Nasal sprays and drops containing corticosteroids can shrink nasal polyps in some cases. A single small polyp is occasionally cured by this type of treatment. Corticosteroid tablets have a similar effect, but can only be used as a short course because of the side effects they can cause. They may be required initially to shrink larger polyps.

Prostate Cancer

“Experts hailed the advance as potentially the biggest in the field of prostate cancer for decades and believe the technique could also be effective on other tumors, such as breast and bowel cancers.” (July 2008)

The Daily Mail reports that British researchers at the Royal Marsden Hospital have made a “dramatic breakthrough against a lethal form of prostate cancer” with trials of a new drug in pill form called Abiraterone, showing it can shrink tumors in up to 80% of cases.

According to the report, experts hailed the advance as potentially the biggest in the field of prostate cancer for decades and believe the technique could also be effective on other tumors, such as breast and bowel cancers.

Lead researcher, Dr Johann de Bono, was quoted as saying patients had been able to control the disease with just four pills a day and very few side effects and that the drug works even if the cancer has spread beyond the prostate, such as to the bone.

“These men have very aggressive prostate cancer which is exceptionally difficult to treat and almost always proves to be fatal,” said de Bono. “We hope that Abiraterone will eventually offer them real hope of an effective way of managing their condition and prolonging their lives. My vision is to make chemotherapy obsolete.”

Research suggests that an ingredient used incough medicines for more than half a century may be an effective treatment for prostate cancer.

Dr Israel Barken, Moshe Rogosnitzky, and Dr Jack Geller tested the cough suppressant noscapine, a non-addictive derivative of opium, on mouse models of prostate cancer. Results showed that noscapine reduced tumor growth by 60% and limited the spread of tumors by 65%, all without causing harmful side effects.

This is not the first time that noscapine has been studied as a treatment for cancer. It has previously been studied as a treatment for breast, ovarian, colon, lung, and brain cancers, and for various lymphomas, chronic lymphocytic leukemia, and melanoma. However, because noscapine is a naturally-occurring substance it is non-patentable and thus finding financial backing for clinical trials has proven difficult.

Mosche Rogonsnitzky, of MedInsight Research Institute, a nonprofit organization committed to making doctors aware of commercially unsponsored medications, off-label (secondary) uses for approved medicines, long-lost therapies, and specialized tests that enable treatment to be tailored to the individual, said of the discovery: “Noscapine is effective without the unpleasant side effects associated with other common prostate cancer treatments. Because noscapine has been used as a cough-suppressant for nearly half a century, it already has an extensive safety record. This pre-clinical study shows that the dose used to effectively treat prostate cancer in the animal model was also safe.”

News release: New study shows that a cough medicine ingredient could effectively treat prostate cancer MedInsight Research Institute. December 18th 2008.

Ovarian Cancer

Introducing chemotherapy directly into the abdomen, instead of into veins as is usually done, can be more effective. This allows physicians to expose the area surrounding the tumor to higher concentrations of medicine, while normal tissues, such as bone marrow, are spared.

Patients who choose the therapy, however, may pay a price for a longer life: Study participants who had the medicines dripped into their abdominal cavities, called intraperitoneal therapy, suffered more severe and more frequent side effects during and right after treatment, including infections, stomach pain, and numbness and tingling in their fingers and toes. Just 42% of the 205 women started on the therapy were able to withstand the 18 weeks of treatment. [NEJM Jan 5, 2006]

Breast Cancer

Chemotherapy given to women with early-stage breast cancer causes their bone density to decline at a faster rate than previously known, increasing the risk of osteoporosis. Scientists at Ohio State University said they were surprised to find that 35 pre-menopausal women treated with chemotherapy experienced up to an 8 percent loss in bone density after 12 months of treatment. The usual loss after menopause is 1 to 2 percent per year. The median age of the women was 42. [Journal of Clinical Oncology, July 2001]

However, a drug that targets only diseased cells has proved effective against an aggressive form of early breast cancer.

Herceptin, made by Genentech Inc., is already used for advanced cancer. But in three studies involving thousands of women with early-stage disease, it cut the risk of a relapse in half.

Herceptin, known generically as trastuzumab, does not help everyone. For one thing, it is only for the estimated 20% of breast cancer cases in which tumors churn out too much of a protein known as HER2. In the recent studies, the drug was used along with standard treatments, including surgery and chemotherapy.

In the first study, 220 women taking standard therapy for a year either developed breast cancer again, showed other kinds of tumors, or died. Only 127 did when Herceptin was added. The two other studies, partly funded by Genentech, reached similar findings in their combined results. At three years, patients on Herceptin showed a disease-free survival rate that was 12 percentage points higher than without it.

The government approved the drug in 1998 for advanced breast cancer that has already spread within the body. But early-stage cases are much more common.

Many doctors are already embracing the drug for such women, cancer experts say, because details of the three studies were first publicized last spring at a medical conference.

For those women with estrogen positive (ER+) tumor cells, anastrozole (Arimidex) may be advised. Anastrozole is a third-generation non-steroidal aromatase inhibitor. It inhibits the final step in biosynthesis of estrogen in the peripheral tissues, which is the primary source of estrogen in postmenopausal women.

Time – April 20, 2008

(Houston, Texas) Lead researcher Dr. Angel Rodriguez, from the Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, released the results of a study on a new breast cancer drug named Lapatinib which has shown remarkable results. According to a Daily Mail report, Lapatinib – licensed in the U.S. – successfully and often dramatically shrank tumors in as little as six weeks’ time.

The report noted that “using Lapatinib led to an average cut of 60% in the size of the tumor and a fall in the number of stem cells that may help the cancer to spread.”

Said reporter Jenny Hope: “After six weeks of treatment, the tumors had gone into complete or near remission in two-thirds of women evaluated, compared with one-quarter of women on standard chemotherapy. But unlike standard treatment, Lapatinib destroyed more stem cells with the capacity to self-renew which might protect women from the cancer coming back.”

“We were excited to see that the results with Lapatinib were different,” said Dr. Rodriguez. “Rather than the broad brush approach, in which cells are killed indiscriminately, targeting the stem cells may be more effective and also prevent some of the unpleasant side effects associated with conventional chemotherapy treatment. International studies are currently underway looking at the effect of Lapatinib in lung, colon, head and neck, gastric, esophageal, and bladder cancer and lymphoma, among others.”

Colon Cancer

The results of a study on colon cancer patients may provide enough compelling evidence to convince oncologists that cimetidine is an effective adjuvant therapy in colon cancer. [Cimetidine increases survival of colorectal cancer patients with high levels of sialyl Lewis-X and sialyl Lewis-A epitope expression on tumour cells. Brit J Can 2002 (86): pp. 161-167]

Cimetidine appears to act as an immune stimulator as well as reducing the likelihood of metastases. It was found that cimetidine does inhibit the ability of cancer cells to attach to vascular endothelium. It was then discovered that cimetidine inhibits the expression of E-selectin (ELAM-1) which is one of the molecules in blood vessels that cancer cells adhere to using their own cell surface ligands, Lewis X and Lewis A. The adhering of cancer cells to E-selectin on a blood vessel wall initiates the metastatic process.

As much as 70% of colon cancers examined have expressed high levels of these Lewis antigens. Other cancers such as breast and pancreatic have been demonstrated to express these Lewis antigens also. Cancer cells in the bloodstream that express Lewis X or Lewis A antigens can’t bind to the blood vessels and establish a metastatic tumor. These cells are instead eventually eliminated.

In order to determine the Lewis antigen expression of your cancer cells, contact IMPATH Laboratories, 521 West 57th Street

New York, NY 10019. Phone: 1-800-447-5816

LEF

Pancreatic Cancer

A common asthma drug reduced pancreatic cancer cell growth in laboratory experiments and animal tests, a new study reports.

A protein called S100P is found in excess amounts in some cancers and is important for pancreatic cancer cell growth and survival. This protein also activates a cell surface protein receptor called RAGE that plays a role in Alzheimer disease, diabetes, and cancer.

A drug called cromolyn, an allergy and asthma treatment, has been shown to bind to proteins similar to S100P. To test cromolyn’s effects on S100P in pancreatic cancer cells, Thiruvengadam Arumugam, Ph.D., Vijaya Ramachandran, Ph.D., and Craig D. Logsdon, Ph.D., of the University of Texas M. D. Anderson Cancer Center in Houston, conducted experiments with the drug in tissue cultures and in mice with implanted pancreatic cancer.

They found that cromolyn bound to S100P, halted the activation of RAGE, and slowed cancer cell growth and survival in cell lines. In mice, the drug slowed pancreatic tumor growth and improved the effectiveness of gemcitabine, a chemotherapy drug used to treat pancreatic cancer.

“Together, these data support the further investigation of cromolyn as a possible treatment for pancreatic cancer,” the authors write. [JNCI December 20, 2006]

Carcinoid Cancer

Adrenaline-like drugs should be avoided for carcinoid tumors as they can cause carcinoid crisis attacks. Examples include various asthma inhalers, nasal decongestants and adrenaline itself.

Interstitial Cystitis

One good reference for the various drugs used in this condition is from the Interstial Cystitis Association.

Polycystic Ovary Syndrome (PCOS)

Metformin is used to reduce insulin resistance. Treatment with this drug frequently leads to a return of ovulation. Other therapies include clomiphene citrate (to induce ovulation), spironolactone (an antiandrogen), and oral contraceptives (to treat menstual irregularities and hirsutism).

Premenstrual Syndrome / PMDD

In the October 2006 issue of the Journal of Clinical Psychiatry, researchers reported that low doses of sertraline taken for two weeks before the onset of the menstrual period may be an effective and well-tolerated treatment for some women who experience moderate-to-severe premenstrual syndrome, or PMS.

The researchers also tested and found two other anti-depressant dosing strategies to be effective. One of those dosing strategies was taking medication daily throughout the menstrual cycle. The other was waiting until PMS symptoms begin to start medication each cycle, which is known as ‘symptom-onset’ dosing. Sertraline is a selective serotonin reuptake inhibitor (SSRI) approved for the treatment of depression and anxiety, as well as for premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome.

“Our study is the first to evaluate the use of low-dose antidepressant medication for women who have moderate-to-severe PMS, and the first placebo-controlled study to include the novel dosing strategy of ‘symptom-onset dosing,'” said Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics and gynecology in VCU’s School of Medicine and lead author on the study.

“Our findings suggest that women with less severe forms of PMS than PMDD may also benefit from treatment with antidepressant medication, and they may be able to take medication only on the days that they are symptomatic,” she said.

Female Infertility

Fertility drugs such as clomiphene (Clomid, Serophene), gonadorelin (Factrel, Lutrepulse), human chorionic gonadotropin – HCG (A.P.L., Fullutein, Humegon, Pregnyl, Profasi), and human menopausal gonadotropins – HMG (Metrodin, Pergonal, Repronal) are commonly prescribed.

Endometriosis

Hormonal therapy that attempts to mimic either menopause or pregnancy can often provide relief of symptoms. Lupron, Zoladex and Synarel are medications called GnRH-agonists. They lower your estrogen level which should suppress endometriosis.

Birth control pills to mimic pregnancy may relieve symptoms and these may be quite effective for many women, though side effects are common. When any medication is stopped, symptoms return, since the problem causing tissues were not removed – just kept under control.

Erectile Dysfunction (ED, Impotence)

In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat ED. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved.

Vaginitis/Vaginal Infection

The OTC products for vaginal yeast infections have one of four active ingredients: butoconazole nitrate (Femstat 3), clotrimazole (Gyne-Lotrimin and others), miconazole (Monistat 7 and others), and tioconazole (Vagistat). These drugs are in the same anti-fungal family and work in similar ways to break down the cell wall of the Candida organism until it dissolves. They are available in generic form also and those work just as well.

Vulvodynia / Vestibulitis

If intercourse is painful, you can apply xylocaine jelly to numb the sore areas.

Premature Ejaculation

In the early 1990s, doctors noted that many depressed men refused to take their medications because it prevented them from reaching a climax, so they prescribed antidepressants, such as Anafranil, Paxil, Prozac or Zoloft to premature ejaculators, who then reported better performance. A recent study from the Netherlands shows that 20mg of Paxil 1-4 hours before the event may be the most effective treatment. [Journal of Clinical Psychopharmacology, 2001, Vol 21, Iss 3, pp 293-297.] The U.S. FDA has not approved these drugs for this purpose.

Urinary Stress/Overactive Bladder

If synthetic hormones (HRT) are being used in females, it should be remembered that they increase the risk and degree of stress incontinence. Please see the link between the HRT question and Incontinence. It is believed that bioidentical sex hormones do not have this side effect. [JAMA, February 23, 2005]

Male Infertility (Low Sperm Count)

The use of anabolic androgenic steroids among young men is significant.These exogenous androgens depress testicular production of testosterone and, thus, intra-testicular testosterone levels. This may cause a low or zero sperm count. It has been suggested that there can be a persistent depression of the hypothalamus and pituitary which may be irreversible, even when the steroids are stopped.

Nocturia

Some prescription medicines can cause nighttime urination.

Possible Pregnancy-Related Issues

In December 2005, the Food and Drug Administration warned pregnant women and their doctors away from the antidepressant Paxil because of an increased risk of heart defects in newborns. With this warning, the agency for the first time placed a popular antidepressant – one in the same drug class as Prozac and Zoloft – into its second-highest category for risk of birth defects.

July 2011. Children whose mothers take Zoloft, Prozac, or similar antidepressants during pregnancy are twice as likely as other children to have a diagnosis of autism or a related disorder, according to a small new study, the first to examine the relationship between antidepressants and autism risk.

Using Kaiser Permanente’s patient database, which includes more than 3.2 million people, Croen and her team identified 298 children with an ASD who were born between 1995 and mid-1999, and matched them with 1,507 children without autism who were roughly the same age and were born in the same hospitals.

The authors then cross-checked whether their mothers, in the year before delivery, filled prescriptions for an SSRI, including Prozac, Zoloft, Luvox, Celexa, and Paxil (or their generic versions). The researchers could not confirm whether the mothers actually took the medication, however.

A larger study needs to be done to confirm this relationship, but based upon this discovery, it would seem wise to avoid antidepressants, if possible, during pregnancy.