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Medications That Can Cause Weight Gain

Many of us struggle to maintain a healthy weight. For people who take certain prescription medications, extra pounds may be an unwanted side effect. The most common medications that contribute to weight gain are two commonly prescribed drug classes—corticosteroids and antidepressants. But there are others. Learn about some common medicines that can lead to drug-induced weight gain.

Corticosteroids include the anti-inflammatory drugs prednisone and hydrocortisone. Doctors prescribe them to treatment inflammatory conditions, such as arthritis, dermatitis, asthma, ulcerative colitis, and Crohn’s disease. 

Corticosteroids can cause an increase in appetite, leading to weight gain. They also change the way your body distributes fat. It tends to accumulate in the face, neck, back and abdomen. This side effect depends on how much and how long you take corticosteroids. Watching your diet and exercising can help. Any weight gain should resolve within a few months of stopping the corticosteroid.

Some antidepressant drugs are more likely than others to cause weight gain than others. Tricyclic antidepressants, monoamine oxidase inhibitors, and serotonin reuptake inhibitors (SSRIs) tend to cause weight gain. It’s unclear how they cause it, but their effects on brain chemicals and metabolism may play a role. 

If you experience weight gain, your doctor may recommend switching to a different drug. There are a few antidepressants that are weight neutral or that may actually help you lose weight. These include bupropion (Wellbutrin), venlafaxine (Effexor), and duloxetine (Cymbalta).

Antipsychotic drugs mainly treat bipolar disorder and schizophrenia, although they do have other uses. Like the antidepressants, some of them cause more problems with weight gain than others. Antipsychotics may cause weight gain through appetite stimulation and changes in metabolism. The most problematic ones are some of the second-generation drugs, such as clozapine (Clozaril) and olanzapine (Zyprexa). Aripiprazole (Abilify) and ziprasidone (Geodon) tend to cause fewer problems with weight gain. Talk to your doctor to find out if one of these might work for you.

Doctors use antiseizure drugs primarily to treat epilepsy and other seizure disorders. But this class has many other uses, including treating some types of pain, preventing migraines, and stabilizing mood. These drugs affect brain chemicals and may cause weight gain as a side effect. 

Out of this group, carbamazepine (Tegretol), gabapentin (Neurontin), and valproic acid (Depakote) tend to cause the most problems. If you experience weight gain, your doctor may recommend switching drugs. Lamotrigine (Lamictal), topiramate (Topamax), and zonisamide (Zonegran) may be options.

Some diabetes treatments can cause weight gain. And it all comes down to insulin—the hormone that is lacking or not working right in diabetes. Insulin promotes weight gain by regulating how your body uses and stores energy. Starting insulin therapy often leads to weight gain. But the health benefits of controlling blood sugar levels far outweigh this side effect. And working with your diet and exercise habits can help manage it. 

Other diabetes treatments can cause weight gain by stimulating your body to release insulin. This includes the sulfonylureas, such as glipizide (Glucotrol), and the thiazolidinediones, such as pioglitazone (Actos).

There are more medicines and classes of drugs that can cause weight gain. Some examples include beta blockers for high blood pressure, antihistamines, and birth control pills. If you are concerned about weight gain, talk to your doctor before you start any new drug. 

And tell your doctor about any new or unusual symptoms you experience after starting a medicine. Your doctor can determine whether the medicine might be the problem. If so, you can work out a plan for dealing with the side effect or trying a new treatment.

If you’re taking prescription drugs that cause weight gain, you can still control the numbers on your bathroom scale. Your doctor may suggest you make diet and lifestyle adjustments to avoid gaining weight. Watching your meal portions and getting enough regular exercise may help. If your condition makes it difficult for you to stick with diet and exercise, talk with your doctor about other ways to avoid medication-related weight gain. Strategies such as cognitive behavioral therapy or switching to a different type of medication may help.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

What are non-steroidal anti-inflammatory drugs (NSAIDs)?

When your back hurts, head aches, arthritis acts up or you’re feeling feverish, chances are you’ll be reaching for an NSAID (non-steroidal anti-inflammatory drug) for relief.

You take an NSAID every time you consume an aspirin, or an Advil®, or an Aleve®. These drugs are common pain and fever relievers. Every day millions of people choose an NSAID to help them relieve headache, body aches, swelling, stiffness and fever.

You know the most common NSAIDs:

  • Aspirin (available as a single ingredient known by various brand names such as Bayer® or St. Joseph® or combined with other ingredients known by brand names such as Anacin®, Ascriptin®, Bufferin®, or Excedrin®).
  • Ibuprofen (known by brand names such as Motrin® and Advil®).
  • Naproxen sodium (known by the brand name Aleve®).

You can get non-prescription strength, over-the-counter NSAIDs in drug stores and supermarkets, where you can also buy less expensive generic (not brand name) aspirin, ibuprofen and naproxen sodium.

Acetaminophen (Tylenol®) is not an NSAID. It’s a pain reliever and fever reducer but doesn’t have anti-inflammatory properties of NSAIDs. However, acetaminophen is sometimes combined with aspirin in over-the-counter products, such as some varieties of Excedrin®.

What do you use NSAIDs for?

NSAIDs are used to treat:

They can also be used to reduce fever or relieve minor aches caused by the common cold.

How do NSAIDs work?

NSAIDs block the production of certain body chemicals that cause inflammation. NSAIDs are good at treating pain caused by slow tissue damage, such as arthritis pain. NSAIDs also work well fighting back pain, menstrual cramps and headaches.

NSAIDs work like corticosteroids (also called steroids), without many of the side effects of steroids. Steroids are man-made drugs that are similar to cortisone, a naturally-occurring hormone. Like cortisone, NSAIDs reduce pain and inflammation that often come with joint and muscle diseases and injuries.

How long should I use an over-the-counter NSAID?

Don’t use an over-the-counter NSAID continuously for more than three days for fever, and 10 days for pain, unless your doctor says it’s okay. Over-the-counter NSAIDs work well in relieving pain, but they’re meant for short-term use.

If your doctor clears you to take NSAIDs for a long period of time, you and your doctor should watch for harmful side effects. If you notice bad side effects your treatment may need to be changed.

How long do NSAIDs take to work?

That depends on the NSAID and the condition being treated. Some NSAIDs may work within a few hours, while others may take a week or two.

Generally, for acute (sharp sudden pain) muscle injuries, we recommend NSAIDs that work quickly. However, these may need to be taken as often as every four to six hours because of their short action time.

For osteoarthritis and rheumatoid arthritis that need long-term treatment, doctors usually recommend NSAIDs that are taken only once or twice a day. However, it generally takes longer for these drugs to have a therapeutic (healing) effect.

How are NSAIDs prescribed?

NSAIDs are prescribed in different doses, depending on the condition. These drugs may need to be taken from one to four times a day. Don’t increase the dose without asking your doctor first.

You may be prescribed higher doses of NSAIDs if you have rheumatoid arthritis (RA), for example. RA often causes a significant degree of heat, swelling and redness and stiffness in the joints. Lower doses may be prescribed for osteoarthritis and acute muscle injuries since there is generally less swelling and frequently no warmth or redness in the joints.

No single NSAID is guaranteed to work. You and your doctor may need to try out several types of NSAIDs in order to find the right one for you.

When are stronger NSAIDs prescribed?

Prescription-strength NSAIDs are often recommended for rheumatologic diseases, including rheumatoid arthritis and moderate-to-severe osteoarthritis. These NSAIDs are also prescribed for moderately painful musculoskeletal conditions such as back pain.

What are some prescription NSAIDs?

Here are a few examples of prescription NSAIDs. Some NSAIDs are only available as generic formulations (no brand names).

Generic names/common brand names
  • Celecoxib (Celebrex®).
  • Diclofenac (Voltaren® [available by brand name in topical form]).
  • Fenoprofen (Nalfon®).
  • Indomethacin (Indocin® [available by brand name in liquid form]).
  • Ketorolac tromethamine (Toradol®).

Generic names (no brands)

  • Meclofenamate sodium.
  • Diflunisal.
  • Tolmetin.
  • Ketoprofen.
  • Flurbiprofen.

How does my doctor choose an NSAID that’s right for me?

In planning your treatment, your doctor looks at the effectiveness and the risks of these drugs. Your medical history, physical exam, X-rays, blood tests and presence of other medical conditions all play a part in deciding which NSAIDs will work for you.

After you start your NSAID program meet with your doctor regularly to check for any harmful side effects and, if necessary, make any changes. Blood tests or other tests (including a kidney function test) may need to be done for this part of your treatment.

Are there specific warnings associated with NSAID use?

The Food and Drug Administration requires that the labeling of NSAIDs contain these specific warnings:

These warnings are for non-aspirin NSAIDs:

  • Non-aspirin NSAIDs can increase the chance of heart attack or stroke. This risk may be greater if you have heart disease or risk factors (for example, smoking, high blood pressure, high cholesterol, diabetes) for heart disease. However, the risk may also be increased in people who do not have heart disease or those risk factors. This risk can occur early in treatment and may increase with longer use.
  • Heart problems caused by non-aspirin NSAIDs can happen within the first weeks of use and may happen more frequently with higher doses or with long-term use.
  • Non-aspirin NSAIDs should not be used right before or after heart bypass surgery.

This warning is for all NSAIDs including aspirin:

NSAIDs may increase the chance of serious stomach and bowel side effects like ulcers and bleeding. These side effects can occur without warning signs. This risk may be greater in people who:

  • Are older.
  • Have previous history of stomach ulcers or bleeding problems.
  • Are on blood thinners.
  • Are on multiple prescription or over-the-counter NSAIDs.
  • Drink three or more alcoholic beverages per day.

What are common side effects of NSAIDs?

You may have side effects if you take large doses of NSAIDs, or if you take them for a long time. Some side effects are mild and go away, while others are more serious and need medical attention. Unless your doctor tells you to do so, don’t take an over-the-counter NSAID with a prescription NSAID, multiple over-the-counter NSAIDs or more than the recommended dose of an NSAID. Doing so could increase your risk of side effects.

The side effects listed below are the most common, but there may be others. Ask your doctor if you have questions about your specific medication.

The most frequently reported side effects of NSAIDs are gastrointestinal (stomach and gut) symptoms, such as:

These gastrointestinal symptoms can generally be prevented by taking the drug with food, milk or antacids (such as Maalox® or Mylanta®).

Call your doctor if these symptoms continue for more than a few days even if you’re taking the NSAID with food, milk or antacid. The NSAID may need to be stopped and changed.

Other side effects of NSAIDs include:

  • Dizziness.
  • Feeling lightheaded.
  • Problems with balance.
  • Difficulty concentrating.
  • Mild headaches.

If these symptoms go on for more than a few days, stop taking the NSAID and call your doctor.

What side effects should I tell my doctor about right away?

If you have any of these side effects, it is important to call your doctor right away:

Gastrointestinal/urinary

  • Black stools — bloody or black, tarry stools.
  • Bloody or cloudy urine.
  • Severe stomach pain.
  • Blood or material that looks like coffee grounds in vomit (bleeding may occur without warning symptoms like pain).
  • Inability to pass urine, or change in how much urine is passed.
  • Unusual weight gain.
  • Jaundice.

Head (vision, hearing, etc.):

  • Blurred vision.
  • Ringing in the ears.
  • Photosensitivity (greater sensitivity to light).
  • Very bad headache.
  • Change in strength on one side is greater than the other, trouble speaking or thinking, change in balance.

Possible allergic reactions and other problems

  • Fluid retention (recognized by swelling of the mouth, face, lips or tongue, around the ankles, feet, lower legs, hands and possibly around the eyes).
  • Severe rash or hives or red, peeling skin.
  • Itching.
  • Unexplained bruising and bleeding.
  • Wheezing, trouble breathing or unusual cough.
  • Chest pain, rapid heartbeat, palpitations.
  • Acute fatigue, flu-like symptoms.
  • Very bad back pain.
  • Feeling very tired and weak.

Can I take NSAIDs if I’m being treated for high blood pressure?

NSAIDs can cause high blood pressure (hypertension) in some people. You may have to stop taking NSAIDs if you notice your blood pressure increases even if you’re taking your blood pressure medications and following your diet. Ask your doctor about this before you start taking NSAIDs.

In what cases should I check with my doctor before taking NSAIDs?

If you have any of the following conditions or circumstances please check with your doctor before you take NSAIDs:

  • Pregnancy (NSAIDs should be avoided in the third trimester. Consult with your provider about use in the first or second trimester).
  • Children and teenagers with viral infections (with or without fever) should not receive aspirin or aspirin-containing products due to the risk of Reye’s syndrome (a rare but deadly illness that can affect the brain and liver).
  • Those who have an upcoming surgical procedure, including dental surgery.
  • People who have three or more alcoholic beverages per day.
  • Asthma that gets worse when taking aspirin.
  • If you are 65 years of age or older.

Disease states

Heart and bleeding conditions

  • Bleeding problems (people who have a history of prolonged bleeding time or who bruise easily).
  • High blood pressure that is difficult to control.
  • Active congestive heart failure.
  • History of stroke or heart attack.

Allergic and drug interactions

  • Known allergies to medications, especially aspirin, other NSAIDs and sulfa drugs.
  • Nasal polyps (linked to a greater chance of NSAID allergy).
  • Please check with your pharmacist or healthcare provider before starting an NSAID to determine if your current medications, both prescription and OTC, and also your dietary/herbal supplements, are compatible with the NSAID. Do this especially if you are on warfarin (Coumadin®), clopidogrel (Plavix®), corticosteroids (for example, prednisone), phenytoin (Dilantin®), cyclosporine (Neoral®, Sandimmune®), probenecid and lithium (Lithobid®).
  • If you take diuretics (also known as water pills) to control your blood pressure, you may be at greater risk of kidney problems if you take an NSAID.
  • Phenylketonuria (PKU). Some nonprescription NSAIDs are sweetened with aspartame, a source of phenylalanine.

Can NSAIDs cause allergic reactions?

Rarely, an NSAID can cause a generalized allergic reaction known as anaphylactic shock. If this happens, it usually occurs soon after the person starts taking the NSAID. The symptoms of this reaction include:

  • Swollen eyes, lips or tongue.
  • Difficulty swallowing.
  • Shortness of breath.
  • Rapid heart rate.
  • Chest pain or tightness.

If any of these symptoms occur, call 9-1-1 or have someone drive you to the nearest emergency room immediately.

Remember, before any medication is prescribed, tell your doctor:

  • If you are allergic to any medications, foods or other substances.
  • If you currently take any other medications (including over-the-counter medications) and/or herbal or dietary supplements.
  • If you are pregnant, planning to become pregnant, or are breast-feeding.
  • If you have problems taking any medications.
  • If you have anemia, kidney or liver disease, stomach or peptic ulcers, heart disease, high blood pressure, bleeding or clotting problems, asthma or growth in the nose (nasal polyps).

Naproxen: medicine to relieve pain and swelling

Always take your naproxen tablets with or just after a meal so you do not get an upset stomach.

As a general rule in adults, the dose to treat:

  • diseases of joints is 500mg to 1,000mg a day in 1 or 2 doses
  • muscle, bone disorders and painful periods is 500mg at first, then 250mg every 6 to 8 hours as required
  • attacks of gout is 750mg, then 250mg every 8 hours until the attack has passed

Doses are usually lower for elderly people and people with heart, liver or kidney problems.

The doctor will use your child’s weight to work out the right dose.

If you get naproxen on prescription, the dose depends on the reason why you’re taking it, your age, how well your liver and kidneys work, and how well it helps your symptoms.

If you buy naproxen from a pharmacy for painful menstrual periods:

  • on the first day – take 2 tablets when the pain starts, then after 6 to 8 hours take 1 more tablet that day if you need to
  • on the second and following days – take 1 tablet every 6 to 8 hours if needed

How to take naproxen

Naproxen on prescription comes as 2 different tablets: effervescent and gastro-resistant tablets.

Effervescent tablets are dissolved in water before you take them.

Gastro-resistant tablets have a coating to protect them from being broken down by the acid in your stomach. Instead, the medicine is released further down the gut in your intestine.

If you take gastro-resistant tablets, swallow them whole with or after food. Do not crush or chew them.

If you take effervescent tablets, dissolve 1 to 2 tablets in a glass (150ml) of water and drink.

Doses of 3 tablets should be dissolved in 300ml. To make sure there’s no medicine left, rinse the empty glass with a small amount of water and drink it. Take with or after food.

What if I forget to take it?

Take your forgotten dose as soon as you remember, unless it’s nearly time for your next dose.

Do not take a double dose to make up for a forgotten dose.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take too many naproxen tablets, you’re more likely to get some of the common side effects. Contact your doctor straight away.

Meloxicam side effects and how to avoid them

Meloxicam side effects | Headaches | Weight gain | Overdose | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Meloxicam is a generic prescription drug that relieves pain and swelling caused by osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. Also found in pharmacies under the brand names Mobic, Vivlodex, Qmiiz, and Anjeso, meloxicam can be taken by mouth as a tablet, capsule, disintegrating tablet, or oral suspension, or it can be injected directly into the bloodstream by a healthcare professional. 

As a nonsteroidal anti-inflammatory drug (NSAID), meloxicam belongs to the same family of the well-known drugs aspirin, ibuprofen, and naproxen. However, meloxicam is not just an amped-up version of Advil or Aleve. People should be aware that meloxicam as a prescription NSAID comes with more serious risks, side effects, warnings, and drug interactions than ordinary over-the-counter NSAIDs.   

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Common side effects of meloxicam

The most common side effects of meloxicam (affecting 2% or more of people taking the medication) are:

  • Abdominal pain
  • Headache
  • Flu-like symptoms
  • Dizziness
  • Nausea
  • Diarrhea
  • Sore throat 
  • Fluid retention
  • Accidents and falls
  • Constipation
  • Insomnia
  • Upper respiratory tract infection
  • Urinary tract infection
  • Joint pain
  • Back pain
  • Stomach upset
  • Flatulence
  • Rash
  • Itching
  • Urination problems
  • Vomiting

Serious side effects of meloxicam

Meloxicam can produce serious and even life-threatening side effects, particularly if used in high doses or for an extended time. These include:

  • Heart attack
  • Stroke
  • Blood clots
  • High blood pressure
  • Congestive heart failure
  • Bleeding, ulcers, or perforations in the stomach or intestine
  • Liver damage or liver failure
  • Kidney dysfunction or kidney failure
  • Anemia
  • Bleeding problems
  • Asthma attacks in people with asthma
  • Severe and potentially life-threatening allergic reactions such as anaphylaxis, trouble breathing, or severe skin reactions

Serious side effects will require immediate medical attention.

Meloxicam and headaches

Headaches are a common, less serious side effect of meloxicam. In two 12-week clinical trials in patients with osteoarthritis or rheumatoid arthritis, between 5.5% to 8.3% of people taking meloxicam reported headaches. In six-month trials, 2.6% to 3.6% of people taking meloxicam experienced headaches. However, headaches as a side effect do not seem to be dose-dependent.

Meloxicam and weight gain

Weight gain and loss are uncommon side effects of meloxicam, observed in less than 2% of people taking it. However, fluid retention (edema) is a common side effect, reported in 0.6% to 4.5% of people taking meloxicam in clinical studies. Left untreated, edema can lead to cardiovascular problems including congestive heart failure in vulnerable people. Fluid retention can be partly identified by an unexplained rise in body weight, so involuntary weight gain should be reported to the prescribing physician or other healthcare professional. 

Meloxicam overdose

As an NSAID, a meloxicam overdose can lead to serious health issues, evident from more common experiences of people overdosing on common over-the-counter NSAIDs, such as aspirin or ibuprofen. The most common symptoms of an NSAID overdose are:

  • Lack of energy
  • Drowsiness
  • Nausea
  • Vomiting
  • Stomach pain
  • Blurred vision
  • Dizziness
  • Bloody vomiting
  • Black or tarry stools

A severe overdose can result in high blood pressure, kidney failure, seizures, coma, respiratory distress, and death. People with any symptoms of NSAID overdose will require immediate medical attention.

How long do meloxicam side effects last?

Most of the common side effects of meloxicam are temporary and will abate after the drug is discontinued. Unfortunately, meloxicam stays in the body much longer than other NSAIDs, so side effects may linger a day or two after the last dose. More serious side effects, such as ulcers and gastrointestinal bleeding, can take much longer to resolve, even after discontinuing meloxicam.

Meloxicam contraindications & warnings

Like all prescription NSAIDs, meloxicam has risks that may outweigh the benefits for some people. The FDA determines if a medicine is safe for certain people by issuing contraindications and warnings. When a medicine carries a high risk for hazardous adverse effects in certain people, it is contraindicated for those people—it is never to be used in those patients. When a medication is riskier than normal in some patients, the medication comes with a warning. It is okay to take the medicine, but use and dosage will require monitoring or modification. 

Allergies

Meloxicam should never be used in people with known allergies to meloxicam or other NSAIDs.

Coronary artery bypass graft (CABG) surgery

Better known as “bypass surgery” or “coronary bypass,” CABG surgery restores normal blood flow to the heart’s muscles by either diverting a coronary artery or using a blood vessel graft to “go around” an obstructed coronary artery. Because meloxicam can cause blood clotting and cardiovascular problems, it is never used in the period leading up to bypass surgery or in the weeks after.

Asthma

Some people have aspirin-sensitive asthma, also known as aspirin-exacerbated respiratory disease (AERD). When given aspirin or other NSAIDs, those with AERD react with classic asthma symptoms, such as wheezing and coughing. This reaction can be fatal. Meloxicam should never be given to people with aspirin-sensitive asthma. Other people with asthma will require caution and monitoring just in case there is a serious reaction.

Other medical conditions

Meloxicam and other NSAIDs may worsen existing medical conditions, so these medications require  caution and monitoring when prescribed to people with risk factors such as:

  • Heart disease
  • Congestive heart failure
  • Blood clots and stroke
  • Ulcers or bleeding in the digestive system
  • High blood pressure
  • Fluid retention
  • Bleeding disorders
  • Kidney problems
  • Liver disease and
  • Poor general health

Children

Meloxicam is FDA approved to treat juvenile rheumatoid arthritis in children 2 years of age and older. In three clinical trials, children experienced the same types of side effects as adults, but at a higher rate.

Seniors

People 65 years and older are at a higher risk for side effects, so they may be started at a lower dose and monitored. 

Fertility

Meloxicam may cause a delay in ovulation, so women who are trying to get pregnant or undergoing fertility treatment may not be prescribed meloxicam.

Pregnancy

Meloxicam is not to be taken by pregnant women after 30 weeks because NSAIDs affect the heart development in the unborn baby. There is not enough research to know if meloxicam is safe for women or an unborn baby in the first 30 weeks of pregnancy. Women who are pregnant or considering getting pregnant should discuss the risks with a doctor. 

Breastfeeding

It is not certain if meloxicam is safe to take while nursing or how much passes into human breast milk. Nursing mothers should seek medical advice before taking meloxicam.

Dependence

Meloxicam does not create dependence nor does it require a tapered dose when stopping the medication. 

Meloxicam interactions

Taking two or more drugs can sometimes lead to trouble. Meloxicam is no exception. Because of the way it works, meloxicam affects many organs and systems in the body, particularly the blood, stomach, and kidneys. There are, then, a variety of ways that meloxicam can interact with other medications and foods. Here is how to make sense of all of them:

Meloxicam and NSAIDs

As previously stated, meloxicam is an NSAID. When taken with other NSAIDs, including ordinary aspirin or ibuprofen, the risk of side effects increases due to their additive effects. This is because all NSAIDs more or less cause similar side effects, particularly gastrointestinal problems including stomach pain, bleeding, and ulcers. As a general rule, taking two or more NSAIDs should be avoided except under the advice of a doctor. Taking multiple types of NSAIDs will delay it leaving your body and put you at a higher risk of side effects. Acetaminophen, the active ingredient in Tylenol, can acutely be substituted for NSAIDs for treating pain or fever, but not long-term when taking meloxicam.

Meloxicam and bleeding

Meloxicam interferes with the body’s ability to form blood clots. So, when meloxicam is taken with blood thinners such as warfarin, there is an increased risk of bleeding episodes, particularly stomach bleeding. This is because NSAIDs also target COX-1receptors, which protect the mucus lining of the stomach.  A physician will need to monitor blood coagulation in any person taking meloxicam with blood thinners. SSRIs (antidepressants), SNRIs (antidepressants), and some anticancer drugs also increase the risk of bleeding and gastrointestinal bleeding when combined with meloxicam.

Some drugs specifically raise the risk of gastrointestinal bleeding, including corticosteroids, some osteoporosis drugs (bisphosphonates), and some anticancer drugs. These, too, need to be used carefully when combined with meloxicam.

There are several over-the-counter dietary and herbal supplements that also interfere with blood clotting, such as fish oil, garlic, ginkgo, willow bark, krill oil, and saw palmetto. A healthcare professional can provide sound advice about combining these supplements with meloxicam.

Meloxicam and blood pressure

Elevated blood pressure is a common side effect of meloxicam, so taking meloxicam may counteract the effects of medications intended to lower blood pressure. Also, taking meloxicam with ACE inhibitors and angiotensin II receptor blockers (ARBs)—two common types of blood pressure medications—increases the risk of kidney problems and elevated potassium (hyperkalemia) in seniors or people with existing kidney problems. 

Several types of drugs also raise blood pressure. Combining any of them with meloxicam raises the risk of high blood pressure:

  • Caffeine, alcohol, and nicotine
  • Stimulants
  • Antidepressants
  • Asthma medications
  • Decongestants
  • Birth control pills
  • Migraine medications
  • Some immune-suppressing anticancer drugs
  • Parkinson’s disease medications

These drugs are not necessarily prohibited from taking with meloxicam, but blood pressure should be monitored when taking them together. 

Some popular herbal remedies and supplements also raise blood pressure, such as ephedra, licorice, and Yohimbe. Again, the risk of high blood pressure increases when these supplements are taken with meloxicam.

Meloxicam and diuretics

Taking meloxicam with certain types of loop diuretics or thiazide diuretics may lower sodium levels, which can be potentially hazardous, or diminish kidney function. If you’re uncertain what type of diuretic you’re taking, a doctor, pharmacist, or another healthcare provider can help identify it. Therapy will need to be monitored and may need to be modified.

Meloxicam and the kidneys

Meloxicam affects substances that regulate blood flow in the kidneys, changing how well the kidneys eliminate drugs from the body. This can increase the damage to the kidneys caused by other drugs, such as cyclosporine and tacrolimus. Alternatively, meloxicam can decrease the ability of the kidneys to eliminate certain drugs, particularly lithium, a drug used to treat bipolar disorder, methotrexate, a drug used to treat cancer or rheumatism, and pemetrexed, an anticancer drug. This may sound like a good thing, but it actually means that these drugs linger longer in the body at higher concentrations, increasing their toxicity and the likelihood of adverse effects. Again, these drugs are not to be avoided outright, but their dosing regimens may need to be modified.

How to avoid meloxicam side effects

Like all medications, meloxicam can have side effects, particularly problems with the stomach and small intestine. A few rules of thumb can help improve the odds:

1.  Take meloxicam as directed

Take the daily dose as prescribed. Don’t increase or decrease the dose. Don’t miss a dose and, if you do, don’t take extra medicine to make up for a missed dose.

2.  Avoid taking other NSAIDs

Many over-the-counter pain relievers belong to the same class of drugs as meloxicam, including aspirin. They have many of the same side effects as meloxicam and are eliminated the same way, so it’s a good idea to avoid them while taking meloxicam. 

3.  Take meloxicam with food

Meloxicam can be taken with or without food. If taking meloxicam produces stomach problems, consider taking meloxicam with food. Meloxicam can also be taken safely with antacids.

4.  Avoid taking meloxicam long-term

The likelihood of side effects, including serious side effects, increases the longer the medication is taken. To minimize adverse effects, meloxicam is intended to be taken at the lowest possible dose for the shortest duration possible to achieve therapy goals. If a medical condition like rheumatoid arthritis requires continual use of pain relievers, a healthcare professional can suggest alternatives to the long-term use of meloxicam.

5.  Avoid smoking and alcohol

Smoking and drinking alcohol raise the risk of stomach ulcers in people taking NSAIDs such as meloxicam. 

6.  Tell the doctor about all medical conditions

To reduce the risk of side effects, make sure the prescribing doctor is aware of all medical conditions past and present, particularly:

  • Heart problems including heart disease or heart attack
  • A history of blood clots or stroke
  • Ulcers or gastrointestinal bleeding
  • Fluid retention
  • Asthma
  • High cholesterol
  • Diabetes
  • Liver problems or
  • Kidney problems
  • Allergies to NSAIDs

The prescribing doctor will also need to know about pregnancy status, breastfeeding, fertility treatments, or any plans on becoming pregnant.

7.  Tell the doctor about all medications being taken

Many side effects of prescription drugs like meloxicam are simply caused by combining them with the wrong medications. For anyone with a chronic condition like arthritis, it’s helpful to keep a list of all medications used. Prescription drugs, over-the-counter drugs, dietary supplements, and herbal remedies, taken both regularly or rarely should be included. Keep this list on hand so it can be readily shared with a doctor, pharmacist, or another healthcare provider before a prescription is written. Follow their advice if they indicate certain drugs, supplements, or foods should be avoided.

Resources:

Medications that cause weight gain and alternatives in Canada: a narrative review

Abstract

Background

The cause of the obesity epidemic is multifactorial, but may, in part, be related to medication-induced weight gain. While clinicians may strive to do their best to select pharmacotherapy(ies) that has the least negative impact on weight, the literature regarding the weight effects of medication is often limited and devoid of alternative therapies.

Results

Antipsychotics, antidepressants, antihyperglycemics, antihypertensives and corticosteroids all contain medications that were associated with significant weight gain. However, there are several medication alternatives within the majority of these classes associated with weight neutral or even weight loss effects. Further, while not all of the classes of medication examined in this review have weight-favorable alternatives, there exist many other tools to mitigate weight gain associated with medication use, such as changes in dosing, medication delivery or the use of adjunctive therapies.

Conclusion

Medication-induced weight gain can be frustrating for both the patient and the clinician. As the use of pharmaceuticals continues to increase, it is pertinent for clinicians to consider the weight effects of medications prior to prescribing or in the course of treatment. In the case where it is not feasible to make changes to medication, adjunctive therapies should be considered.

Keywords: weight gain, weight loss, weight neutral, adverse effects of medications, obesity, adjunctive therapy

Introduction

Worldwide, rates of obesity continue to rise, resulting in concurrent increases in metabolic disorders, such as type 2 diabetes and hypertension, which often require pharmacotherapy. This poses a major public health concern. Interestingly, close to 50% of North Americans will have taken a medication for a therapeutic purpose in the last 30 days.1,2 While pharmacotherapy is meant to be used for improving medical conditions, medications can be associated with a wide variety of adverse effects, including weight gain.1,3 This has tremendous consequences as excess weight is associated with worse health outcomes which can result in medication nonadherence in patients. Given these potentially poor outcomes combined with the global obesity crisis, it is important that clinicians consider the weight effects of medications.

There are several clinical guidelines that categorize medications as those that promote weight loss, weight gain or have weight neutral effects. However, inconsistencies exist when defining the weight effects of medication. Further, existing weight estimates are sparse, which makes it challenging for clinicians to recommend medications while considering the weight effects. This can result in weight-related side effects of prescription medications being overlooked. Lastly, recently, some reviews have been published which examine the weight effect of medication.4,5 However, similar to clinical guidelines, they are either devoid of or only provide estimates for some of the medications discussed. Thus, this paper will provide a comprehensive overview of the medications associated with weight change and suggest pharmaceutical substitutions to promote a more favorable body weight response. Medication classes were selected based on their use in prevalent medical conditions that are complications or comorbidities of obesity.

Classes of medications

Antipsychotics and mood stabilizers

Psychopathologies are tightly linked with weight changes.69 Patients with mental health disorders are two to three times more likely to develop obesity than the general population.10 A review examining psychiatric medication effect on weight suggests that over the course of treatment, ~70% of patients will experience some weight gain.6 A list of commonly used antipsychotics and their weight effects can be found in .

Table 1

Treatment-emergent weight changes associated with antipsychotics and mood stabilizers

Drug name Weight effect
Aripiprazole15,20,29 a
Carbamazepine33,34,37,b − −a
Chlorpromazine1820 + +
Clozapine1113 + +a
Haloperidol20,23,24 + +a
Iloperidone20,24,26 +a
Lamotrigine32,34,36,b − −a
Lithium3033 + +
Lurasidone20,26,28 Neutral
Olanzapine5,1316 + +a
Paliperidone20,26,27 + & −a
Quetiapine2022 + + & −
Risperidone13,20,24 +a
Sertindole13,20,25 +a
Valproic acid3436,b + +a
Ziprasidone13,16,20 a

Medications for schizophrenia are known to result in significant weight gain. Clozapine- and olanzapine-treated patients can gain on average 4.5–16.211,13 and 3.6–10.2 kg,5,1316 respectively. Nonetheless, there is considerable variability in the proportion of individuals that will experience weight gain. Studies report that, on average, 29%–89%11,12 of patients receiving clozapine will gain some weight and 8%–37% of patients taking olanzapine will gain ≥7% of their body weight.15,17

Aside from clozapine and olanzapine, commonly prescribed medications for schizophrenia such as chlorpromazine (0.6–15.9 kg18,20), quetiapine (−1.5 to +4.1 kg20,22), haloperidol (−0.1 to +4.0 kg20,23,24), sertindole (0.5–2.9 kg13,20,25), iloperidone (0.6–2.5 kg20,24,26) and risperidone (0.4–2.1 kg13,20,24) are also reported to elicit significant weight gain. Conversely, the use of paliperidone (−1.3 to +1.9 kg20,26,27), lurasidone (0.1–0.9 kg20,26,28), ziprasidone (−1.1 to 0.1 kg13,16,20) and aripiprazole (−1.4 to +0.2 kg15,20,29) is associated with the least amount of weight gain among medications for schizophrenia, and thus, may be a more weight-favorable alternative.

Lithium is commonly prescribed for the treatment of bipolar disorder and has been associated with lesser, yet relevant weight gain (1.1–9.9 kg30,33). Additionally, valproic acid, a second-line treatment option for bipolar disorder, is also associated with significant gain in weight (0.7–6.9 kg34,36), albeit slightly lesser than reported with lithium. Conversely, lamotrigine (−4.2 to +0.6 kg32,34,36) and carbamazepine (−3.1 to +0.4 kg33,34,37), mood stabilizers used in the treatment of epilepsy and bipolar disorder, are associated with weight neutral to weight loss properties and may be used in lieu of lithium or valproic acid as a more favorable weight alternative medication.

Antidepressants

Antidepressants consistently have a lower weight gain potential when compared to antipsychotics. However, antidepressants may carry a greater weight gain burden globally as they are prescribed more frequently than antipsychotics.38 There are five classes of antidepressants – tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors and atypicals. Information on the weight effects of the five classes of antidepressants can be found in .

Table 2

Treatment-emergent weight changes associated with antidepressants

Drug name Weight effect
Atypical
Bupropion (norepinephrine–dopamine reuptake inhibitor)5,42,47,51,66 a
Mirtazapine (noradrenergic and specific serotonergic)5,42,71,72 +a
Monoamine oxidase inhibitors
Isocarboxazid57,58 a
Phenelzine45,49,54,55 + +a
Tranylcypromine45,49,56 + +a
Selective serotonin reuptake inhibitor
Citalopram42,5961 + +a
Escitalopram42,60,64 +a
Fluoxetine5,4143,48,50,61 a
Fluvoxamine6163 + & − −a
Paroxetine42,61,65 +a
Sertraline42,61,66,67 a
Serotonin–norepinephrine reuptake inhibitor
Desvenlafaxine6870 + & −a
Duloxetine42,64,65 +a
Venlafaxine42,52,71,72 + & −a
Tricyclic antidepressant
Amitriptyline5,3942 + +a
Desipramine40,41,43 +a
Doxepin4649 +a
Imipramine39,44,45 +a
Nortriptyline39,40,42 + +a
Trazodone5052 a

TCAs have been prescribed since the 1950s and are reported to elicit the greatest weight gain among antidepressants. Amitriptyline (0.4–7.3 kg5,39,42) and nortriptyline (0.3–4.1 kg39,40,42) appear to be associated with the greatest amount of weight gain for these types of antidepressants. Other TCAs, such as desipramine (−0.9 to +2.0 kg40,41,43), imipramine (+0.6–1.8 kg39,44,45) and doxepin (0.0–2.7 kg46,49) are associated with more weight neutral effects. Lastly, trazodone (−1.2 to +0.9 kg50,52) may have the most favorable weight profiles of all TCAs as a few studies have observed small amounts of weight loss with its use.

Studies consistently report that of the MAOIs, phenelzine elicits the greatest amount of weight gain.53 While several studies compare the use of phenelzine with other classes of antidepressants, there are only a few studies which adequately report on weight. Some studies45,54 report weight outcomes as no significant change with no weight estimate provided, while other studies examine weight gain as a side effect of phenelzine, but only report mean changes in the subpopulation experiencing these side effects, or based on a threshold. For example, one study observed a mean weight gain of 9.1 kg in 6 of 14 patients taking phenelzine55 and another reported a 6.8 kg weight gain in 11 of 141 patients.49 Conversely, tranylcypromine appears to have a more favorable weight change profile and is associated with lesser to no weight changes (0.0–4.1 kg45,49,56) in users. Additionally, isocarboxazid is reported to cause minor weight gain and even weight loss (−2.6 to +0.8 kg57,58), and may be used as a more favorable weight alternative when the use of MAOIs is indicated.

Citalopram (−0.1 to +7.1 kg42,59,61) is associated with the greatest amount of weight gain and fluvoxamine (−3.5 to +1.7 kg61,63) with the greatest amount of weight loss for SSRIs. However, in contrast to TCAs and MAOIs, other commonly prescribed SSRIs appear to be relatively weight neutral. Escitalopram (−0.1 to +1.83 kg42,60,64), paroxetine (+0.1 to 1.7 kg42,61,65), sertraline (−1.6 to +1.0 kg42,61,66,67) and fluoxetine (−1.3 to +0.5 kg5,41,43,48,50,61) are all associated with weight changes of around ±2.0 kg. Thus, weight neutral SSRIs such as fluoxetine or sertraline or those that have a trend toward weight loss, such as fluvoxamine, may be used as an alternative to citalopram. Comparatively, serotonin–norepinephrine reuptake inhibitors are often weight neutral and include agents such as duloxetine (−0.5 to +1.1 kg42,64,65), desvenlafaxine (−1.3 to +1.3 kg68,70) and venlafaxine (−1.4 to +1.2 kg42,52,71,72).

Atypical antidepressants are newer medications with distinct mechanisms from other classes of antidepressants. Mirtazapine is a used atypical antidepressant which is associated with a mean weight gain of 0.4–2.4 kg,5,42,71,72 while bupropion is associated with mean losses of 0.4 to 2.4 kg5,42,47,51,66 and is commonly used as a substitute for some SSRIs.18,19 Further, owing to the weight loss attributed to bupropion, it has been combined with naltrexone and approved as a weight management medication (Contrave®; Valeant, Bridgewater Township, New Jersey, USA). Additional information on Contrave can be found in the “Considerations for pharmaceutical treatment” section.

Antihyperglycemics

There is a high prevalence of comorbid obesity and diabetes, with over 80% of patients who have type 2 diabetes also having obesity. Metformin is a first-line treatment option for type 2 diabetes73 and is associated with favorable weight outcomes. Weight loss is reported as a known side effect of this medication,74 with average decreases of 1.0–2.9 kg5,75,78 ().

Table 3

Treatment-emergent weight changes associated with antihyperglycemics

Drug name Weight effect
α-glucosidase inhibitors
Acarbose5,77,87,105 a
Glucagon-like peptide 1 receptor
Exenatide5,100,108,109 − −
Liraglutide5,91,102 − −
Inhibitors of dipeptidyl peptidate-4
Alogliptin97100 Neutral
Linagliptin90,100,106,107 a
Saxagliptin100,103105 a
Sitagliptin100103 a
Insulin85,86,88,118 + +a
Insulin secretagogues
Meglitinides
Nateglinide5,95,96 Neutral
Repaglinide79,89,109,a +a
Sulfonylurea drugs
Chlorpropamide8486 + +
Gliclazide75,80,94 + +a
Glimepiride5,9093 + & −a
Glyburide78,88,89 + +a
Tolbutamide5,76,87 ++
Insulin sensitizers
Biguanides
Metformin5,7578
Thiazolidinedione
Pioglitazone5,7981 + +
Rosiglitazone78,82,83 + +
SGLT2 inhibitors (or gliflozin)
Canagliflozin93,110,111 − −
Dapagliflozin112114 − −a
Empagliflozin115117

Alternative treatment options for patients with type 2 diabetes include thiazolidinediones. These medications carry a lower risk of hypoglycemia than other antihyperglycemic medications as they lower the blood sugar by making the body more sensitive to insulin rather than by increasing the production. However, thiazolidinediones are associated with the most weight gain of antihyperglycemics, second only to insulin. Pioglitazone and rosiglitazone are associated with gains in weight of 2–3.95,79,81 and 1.2–5.3 kg,78,82,83 respectively.

Insulin secretagogues are another alternative treatment option for diabetes. Sulfonylurea drugs such as chlorpropamide and tolbutamide are associated with weight gains of 2.6–5.384,86 and 1.6–2.8 kg,5,76,87 respectively. This side effect associated with taking these medications may be why other more weight neutral sulfonylureas, such as glyburide (−0.9 to +1.6 kg78,88,89), glimepiride (−1.4 to +1.2 kg90,93) and gliclazide (−1.0 to +0.8 kg75,94), are more frequently prescribed. It is important to note that patients who are given sulfonylureas as a first-line treatment regimen may experience greater weight gain. More pronounced gains of 3.689 and 4.2 kg80 have been reported in patients prescribed glyburide and gliclazide as the first-line diabetes treatment, respectively. Other insulin secretagogues, such as meglitinides, are associated a lower risk of hypoglycemia and may be a more weight-favorable alternative than sulfonylurea drugs. Indeed, repaglinide and nateglinide are associated with weight neutral to lesser weight gain properties, with changes of −0.2 to +1.879,89,95 and 0.3–0.9 kg,5,95,96 respectively.

Inhibitors of dipeptidyl peptidate-4 (DPP-4) are essentially weight neutral and include alogliptin, sitagliptin, saxagliptin and linagliptin. Alogliptin is the most weight neutral DDP-4 inhibitor and associated with a weight change of −0.9 to +0.7 kg.97100 Conversely, sitagliptin, saxagliptin and linagliptin are associated with modest weight losses ranging from 0.1 to −2.6,100103 2.1 to 0.5100,103105 and 2.1 to 0.6 kg,90,100,106,107 respectively. Acarbose, an α-glucosidase inhibitor, is limited in its use due to gastrointestinal side effects, but is associated with modest weight loss of 0.4–2.8 kg.5,77,87,105

Recently, there have been two new classes of diabetes medications that have made it to the market: glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose co-transporter 2 (SGLT-2) inhibitors with promising weight reduction properties. GLP-1s have been on the market slightly longer than SGLT-2 inhibitors. Unlike other antihyperglycemics, GLP-1R agonists are administered as an injection like insulin. Exenatide, a GLP-1 analog, is associated with weight loss ranging from 1.2 to 4.0 kg,5,100,108,109 while liraglutide 1.8 mg is associated with slightly more modest weight loss of 1.7–3.4 kg.5,91,102 Additional information on the use of liraglutide 3.0 mg as a weight management pharmaceutical (Saxenda®, Novo Nordisk A/S, Bagsværd, Denmark) can be found in the “Considerations for pharmaceutical treatment” section. In regards to SGLT-2 inhibitors, there are currently three approved medications in Canada that fall into this class of antihyperglycemic medication: canagliflozin, dapagliflozin and empaliflozin. Similar to GLP-1s, all of the approved medications in this class are associated with weight loss in clinical trials, with the greatest weight loss observed in patients taking canagliflozin (1.9–4.0 kg93,110,111), followed by dapagliflozin (1.0–4.5 kg112,114) and empaliflozin (1.5–2.9 kg115,117).

Weight gain is a well-known side effect of insulin and can range from 0.4 to 4.8 kg.85,86,88,118 However, currently, insulin is the only treatment option for type 1 diabetics and is used for type 2 diabetics when they cannot tolerate or are not responsive to other hypoglycemics, which prevents the use of alternative treatments. There is considerable variability in the amount of weight gain associated with the use of insulin. Aside from genetics, other factors which can contribute to insulin-related weight gain, such as drug administration, dose and speed of release (rapid vs slow), can be manipulated to decrease the weight gain potential of this medication. For example, a study examining the weight and glycemic effects of once a day insulin injection vs the use of an intermediate-acting insulin observed significantly greater weight gains in those using the intermediate compared to the once-daily insulin injection (+1.9 vs +0.4 kg) over a 6-month period.118

Antihypertensives

Hypertension is a prevalent condition among individuals with excess weight. In fact, gaining weight is associated with increases in both systolic and diastolic blood pressure.119 Dietary changes and weight management are typical first-line treatments for hypertension,120 and as such, medications which are associated with weight gain should be avoided. Fortunately, the majority of medications within this class appears to be weight neutral or associated with weight loss ().

Table 4

Treatment-emergent weight changes associated with antihypertensives

Drug name Weight effect
Alpha-blockers
Clonidine155,156 +a
Prazosin157,158 Neutral
ACE inhibitors
Enalapril131133 − −a
Lisinopril124,137,138 a
Perindopril134136 + & − −a
Ramipril139141 a
ARBs
Irbesartan161,165,166 Neutral
Losartan131,163,164 − −a
Olmesartan161,162,165 Neutral
Telmisartan159162 a
Valsartan167169 +a
Beta-blockers
Acebutolol153,154 Neutral
Atenolol143145 + +a
Metoprolol148,149 +a
Propranolol146,147 +a
Timolol150152 a
CCBs
Amlodipine170172 Neutral
Diltiazem173175 +a
Direct renin inhibitors
Aliskiren176178 Neutral
Diuretics
Chlorthalidone122,125,126,a a
Furosemide122,123,130a − −
Hydrochlorothiazide121124,a a
Indapamide127129,a a

Diuretics, more specifically hydrochlorothiazide, are associated with modest weight losses of 0.4–2.7 kg.121124 This is a consistent characteristic of this class of medication, with other commonly prescribed diuretics including chlorthalidone (−1.8 to 0.2 kg122,125,126), indapamide (−2.7 to 0.5 kg127,129) and furosemide (−4.1 to +0.3 kg122,123,130) being similarly associated with weight neutral to weight loss effects.

Of the commonly prescribed angiotensin-converting enzyme inhibitors, enalapril (−3.0 to +0.4 kg131,133) and perindopril (−3.2 to +1.1 kg134,136) are associated with the greatest amount of weight loss. Lisinopril (−1.5 to 0.0 kg124,137,138) and ramipril (−1.5 to +1.0 kg139,141) may also be associated with weight loss, but appear to be more weight neutral.

Beta-blockers are typically associated with weight gain for the first few months of treatment, followed by a plateau. However, the amount of weight gain associated with beta-blockers is moderate and may not be clinically significant.142 Of the commonly prescribed beta-blockers, atenolol (−0.5 to +3.4 kg143,145), propranolol (−0.5 to +2.3 kg146,147) and metoprolol (1.2–2.0 kg148,149) are associated with the highest weight gain. Conversely, timolol (−1.8 to +0.4 kg150,152) and acebutolol (−0.6 to 0.0 kg153,154) appear to be weight neutral and may even have some weight loss properties. For alpha-blockers, weight gain is not a commonly reported side effect. In general, changes in weight for alpha-blockers appear to be minor or nonexistent, with the average changes in weight following clonidine (0.4–1.4 kg155,156) and prazosin (0.0–0.5 kg157,158) being <1.5 kg.

Angiotensin II receptor blockers and calcium channel blockers are the second-line treatment options for hypertension that are commonly compared in efficacy trials. Of the most commonly used angiotensin II receptor blockers, telmisartan (−2.1 to +0.2 kg159,162) and losartan (−4.2 to −0.1 kg131,163,164) are associated with the greatest amount of weight loss. Olmesartan (−0.5 to +0.3 kg161,162,165) and irbesartan (−1.0 to +0.2 kg161,165,166) are associated with weight neutral effects and valsartan (0.6–2.4 kg167,169) is primarily weight neutral, but can be associated with modest weight gains. Conversely, the two most commonly used calcium channel blockers, amlodipine (−0.7 to +0.8 kg170,172) and diltiazem (−0.1 to +1.2 kg173,175), are relatively weight neutral with <1.5 kg weight changes on average.

In 2008, a new class of hypertension medications was approved for use in Canada, called direct renin inhibitors. Currently, aliskiren is the only medication within this class approved for use and appears to have weight neutral effects (0.0–1.0 kg176,178).

Corticosteroids

Corticosteroids including cortisone and other glucocorticosteroids can be used for the treatment of conditions such as asthma, dermatological or inflammatory disorders and rheumatic or autoimmune diseases.179 The short-term use of corticosteroids has not been shown to be associated with significant changes in body weight180 (). Conversely, literature on the long-term usage (≥3 months) of corticosteroids suggests the opposite,181 with prednisone (1.7–5.8 kg182,184), prednisolone (1.5–4.4 kg185,186) and cortisone (1.5–8.4 kg187,189) being associated with significant weight gains. Additionally, there is considerable variability in the amount of weight gain that patients will experience while taking this class of medication, with one study reporting weight gains of ≥10 kg in more than one-fifth of patients taking prednisone at 1 year.182 Very few alternatives exist for the use of corticosteroids. However, changes in treatment regimen can be useful in reducing weight increases.190 Alternate day dosing schedule for prednisone may be beneficial as it has been shown to attenuate weight gains and even promote weight loss.190

Table 5

Treatment-emergent weight changes associated with corticosteroids

Considerations for pharmaceutical treatment

Improving clinical indicators and patient’s health is paramount when selecting pharmaceutical treatment options and there are several factors that need to be taken into consideration. Given that weight gain is a commonly reported side effect for many medications, clinicians should strive to prescribe medication(s) with more favorable weight-related outcomes whenever clinically possible. With the overwhelming evidence of the health risk of excess weight and the association of gaining weight and nonadherence to medication, it is important to discuss and evaluate this potential side effect with the patient when prescribing a medication.

In order for fluctuations in weight to be monitored, baseline weight measurements should be taken prior to initiating a pharmaceutical treatment. A weight gain of >2.0 kg within a month, in the absence of health and lifestyle changes suggests that intervention may be necessary.8 Prior to making changes to medication, changes to dietary and physical activity may be able to counteract the weight gaining effects of medications. Indeed, research has suggested that individuals taking psychiatric medications that are associated with weight gain can still lose a clinically significant amount of weight by participating in a lifestyle intervention without the need to alter their medication.191,192 If lifestyle changes alone do not result in the desired amount of weight loss, changes to medication should be considered. Where possible, changes to the dose or delivery of the medication should be attempted prior to medication substitution. When it is not feasible, clinicians should consider substituting medications. Fortunately, many of the medications examined in this review have more weight-favorable outcomes.

Once the decision has been made to change medications, clinicians should be cognizant to switch only one medication at a time, so that the effects on weight and medical efficacy can be appropriately evaluated.190 A protocol highlighting clear instructions should be created for the patient to minimize the potential of withdrawal symptoms. When switching to a more weight-favorable medication, non-weight-related side effects must also be taken into consideration. For example, while bupropion is often recommended as an alternative therapy to other antidepressants due to its weight loss side effects, it is also associated with a risk of seizures. Further, cost is an important consideration as it can contribute to nonadherence. This may be the case with liraglutide 1.8 mg, which is associated with a better side effect and weight profile than other antihyperglycemic medications, but costs considerably more.

During the course of treatment, switching pharmacotherapies may not be feasible due to a variety of reasons such as cost and efficacy. In such cases, adjunctive therapies may be used to better manage treatment-induced weight gain. Currently, there are three medications approved for weight management in Canada. Orlistat, a lipase inhibitor, has been available since the 1970s and is associated with placebo-subtracted weight losses of 4.3 kg.193 Unfortunately, the common side effects of this medication include oily and loose stools, which can ultimately lead to nonadherence and discontinuation. In comparison, liraglutide 3.0 mg, at a clinical dose of 3.0 mg, is also approved for weight management and has been associated with placebo-subtracted weight losses of 4.5–6.0 kg.4,27 While there are beneficial effects such as improved HbA1c levels, there are some more severe rare side effects such as gallstones and pancreatitis.194 In 2018, Health Canada approved Contrave, which is a combination medication of bupropion, an norepinephrine-dopamine reuptake inhibitor, and naltrexone, an opiate antagonist. Results of a Phase 3 clinical trial suggest that the use of Contrave, as an adjunct to a lifestyle intervention, results in superior weight loss to placebo (5.0%–6.1% vs 1.3%), but as with other weight management medications, nausea appears to be a common side effect.195

Where it is not possible to add an adjunctive therapy due to drug interactions or cost, patients should be made aware of the weight change potential, and research suggests that implementing lifestyle changes (ie, quality of diet and increased physical activity) may be beneficial to combat the weight gaining effects. For example, a study which compared metformin therapy alone and in addition to a lifestyle modification program observed greater weight loss in the group participating in the lifestyle modification (5.6 vs 2.1 kg196).

There are several limitations that warrant mentioning. Due to the number of pharmaceuticals approved for treatment worldwide, it is not possible to examine the weight effect of every agent. As such, this review is not an exhaustive list, rather it evaluates commonly used pharmaceuticals that have been approved for use in Canada. The effect of pharmaceutical medications on weight depends of a multitude of factors; thus, the associations in this paper need to be interpreted with caution. As population demographics have shifted dramatically in the last 30 years, findings of studies examined may be dated and may not be generalizable to the population today. Patient demographics are an important consideration because differences in age, sex, body mass index and so on may have a significant impact on the weight changes that occur. Specifically, the weight gains associated with lithium are more severe in patients with obesity than their lower-weight counterparts (6.1 kg obese vs 1.1 kg non-obese32). Conversely, the weight gains associated with olanzapine are lower with increasing body mass index.197 Further, this paper provides the mean ranges of absolute weight change, which may be useful for interpreting the impact of medication on weight change. However, these ranges merely reflect the results of available studies, some of which have small sample sizes (ie, n<10) and may not be generalizable to a heterogeneous population. As studies differ in treatment duration, dose, concomitant medications and intervention type, changes in weight observed in clinical practice may be different from the results presented here. For example, the duration of treatment has a significant impact on the weight outcome of patients for some medications. In one study, patients plateaued after 37 weeks of olanzapine treatment,197 while another study observed that patients taking clozapine may persist in gaining weight after 46 months.198 Given that weight gain is a complex and multifactorial issue, it may be possible that other factors contribute to the reported weight changes. Several of the studies examined did not account for potential confounding factors such as lifestyle changes. This may be especially pertinent in the case with glucocorticoids, where the results from a recent systematic review suggest that dietary intake is infrequently reported, making it difficult to assess weight changes.179 However, as the course of pharmaceutical treatment does not occur independently of side effects such as weight gain, the estimates reported are still relevant to clinical practice.

Chronic inflammation and weight gain

Medical treatments for chronic disease and even weight loss are focusing more and more on the need to prevent and reduce chronic inflammation. Studies show that inflammation is a common underlying factor in all major degenerative diseases — including heart disease, cancer, hypertension, and diabetes — and that it can also cause weight gain and difficulty losing weight.

The good news: inflammation is linked to several diet and lifestyle factors. By making key changes in these areas, you can reduce inflammation in the body, lower your risk of degenerative disease, and help your body shed excess weight. Continue reading to learn more about inflammation, how it affects your health, and how to reduce it.

Need help reducing inflammation and losing weight? Contact us today for a no-cost consultation, download your copy of our FREE Inflammation E-book, or watch our inflammation video!

 

What is inflammation?

Inflammation is your body’s response to an injury or threat. In certain situations, inflammation is necessary and helpful. Stubbing your toe or cutting your finger can cause what’s known as acute inflammation, which is characterized by four key markers: redness, heat, swelling, and pain. Blood flow increases to the area so that white blood cells can accumulate at the site of the injury and help protect the body against disease and foreign invaders, such as bacteria.

This inflammatory response is your body’s way of defending itself and repairing damaged tissue. Without acute inflammation, wounds would never heal. Acute inflammation is temporary and typically goes away after a few days.

Chronic inflammation, on the other hand, occurs inside the body, and can lead to major health complications — including weight gain.

What is chronic inflammation?

When cells are damaged on the inside of the body, the same inflammatory response occurs. However, chronic inflammation can persist for months or years if the problem is not eliminated. In some cases, inflammation can continue even if the threat is eliminated.

Chronic inflammation, also referred to as systemic inflammation, puts your body into an emergency state for a prolonged period of time, which can lead to health problems. White blood cells may begin attacking healthy tissue and organs, causing even more inflammation that can affect processes throughout the body.

How inflammation affects the body

Chronic inflammation can impair functions throughout the body related to cardiovascular health, cognitive function, digestion, metabolism, hormone levels, and more.

When inflammatory cells are present in the body for an extended period, it can promote the buildup of dangerous plaque in the arteries. As plaque continues to build, it increases the risk of heart attack or stroke.

Similarly, inflammatory cells in the brain may play a role in Alzheimer’s disease and dementia. High levels of inflammatory markers have also been linked to depression.

Chronic inflammation damages the lining of the gut and can lead to leaky gut syndrome, also known as intestinal permeability. In addition to causing digestive issues, leaky gut syndrome allows substances from food and other sources to leak into your bloodstream and cause damage to internal organs and normal bodily processes.

Research also shows that inflammation is involved in tumor progression, and that many cancerous tumors begin at sites of chronic irritation and inflammation.

How inflammation causes weight gain

Inflammation can also affect body weight in numerous ways. When the immune system detects a threat, the body releases substances called cytokines, which activate the body’s immune response. Cytokines are pro-inflammatory, and they also interfere with the body’s insulin response.

When the body becomes resistant to insulin, the pancreas must release more of it, which triggers the body to store fat. Individuals with insulin resistance tend to store more fat in the abdominal region.

This abdominal fat is particularly dangerous. It increases production of cytokines, which in turn increases the risk of heart disease. Belly fat is also linked to an increased risk of cancer.

Inflammation can also interfere with the body’s response to leptin, a hormone that tells the brain when you’ve had enough to eat. If your brain doesn’t receive this signal, it can cause you to eat more than necessary. Resistance to leptin is now thought to be a major driver of weight gain in humans.

What causes inflammation in your body?

Anything that causes cellular damage or malfunction can trigger an inflammatory response inside the body. This cellular damage can be caused by factors such as exposure to toxins, poor nutrition, and bacterial imbalances in the gut.

Some common causes of inflammation include:

  • Chronic stress. Stress leads to elevated levels of cortisol, which is also linked to increased abdominal fat.
  • Exposure to chemicals, including food additives, pesticides, and environmental pollution. Skincare products and cosmetics often contain phthalates, which are linked to oxidative stress and inflammation.
  • Smoking
  • Nutritional deficiencies. Any nutrient deficiency can lead to cellular damage either directly or indirectly, but some are especially known to cause inflammation, including low levels of vitamin D, vitamin B6, and vitamin B12.
  • Excess weight can also increase inflammation, as it can place stress on the body that leads to additional cellular damage.

What are inflammation markers?

Chronic inflammation isn’t always obvious because it is internal. Symptoms such as excess abdominal weight, fatigue, mouth sores, skin issues, brain fog, and joint pain may be an indication of systemic inflammation.

Certain inflammatory markers can also be measured with a blood test. One such marker is c-reactive protein, a substance produced by the liver in response to inflammation. Research from Harvard doctors found that men with high levels of CRP had double the risk of stroke and three times the risk of heart attack as men with little or no inflammation.

What are inflammation causing foods?

Certain foods naturally trigger inflammation in the body. These include sugar, vegetable oils, fried foods, refined carbohydrates, artificial sweeteners, and other artificial food additives.

Many of these foods contribute to the formation of acid in the body, which increases inflammation. Other acid-forming foods include coffee, dairy products, soda, most sports drinks, bottled fruit juice, potato chips, alcohol, processed meats, and red meat.

Sugar in particular is known to drive inflammation. A study of 29 healthy adults found that those who consumed just one sugar-sweetened beverage per day experienced increases in c-reactive protein and insulin resistance, as well as LDL cholesterol.

Does dairy cause inflammation?

Evidence on the relationship between dairy products and inflammation is mixed. Some studies indicate that the consumption of dairy products does not increase inflammatory markers. However, because dairy is acid-forming, dairy products could further contribute to an acidic internal environment, which contributes to inflammation. Conventional dairy products are also typically loaded with hormones and antibiotics. If your goal is to reduce inflammation, it may be wise to avoid dairy products and use alternatives such as almond milk.

Foods that reduce chronic inflammation

To combat inflammation, make a point of including healthy, whole fruits and vegetables in every meal. Also, drink plenty of water throughout the day to help flush toxins and waste from your body.

Some foods offer especially powerful anti-inflammatory benefits in the form of antioxidants, vitamins, and minerals that help fight inflammation while also boosting your metabolism.

Best foods for inflammation

  • Leafy greens (kale, spinach)
  • Green vegetables such as broccoli
  • Olives and olive oil
  • Coconut oil
  • Fatty fish (salmon, sardines, herring, mackerel)
  • Berries (strawberries, blueberries, raspberries, blackberries)
  • Grapes
  • Cherries
  • Tomatoes
  • Bell peppers and chili peppers
  • Mushrooms
  • Avocados
  • Nuts
  • Seeds
  • Turmeric
  • Dark chocolate
  • Green tea

Reducing inflammation in the body

Given the wide range of factors that contribute to inflammation, it’s clear that reducing inflammation in the body should be a multi-faceted approach.

Eating a healthy diet full of anti-inflammatory foods is an important step in combating chronic inflammation. Reduce your intake of inflammatory and acidic foods such as processed foods, fried foods, and refined carbohydrates, including sugar.

It’s important to note, however, that changing your diet alone may not be enough to rid your body of inflammation. Conditions such as leaky gut syndrome can prevent your body from absorbing the nutrients it needs from your food. Hormonal imbalances, as indicated above, can also interfere with your body’s response to food. An anti-inflammatory diet must also include measures to help heal the gut and correct any hormonal imbalances.

Practices such as intermittent fasting have been found to be effective in reducing inflammation and helping to reset the metabolism, so that they body can function at an optimal level and better respond to a healthy diet. In clinical trials, the ProLon fasting mimicking diet has been shown to reduce levels of c-reactive protein in the body.

Exercising regularly and getting plenty of sleep are also important components of an anti-inflammatory lifestyle.

To reduce your exposure to chemicals, use skin care products and cosmetics that are free of phthalates, and choose food containers and water bottles that at BPA free. Don’t smoke, and limit your exposure to secondhand smoke.

Finally, adopt good stress management techniques, such as mindfulness meditation. Yoga breathing exercises have also been found to help reduce inflammation.

Using nutritional supplements to combat inflammation

Some nutritional supplements can further help you fight inflammation. B vitamins can help reduce chronic inflammation, as well as omega-3 fatty acids, calcium, magnesium, and vitamin D.

Take fish oil supplements to shut down inflammatory pathways, and use a vitamin B12 supplement to help control levels of cytokines.

At Garcia Weight Loss and Wellness Centers, we provide all of our patients with a personalized low-glycemic diet plan that can help reduce chronic inflammation. We also offer additional therapeutic interventions that can help balance hormones, reduce stress, and lower levels of inflammatory markers such as c-reactive protein.

Need help reducing inflammation and losing weight? Contact us today for a no-cost consultation!

 

Medically reviewed by Jay J. Garcia, MD on July 10, 2018

This post was originally published in August, 2017, and has been updated for freshness, accuracy, and comprehensiveness.

Muscle Relaxers and Weight Gain

Weight Gain

Image Credit: Stockbyte/Stockbyte/Getty Images

Muscle relaxers can be useful to treat various ailments including back and muscle injuries. Taking oral medication means that the drug is circulated throughout your body, not just to the site of injury. These medications can affect your body in many ways besides reducing the spasms in your injured muscles. Although muscle relaxers do not directly cause weight gain, the reduced mobility of the injury and the effects of the medications can result in weight gain as a result of decreased activity.

The Uses of Muscle Relaxers

Muscle relaxers are commonly used to treat back pain and other muscle injuries. When a muscle is injured, it twitches and spasms causing pain and more injury to the muscle. Muscle relaxers reduce this reaction to injury by allowing the muscle to stop contracting and start healing. Use of these medications can help you exercise the injured muscles, maintain fitness and prevent weight gain from inactivity.

Function

Muscle relaxing medications are sedatives; this class of drugs includes carisoprodol, cyclobenzaprine, naproxen and diazepam. Sedatives are central nervous system depressants and act on your body by slowing down brain activity and causing skeletal muscle relaxation. Sedatives such as muscle relaxers can cause drowsiness, impaired thinking and decrease your ability or interest in making good nutrition choices. Older adults are at particular risk for cognitive impairment with these medications and as a result they may experience significant weight gain if the medication is used for a chronic pain condition.

Sedatives and Weight Gain

Muscle relaxers depress your central nervous system and so slows down many of the processes that make your body function. These medications are generally prescribed for a short period of time of five to seven days for acute conditions. Short-term use of these medications can cause a slight weight gain of 2 to 3 lbs. as you reduce your activity to heal from your injury. Long-term use or abuse of these medications can cause more significant weight gain as you continue to experience a decrease in your overall physical activity.

Muscle Relaxers for the Short Term

Muscle relaxers, along with pain medication and physical therapy, are useful short-term treatment for muscle injuries. Following your primary care provider’s treatment regimen for your injury will result in faster healing times and little risk of side effects such as weight gain. If the need for longer term treatment with muscle relaxer medication is needed; be aware that there is a risk for weight gain as well as the potential for addiction.

Sumatriptan and Naproxen | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Treximet

Trade names: Canada

Suvexx

Warning

  • This drug may increase the risk of heart and blood vessel problems, such as heart attack and stroke.These effects can be deadly. This risk may be increased if you have heart disease or have risk factors for such diseases. However, the risk may be increased even for people who do not have or are not at risk of developing heart disease. The risk may arise during the first weeks of using this drug and may increase with higher doses or with long-term use. This drug should not be used immediately before or after coronary artery bypass surgery.
  • This drug may increase the likelihood of severe and sometimes fatal stomach or intestinal problems such as ulcers or bleeding. The risk is increased in the elderly and in people who have previously had ulcers or bleeding in the stomach or intestines. Such violations can occur suddenly.

What is this drug used for?

  • Used to treat migraines.

What should I tell my doctor BEFORE taking this drug?

  • If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
  • If you are allergic to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
  • If you have ever had asthma caused by salicylate drugs, such as aspirin, or drugs such as this drug, such as non-steroidal anti-inflammatory drugs (NSAIDs).
  • If you have any of the following health problems: high blood pressure or liver disease.
  • If you have any of the following health conditions: Heart failure (weak heart) or have recently had a myocardial infarction.
  • If you have any of the following health problems: gastrointestinal bleeding or kidney problems.
  • If you have ever had any of the following health conditions: chest pain or angina pectoris, arterial disease of the lower or upper extremities, myocardial infarction or other heart disease, poor circulation in the heart, brain, intestines or kidneys, stroke or transient ischemic attack (TIA), some types of migraine, such as hemiplegic or basilar migraine, or an abnormal heart rhythm, such as Wolff-Parkinson-White syndrome.
  • If you are unable to get pregnant or are checking if you are able to get pregnant.
  • If you are pregnant, plan to become pregnant, or become pregnant while taking this drug. If you take this drug after 20 weeks of pregnancy, it can cause fetal harm. If you are between 20 and 30 weeks pregnant, take this drug only as directed by your doctor. Do not use this drug after 30 weeks of pregnancy.
  • If you are breast-feeding or planning to breast-feed.
  • If you are taking NSAIDs, a salicylate such as aspirin, or pemetrexed.
  • If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
  • If you have taken the following drugs in the past 24 hours: almotriptan, eletriptan, frovatriptan, naratriptan, risatriptan, sumatriptan, or zolmitriptan.
  • If you have taken ergotamine, methysergide, dihydroergotamine or similar medications within the past 24 hours.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

  • Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
  • Avoid driving or other activities that require increased attention until you see how this drug affects you.
  • If you smoke, consult your doctor.
  • If you have asthma, consult your doctor. You may be more sensitive to the drug.
  • Very bad and sometimes life-threatening heart problems, such as a heart attack or an irregular heartbeat, have rarely happened within hours after taking this drug.See your doctor right away if you have a feeling of tightness, pain, pressure, or heaviness in your chest, throat, neck or jaw, if you have a cold sweat, if you have shortness of breath, rapid heartbeat, irregular heartbeat, or very severe dizziness or fainting …
  • Very bad and sometimes deadly brain damage, such as a stroke, has rarely happened with this drug. If you have weakness on 1 side of your body, difficulty speaking or thinking, imbalance, drooping of 1 side of your face, or blurred vision, see your doctor immediately.
  • The risk of developing heart failure is increased with the use of drugs of this kind. People with heart failure have an increased risk of myocardial infarction, hospitalization for heart failure, and death. Consult your doctor.
  • People who have had myocardial infarction and are taking drugs of this kind have an increased risk of recurrence of myocardial infarction and death due to heart problems.People who took drugs of this kind after their first heart attack were also more likely to die one year after myocardial infarction compared with those who did not take these drugs. Consult your doctor.
  • Liver dysfunctions have been reported while taking drugs of this kind. Sometimes these cases were fatal. Call your doctor right away if you have signs of liver dysfunction, such as dark urine, tired feeling, lack of appetite, nausea or abdominal pain, light colored stools, vomiting, yellow skin or eyes.
  • Possible severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis). This can lead to serious and permanent health problems and sometimes death. Get immediate medical attention if you experience symptoms such as redness, skin swelling with blistering or scaling (with or without a high fever), redness or irritation of the eyes, and ulceration in the mouth, throat, nose, or eyes.
  • Severe and sometimes fatal reactions have occurred with other drugs of this nature. In most cases, this reaction was accompanied by symptoms such as fever, rash, inflammation of the lymph nodes, and dysfunction of various organs such as the liver, kidneys, blood, heart, muscles, joints and lungs. If you have any questions, please consult your doctor.
  • If you are 65 years of age or older, use this drug with caution.You may have more side effects.
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as this drug, can interfere with egg release (ovulation). This can negatively affect your ability to get pregnant. As a rule, the ovulation process is restored after you stop taking this drug. Consult your doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects.Call your healthcare professional or get medical attention right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.In rare cases, certain allergic reactions have resulted in death.
  • Signs of bleeding such as vomiting or coughing up blood; vomiting of the type of coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruising that occurs or increases for no reason; bleeding that you cannot stop.
  • Signs of kidney problems, including lack of urination, change in urine volume, blood in the urine, or rapid weight gain.
  • Signs of elevated potassium levels such as a feeling of a disturbed heartbeat, confusion, feeling weak or dizzy, feeling light-headed, feeling numb or tingling, or shortness of breath.
  • Signs of high blood pressure, such as very severe headache, or dizziness, or loss of consciousness, or blurred vision.
  • Severe abdominal pain or diarrhea with bloody stools.
  • Changes in vision, eye pain or very severe eye irritation.
  • Loss of vision. Can persist for a long time.
  • Shortness of breath, sudden weight gain, or swelling of the arms or legs.
  • Convulsions.
  • Unusual burning, numbness, or tingling sensations.
  • Swelling of the gland.
  • A serious and sometimes fatal complication called serotonin syndrome can occur. This risk may increase with the concomitant use of certain other drugs. Call your doctor right away if you have anxiety, imbalance, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , very severe headache.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

  • Heartburn.
  • Constipation, diarrhea, vomiting or nausea.
  • Gas.
  • Feeling dizzy, sleepy, tired, or weak.
  • Hyperemia (blush).

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https: // www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

  • Take with or without food. Take with food if the medicine causes nausea.
  • Swallow whole. Do not chew, break, or crush.
  • Take with liquids as early as possible after the onset of an attack.
  • If your headache persists after the first dose, consult your doctor. If your headache comes back or you only feel some relief, you can take 1 more dose as directed by your doctor. If you are taking a second dose, be sure to wait at least 2 hours after taking the first dose.
  • If you have a headache that is not like your usual migraine headache, talk with your doctor before using this drug.
  • Taking too much of this drug (higher doses, more frequent use) than what your doctor tells you to do may make your headaches worse.
  • Be careful if you have risk factors for heart disease (high blood pressure, high cholesterol, being overweight, high blood sugar or diabetes, cigarette smoking, male and over 40 years of age, early heart disease in other members families, postmenopausal women).Consult your doctor.
  • This medication is not intended to prevent or reduce the incidence of migraine headaches.
  • There is an increased likelihood of bleeding. Be careful and avoid injury. Use a soft toothbrush and electric shaver.
  • Consult a physician before drinking alcohol.
  • If you are taking aspirin to prevent myocardial infarction, consult your doctor.
  • High blood pressure has been reported with this type of drug.Monitor your blood pressure as directed by your doctor.
  • This drug may interfere with some laboratory tests. Tell all healthcare providers and lab staff that you are taking this drug.

What should I do if a dose of a drug is missed?

  • Take this medication as needed. Do not exceed 2 tablets in a 24 hour period.

How do I store and / or discard this drug?

  • Store at room temperature in a dry place. Do not store in the bathroom.
  • Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so.If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your health does not improve or even worsens, see your doctor.
  • You should not give your medicine to anyone and take other people’s medicines.
  • Some medicines may have different patient information sheets.If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • A separate patient instruction sheet is attached to the product. Please read this information carefully. Reread it every time you replenish your supply. If you have questions about this drug, talk with your doctor, pharmacist, or other healthcare professional.
  • If you think there has been an overdose of a drug, call a Poison Control Center immediately or seek medical attention.Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Copyright

© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

Periactin (Cyproheptadine Hydrochloride) [LifeBio.wiki]

Periactin (Cyproheptadine hydrochloride) is a first generation histamine and serotonin receptor antagonist.In the United States, the drug is most commonly prescribed to treat allergy-related symptoms such as hay fever, runny nose, eye irritation, hives, and swelling. In addition, the drug is FDA approved for the treatment of anaphylactic reactions caused by allergens, often as an adjunct to epinephrine injections. The unique ability of the drug to increase appetite is provided by its action on serotonin inhibition. This feature provokes the massive use of the drug not for its intended purpose, but as a means of gaining weight, especially in patients suffering from muscle loss associated with AIDS, cancer or other debilitating diseases.Cyproheptadine hydrochloride is also sometimes used as an adjunct to growth hormone therapy in children for greater nutrient absorption and more linear growth than is achieved with GH alone. Bodybuilders and athletes use Periactin to increase their calorie intake, usually during periods of weight gain, and the drug is often used in conjunction with anabolic / androgenic steroids. Although the issue of such use is still controversial, the effect of cyproheptadine hydrochloride on stimulating appetite is abundantly described in the medical literature.One of the more detailed studies compares the effects of cyproheptadine hydrochloride megestrol acetate on increased appetite in a group of 14 people with HIV-related weight loss. Another drug, megestrol, is a progestin approved by the FDA in 1993 for the treatment of anorexia, cachexia, or weight loss in AIDS patients. In this study, cyproheptadine hydrochloride showed similar activity levels to megestrol, with patients eating about 500 more calories per day and moderate weight gain in both groups.Although the drug benefits were similar, the side effects were different. The researchers reported that more than 50% of patients taking megestrol suffered from impotence during the study, while no such side effects were observed in the cyproheptadine hydrochloride group. Cyproheptadine hydrochloride may be an effective alternative to megestrol for many patients, especially those prone to negative side effects associated with this type of hormonal disorder.

Pharmacological group: Antihistamines.Antiserotonergic drugs.
Pharmacological action: It is an antagonist of serotonin and histamine, has the ability to stimulate appetite. Blocks H1 receptors. Effects on receptors: Serotonin receptors (antagonist). Histamine receptors (antagonist) H1 receptors (blocker).

History of Cyproheptadine Hydrochloride

Cyproheptadine hydrochloride is an antihistamine that has been marketed as a drug in most developed countries for decades.In 1961, the drug appears in the United States under the brand name Periactin® from Merck & Co. Under this brand, cyproheptadine hydrochloride has been available in the United States for many years, but in 2003 Merck & Co voluntarily discontinued the drug in the United States and Canada. Despite the fact that Merck & Co. has stopped selling Periactin in a number of other countries (probably due to low financial benefits), the brand is still available in more than a dozen countries, including Australia, Austria, Belgium, Ireland, Italy. , The Netherlands, New Zealand, South Africa, Spain, Sweden, Thailand and the UK.It is also marketed under a variety of other brand names around the world, in both single and multi-ingredient formulations. A number of generic drugs are still available in both the US and Canada. After studies of cyproheptadine hydrochloride for long-term weight gain, in 1994 the World Health Organization issued a warning against the use of the drug for this purpose. Despite this, many people still take cyproheptadine hydrochloride as a short-term appetite stimulant.

How Supplied Periactin

Cyproheptadine hydrochloride (Periactin) is most commonly supplied in 4 mg tablets.

Structural characteristics

Cyproheptadine hydrochloride is an antihistamine and antiserotonergic drug with the chemical designation 4 (5H-dibenzo [a, d] cyclohepten-5-ylidene) -1methylpiperidine hydrochloride sesquihydrate.

Side effects Cyproheptadine hydrochloride

As a first generation antihistamine, cyproheptadine hydrochloride can exhibit a number of side effects, the most common of which is sedation or the classic “antihistamine lethargy”.For some users, fatigue from cyproheptadine hydrochloride will outweigh any potential weight gain benefits of the drug. Most users, however, do not notice this side effect. Other less common side effects include, but are not limited to: dizziness, lack of coordination, muscle weakness, nausea, vomiting, diarrhea, constipation, dry mouth, difficulty urinating, dizziness, visual disturbances, chest tightness, shortness of breath, difficulty breathing , sweating, decreased periods of menstruation, headache and weakness.If you experience any strong unwanted side effects, you must immediately stop taking the drug or even consult a doctor.

Instructions for the use of Periactin (Cyproheptadine hydrochloride)

The dosage required for medical purposes may vary depending on the individual characteristics of patients and their specific needs. The established therapeutic dose range for Periactin (Cyproheptadine Hydrochloride) is 4 mg to 20 mg per day, with most adults taking 12 mg to 16 mg per day.The total daily dose is usually divided into three doses. When used (off-label) as an appetite stimulant, a dosage of 4 mg 2-3 times daily (8-12 mg) is usually used. As this level rises, side effects may become more noticeable (especially drowsiness), and often overshadow the benefits of the drug. The drug can be used during a steroid cycle to gain weight, while the use of cyproheptadine hydrochloride usually lasts no more than 4-8 weeks. For users who are tolerant of side effects (most often fatigue), cyproheptadine hydrochloride is often a very valuable appetite stimulant.This is especially true for individuals who have trouble consuming enough food to satisfy a high-calorie protein diet for optimal muscle growth.

Stock:

Cyproheptadine hydrochloride is available in many countries around the world. Although the drug is rarely found on the black market, the drug’s high supply and relatively mild side effects make it readily available for purchase when needed. Given the low demand, counterfeits of Cyproheptadine Hydrochloride are quite rare.The price of Cyproheptadine Hydrochloride (Periactin) varies depending on the manufacturer. It is also interesting to note that Anabolex, a steroid product from the Dominican Republic, in every 3 mg methandrostenolone tablet contains 1.5 mg of cyproheptadine hydrochloride, added by the developers to increase calorie intake. A ratio of 2: 1 is optimal with a daily dose of 24 mg of Dianabol, which will provide 12 mg of cyproheptadine hydrochloride (the most common maximum daily dose).It is the only anabolic steroid that contains Cyproheptadine Hydrochloride.

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periactin.txt · Last modified: 2021/06/20 14:43 – dr.cookie

Medicines for the prevention of migraines | Irina-Web.Ru

So today I have my last (hopefully) article on migraines, and this time we’ll look at how you can prevent new attacks.In the previous series: how to understand that you have a migraine, how to relieve a migraine attack.

If you begin to notice that you have seizures more than 2 times a month, they pass hard, and you completely lose the opportunity to do something during them, and you can only lie and suffer – then it’s time to start preventing seizures. Once again, I advise you to contact a doctor for the appointment of therapy, best of all – a special doctor who deals with headaches – a cephalgologist. If this is not the case, an ordinary neurologist will do, but only a good neurologist who knows how to work with migraines.

I must say right away that often prescribed vascular drugs do not help in prevention – this is a very expensive vasobral, which is very beloved by neurologists, and no less expensive, but at the same time does not have an evidence base, Cortexin, and all sorts of piracetams with cinnarizins. If you have been prescribed these drugs – look for another doctor, this one is not familiar with the prevention of migraine at all.

So, all drugs that can reduce the frequency of your attacks and improve the effect of pain relievers are divided into three groups, depending on the study of their effectiveness.It is worth noting that in international practice all this has long been researched and volumes have been written about what is considered an effective treatment and what is not. Well, we, as always, are a little late, but there are such studies in our country as well.

So.

First line of drugs for the prevention of migraine

These funds received the highest rating in research, that is, they are most likely to help you.

Beta blockers . These are drugs used to treat hypertension and all kinds of heart disease.However, they also have the ability to act as prophylactic agents for migraines. They are the best option if you have high or normal blood pressure, and not very good if you are hypotonic – you will not be able to get out of bed. Also, these drugs are not suitable for people with depression, as they can worsen it. The most effective drugs in this group are metoprolol and propranolol (anaprilin). I already drank the first one, his tolerance is not bad, but he did not help me very much. So now I take anaprilin, I tolerate it worse (pressure and pulse are trying to fall almost to zero), but the result was from the first day – a 10-day headache, when one attack turned into another, passed.Here are my full impressions of Anaprilin.

Anticonvulsants . Do not be alarmed, but these are drugs for the treatment of epilepsy. Yes, they also affect migraines, and many praise them. However, in the reviews it is often found that they cause a breakdown and constantly want to sleep. But, perhaps, with prolonged use, these side effects will pass. If you are sitting at home and not working, then you may well prefer this option – well, get more sleep than you need for a week, and then, you see, and you will get used to it.Anticonvulsants are especially good for those who suffer from unstable mood. The most effective drugs in this group are valproic acid and topiramate.

Triptans . Yes, the very remedies that relieve an attack can prevent it. Unfortunately, only one drug is most effective – frovatriptan, and it is not registered in Russia. And it proved its effect only for one type of migraine – menstrual. They begin to take it a few days before the onset of menstruation and drink it in a very short course.

Second line of drugs for the prevention of migraine

With these drugs, things are a little more complicated – studies have shown that for some they are effective, for some they are not. But there is already a wider selection of drugs.

Beta blockers. And they are here too. The most effective are atenolol and nadolol.

Antidepressants . And here is a new group of drugs. Yes, antidepressants are also good at preventing migraines if your headaches are mostly stress-related.However, you may not be depressed. They are used in lower doses than for depression. Effective drugs are amitriptyline (inexpensive, but many people get better on it and walk like sleepy flies) and venfalaxine (quite expensive, but at the same time you will most likely not be sleepy and you will not get better).

Triptans . They are used only for menstrual migraines, like frovatriptan – in short courses before menstruation. Naratriptan and zolmitriptan are used.

NSAID . We have already met them in the article on relieving a migraine attack – these are naproxen and ketoprofen. They are not suitable for those who have diseases of the stomach and intestines, and they mainly act on menstrual migraines.

Third line of drugs for the prevention of migraine

There are funds on which there is even less research than on the second line. It is possible that some of them will help you, especially if you have already tried something and points 1 and 2, and did not work for you.Here we have drugs of new groups.

ACE inhibitors . The most effective is lisinopril, it is also taken at high blood pressure. But, again, if you are hypotensive, then such drugs should be avoided.

Further very terrible names.

Angiotensin receptor antagonists and alpha-adrenergic agonists . Candesartan, clonidine, and guanfacine. Not very familiar names even for me. They also treat hypertension and, in parallel, can act as a means for the prevention of migraine.

Anticonvulsants . There is only one drug here – carbamazepine (finlepsin). It is so hypnotic that even half can knock you into sleep for five hours. However, it does not work like that on everyone, so everything needs to be checked. I didn’t get carbamazepine at all.

Beta blockers . And finally, the last group of drugs. As you can see, beta blockers are present in all three groups, but not all of them are effective enough. The least studied for the prevention of migraine are nebivolol and pindolol.

Phew, everything. This list is not a guide to action, but a direct indication to go to the doctor and select drugs with him. In addition, their combinations are possible – most often it is a beta blocker and an antidepressant. For example, I am currently taking anaprilin and amitriptyline. This combination is effective if you need a quick effect, then amitriptyline can be canceled. But I have not yet reached even the minimum effective dose of anaprilin, because the pressure and pulse are greatly reduced, so the withdrawal of the antidepressant will not happen soon.

The most you can do is ask a neurologist about the above drugs. If he agrees to assign you one of them – for God’s sake. But just don’t do it yourself. Not only are many drugs sold by prescription only, but you yourself may not consider some side effect or contraindications, and then plant yourself a heart or stomach. In general – down with self-medication!

If you have any questions – ask.

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    indications and contraindications, composition and dosage – Pharmacy Mos

    Interaction of Pilobact tablets and capsules set 250mg + 20mg + 500mg

    Clarithromycin.With simultaneous use with astemizole, cisapride, pimozide, terfenadine, an increase in the concentration of the latter in the blood has been reported, which can lead to cardiac arrhythmias (prolongation of the QT interval on the electrocardiogram, ventricular tachycardia, ventricular fibrillation, “pirouette” tachycardia). Concomitant use of clarithromycin with astemizole. cisapride, pimozide, terfenadine is contraindicated. The simultaneous use of clarithromycin and ergotamine or dihydroergotamine (ergot alkaloids) can lead to acute ergotamine intoxication, accompanied by severe peripheral vasospasm (impaired sensitivity, paresthesia, pain and a marked decrease in pulsation in the extremities, disturbances from the central nervous system, dizziness).Simultaneous administration of clarithromycin with ergot alkaloids is contraindicated. Caution should be exercised with the simultaneous use of clarithromycin with ototoxic drugs, primarily with aminoglycosides, due to an increase in ototoxicity. During and after the end of treatment, the function of the organ of hearing and the vestibular apparatus should be monitored. Concomitant use of zidovudine in HIV-infected adult patients may lead to a decrease in the equilibrium concentrations of zidovudine.Since clarithromycin affects the absorption of concomitant oral zidovudine, it is recommended that these drugs be taken at least 4 hours apart.
    Concomitant use of clarithromycin and digoxin.
    Digoxin is assumed to be a Pgp substrate. Clarithromycin is known to inhibit Pgp. With the combined use of clarithromycin and digoxin, inhibition of Pgp by clarithromycin can lead to an increase in the action of digoxin. Post-marketing studies have shown that co-administration of digoxin and clarithromycin can also lead to an increase in serum digoxin concentration.Some patients have had clinical symptoms of digoxin poisoning, including potentially fatal arrhythmias. When clarithromycin and digoxin are taken together, the serum digoxin concentration should be carefully monitored.
    Interactions due to CYPZA isoenzymes. Drugs that induce the isoenzyme CYPZA4 (for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John’s wort) can induce the metabolism of clarithromycin. This can lead to subtherapeutic concentration of clarithromycin, which leads to a decrease in its effectiveness.In addition, it is necessary to control the concentration of the CYPZA isoenzyme inducer in the blood plasma, which may increase due to the inhibition of the CYPZA isoenzyme by clarithromycin. The following drugs have a proven or suspected effect on plasma clarithromycin concentration; in the case of their combined use, dose adjustment or transition to alternative treatment may be required. Efavirenz, nevirapine, rifampicin, rifabutin, rifapentin increase the metabolism of clarithromycin, decreasing its concentration in blood plasma and increasing the concentration of its biologically active metabolite 14-hydroxyclarithromycin.Alternative antibiotic therapy should be considered in patients receiving CYP3A isoenzyme inducers. The simultaneous use of clarithromycin and rifabutin leads to an increase in the concentration of rifabutin and a decrease in the concentration of clarithromycin in the blood plasma with the risk of developing uveitis. The concentration of clarithromycin decreases with the use of etravirine, but the concentration of the active metabolite 14-hydroxyclarithromycin increases.
    Since 14-hydroxyclarithromycin has low activity against Mycobacterium avium complex (MAC) infections, the overall activity against their pathogens may vary, so alternative treatment should be considered for the treatment of MAC.The simultaneous use of fluconazole leads to an increase in the equilibrium concentration and the area under the concentration-time curve of clarithromycin by 33% and 18%, respectively. In this case, the equilibrium concentration of 14-hydroxyclarithromycin does not change. No clarithromycin dose adjustment is required. A pharmacokinetic study showed that the combined use of ritonavir at a dose of 200 mg every eight hours and clarithromycin at a dose
    500 mg every 12 hours resulted in a marked suppression of clarithromycin metabolism.With the combined use of ritonavir, the maximum concentration of clarithromycin increased by 31%, the minimum by 182%, and the area under the concentration-time curve increased by 77%. Complete suppression of the formation of 14-hydroxyclarithromycin was noted. In patients taking ritonavir with normal renal function, clarithromycin may be administered without dose adjustment. In patients with chronic renal failure, dose adjustment is required: with creatinine clearance of 30-60 ml / min. the dose of clarithromycin should be reduced by 50%, and with creatinine clearance less than 30 ml / min.the clarithromycin dose should be reduced by 75%. Ritonavir should not be co-administered with clarithromycin in doses greater than 1 g / day.
    With the simultaneous use of clarithromycin and insulin, as well as some oral hypoglycemic drugs that lower the concentration of glucose, such as nateglinide, pioglitazone, repaglinide and rosiglitazone, hypoglycemia may develop due to inhibition of the CYPZA isoenzyme by clarithromycin. Close monitoring of glucose concentration is recommended. The simultaneous use of clarithromycin, which inhibits CYPZA, with a drug, the metabolism of which is carried out by CYPZA, can lead to an increase in the concentration of this drug, to an increase or prolongation of both its therapeutic effect and side effects.Clarithromycin with CYPZA substrates should be used with caution, especially in the case of a narrow safety profile (for example, carbamazepine) and / or if the substrate is actively metabolized by CYPZA isoenzymes. If necessary, the dose of drugs is corrected. It is recommended to monitor the concentration of drugs metabolized by CYPZA while using clarithromycin. The metabolism of the following drugs / classes is carried out by the same CYPZA isoenzyme as the metabolism of clarithromycin, for example, alprazolam, carbamazepine, cilostazol, cyclosporine, disopyramide, methylprednisolone, midazolam.omeprazole, indirect anticoagulants (eg, warfarin), quinidine, rifabutin, sildenafil, tacrolimus, triazolam, vinblastine, quetiapine. Also, agonists of the CYPZA isoenzyme include the following drugs that are contraindicated for combined use with clarithromycin: astemizole, cisapride, pimozide, terfenadine, lovastatin, simvastatin, ergot alkaloids. Drugs that interact in a similar way through other isoenzymes within the cytochrome P450 system include phenytoin, theophylline, and valproic acid.With the simultaneous use of indirect anticoagulants
    (including warfarin), it is possible to enhance their action, therefore, careful monitoring of prothrombin time and international normalized ratio (INR) is recommended. With simultaneous use with clarithromycin, an increase in the equilibrium concentrations of omeprazole is noted (the maximum concentration, the area under the concentration-time curve and the half-life increase by 30%, 89% and 34%, respectively). The average pH in the gastric lumen changes from 5.2 with omeprazole alone to 5.7 with the simultaneous use of clarithromycin.The metabolism of sildenafil, tadalafil, vardenafil (phosphodiesterase-5 inhibitors – PDE5) takes place with the participation of CYPZA isoenzymes. With the combined use of clarithromycin with sildenafil, tadalafil or vardenafil, an increase in the inhibitory effect on PDE5 is possible. When using these drugs in conjunction with clarithromycin, consideration should be given to reducing the dose of sildenafil, tadalafil and vardenafil. The simultaneous use of clarithromycin and theophylline leads to an increase in the concentration of theophylline in the blood plasma.In patients receiving high doses of theophylline. control of plasma theophylline concentration is necessary. The simultaneous use of clarithromycin and carbamazepine can lead to an increase in the concentration of carbamazepine in the blood plasma. With the simultaneous use of clarithromycin with tolterodine in patients with low activity of the isoenzyme CYP2D6, a dose reduction of tolterodine may be required. since in this group of patients, tolterodine is metabolized through CYPZA. With the simultaneous use of clarithromycin (1 g / day.) with oral midazolam, it is possible to increase the area under the concentration-time curve of midazolam by 7 times. With the simultaneous use of midazolam for intravenous administration, this figure increased 2.7 times. Concomitant use of clarithromycin with oral midazolam is contraindicated. Caution should be exercised and the possibility of dose adjustment should be considered with the simultaneous use of clarithromycin with intravenous midazolam, as well as with other benzodiazepines that are metabolized by CYPZA isoenzymes (triazolam and alprazolam).Clarithromycin decreases the clearance of triazolam and thus may increase its effect with the development of drowsiness and confusion. A clinically significant interaction of clarithromycin with benzodiazepines, the metabolism of which does not depend on CYPZA isoenzymes (temazepam, nitrazepam, lorazepam), is unlikely.
    It is prescribed with caution with cilostazol, cyclosporine, methylprednisolone, tacrolimus, vinblastine, phenytoin and valproic acid (metabolized through other cytochrome P450 isoenzymes).It is necessary to adjust the dose of the drug and control the concentration in the blood. When taken together with antiarrhythmic drugs of class IA (quinidine, procainamide, disopyramide) and class III (dofetilide, amiodarone, sotalol), “pirouette” ventricular tachycardia may occur. It is necessary to monitor the ECG (increase in the QT interval), serum concentrations of these drugs. Cases of hypoglycemia have been reported with the combined use of clarithromycin and disopyramide. It is necessary to control the concentration of glucose in the blood plasma while using these drugs.Concomitant use with HMG-CoA reductase inhibitors (simvastatin, lovastatin) leads to an increased risk of myopathy and rhabdomyolysis. Concomitant use of clarithromycin with simvastatin and lovastatin is contraindicated. Clarithromycin should be used with caution when combined with other statins. If it is necessary to take it together with statins, it is necessary to use statins that do not depend on the metabolism of CYPZA (for example, fluvastatin). The smallest dose of statin is recommended.The development of signs and symptoms of myopathy should be monitored. With the simultaneous use of clarithromycin and blockers of “slow” calcium channels, which are metabolized by the isoenzyme CYPZA4 (eg verapamil, amlodipine, diltiazem), caution should be exercised, since there is a risk of arterial hypotension and bradyarrhythmia. Plasma concentrations of clarithromycin, as well as blockers of “slow” calcium channels, may increase with simultaneous use. Arterial hypotension, bradyarrhythmia and lactic acidosis are possible while taking clarithromycin and verapamil.Colchicine is a substrate for both CYPZA and P-glycoprotein, which are inhibited by clarithromycin. A single dose of 0.6 mg colchicine while using clarithromycin 250 mg twice daily for a week increased the maximum concentration of colchicine by 197% and the area under the concentration-time curve by 239% compared with the isolated use of colchicine. The concomitant use of clarithromycin and colchicine is contraindicated. With the simultaneous use of clarithromycin (1 g / day.) and atazanavir (400 mg / day), an increase in the area under the concentration-time curve of atazanavir by 28%, clarithromycin by 2 times, a decrease in the area under the concentration-time curve of 14-hydroxyclarithromycin by 70% is possible. Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with creatinine clearance of 30-60 ml / min. the dose of clarithromycin should be reduced by 50%, and in patients with creatinine clearance less than 30 ml / min.the dose should be reduced by 75%. Doses of clarithromycin in excess of 1000 mg should not be used concomitantly with protease inhibitors.
    With the simultaneous use of clarithromycin and itraconazole, a mutual increase in the concentration of drugs in plasma is possible. For patients taking itraconazole and clarithromycin at the same time. close monitoring is necessary because of the possible increase or increase in the duration of the pharmacological effects of these drugs. With the simultaneous use of clarithromycin (1 g / day.) and saquinavir (in soft gelatin capsules, 1200 mg 3 times a day), the area under the concentration-time curve and the equilibrium concentration of saquinavir may increase by 177% and 187%, respectively, and clarithromycin by 40%. With the simultaneous use of these two drugs for a limited time in the doses and dosage forms indicated above, dose adjustment is not required. Interaction studies using saquinavir softgel may not be consistent with those seen with saquinavir softgel.The results of drug interaction studies with saquinavir monotherapy may not be consistent with the effects observed with saquinavir / ritonavir therapy. When taking saquinavir with ritonavir, the potential effect of ritonavir on clarithromycin should be considered.
    Omeprazole. The effect of omeprazole on the pharmacokinetics of other drugs. A decrease in the secretion of hydrochloric acid in the stomach during treatment with omeprazole and other proton pump inhibitors can lead to a decrease or increase in the absorption of other drugs, the absorption of which depends on the acidity of the medium.Like other drugs that reduce the acidity of gastric juice, treatment with omeprazole can lead to a decrease in the absorption of ketoconazole, itraconazole. posaconazole and erlotinib; and increased absorption of drugs such as digoxin. Co-administration of omeprazole at a dose of 20 mg once a day and digoxin increases the bioavailability of digoxin by 10% (the bioavailability of digoxin increased by up to 30% in 20% of patients). Concomitant use of omeprazole with erlotinib or posaconazole is contraindicated.Omeprazole has been shown to interact with some antiretroviral drugs. The mechanisms and clinical significance of these interactions are not always known. An increase in pH during omeprazole therapy may affect the absorption of antiretroviral drugs. Interaction at the level of the isoenzyme CYP2C19 is also possible. With the combined use of omeprazole and some antiretroviral drugs, such as atazanavir and nelfinavir, during therapy with omeprazole, there is a decrease in their concentration in serum.Therefore, co-administration of omeprazole with antiretroviral drugs such as atazanavir and nelfinavir is not recommended. With the simultaneous use of omeprazole and saquinavir, an increase in the concentration of saquinavir in serum was noted, when used with some other antiretroviral drugs, their concentration did not change. Omeprazole inhibits CYP2C19, the main isozyme involved in its metabolism. The combined use of omeprazole with other drugs in the metabolism of which the isoenzyme CYP2C19 is involved, such as diazepam, warfarin (R-warfarin) or other vitamin K antagonists.phenytoin and cilostazol may slow down the metabolism of these drugs. Monitoring of patients taking phenytoin and omeprazole is recommended, a dose reduction of phenytoin may be required. However, concomitant treatment with omeprazole in a daily dose of 20 mg does not affect the concentration of phenytoin in blood plasma in patients taking the drug for a long time. When using omeprazole in patients receiving warfarin or other vitamin K antagonists, monitoring of the international normalized ratio is necessary; in some cases, it may be necessary to reduce the dose of warfarin or another vitamin K antagonist.At the same time, concomitant treatment with omeprazole in a daily dose of 20 mg does not lead to a change in the coagulation time in patients taking warfarin for a long time. The use of omeprazole at a dose of 40 mg once a day led to an increase in Cmax and AUC of cilostazol by 18% and
    26%, respectively; for one of the active metabolites of cilostazol, the increase was 29% and 69%, respectively.
    According to the research results, a pharmacokinetic / pharmacodynamic interaction was noted between clopidogrel (loading dose of 300 mg and maintenance dose of 75 mg / day.) and omeprazole (80 mg / day. orally), which leads to a decrease in exposure to the active metabolite of clopidogrel, on average, by 46% and a decrease in the maximum inhibition of ADP-induced platelet aggregation, on average, by 16%. The clinical relevance of this interaction is not clear. An increase in the risk of cardiovascular complications with the combined use of clopidogrel and proton pump inhibitors, including omeprazole, was not shown in a prospective, randomized, unfinished study involving more than 3760 patients who received placebo or omeprazole at a dose of 20 mg / day.concurrently with therapy with clopidogrel and acetylsalicylic acid (ASA), and is not confirmed by an additional non-randomized analysis of the clinical outcomes of large-scale prospective randomized trials involving more than 47,000 patients. The results of a number of observational studies are contradictory and do not give an unambiguous answer about the presence or absence of an increased risk of thromboembolic cardiovascular complications against the background of the combined use of clopidogrel and proton pump inhibitors.When clopidogrel was used together with a fixed combination of 20 mg of esomeprazole and 81 mg of ASA, the exposure to the active metabolite of clopidogrel decreased by almost 40% compared with clopidogrel monotherapy, while the maximum levels of inhibition of ADP-induced platelet aggregation were the same, which is probably due to the simultaneous taking ASA in a low dose.
    Omeprazole does not affect the metabolism of drugs metabolized by the CYPZA4 isoenzyme. such as cyclosporine, lidocaine, quinidine, estradiol, erythromycin, and budesonide.There was no interaction of omeprazole with the following drugs: antacids, caffeine, theophylline, S-warfarin, piroxicam, diclofenac, naproxen, metoprolol, propranolol and ethanol. With the simultaneous use of omeprazole and tacrolimus, an increase in the concentration of tacrolimus in the blood serum was noted.
    In some patients, a slight increase in the concentration of methotrexate was noted against the background of combined use with proton pump inhibitors. When prescribing high doses of methotrexate, the possibility of temporarily discontinuing omeprazole should be considered.The effect of drugs on the pharmacokinetics of omeprazole. The isoenzymes CYP2C19 and CYPZA4 are involved in the metabolism of omeprazole. The combined use of omeprazole and inhibitors of the isoenzymes CYP2C19 and CYPZA4, such as clarithromycin and voriconazole, can lead to an increase in the concentration of omeprazole in the blood plasma by slowing down the metabolism of omeprazole. The combined use of voriconazole and omeprazole leads to more than a twofold increase in the AUC of omeprazole. Due to the good tolerance of high doses of omeprazole, with a short-term joint use of these drugs, no dose adjustment of omeprazole is required.Co-administration of omeprazole with amoxicillin or metronidazole does not affect the concentration of omeprazole in blood plasma. Drugs that induce the isoenzymes CYP2C19 and CYPZA4, such as rifampicin and St. John’s wort preparations, when used together with omeprazole, can lead to a decrease in the concentration of omeprazole in the blood plasma by accelerating the metabolism of omeprazole.
    Tinidazole. Tinidazole enhances the effect of indirect anticoagulants and the effect of ethanol – disulfiram-like reactions are possible.Compatible with sulfonamides and antibiotics (aminoglycosides, erythromycin, rifampicin, cephalosporins). It is not recommended to prescribe in conjunction with ethionamide. Phenobarbital accelerates the metabolism of tinidazole.

    Arthrosis of the ankle joint | ILYSSA MEDICAL GROUP

    Through the ankle joint, the talus of the foot is connected to the lower leg. The ankle provides up and down flexion of the foot, but is not designed for lateral movement.This is the reason for his injury in the event of a twisting of the leg.

    Injuries also affect the muscles and ligaments that strengthen the joint. All this further leads to arthrosis of the ankle, which, however, is successfully cured provided that the treatment is started in a timely manner, and the patient fulfills all medical prescriptions.

    Ankle arthrosis symptoms

    There are 3 stages of arthrosis development, which differ from each other both in symptomatology and in the degree of joint damage.

    Stage 1 : no pronounced symptoms. After a heavy load, the joint becomes sore. Rapid fatigue of the ankle is observed.

    Stage 2: painfulness of the joint becomes pronounced, increases with movement, can persist even at night. The limitation of mobility is progressing. Signs of joint deformation (crunch when moving) begin to appear.

    Stage 3: sometimes there is a complete loss of mobility, there is a pronounced deformation of the joint, curvature of the foot.Patients are forced to move with a cane or crutch.

    Ankle arthrosis can be deforming or post-traumatic.

    Treatment of ankle arthrosis

    Medical care for arthrosis of the ankle pursues the following goals:

    • Pain relief.
    • Removal of local inflammatory process.
    • Restoration of cartilage tissue.
    • Restoration of joint mobility.

    Improvement of metabolic processes in the ankle and adjacent anatomical areas.These tasks are solved by comprehensive treatment, including:

    • Drug therapy.
    • Physiotherapy.
    • Physiotherapy exercises.
    • Traditional medicine.

    When the stage of arthrosis is advanced, a surgical operation can be prescribed.

    For the treatment of ankle arthrosis, fast-acting and delayed-acting drugs are used. The drugs of the first group are used for symptomatic treatment (relieving pain).The second group of medicines inhibits the progression of arthrosis.

    The first group of drugs includes the so-called non-steroidal anti-inflammatory drugs (for example, ibuprofen, nimesulide, diclofenac, naproxen, etc.). They cope well with the task of pain relief, but at the same time they have a serious disadvantage – they have a bad effect on the mucous membrane of the gastrointestinal tract. With prolonged use, these funds can cause gastritis, and sometimes lead to peptic ulcer disease.Such drugs should only be administered in short courses and should be monitored.

    In addition to the above drugs for ankle arthrosis, ointments with analgesic properties are used (for example, finalgon, diclac, fastum gel). For severe pain, corticosteroids are injected into the joint. But it should be remembered that this procedure does not affect the pathogenesis of the disease, but only temporarily eliminates pain.

    Proper nutrition for arthrosis is also extremely important.The diet should be selected in consultation with the attending physician so as to ensure the maximum supply of nutrients to the joints, without provoking excess weight gain. Proper nutrition plays an important role in the prevention of arthrosis.

    The most common type of physiotherapeutic treatment for ankle arthrosis is electrophoresis. Various medications are delivered to the joints by electrophoresis; in addition, this procedure improves metabolic processes. ultrasound and microwave therapy also provide a good effect.

    Exercises of exercise therapy are prescribed in agreement with the attending physician. Water gymnastics is effective, as well as swimming. It should be remembered that the exercises should not place a significant stress on the joints. Exercise therapy should be used in combination with the other methods listed above.

    As mentioned above, the treatment of arthrosis of the ankle joint must necessarily be comprehensive and carried out under the constant supervision of the attending physician. Only in this case can it be truly successful.

    90,000 Traumatic brain injury

    Mild traumatic brain injury is considered cases of direct or indirect mechanical damage to the brain with an assessment on the Glasgow Coma Scale (GCS) 13-15 30 minutes after injury

    Mild traumatic brain injuries in the overwhelming majority of cases proceed without consequences, or with transient disorders that persist for several days / weeks.

    Concussion

    Concussion is defined as a complex pathophysiological process caused by traumatic biomechanical forces.
    Traumatic brain changes share a number of clinical, pathophysiological, and biomechanical characteristics.

    Concussion

    • can be caused by a direct blow to the head, face, neck and other parts of the body with the transfer of kinetic energy to the head.
    • usually leads to the acute development of short-term neurological disorders that pass spontaneously.
    • Concussion of the brain may be accompanied by pathological changes in the brain tissue, however, the development of symptoms is mainly based on functional disorders.Traumatic changes are not detected during standard neuroimaging procedures.
    • leads to a consistent appearance of clinical syndrome, among which there may be no loss of consciousness. A consistent fading of the severity of violations is characteristic. However, it is important to remember that some of them can persist for a long time.

    In addition to concussion, minor craniocerebral trauma includes mild brain contusion.

    Symptoms of minor traumatic brain injury

    Neurological

    • Headache
    • Nausea
    • Vomiting
    • Doubling and “fog” in the eyes
    • “Flashes” or “stars” in the eyes
    • Balance disorders
    • Dizziness
    • Light and sound phobia
    • Tinnitus

    Behavioral or emotional

    • Stagnation
    • General weakness or drowsiness
    • Irritability
    • Depression
    • Alarm
    • Increased sleep duration, more than usual
    • Difficulty falling asleep

    Cognitive

    • Feeling of slowness
    • Feeling of “numbness”, “as if in a fog”
    • Difficulty concentrating

    Deterioration of the condition of a patient with mild traumatic brain injury (appearance / aggravation of headache, appearance / aggravation of neurological symptoms, the appearance of confusion and depression of consciousness) may indicate the development of an intracranial hematoma and requires urgent neuroimaging


    Short-term symptomatic treatment is sufficient for most patients:

    • analgesics and NSAIDs (paracetamol, ibuprofen, naproxen) are used for headache,
    • for nausea and vomiting – drugs for motion sickness and sedative antihistamines – with mild severity – dramina, atarax, with pronounced – antiserotononergic drugs – ondansetron, granisetron (Avomit, Kitril).

    Many famous people have boxed and probably suffered from repeated head injuries.

    From this list, Ernest Hemingway and Vladimir Vladimirovich Nabokov impressed me the most.

    It was boxing that “opened” Charlie Chaplin to the world, he worked as a lightweight sparring partner, he was noticed by the director of the Chicago Circus and invited to his place with the number “In the arena – boxing”.

    Exceptions: after 3 months, persistent consequences in the form of cognitive, mental or neurological impairments remain in 10-15% of people with mild traumatic brain injury (Iverson, 2005).This condition is called post-concussion syndrome.

    Post-contusion syndrome includes at least three of the following groups of syndromes that developed within no more than 4 weeks after injury:

    • Headache, dizziness, malaise, general weakness, hypersensitivity to loud sounds;

    • Irritability, depression, anxiety, emotional lability;

    • Impaired memory and attention, thinking disorders that are perceived by the patient subjectively and are not recorded – neuropsychological tests

    • Insomnia

    • Decreased alcohol tolerance

    • Increased preoccupation with the symptoms described above with a hypochondriacal mood and a painful sense of self

    In patients with focal brain lesions, including traumatic ones, as well as in alcohol abusers, repeated, even minor, craniocerebral injuries significantly increase the risk of post-traumatic seizures and epilepsy.

    The development of “boxer dementia” is rarely observed in persons with repeated minor craniocerebral trauma. People with ApoE ε4 (a subtype of lipoprotein, a protein-lipid complex) are predisposed to this complication.

    A small proportion of patients develop second-impact syndrome (SIS) – diffuse cerebral edema after repeated trauma. More often occurs in athletes against the background of symptoms of a previous concussion of the brain.
    In 1998, 17 cases were described, of which 12 were incomplete.The 2013 paper did not identify conditions that can be unambiguously considered as risk factors for SIS .


    perform craniography if it is possible to perform computed tomography (CT) of the brain – skull fractures without brain contusion – casuistry. If a fracture is detected, CT of the brain cannot be dispensed with to exclude bruising and hematoma, if not, the study does not exclude dangerous manifestations of trauma in the patient.

    • In practice, doctors often find it difficult to assess the bones of the facial skeleton on the basis of radiographs, which also requires a repeat CT scan.
    • If you have a tomograph, there is no need to waste time on echoencephaloscopy.
    • If access to CT or MRI is limited, it is necessary to select those who really need the examination in a reasonable way.

    Different sets of indications are given below for information purposes:

    Canadian set of indications *
    • GCS score <15 points;
    • Suspected open or depressed skull fracture;
    • Clinical signs of a skull base fracture (hemotympanum, “raccoon eyes”, “raccoon eyes,” liquorrhea from the ears and nose, bruising in the parotid region “Battle’s sign”;
    • Two or more episodes of vomiting;
    • Age ≥65 years;
    • Duration of anterograde amnesia ≥30 ‘from the moment of injury;
    • Hazardous mechanism of injury (motorcycle injury, fall from a height of more than 3 feet (about 1 meter), or more than five steps;

    * The scale is not suitable for cases with the possibility of developing disorders of consciousness due to causes not associated with trauma, when assessed by GCS <13 points, patients age <16 years, if the patient is taking oral anticoagulants (warfarin, pradaxa, xarelto, etc.) dr.) or suffers from diseases with an increased tendency to bleeding.

    New Orleans set of indications
    • Headache;
    • Vomiting;
    • Drug or alcohol intoxication;
    • Persistent antegrade amnesia (short-term memory disorders)
    • Traumatic injury above the clavicle;
    • Convulsive seizures;
    • Age ≥60 years;

    The risk of detecting brain pathology is higher in patients with a Glasgow coma score 30 minutes after injury, 13-14 points than 15 points.The following groups were identified according to the severity of risk:

    Low risk – 15 GCS points after injury, without loss of consciousness, amnesia, nausea, vomiting, headache – the risk of developing an intracranial hematoma requiring neurosurgical treatment 0.1: 100

    Average risk – 15 GCS points in combination with loss of consciousness, amnesia, nausea, vomiting, headache – the risk of detecting an intracerebral hematoma requiring neurosurgical intervention is 1-3: 100, a CT scan of the brain is required.

    High risk – score 14-15 points on the GCS, signs of a skull fracture, neurological deficit. The risk of detecting a hematoma requiring neurosurgical intervention is 6-10: 100.

    The group of high-risk patients, regardless of the clinical manifestations of trauma, includes persons with a history of anticoagulants, before the injury, persons> 60 years old.

    In cases where CT of the brain was not performed, recommended:

    – refrain from taking alcohol and painkillers, driving a car and other vehicles within two weeks from the moment of injury;

    – inform loved ones about the previous traumatic brain injury and warn that in case of behavioral disorders and increased drowsiness it is necessary to call an ambulance,

    – seek help yourself with increased headache, double vision, nausea and vomiting, limb weakness and other neurological disorders.


    – perform a CT scan of the brain after receiving a negative result with an MRI of the brain (the institution where care is provided has an MRI, but no CT)

    Due to the heterogeneity of conditions caused by biomechanical damage to the brain, which are characterized by impaired memory and orientation, sometimes with loss of consciousness (definition of a concussion from 2013), the issue of neuroimaging traumatic brain injury is difficult.The diagnosis is based on the clinical characteristics of the patient, in most cases, conventional CT and MRI studies do not reveal changes in the substance of the brain in persons with mild CCI.

    In the presence of a magnetic resonance imager, the method has sufficient sensitivity to detect focal traumatic changes in the brain and intracranial hemorrhages.

    MRI, in comparison with CT of the brain, is more sensitive in detecting focal lesions of the brain.However, none of the other studies provide results that correlate with the degree and nature of neuropsychological disorders.

    Both research methods do not accurately detect signs of diffuse axonal damage.

    In practice, it is important to identify conditions requiring neurosurgical intervention: hematomas, skull fractures.

    The use of data on the nature and prevalence of brain contusions in the formation of a prognosis and a plan of rehabilitation treatment has not been developed.

    – perform repeated neuroimaging studies (CT and MRI) without medical indications

    An unmotivated alarm by the attending physician is not related to indications. Repeated examinations are indicated for patients with progression of consciousness disorders and focal neurological symptoms, with the development of seizures. A CT scan exposes the patient to ionizing radiation, which increases the risk of cancer.

    The harm from MRI of the brain for health has not been proven, for the wallet of the patient and the medical institution it is indisputable.

    – use rheoencephalography when examining a patient, both after trauma and in the long-term period

    The study does not provide valuable information, its results will differ upon repeated studies, is not needed to treat patients, and act as an additional source of anxiety.

    – perform electroencephalography for patients with TBI who did not have epileptic seizures and their equivalents

    After TBI, nonspecific changes are more often observed: single sharp waves, groups of acute waves, less often, “peak-wave” complexes, uneven alpha rhythm; high sensitivity to functional tests.