Eating a grapefruit or having a glass of grapefruit juice in the morning can be a healthy way to start your day – the fruit is high in vitamin C and potassium. But the FDA is reminding consumers that grapefruit can interact with many drugs and how they work in the body, especially if you have high blood pressure or an irregular heartbeat.
When grapefruit interacts with certain medications, the problem is that the juice causes too much of the drug to enter the bloodstream. That can lead to more side effects. For example, drinking grapefruit juice while taking statins such as Zocor (simvastatin) and Lipitor (atorvastatin), drugs used to lower cholesterol, can lead to too much of the drug remaining in your system, increasing your risk for liver and muscle damage that can lead to kidney failure.
Here are some types of drugs that may interact with grapefruit juice:
Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine)
Some organ-transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine)
Some anti-anxiety drugs, such as buspirone
Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as Entocort EC and Uceris (both budesonide)
Some drugs that treat abnormal heart rhythms, such as Pacerone and Nexterone (both amiodarone)
Some antihistamines, such as Allegra (fexofenadine)
For a further list of drugs that interact with grapefruit, click here.
Grapefruit juice actually causes less Allegra to enter the bloodstream, which may hamper the effectiveness of the drug.
If you eat grapefruit or drink grapefruit juice and have concerns about it interacting with any of the drugs you are taking, talk it over with your doctor. You can also read the medication guide or patient information sheet that comes with your prescription drugs to see if there is a grapefruit juice warning. For OTC (over-the-counter) drugs, check out the Drug Facts label on the bottle.
If you have to avoid grapefruit and grapefruit juice, pay attention to the labels of other fruit juices as they may contain grapefruit juice. Seville oranges, pomelos and tangelos can have the same effect on drugs as grapefruit, so best to avoid them if you know your drug can interact with grapefruit.
Around half of people on psychiatric medications for the long term who decide to stop taking at least one of them are successful, though they say their doctor could have provided more support to deal with withdrawal symptoms, according to a new study.
Researchers asked 250 long-term users (9 months or more) of psychiatric medications about their experiences trying to discontinue use. Overall, 54% did so for at least a year, with few reporting a relapse. Also, 54% experienced severe withdrawal symptoms such as crying, diarrhea and insomnia. The results were published in the journal Psychiatric Services.
More than 70% of those surveyed were on a drug for 10 years or more.
Many of the people that were successful were critical of the support they got from their prescriber: 55% said that individual was not helpful while they were discontinuing their medication.
When asked why they wanted to quit, a majority of respondents said it was over concerns about the health impacts of long-term use and side effects of the drugs.
Taking magnesium is safe for depression and has efficacy comparable to prescription SSRI (selective serotonin reuptake inhibitors) antidepressants. Researchers at Larner College of Medicine at the University of Vermont examined 126 adults who were experiencing mild to moderate depression. The study team found that participants who received 248 milligrams of elemental magnesium per day over 6 weeks resulted in a clinically significant improvement in measures of depression and anxiety symptoms compared to those who received no treatment at all. In addition, positive effects of magnesium were seen in as little as 2 weeks, and the supplement was well tolerated. Most antidepressants can take a month or more for clinical benefits to be seen, and are often accompanied by side effects. Posted June 27, 2017. Via Larner College of Medicine.
Buprenorphine and naltrexone, 2 medications used to treat opioid abuse, have been underutilized in adolescents and young adults. Researchers at Boston University School of Medicine examined health insurance claims for 9.7 million young people (ages 13 to 25) to measure dispensing of buprenorphine or naltrexone and to identify those who received an opioid use disorder diagnosis from 2001 through June 2014. The rate of diagnosis of opioid use disorder increased nearly six-fold from 2001 to 2014. But just 5,580 out of 20,822 young people with opioid use disorder — just 26.8% — were dispensed a medication within 6 months of diagnosis, with 89% receiving buprenorphine and about 11% receiving naltrexone. Researchers did note that use of the 2 medications in these youths increased from just 3% in 2002 to 27.5% in 2014. However, women, black and Hispanic youths were less likely to receive the medications. Posted June 19, 2017. Via JAMA Pediatrics.
The FDA will assign more personnel to review applications for drugs to treat rare diseases to reduce a huge backlog. The agency currently has around 200 applications seeking orphan drug designation for a medication. That designation, given to drugs that treat diseases with fewer than 200,000 patients in the US, provides incentives to drugmakers, such as tax credits for clinical trial costs and longer time on the market before generic competition for the medication. The FDA also said it is making changes to ensure that future applications receive a response within 90 days. Posted June 29, 2017. Via FDA.
Slightly more than half of all of the opioid prescriptions written each year are given to people with mood disorders, depression and anxiety, a troubling statistic since those with mental illness face a higher risk of overdose and abuse.
About 115 million opioids prescriptions are given each year, and 51.4% of them went to people who also had a mental health disorder, according to research published in the Journal of the American Board of Family Medicine. Opioid use was defined as patients that received 2 or more opioid prescriptions in a year.
Results also showed that 18.7% of adults with a mental illness are given opioids. But just 5% of adults without a mental disorder are prescribed one.
As to why those with mental illness are more likely to receive an opioid, there are several potential reasons. Study co-author Brian Sites, MD, of the Dartmouth-Hitchcock Medical Center, told STAT that some physicians may be sympathetic to patients who have both a mental illness and another condition, making them more likely to prescribe an opioid. Also, people with mood disorders may experience pain differently. He also noted that opioids may have antidepressant effects in the short-term, prompting those with depression to ask their doctor for a prescription.
“The high prevalence of mental health disorders coupled with prescription opioid use suggests that this population is critical to consider when addressing the issue of opioid use from a health system or policy perspective,” the study authors wrote.
From the outside, a person with fibromyalgia looks perfectly normal. But on the inside, it can feel like the pain volume dial has been cranked up to high and can’t be turned down. On top of this, the high level of fatigue can interfere with life on every single level.
“Fibromyalgia is a very interesting illness,” says Dr. Jordan Tishler, a Harvard-trained physician who focuses on holistic care. “Twenty years ago we felt that it was largely a psychological illness, partly because we couldn’t find much else wrong, and partly because it responds, at least for some, to antidepressants like SSRIs.
“We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on,” he adds. “There is clearly a psychological component, but this exists on top of a vague immune condition that we’re still working to define.”
The symptoms of fibromyalgia are widespread diffuse pain; psychological symptoms such as depression and anxiety; and somatic symptoms such as fatigue, memory difficulties and poor sleep quality. Due to these wide-ranging symptoms, there are an equally wide number of medications commonly prescribed for fibromyalgia — everything from strong pain medicines and sleeping pills to antidepressants.
While medications may provide benefits, all pharmaceutical drugs come with side effects that may contribute to more negative outcomes, rather than the positive improvements you might hope for. That’s why we’re here to inform you about the possible side effects of commonly prescribed medications and to provide more information about natural treatment options that are known to be effective.
MEDICATIONS
Lyrica (pregabalin)
You may have heard of the heavily advertised fibromyalgia drug, Lyrica (pregabalin). It’s an antiepileptic, anticonvulsant medication that slows down seizure-related impulses in the brain, and also influences nervous system pain-signalling chemicals in the brain, which is why it’s commonly prescribed for fibromyalgia.
According to a recent review of studies on Lyrica, using the drug daily does reduce pain by 30 to 50%. But 70 to 90% of people also experience side effects, the most common being dizziness (38%), drowsiness (23%), weight gain (9%) and peripheral edema (8%).
There are more serious side effects that can also occur:
mood or behavior changes
depression and anxiety
panic attacks
trouble sleeping
feeling impulsive
irritable, agitated, hostile, aggressive behavior
suicidal tendencies, or having thoughts about suicide or hurting yourself
If you experience any of these more serious symptoms, consult with your doctor immediately.
Antidepressants
Antidepressants such as tricyclics (amitriptyline and cyclobenzaprine), selective norepinephrine reuptake inhibitors (SNRIs) such at Cymbalta (duloxetine), Savella (milnacipran) and the SSRI Prozac (fluoxetine) are often prescribed. Though they can be effective, nearly all antidepressants are associated with side effects and can sometimes result in serious adverse events, too.
‘We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on.’
— Jordan Tishler, MD
Opioids
For more severe pain, opioid receptor agonists may be prescribed, the side effects of which are sedation, dizziness, nausea, constipation (very high rate), tolerance (requiring higher doses) and psychological addiction/physical dependence on the drug. Chronic opioid use leads to changes in brain neuroplasticity, which is what causes this.
As you can see, it’s important to read up on the possible side effects because if you find your fibromyalgia symptoms are getting worse, not better, it could be the type of medication you’ve been prescribed. Don’t be afraid to ask your doctor to review your options.
Alternatively, you could try some natural treatments that have demonstrated efficacy.
NATURAL TREATMENTS
Regular Exercise
“Even though it seems counteractive due to the high levels of fatigue experienced by fibromyalgia sufferers, exercise (both aerobic and strength-based approaches) actually works to decrease symptoms and fatigue,” says Dr. Tishler. “The message here, though, is to ‘start low and go slow.’”
Eliminate Inflammatory Foods
Registered dietitian Ryan Whitcomb recommends identifying inflammatory and allergenic foods through a food sensitivity test known as an MRT (mediator release test.)
“This is my first go-to line of defense because it eliminates all the guesswork when it comes to problematic foods,” says Whitcomb. “Once these foods are identified, they are removed from the diet and we slowly add in safe, non-reactive foods.”
One such inflammatory food identified as a problem is gluten. Studies have shown that people with fibromyalgia commonly have non-celiac gluten sensitivity — not an allergy, but an intolerance to gluten. In one small study with fibromyalgia patients, 75% of them experienced a dramatic reduction in widespread pain after eliminating gluten. Some even no longer had pain at all. And in a few of the patients taking opioid medications, the drugs were discontinued, simply by following a gluten-free diet.
Address Nutrient Deficiencies
Once inflammatory foods are removed from the diet, it may be that people have nutrient deficiencies that also need to be addressed.
“Magnesium and vitamin D are common deficiencies,” says Whitcomb. “But rather than assuming that’s the patient’s issue, I run a comprehensive micronutrient panel that looks at 33 nutrients to get a broad overview of what’s really going on in their body.
“Once we know their deficiencies, we can talk about repleting through food and supplements. Food is preferable, but some nutrients, like vitamin D, need to be supplemented since there aren’t many foods that contain it.”
Examine Sleep Quality
“Poor sleep seems to be a major contributor to this illness, so good sleep habits, such as reducing stimulants like coffee, and the occasional use of prescription sleep aids are important approaches,” says Dr. Tishler.
Try Medical Cannabis Therapy
“I have many fibromyalgia patients in my practice and have found cannabis can be a very effective treatment,” says Dr. Tishler, who is also a medical marijuana specialist. “Cannabis is great for pain control and equally good for promoting sleep. In fact, it’s considerably better for sleep than any conventional medication. It’s also considerably safer for pain control than opioid options.
“And on top of this, cannabis is effective for mild depression and anxiety, both of which are associated with fibromyalgia as well. I have certainly found cannabis to be truly effective for fibromyalgia patients because it addresses the illness on so many levels,” he adds.
The vast majority of people who receive psychotherapy through the Internet benefit from the treatment, though a small number do experience some kind of side effect.
Alexander Rozental, PhD, a psychologist, decided to explore the side effects of online cognitive behavioral therapy (CBT). Online CBT is similar to the CBT one would get from seeing a mental health professional directly or reading a self-help book, but support is given through email with a psychiatrist. The dissertation is thought to be the first examination of the side effects of Internet-based therapy.
Rozental’s research found that only 6% of 3,000 patients receiving Internet-based therapy got worse during treatment.
When he examined patients who received psychotherapy in an outpatient setting that were asked if they had negative effects of the treatment, one-third said they had a difficult memory resurface, had more anxiety or felt stressed. In addition, some said they had a poor relationship with their therapist or the treatment was subpar.
Rozental explained that what is needed in further research is a better understanding of therapy side effects, both to identify patients who become worse early in treatment and to shield patients from bad therapists.
“’I hope that psychologists and psychotherapists become more aware that there can actually be side effects and that they need to ask patients whether they are experiencing any,” he said.
Put down the Xanax. This week, MedShadow Founder Su Robotti and Content Manager Jonathan Block talk about using easy forms of meditation to manage stress during the holidays.
Su Robotti: Hello and welcome to MedShatowTV. My name is Sue Robotti, and I’m the founder of MedShadow.
Jonathan Block: And I’m Jonathan Block. I’m the content manager for MedShadow.
SR: Today, we’re going to talk to you about stress. We’ve been feeling a lot of stress. The holidays are coming, and stress is caused by too much food, too many relatives, too much pressure, too much gift shopping, too much drinking.
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The key here is too much. Today, we want to help you take it down a notch, calm down, and we want to help you do that through meditation.
First of all, what is stress? The physical response to a stressful situation is adrenalin and cortisol enter your bloodstream. It increases your blood pressure, and your heart rate starts to go stronger. And if this isn’t dealt with easily or quickly, and it continues for a period of time, it can lead to gastrointestinal problems. It can lead to heart disease. It can lead to brain dysfunction like I’m having now. It can lead to a lot of long-term issues with heart disease and gastrointestinal problems among other things.
But Jonathan, what do you suggest we do? Should we pop a pill? That would be very quick.
JB: Absolutely, don’t. You’ve actually alluded to it, and that was through meditation, which is the main part of an idea known as mindfulness, which is defined as being aware of the present. I mean, I know what a lot of people are thinking — the same thing that I was thinking when I heard the word mindfulness. That just sounds like a whole bunch of new age hooey.
SR: Hooey?
JB: Hooey.
SR: Okay.
JB: I’m going old school. I can tell you from a personal experience as somebody who’s dealt with stress, and anxiety, and depression. Meditation associated with mindfulness actually does work. It works well.
And why don’t you take a pill? Because pills have side effects.
Mindfulness meditation — and we’ll be discussing this in a little bit — there are clinical studies that have demonstrated that mindfulness meditation can be used for a number of different conditions avoiding these sort of drugs, which as our MedShadow audience knows, most of which — if not all — are associated with side effects, drug interactions, or other nasty effects.
SR: In fact, is meditation as effective as antidepressants?
JB: Yes, it is. There’s been, I want to say, 40 to 50 clinical studies done just on comparing mindfulness and meditation with antidepressants. They’ve all come to the same conclusion. Mindfulness meditation is as effective as antidepressants.
So why — I know what you’re going to say. I’m going to read your thoughts. But why not just take a pill, right?
SR: Why not?
JB: I know that’s the easy way to go out. The thing is is that as I just mentioned, antidepressants and other antianxiety pills like the Xanax or the Valium that some people in our audience may be taking, have taken, or thinking about taking.
Mindfulness meditation is something that you can teach your brain how to think. It helps you relax without the use of drugs, and therefore you can learn how to deal with stress and anxiety over the long term. It’s actually much better for you, because you’ll actually train your brain how to better handle stress and anxiety but without the nasty side effects of a pill which means it is harder work.
But in the long term, the long-term efficacy of it has been demonstrated whereas with antidepressants, we know that people develop problems, and they lose their efficacy. And for some people taking antidepressants and anti-anxiolytic drugs, they just aren’t even effective anymore.
SR: So let’s take a breath.
JB: Yes.
SR: And how do you meditate? Do you have to sit cross legged? Do you have to hold your fingers in the air? Do you have to say, “Ohmm”?
JB: No, you’re thinking of some of the Buddhist meditation. But this type of meditation like the meditation that pretty much busy people or people that don’t want to go, “Ohmm,” want to do — can take as little as 10 minutes.
That’s what I do a day. I only do 10 minutes. I do some breathing exercises. There are also ways which if you learn more about mindfulness and we’ll provide you with some information about that in a second — the mindfulness, actually, you train your brain to relax. I know this sounds weird, because I didn’t believe it until I started doing it. And then in the words of a great Monkees song, “I’m a Believer,” and I’m a believer now about how effective mindfulness is and how effective mindfulness meditation is as well.
SR: So do you take classes? How do you learn to do this?
JB: I do a combination of things. I have read some books. There’s an excellent website that is operated by the fine people at UCLA known as the UCLA Mindfulness Awareness Research Center. That address is http://marc.ucla.edu. They actually have free relatively short meditations that you can download and listen to, and you can start on your own.
There’s another resource that I use a lot. This is a paid resource. It’s an app, and you can also do on your computer called Headspace. But I pay — I find it particularly effective. I looked at a lot of them, and I find Headspace — just to let the audience know, neither Headspace nor UCLA has asked us to mention them. This is just from my own personal experience.
SR: And then I’ll add one that’s free that I use; it’s called Breathe. But there are many, and you’ll find the one that you like if you just Google guided meditations, and you’ll find it.
I started meditating by simply becoming quiet and not using guided meditation — just setting a timer and trying to still my thoughts calmly for 3 minutes at a time. I got up to 5 minutes. And honestly, guided meditation is much easier.
JB: Oh, yes.
SR: And I would like to graduate to regular quiet meditation. But for now, I’m finding that I become more calm and happy using the guided meditation.
JB: And if you’re a novice — I still consider myself a novice — I find that the guided meditation works a lot better.
Just one other point because I know we’re talking a lot about this. It’s that mindfulness meditation is actually good not only for — works well, I should say — works not only well for depression, anxiety, and stress, but it’s been shown that people that want to lose weight through practice of mindfulness meditation, they can actually teach themselves to eat less.
SR: Eat less during meditation?
JB: No, afterwards, because they train their brain.
SR: You mean through their mindfulness.
JB: Right, because they think — like they ‘think before.’ You’ve heard the term, “Think before you act.”
SR: Uh-hum.
JB: You teach yourself how to think before you eat, and you’re more careful at what you eat. But just by taking a few — by doing 10 minutes of meditation every day and then when you go and decide to have your meal, people who have done meditation and mindfulness, they train their brain to think, “Maybe I don’t need that side of French fries. Maybe I should get a side of quinoa or something of that nature, something of a more healthy starch.”
SR: Yes. My downfall is more of when I’m in a family situation, and there’s cheese, and crackers, and nuts, and all these good stuff in front of me, and I find I’m eating without thinking. I think you’re going to tell me that that’s not mindful.
JB: It’s not mindful, but everybody is allowed during the holidays to cheat a little bit. The thing is not to make it a regular part of your life. And even if you just have a few — if you — let’s say you cut out — maybe you only eat nuts, but instead of reaching for the Ferrero Rocher chocolate, maybe in parties you might have had 3. Now, maybe you’ll only have 1. That’s even mindfulness just like making even a slight change. And then as you get better and better at mindfulness and meditation, you’ll learn to control yourself better.
SR: Okay. So instead of taking a pill, instead of eating chocolate, instead of taking a long hot soak in the tub, what we’re going to do is try meditating to de-stress.
JB: Actually, taking a long hot soak in the tub is actually very good.
SR: Soak in the tub — we’re saying yes to this.
JB: We are saying yes to that.
SR: What about taking a walk or a jog?
JB: Also excellent.
SR: Okay.
JB: Just lose the medications and go easy on the chocolate.
SR: Okay. Do that and have a great holiday.
JB: Yes. From all of us here at MedShadow, thank you for making MedShadowTV, which just premiered this year, such a wonderful success, and a happy holidays to you and your family. Take care.
