Can cyproheptadine be given 1 tablet per day for appetite?

Question: Dosage of cyproheptadine for appetite usually 1 tablet 3 times a day. Is the effectiveness of appetite reduced or not, if it is given orally 1 tablet once daily?

Answer: cyproheptadine is an anti-histamine. It is used to treat allergy symptoms. Cyproheptadine has been used to stimulate appetite.

There are reports of clinical studies in healthy volunteers about efficiency in stimulating appetite. The dose of cyproheptadine used is 4 mg 3 times a day. It is found that the volunteers had appetite and weight gain when compared to placebo.

However, no information on the effectiveness of cyproheptadine for stimulate the appetite, when the drug is eaten 4 mg once daily.

References:

1. Noble RE. Effect of cyproheptadine on appetite and weight gain in adults. JAMA.1969; 209: 2054-5.

2. Silverstone T, Schuyler D. The effect of cyproheptadine on hunger, calorie intake, and body weight in man. Psychopharmacologia. 1975; 40: 335-40.

Will high dose of foliamin can affect the baby?

Question: I am pregnant and have eaten foliamin 1 tablet two times a day, morning and evening for about one month. Later I knew that the doctor ordered me to take one tablet once a day after breakfast, only. Now I worry about what happens to the pregnancy. Will it affect the unborn child or not?

Answer: Foliamin or Folic acid is used in pregnant women for prevention of disorders of the brain and spinal cord of baby. The recommended dose in pregnant women is 0.4-0.5 mg per day. The questioner did not specify the dose received, but it is expected to be 5 mg per tablet which is commonly used, especially in pregnant women with risk of neural tube defect of baby.

A follow-up study of the intellectual development of infants born from mothers who received folic acid in doses of 5 mg per day, higher dose of 5 mg per day, compared with mothers who did not receive folic acid during 14-18 weeks of pregnancy.

The data found that children born from mothers who received folic acid in doses of 5 mg per day was associated with improved understanding of the language and improved language usage when compared with children born from mothers who did not receive folic acid, and children born from mothers who take folic acid in high doses over 5 mg per day did not develop increasing more than children born from mothers who received foliamin 5 mg per day

However, the study did not report the danger caused by folic acid in high doses over 5 mg. Information on toxicity of folic acid when given in high doses is unknown. But it is reported that healthy volunteers who received high doses of about 15 milligrams of folic acid per day is associated with behavioral changes such as restlessness. And they increased response to stimuli and had sleep disorders.

References:

1. Chatzi L et al. Effect of high doses of folic acid supplementation in early pregnancy on child neurodevelopment at 18 months of age: the mother-child cohort "Rhea" study in Crete, Greece. Public Health Nutrition 2012; 15 (9): 1728-36.

2. Briggs GG, Freeman RK, Yaffe SJ. Drug in pregnancy and lactation. 8th ed. Philadelphia wolters Kluwer Lippincott Williams and wikins; 2008.

Zinc chelate and biotin for hairloss

Question: I have hair loss and I had bought zinc chelate 15 mg and biotin 150 mcg. But I do not know how to eat, and how long can they be eaten? Can they solve the problem of hair loss?

Answer: Zn (zinc) is a mineral used in body processes. It is used as catalysts in combination with various enzymes which is vital to the functioning of organs such as growth, creating various tissues, including the proliferation of hair follicle cells and so on.

Generally the body gets zinc from diet as normal. But a lack of zinc can be found in people who have the problem of absorption.

The zinc deficiency is one cause of the hair loss and thinning hair spread over the entire head. Zinc chelate is zinc in the form of binding with organic molecules such as amino acids to increase absorption.

There is currently no reliable study yielded a clear result of the use of zinc to treat hair loss, including the dose and duration. But there is a study about the levels of zinc in the blood in patients with diffuse thinning hair over the entire head which showed that the amount of zinc did not differ from the control group (=normal people). But in a study of patients with patchy hair loss which have low blood zinc levels. To receive zinc supplements for replacement which can help improve symptoms of their hair loss.

Biotin (biotin) is classified in the same group with thiamine (vitamin B). It is often sufficient in food. So biotin deficiency is rarely happens. The body needs to take biotin in the process of producing new cells, especially cells that are constantly dividing, such as hair and nails. Therefore biotin deficiency can cause hair loss and inflammation of the skin.

There is currently no convincing evidence about dose, duration and effectiveness obtained from the use of biotin treatment of hair loss as well.

The more information about hair loss: It may be caused by many factors such as a lack of nutrients, genetics, stress, chronic hair pulling, hair decoration, some skin diseases and the use of some drugs for a long time.

This may require further research to find the causes of hair loss.

References:

1. Goldberg LJ, Lenzy Y. Nutrition and hair. Clin Dermatol.2010; 28: 412-9.

2. Park H, Kim CW, Kim SS, Park CW. The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. Ann Dermatol 2009; 21: 142-6.

3. Arnaud J, Beani JC, Favier AE, et al. Zinc status in patients with telogen effluvium. Acta Derm Venereol 1995; 75: 248-9.

4. Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother 1990; 44: 511-4.

Can people with high cholesterol eat coconut?

Question: Do coconut water and coconut meat affect blood cholesterol especially in patients or people with high blood cholesterol?

Answer: Generally, fat in food can be divided into several types: saturated fat, trans-fat and cholesterol. Blood lipid levels are different depending on the type of fat that have been eaten.

Coconut water and coconut meat contain the following components:

- 100 grams of coconut water provides 16 kilo calories of energy. The main component is water and there are other components such as carbohydrates 3.9 g., protein 0.1 g., vitamins and minerals.

- 100 grams of Coconut meat provides 81 kilo calories of energy. The main component is water and there are other components such as 5.9 grams of fat, 3.8 g of carbohydrates, 3.2 g of fiber, 1.8 grams of protein, vitamins and minerals.

The data shows that carbohydrates are the main ingredient in coconut water and there is a little fat. So eating coconut water can affect blood sugar levels more than blood lipid levels.

But the coconut meat will have major component of fat and carbohydrates. The fat from coconut is mainly saturated fat, which can increase blood cholesterol levels. It is recommended for normal people to eat saturated fat no more than 7% of calories received per day, or about 16 grams. In addition, coconut meat also contains sugar, which can affect blood sugar levels as well.

If possible, it is the best for patients with high cholesterol that they should avoid eating coconut meat.

References:

1. Dignan C, Burlingame B, Kumar S, Aalbersberg W. The Pacific Islands Food Composition Tables. FAO Publications, Rome 2004.

2. American Heart Association National Center.http://www.heart.org/HEARTORG/GettingHealthy/FatsAndOils/Fats101/Saturated-Fats_UCM_301110_Article.jsp#

Diarrhea and vomiting affect the action of oral contraceptives.

Question: Diarrhea and vomiting affect the action of oral contraceptives. Is it true or not?

Answer: The data found that diarrhea and vomiting affect the action of oral contraceptives. The diarrhea that results in reduced effectiveness of oral contraceptives is severe diarrhea. It does not have to define definition of severe diarrhea (such as yet undefined number of time that defecation), and there is no evidence or clinical studies about the efficacy of the drug to decline that would affect pregnancy or hormone levels when severe diarrhea.

There is also a suggestion that if the diarrhea for at least 48 hours during taking oral contraceptives. It is not necessary to eat more contraceptives and do not need to use another more contraception.

But if you have diarrhea for up to 48 hours or longer, it is recommended to eat the next tablet of contraceptives as usual, but using drug together with other methods of contraception, such as using condoms, or avoiding having sex as long as until having eaten a pill every day for at least seven days after stopped diarrhea. And it may require more emergency contraceptives in some cases that have sex without protection.

Reference:

1. US Selected Practice Recommendations for Contraceptive Use, 2013. MMWR 2013; 62 (5): 1-60.

Can I take zinc and vitaminC for a long time?

Question: How useful are zinc and vitamin C 1,000 mg to the body? And can I take them for a long time?

Answer: In general, food helps to absorb vitamins and minerals. So vitamins and minerals should be taken with or after food. However, the body will usually get vitamins and minerals from food. Therefore, vitamin or mineral supplements should be eaten only when necessary as in the case of the elderly. Elderly people will have reduced absorption of food. It may cause a deficiency of vitamins or minerals. But if there is no risk of lack of vitamins or minerals, vitamins and supplements should not be eaten. Because it may get the vitamins or minerals in excessive amounts until it can adversely affect the body.

Zinc is a mineral that used in the process of the body. It is used as catalysts in combination with various enzymes which is important to the functioning of organs such as growth, tissue regeneration and etc. Generally the body gets zinc from the diet, but lack of zinc can be found in people with problem of absorption.

Each person needs a different amount of zinc based on gender and age. Zinc usually should not be taken more than 40 mg per day.

To get zinc in excessive quantities, it may interfere with the functioning of various systems such as metabolism of copper and iron, or it may cause nausea, vomiting, abdominal pain, diarrhea and etc. However, eating zinc for a long time should be in the care of a physician.

Vitamin C normally should be taken in 50-60 milligrams daily for adults, but in certain conditions such as pregnant women, smoker, people with frequent colds, it should take vitamin c more than normal.

There were no reports about the toxicity of vitamin C. The most common side effects occur in gastrointestinal tract (when vitamin C is eaten in high doses), such as abdominal discomfort, diarrhea.

Since most of the nutrients and vitamins can get from the diet. If we eat nutritious food which contains 5 groups of carbohydrate, protein, fat, vegetables and fruits. Vitamin or supplements may not be needed, because it may have the opportunity of dangerous from excessive eating.

References:

1. Drug Information Handbook, 19th Edition 2010-2011.

2. http://www.webmd.com/vitamins-supplements.

Is it dangerous to take daflon 2 tablets once daily?

Question: I am a little varicose vein, now I'm taking a drug named daflon two tablets once daily after breakfast. Is it dangerous?

Answer: Daflon 500 mg® contain diosmin 450 mg and hesperidin 50 mg for the treatment of chronic venous diseases such as hemorrhoids, varicose vein, etc.

The recommended dose of daflon for varicose vein is 1000 mg per day (1 tablet orally two times a day, or two tablets once daily).

There were quite a few reports of adverse reactions which were found include gastrointestinal such as nausea, vomiting, abdominal pain, diarrhea, dyspepsia, and neurological symptoms such as dizziness, insomnia, headache. And there were no reports of serious adverse reactions.

However, medication should be considered appropriate and necessary to use, in order to avoid side effects that may occur.

References:

1. MICROMEDEX 2.0® [Database on the internet]: Diosmin. Available from: http://www.micromedexsolutions.com

2. Daflon 500 mg. Available from: http://www.mims.com

Is ranitidine used to treat people with allergies?

Question: What is indication of ranitidine 300mg? Is it used to treat people with allergies (urticaria) or not?

Answer: Ranitidine is a gastric proton-pump inhibitor. It is used to treat gastric and duodenal ulcers and GERD (gastroesophageal reflux disease).

Ranitidine is H2-receptor antagonist which inhibits the action of histamine on H2-recepetor. Histamine is important substance associated with allergic reaction, swelling, itching through the mechanism of action on H2-receptor.

Thus ranitidine is brought in combination with other medications to treat some allergic reactions. Such as ranitidine is used in combination with diphenhydramine which is H1-receptor antagonist, to treat urticaria.

This method is more effectiveness than single medication treatment.

Reference:

1. Fedorowicz Z, van Zuuren EJ, Hu N. Histamine H2-receptor antagonists for urticaria (Review). The Cochrane Library 2012, Issue 3.

2. Lin RY, Curry A, Pesola GR, Knight RJ, Lee Hs, Bakalchuk L. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonists. Ann Emerg Med 2000; 36 (5): 46

Which antihistamines can I eat while I am pregnant?

Question: I am pregnant and now I catch a cold. Which antihistamines can I eat?

Answer: Antihistamines are generally supplied in the market including chlorpheniramine (CPM), loratadine, cetirizine and fexofenadine. The U.S. Food and Drug Administration has identified the risks that may occur from drug using in pregnant women, it is 5 category A, B, C, D and X. Sequentially, category A is the most safety and category X is the most dangerous.

Chlorpheniramine (CPM) and fexofenadine are classified in category C in the whole period of pregnancy, loratadine and cetirizine are classified in category B in the whole period of pregnancy.

Therefore, antihistamines are not a contraindication in pregnancy, but they should be used as needed. Cetirizine and loratadine are the kinds of drug that are safer than other drugs.

References:

1. Chlorpheniramine. In: DRUGDEX System [database on the internet]. Ann Arbor (MI): Truven Health Analytics; 2013 [cited 26 Nov 2013]. Available from: www.micromedexsolutions.com.

2. Loratadine. In: DRUGDEX System [database on the internet]. Ann Arbor (MI): Truven Health Analytics; 2013 [cited 26 Nov 2013]. Available from: www.micromedexsolutions.com.

3. Cetirizine. In: DRUGDEX System [database on the internet]. Ann Arbor (MI): Truven Health Analytics; 2013 [cited 26 Nov 2013]. Available from: www.micromedexsolutions.com.

4. Fexofenadine. In: DRUGDEX System [database on the internet]. Ann Arbor (MI): Truven Health Analytics; 2013 [cited 26 Nov 2013]. Available from: www.micromedexsolutions.com.

Why do I feel a burning sensation in the eyes after the eye drops using?

Question: Why do I feel a burning sensation in the eyes after using the eye drops that contains antazoline and tetrahydrozoline?

Answer: The eye drops contains antazoline and tetrahydrozoline. It can make blood vessel contraction and acts as antihistamine. The eye drops is indicated for the treatment of allergic reaction, irritation or itching and swelling of eyes due to allergies to chemicals, pollen or weather.

The acidity (pH) for stability of the eye drops is about 5.4, and pH of human tears normally is 7.4, so this may cause eye irritation or eye burning.

However, product of eye drops may have the pH in the range 4.5 to 11.5, because the human tears can dilute the acidity of the drug into normal (=7.4). So, after using the eye drops for a moment, symptoms like burning eyes are gone.

There are also reports that antazoline and tetrahydrozoline cause adverse drug reaction such as, eye irritation and burning sensation after using the eye drops. If the symptoms of burning eyes occur unusual, severe and occur for a long time, it is advised to stop using the drug immediately. And you should return to the hospital where you received treatment in order to be determined the exact cause, or a change to another drug.

References:

1. Beringer P, editor. Remington's the science and practice of pharmacy, 21st ed. Philadeiphia: Lippincott Williams & Wikins; 2006.

2. Hista-Oph®- product information.

3. Antazoline. In: DRUGDEX System [database on the Internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.

4. Tetrahydrozoline. In: DRUGDEX System [database on the Internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.

I don't eat the birth control pill at the same time everyday, what will it affect?

Question: I am taking the birth control pill every day at bedtime, but rarely on time.

Sometimes, I eat early no more than two hours. Sometimes, I eat late no more than two hours. What will it affect?

Answer: Eating birth control pill that is not punctual. It may affect the efficacy of oral contraceptives because drug levels in the blood are not steady. So if you want fully effective contraceptives, you should take your birth control pill at the same time every day.

Reference:

http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#Hormonal-Methods