Nifedipine in Raynaud’s | Clinical Pharmacology | 08-2010
The treatment of Raynaud s phenomenon should first focus on nonpharmacological approaches. Raynaud s phenomenon is a vascular response to either cold or to stress, typically presenting with sharply demarcated ...

Gabbing about gabapentin | Clinical Pharmacology, Neurology | 06-2010
Neurologist s response You ll read in the CPS that gabapentin is indicated as adjunctive therapy for the management of patients with epilepsy who are not satisfactorily controlled by conventional ...

Forget the ABC | Clinical Pharmacology | 06-2010
This is an excellent question and, for most vitamins and supplements, the answer is none. The fact is that, for people believed to be healthy, there s scant evidence that ...

Does melatonin work for jet lag? | Clinical Pharmacology | 02-2010
Jet lag is a problem that, for those affected, can be quite profound, having a major impact on the ability to work or partake in vacation activities after a prolonged ...

Vitamin D — it’s all good | Clinical Pharmacology | 02-2010
In northern counties such as Canada relative vitamin D deficiency is much more common than is often appreciated, with the attendant risk of reduced bone density and, over time, fracture. ...

Do proton pump inhibitors weaken clopidogrel? | Clinical Pharmacology, Cardiology | 02-2010
Clinical pharmacologist s answer The question of the safety of concurrent therapy with proton pump inhibitors PPIs and the antiplatelet drug clopidogrel has been a live issue recently, in part ...

Beta-blockers: safe option in asthma? | Clinical Pharmacology | 02-2010
This is an excellent question, as the mainstay of therapy for acute exacerbations of asthma relies on bronchodilation produced by beta-1 agonists such as salbutamol. Thus, classical teaching has suggested ...

Exactly what is an adjuvant? | Clinical Pharmacology | 02-2010
An adjuvant is an agent that lacks a specific antigenic response that, however, does stimulate an immune response to another agent, typically a vaccine. Adjuvants are commonly used with vaccines ...

Statins: safer than aspirin | Cardiology, Clinical Pharmacology | 01-2010
Cardiologist s response Sadly, in real life, arthritis and aches and pains are all too commonly present in the background of high-risk patients. But muscle ache shouldn t preclude statin ...

When biologics backfire | Clinical Pharmacology | 12-2009
The question of undesired immune responses to biologics is one of the major drug safety problems that have limited the approval and clinical use of these agents. In fact, the ...

Cephalosporins for patients with amoxicillin reactions? | Clinical Pharmacology | 11-2009
This is an excellent question but somewhat difficult to answer, notably because the determinants, antecedents and mechanism s of amoxicillin-related serum sickness-like reactions remain unknown. It would appear, however, that ...

No need to obsess over serum drug levels with controlled epilepsy | Clinical Pharmacology | 11-2009
Therapeutic drug monitoring is a surrogate measure for drug efficacy and compliance, and the value of therapeutic drug monitoring for antiepileptic medications is to avoid toxicity, understand therapeutic failure including ...

Does sulpha allergy go beyond antibiotics? | Infectious Disease | 10-2009
It s an underappreciated fact that that the sulphonamides provide a stable backbone for many commonly used drugs, including hydrochlorothiazide, celecoxib and furosemide. This has led several regulatory bodies around ...

Antibiotics and QT interval | Clinical Pharmacology | 10-2009
In this case, the safest choice with respect to the QT interval depends somewhat on what is meant by pencillin allergy. If the allergy is non-anaphylactic, then a cephalosporin would ...

Serotonin syndrome — too much of a good thing | Clinical Pharmacology | 06-2009
The serotonin syndrome is a fascinating complication of SSRI therapy. While the syndrome was actually described nearly 50 years ago, it was essentially unknown in patients as very few drugs ...

Is this a statin side effect? | Clinical Pharmacology, Cardiology | 05-2009
Muscular adverse effects are very common with statins, and indeed are the most frequent reason for cessation or alteration of statin therapy. Statin-induced myopathy remains an issue of concern, with ...

Old enough for bisphosphonates? | Rheumatology | 03-2009
Pharmacology response This is an excellent question, as bisphosphonate use is moving into younger and younger populations. Indeed, there rsquo s now some use of biphosphonates in children with rare ...

Vitamins that go down easy | Clinical Pharmacology | 03-2009
The effects of multivitamins are very dependent on their content. Iron is notoriously tough on the digestive tract, and products with high iron content are more likely to produce effects ...

Old enough for bisphosphonates? | Rheumatology | 03-2009
Pharmacology response This is an excellent question, as bisphosphonate use is moving into younger populations. Indeed, there rsquo s now some use in kids with rare bone disease, albeit on ...

Are BP monitors harming doctors? | Clinical Pharmacology | 01-2009
Mercury is an interesting metal, toxic in certain forms yet fairly innocuous in others. Mercury exists in several forms, elemental metallic , inorganic and organic. The mercury in blood pressure ...

Preventing hip fracture by number | Clinical Pharmacology | 12-2008
The question of number needed to treat is an interesting one and, to be frank, one that physicians rarely consider. But it s a vital question in terms of how ...

Avoiding opiate addiction | Clinical Pharmacology | 12-2008
The main strategy to prevent addiction is to be clear as to the indication for the opiate, i.e. that the physician and patient are clear on the reason that the ...

Anabolic steroids get the boot | Clinical Pharmacology | 11-2008
Anabolic steroids have acquired an unsavoury reputation over the past decade because of their misuse by athletes. While these agents can have potent adverse effects, they also have potent positive ...

Best dose of folic acid before pregnancy | Clinical Pharmacology | 10-2008
Though the efficacy of folic acid in primary prevention of neural tube defect has been shown clearly in a number of trials, these studies didn t demonstrate the ideal dose. ...

Fasting blood test -- first thing in the am? | Clinical Pharmacology | 09-2008
The person would still be fasting, of course, and the short answer is that, if the test results are normal, this is reassuring. On the other hand, if the blood ...

Are seal oil capsules beneficial? | Clinical Pharmacology | 09-2008
As in the case of many natural health products, claims of efficacy for seal oil haven't been backed up by a large body of evidence. That being said, studies of ...

How long can patient remain on cyproterone OC? | Clinical Pharmacology | 07-2008
Venous thrombosis is a relatively uncommon but well described complication of OCs. Interestingly, the product monograph for cyproterone acetate states that there may be a higher risk of VTE for ...

How long can patient remain on cyproterone OC? | Ob/Gyn | 07-2008
Despite numerous reports in the media regarding the risk of VTE from cyproterone ethinyl estradiol vs other OCs, the literature is still difficult to interpret. As a result, this contraceptive ...

Which meds preclude blood donation? | Hematology | 07-2008
The list is extensive -- because some may harm the recipient and others the donor. Before accepting a donation, Canadian Blood Services first asks the person a number of questions ...

Which meds preclude blood donation? | Clinical Pharmacology | 07-2008
You may add growth hormone of human source to the list, as this is an absolute contraindication to blood donation, as is etretinate. For other drugs, it's necessary to wait ...

Antidepressants for pain -- why do they work? | Clinical Pharmacology | 06-2008
While the precise mechanism of action remains unclear, amitriptyline, which was originally developed as an antidepressant, has been shown to work as a pain reduction agent. The effect appears to ...

Check vitamins for purity approval | Clinical Pharmacology | 06-2008
Vitamin purity is largely dependent on where the approval for marketing came from. If there's a Drug Identification Number or DIN on the packaging, the Therapeutics Products Branch of Health ...

Dental work comes before bisphosphonate therapy | Clinical Pharmacology | 05-2008
There are a number of case reports of avascular necrosis of the mandible among patients being treated with bisphosphonates. This problem appears to occur at a rate of 1-5 , ...

Which opiate causes the least dependence? | Clinical Pharmacology | 05-2008
Finding the least addictive opioid has been a clinical problem almost since these substances -- described by Osler as God's own medicine -- entered clinical practice. Very old studies done ...

Navigating the rosiglitazone controversy | Clinical Pharmacology | 04-2008
This is an excellent question. A recent meta-analysis Nissen SE, Wolski K. NEJM 2007 356 24 2457-71 suggested that rosiglitazone, a drug used to treat type 2 diabetes, was associated ...

Statins improve cardiac pain | Clinical Pharmacology, Cardiology | 03-2008
There's no data to suggest that carditis or cardiac pain are caused by statin therapy. In fact, the opposite has been found to be true. Randomized trials on subjects with ...

Unexpected uses for sildenafil | Cardiology, Clinical Pharmacology | 02-2008
There are a number of off-label indications for which nobody really has any data beyond better sexual satisfaction. The major one that comes to mind is in the treatment of ...

Can statins be used in patients with liver disease? | Gastroenterology | 01-2008
Although statins can occasionally cause liver enzyme elevation, they're thought to be fairly safe in stable chronic liver disease. They may in fact be indicated in non-alcoholic fatty liver disease ...

Allergic to fluoroquinolones: what next? | Allergy | 12-2007
It's possible the patient has become sensitized to a common antigen present in all fluoroquinolones. Alternatively, the reaction may be to a unique allergen only found in moxifloxacin. Or the ...

Sodium savvy: is sea salt really better? | Cardiology | 11-2007
Unfortunately, salt is salt. Encouraging the use of sea salt is just a marketing strategy because it still contains the same amount of sodium chloride that leads to hypertension. Remember ...

ASA allergy and cross-reactivity | Allergy | 09-2007
If a patient is intolerant to ASA, all NSAIDs should be avoided. The COX-2 inhibitors are less likely to cause a problem, but even they can occasionally induce a reaction. ...

Breastfeeding after surgery | Pediatrics | 07-2007
Although many suggest amp quot pumping and dumping amp quot breast milk for 24 hours after anesthesia, there's little evidence of harmful effects on the newborn. I like to verify ...

Prescribing raloxifene to prevent breast Ca | Oncology | 06-2007
Last year, the results came out for the Study of Tamoxifen and Raloxifene STAR , a trial that compared the two drugs as primary prevention for women at risk of ...

HIV: are folic acid and vitamin B₆ helpful? | Infection | 05-2007
Our infectious diseases specialist responds While nutritional deficiency would be expected to have an adverse effect in HIV-positive patients, I'm not aware of any evidence that indicates a particular advantage ...

Is Vit A in pregnancy health food supplements too high? | Obstetrics Gynecology | 05-2007
Pregnant women require adequate amounts of vitamin A for normal fetal development, but excessive intake may be a potential hazard, resulting in major fetal abnormalities. Amounts over 25,000 IU day ...

Can a hot diet cool cancer? | Urology | 03-2007
Prostate cancer rates do appear to be lower in East India, a part of the world that consumes a lot of capsaicin, the hot spice in curry and red peppers. ...

Activated protein C: a saviour for sepsis? | Infection | 02-2007
APC action in treating severe sepsis and septic shock relies on both its anti-inflammatory and anticoagulant properties. The PROtein C Worldwide Evaluation in Severe Sepsis PROWESS trial Bernard GR et ...

Choosing fever meds for kids | Pediatrics | 01-2007
After reviewing several articles from reputable journals, I conclude that more research is needed, as there's no clear causal relationship. Until then, I'll continue to prescribe ibuprofen for kids with ...

Can bupropion cause scrotal pain? | Urology | 01-2007
I don't know why improvement should occur with stoppage of an antidepressant, but I've seen it with venlafaxine also. Could it be coincidental Chronic epididymitis is associated with varying pain ...

Are chronic large doses of acetaminophen harmful? | Gastroenterology | 11-2006
Although the acute effects of acetaminophen overdose are well recognized, chronic intake of large doses isn't known to cause liver injury. Assuming alcohol isn't a factor, it's questionable whether the ...

Does zolpidem induce sleepwalking? | Psychiatry | 10-2006
Many medications have been associated with somnambulism -- benzodiazepines, neuroleptics, mood stabilizers and sedatives. Several case reports appear in the literature on zolpidem-induced somnambulism, where the effect began when the ...

Is coenzyme Q₁₀ advised with statin therapy? | Rheumatology | 09-2006
There's no data to support this approach. Appropriate monitoring of creatine kinase levels and education of patients on symptom reporting is advisable. LR amp lt br amp gt see our ...

Grapefruit's potent effect on pills | Clinical Pharmacology | 06-2006
Grapefruit juice has been documented to be a potent inhibitor of the intestinal metabolism of many commonly used drugs, even as small an amount as in a single 240 ml ...

Avoiding anticholinergics in the elderly | Geriatrics | 05-2006
You're quite right to minimize the anticholinergic drug load in patients with cognitive impairment. Specific drugs that are strongly anticholinergic are amp lt br amp gt amp amp 149 tricyclic ...

Skin reactions to anticoagulants | Hematology | 04-2006
Allergic skin reactions to oral anticoagulation amp amp 151 including urticaria, maculopapular rash or pruritus amp amp 151 are rarely seen. Cross-reactivity between the three drugs you've mentioned has been ...

Antifungal use in pregnancy or liver disease | Dermatology | 02-2006
Tinea capitis is most commonly caused by amp lt i amp gt Trichophyton amp lt i amp gt dermatophyte. Frequently, this organism can penetrate the hair shaft and migrate down ...

Who's at risk for SSRI-prolonged QT? | Cardiology | 01-2006
Millions of people use SSRIs with very little toxic effect on the heart. The exact prevalence is unclear, but very rare. Since the withdrawal of rofecoxib and other cyclooxygenase-2 inhibitors, ...

Are bio-identical hormones better than HRT? | Obstetrics Gynecology | 12-2005
Bio-identical hormone replacement applies to combining three types of estrogen amp amp 151 that is, estrone, estriol and estradiol amp amp 151 to resemble the estrogens normally present in the ...

PPI variety dilemma | Gastroenterology | 09-2004
Proton pump inhibitors PPIs are such great drugs that I think both statements are valid. As newer PPIs emerge, there are subtle variations in pharmacology -- such as speed of ...

TOPICAL TACROLIMUS FOR ATOPIC DERMATITIS | ENT | 09-2002
At the time of writing, tacrolimus ointment Protopic, marketed by Fujisawa Canada is now available in two forms, 0.03 and 0.1 . Most of the pharmacology was determined from the ...

NO TO DIURETICS IN ELDERLY | Urology | 02-1995
While it is well known that both thiazide and loop diuretics can increase urinary magnesium excretion, the exact incidence of diuretic-induced hypomagnesemia is not known as there have been no ...

OCS AND ANTIBIOTICS: THE ONGOING SAGA | Infection | 04-1994
With a little luck one learns something new every day Since my response to a similar inquiry February issue, 1994 I have become aware of data suggesting a potential interaction ...