Pharmaceuticals

For each condition there is a variety of classes of drugs that can be used to treat it. We list the pharmaceutical names and common brands for each class of drugs. For example, in the common cold chapter, we cover all the drug classes that are used for colds, including analgesics, topical nasal decongestants, oral decongestants, antihistamines, mucus thinners, and cough suppressants. For each of these classes of drugs we provide information on:

• How do these drugs work?

• What are the benefits?

• What symptoms can be reduced or health benefits gained from this class of pharmaceuticals?

• Potential side effects. This section covers the common or nonlethal side effects that are known to occur with this class of drugs.

• Major cautions. This section covers serious risks such as organ damage or potentially lethal side effects.

• Drug interactions. This section covers the drugs that are known to have potentially harmful interaction with this class of drugs.

• Food or supplement interactions. This section covers foods and supplements known to have potentially harmful interaction with this class of drugs.

• Nutrient depletion/imbalance. This section covers nutrients that are known to be depleted or imbalanced from this class of drugs, along with recommendations for supplementation.

There may be differences for some of the individual drugs within a category. Our summary covers the information common to the drugs in each class. However, there can be individual differences that are not covered within the summary.

Natural Alternatives

This section describes natural supplements and therapies that are recommended as alternatives, including dosages and cautions. Key studies on these natural alternatives are summarized in an easy-to-read format.

PART ONE

What You Need to Know about Pharmaceutical Drugs

Drugs: The Good and the Bad

Pharmaceuticals certainly have their place in health care. For example, drug therapy saves lives in cases of infections, certain cancers, and insulin-dependent diabetes, and it relieves suffering for those in acute and chronic pain. The fact is, we need pharmaceuticals for the proper treatment of a wide variety of illnesses. It is obvious, however, that we in the United States have put too much faith in drug therapy. The “pop a pill and everything will be fine” mentality has led many to an early death or suppressed the health and vitality of others. The fact is that few magic bullets exist in the drug industry. Our health care system has gotten out of balance. We need a shift toward preventing and treating the root cause of illness with diet, lifestyle changes, stress reduction, and natural remedies. Pharmaceutical medications should complement this approach and be used judiciously.

Astoundingly, Americans spend close to $200 billion each year on prescription drugs. This number does not include over-the-counter medications. The United States is the world leader when it comes to popping pharmaceuticals. Did you know that in 1986 there were fewer than 900 prescription medications in existence, but that currently there are over 8,000? There is a drug for everything. Critics argue that new disease labels are being created under the influence of pharmaceutical companies so that pharmaceutical markets can expand.

The Journal of the American Medical Association published an eye-opening report stating that 106,000 patients die each year from adverse reactions caused by drugs administered by medical professionals. In addition, 5 percent of hospital admissions are due to adverse drug reactions. Many researchers believe the incidence is likely much higher.

Over-the-counter or nonprescription drugs are not without risk, either. Many people assume that an over-the-counter item is safe because it does not require a prescription. While there is truth to that perception, nonprescription medications still carry a risk of serious side effects. For example, approximately 16,000 people in the United States die each year from adverse reactions to over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which can cause gastrointestinal bleeding and kidney and cardiovascular problems. Again, many researchers feel this number is conservative and could easily be two to three times higher.

How do the numbers of fatal adverse reactions compare for nutritional supplements? There simply is no comparison. The American Association of Poison Control Centers reports that dietary supplements lead to about 10 deaths yearly, most of which are iron overdoses. As you can see, the risk of serious harm from nutritional supplements out of the millions of doses taken daily is a drop in a lake compared to the risk from pharmaceuticals. Therefore, nutritional supplements should be used instead of pharmaceutical medications whenever possible.

Our children are also at risk from adverse reactions from pharmaceuticals. It makes logical sense that a child’s developing body can be more easily harmed by drugs. While you won’t see it in media headlines, the risk is very clear. A study published in the prestigious journal Pediatrics in 2002 concluded, “Adverse reactions to drug therapy are a significant cause of death and injury in infants and children under two years of age.” It is outrageous, but the truth is that most drugs given to children have never undergone pediatric-related studies! In 2007, Food and Drug Administration (FDA) experts published a 365-page report showing that decongestants and antihistamines have been linked with 123 pediatric deaths since 1969. Pharmaceutical companies announced a voluntary withdrawal of oral cough and cold medicines marketed for use in infants. The FDA also announced that almost 200 unapproved prescription medicines containing hydrocodone, a narcotic that is used to ease pain and cough, must be taken off the market for children under age 6. Frighteningly, pharmaceutical companies had extrapolated data from adult studies to estimate dosages for children. These doses may or may not be accurate.

At the other end of the spectrum, there is concern about the vulnerability of seniors to the toxicity of pharmaceuticals. As people age, the kidneys and liver process pharmaceuticals less efficiently. This means the drugs’ effects are more potent, last longer, and are more likely to cause adverse or fatal reactions.

Many consider the FDA lax in its protection of the public against dangerous drugs. Ongoing congressional hearings on financial interests between FDA employees and drug companies continue to expose a flawed agency. Many drug company executives are former FDA employees, and the FDA gets much of its funding from drug company research fees. The November 2004 edition of the Journal of the American Medical Association disclosed that “an investigation of 18 FDA expert advisory panels revealed that more than half of the members of these panels had direct financial interests in the drug or topic they were evaluating and for which they were making recommendations.” The same report also noted that in 2003 “the pharmaceutical industry earmarked $4.9 million to lobby the FDA.^”

The FDA drug approval system is far from where it needs to be. This is evident from the numerous recalls of popular drugs. You may wonder how the drugs we list below could have been on the market if the testing procedures are so stringent. Two (sometimes one) Phase 3 clinical human trials are required for drug approval by the FDA. This involves a few hundred to a few thousand patients. The trials allow researchers to identify the most common but not always the most serious side effects a drug may have. The problem is that less than 50 percent of all serious adverse reactions to a new drug are identified before it enters the marketplace. This means at least half of the serious adverse reactions are discovered by you—the public.

Following is a brief summary of drugs that were either withdrawn from the market or given new warnings in recent years. Although not an exhaustive list, it demonstrates the point that FDA-approved drugs can be dangerous.

• Erectile dysfunction drugs, including:

Sildenafil (Viagra)

Vardenafil (Levitra)

Tadalafil (Cialis)

Use: Treatment of erectile dysfunction (ED).

In 2007, the FDA informed doctors of reports of sudden decreases or loss of hearing following the use of these drugs.

• Thiazolidinedione class of antidiabetic drugs, including:

Rosiglitazone maleate (Avandia)

Pioglitazone hydrochloride (Actos)

Rosiglitazone maleate and glimepiride (Avandaryl)

Rosiglitazone maleate and metformin hydrochloride (Avandamet)

Pioglitazone hydrochloride and glimepride (Duetact)

Use: Type 2 diabetes.

In 2007, the FDA requested an updated label with a boxed warning on the risks of heart failure.

• Tegaserod maleate (Zelnorm)

Use: Irritable bowel syndrome and constipation.

In 2007, this drug was removed from the market due to serious cardiovascular problems, including myocardial infarction (heart attack), unstable angina (chest pain), and stroke.

• Antidepressant medications

Use: Treatment of depression.

In 2007, the FDA notified the makers of all antidepressant medications to update the existing black box warning on the prescribing information for their products to include warnings about the increased risks of suicidal thinking and behavior in young adults ages 18 to 24 years during the first one to two months of treatment.

• Amphetamine with dextroamphetamine (Adderall), methylphenidate (Ritalin, Concerta)

Use: Pediatric and adult attention deficit/hyperactivity disorder treatment.

In 2006, a black box warning was given for cardiovascular risk.

• Pimecrolimus (Elidel) and tacrolimus (Protopic)

Use: Topical eczema treatments.

In 2006, these were given a black box warning after researchers found a link between these drugs and increased risk of lymphoma and skin cancer.

• Celecoxib (Celebrex)

Use: Anti-inflammatory.

In 2005, a boxed warning was required regarding potentially serious adverse cardiovascular events and possibly life-threatening gastrointestinal events.

• Valdecoxib (Bextra)

Use: Anti-inflammatory.

In 2005, this was withdrawn due to lack of data on the cardiovascular safety of long-term use of Bextra, along with increased risk of adverse cardiovascular events, possibly associated with chronic Bextra use. There also were reports of rare, but serious, potentially life-threatening skin reactions.

• Rofecoxib (Vioxx)

Use: Nonsteroidal anti-inflammatory.

In 2004, this drug was withdrawn due to increased risk of serious cardiovascular events, including heart attacks and strokes.

• Cerivastatin (Baycol)

Use: Cholesterol-lowering.

In 2001, it was withdrawn due to reports of sometimes fatal rhabdomyolysis, a severe muscle adverse reaction.

• Phenylpropanolamine (PPA) and phenylpropanolamine hydrochloride (the active ingredient in PPA)

Use: Ingredients in cold and cough medicines, nasal decongestants, and over-the-counter appetite suppressants and weight-loss products.

In 2000, they were withdrawn due to risk of hemorrhagic stroke.

• Troglitazone (Rezulin)

Use: Treatment of type 2 diabetes.

In 2000, it was withdrawn due to severe liver toxicity.

• Cisapride (Propulsid)

Use: Treatment of acid reflux.

Serious cardiac arrhythmias (irregular heart rhythms) and cardiac arrest. In 2000, it was withdrawn from the market.

Staying Safe with Pharmaceuticals

Get educated. Read as much information as you can on any drug before taking it. Learn the possible dangers and weigh them against the potential benefits. Ask your doctor and pharmacist about their experiences with patients who have used this medication. Find out whether to take the drug with meals or on an empty stomach, side effects to watch for, and what to do in case of an adverse reaction.

Create a “medication card.” Make a list that summarizes all prescription and over-the-counter (OTC) drugs and all supplements you take. Include the name of the product, its strength, the dose and frequency at which you use it, your reason for taking it, the date when you first started it, and the names and phone numbers of your doctors and pharmacist. Keep this card in your wallet as a ready reference. You can also receive a free medication card by mail from the University of Connecticut Health Center. Call 800-535-6232 or download it from http://health.uchc.edu/medicard/index.htm.

Learn about drug interactions. Tell your doctor and pharmacist about all your drugs and supplements. Inquire about possible interactions. Read the drug package inserts. This book also discusses possible drug interactions.

Replenish nutrients known to be depleted by the medications you are taking. This book is a good resource for that purpose.

Be extra-cautious with new drugs. As you read earlier in this chapter, adverse reactions are often discovered after new drugs have been on the market for a few years or longer. Stick with tried-and-true drugs. If you must use a new one, request the lowest starting dose possible.

Choose natural therapies. Whenever you can safely do so, try natural remedies instead of drug therapies. Work with a doctor who will support this decision, and make a holistic doctor a part of your health care team.

References

Fontanarosa, PB, D Rennie, and CD DeAngelis. 2004. Postmarketing surveillance—lack of vigilance, lack of trust. Journal of the American Medical Association. 292(21): 2647-50.

Natural Medicine: A Necessity for Good Health

We are in the midst of a revolution in our nation’s health care. We live in an era when there are more office visits to complementary and alternative medicine practitioners than to primary care medical doctors. The public has demanded safer, less expensive, and more nonsuppressive therapies to prevent disease and restore their health. We have come to the conclusion that as individuals, we want to have control over our own health care decisions. Doctors are to be partners in the decision-making and healing process. As a consequence, we are seeing more and more complementary medicine health care providers in all spheres of medicine. Although there are not enough to meet the demand, we are moving in the right direction.

The fundamental question is, Why is natural medicine a necessity for good health? A 2007 report gave some insight into this question. It disclosed that Americans have a shorter life expectancy than people in 41 other countries. This is eye opening, considering that we in the United States on average spend more on health care than people anywhere else. What’s behind this discouraging statistic? There are various possibilities, including the fact that almost 70 percent of U.S. adults are now overweight, with 32 percent of these considered obese. Lack of medical insurance is another likely reason. A third reason, which you won’t read about in the press, is the suppression of nutritional and holistic therapies in mainstream U.S. health care. Approximately 80 percent of the world’s population rely on plants and other holistic medicines as a primary form of medicine. For people in many cultures, medicine begins in the backyard, where family gardens yield plentiful fruits, vegetables, and healing herbs; and natural, nontoxic therapies such as massage and nutritional therapy are widely used. We encourage you to incorporate holistic healing into your health care—and to urge your insurance carrier to cover these therapies.

Can you have confidence in the dietary and supplement approaches recommended in this book? You certainly can. We have cited key studies and scientific references validating their effectiveness. In addition, among this book’s three authors, we have well over a combined 75 years of clinical experience. It is one thing to read a study on the effectiveness of a particular natural medicine, it is another to monitor a patient and see a health transformation take place.

There is a lot more science behind natural and nutritional therapies than most people, including medical doctors, are aware of. Thousands of scientific studies from around the world are published monthly validating the effectiveness and safety of natural medicine.

Natural medicine is a diverse system of medicine that offers a variety of healing therapies. While there are different philosophies and styles of natural therapies, they have common principles. The following six principles are embraced by modern-day naturopathic and holistic doctors.

1. First, do no harm. Whenever possible, use therapies that have the lowest risk of causing adverse effects. In general, nutritional and other natural approaches are quite safe.

2. Use the healing power of nature. Our bodies have an inherent healing mechanism. We can aid that healing mechanism through the use of nutritional and various natural (as well as conventional) therapies. From a divinely complex design, we see how the medicinal properties of foods, herbs, and other natural substances nourish and stimulate the healing ability of the body.

3. Find the cause. The best way to help individuals with their health needs is to treat their root causes. Holistic doctors are generally very effective at identifying and treating the root cause of an illness. When possible, we should strive to remove the underlying cause of an illness rather than just eliminate or suppress its symptoms.

4. Treat the whole person. Wellness or illness comes from a complex interaction of physical, emotional, dietary, genetic, environmental, lifestyle, and other factors. One is best helped by taking all these factors into account. This includes the physical, mental, emotional, and spiritual aspects of a person.

5. Practice preventive medicine. Illness is often caused by diet, habits, poor stress-coping mechanisms, environmental pollutants, and lifestyle. Good holistic doctors assess risk factors and susceptibility to disease and make appropriate recommendations to prevent illness, or to keep a minor illness from developing into a more serious or chronic disease. The emphasis is on building health rather than on treating symptoms.

6. Practice the principle of doctor as teacher. The original meaning of the word “doctor” is teacher. A good doctor will educate patients on what they should do to achieve health as opposed to just relying on medical intervention.

Now we move on to discuss a variety of health conditions.

References

Ohlemacher, Stephen. 2007. U.S. life expectancy lags behind 41 nations. USA Today, August 11, Health and Behavior section.

PART TWO

Pharmaceuticals and Their Natural Alternatives, Condition by Condition

Acne Drugs and Their Natural Alternatives

What Is Acne?

Acne is a common skin condition caused by oils that get trapped in the pores, forming whiteheads or blackheads (comedones), which can subsequently become infected and inflamed, resulting in pimples or cysts. Because they contain the highest concentration of oil glands, the face, neck, chest, shoulders, and back are usually the most affected areas of the body. Acne ranges in development from very mild to extremely severe. Although generally not dangerous, it can cause scarring and emotional trauma.

Common acne usually affects people in their teen years, with three out of four developing symptoms. Although both sexes develop acne, boys tend to have more severe, longer-lasting acne. While teens are the most affected group, acne is also common in people in their twenties, and can even occur in children, or in adults in their thirties, forties, or fifties.

What Causes Acne?

Statistics suggest that heredity (family history) is a strong predisposing factor for the development of acne. The major physiological factors contributing to the formation of acne are overactive oil glands, blocked skin pores, activity of normal skin bacteria, overgrowth of fungal organisms, diet, hormonal stimulation of the oil glands, and inflammation.

Overactive Oil Glands

Oil glands (or sebaceous glands) produce sebum, which flows to the surface of the skin through canals containing hair follicles, to lubricate the hair follicles and the surrounding skin. Oil glands are stimulated to produce sebum by androgens, which are hormones produced by both males and females. Puberty, stress, and hormonal shifts can cause the body to produce more androgens, and subsequently more oil.

Blocked Skin Pores

If oil cannot flow through the follicular canal and out of the pore due to blockage, it becomes trapped and builds up within the pore. Such blockage is caused by skin cells that have been shed, but which bunch together at the pore for unknown reasons. People with acne tend to produce more dead skin cells, but do not shed them properly. A simple blocked pore will manifest as a white-head or a blackhead.

Activity of Normal Skin Bacteria

The bacterium Propionibacterium acnes is a healthy, normal part of the skin surface; it prevents harmful bacteria from entering the skin. Although it is not the cause of acne, it can play a role in making it worse. When oil becomes trapped, P. acnes grows in the blocked pore, ultimately resulting in inflammation and pimple formation.

Inflammation

In the case of acne, the body’s immune system works to rid itself of bacteria or irritating substances in the pores. The resulting inflammation is characterized by redness, swelling, warmth, and discomfort. Once infection and inflammation have taken hold, the problem can become deeper than a pimple, and pustules, nodules, and/or cysts can develop in the pores.

Things that can additionally stimulate the above processes include oily cosmetics, comedogenic (blackhead-producing) skin care or hair care products, nutritional deficiencies, candida overgrowth, certain drugs such as steroids or estrogen medications, and friction or pressure caused by clothing, helmets, phones, and so on. In some people, food sensitivities may also play a role. Most over-the-counter and prescription medications for acne such as benzoyl peroxide, salicylic acid, antibiotics, and retinoids address one or more of the root causes discussed above in a noncurative fashion.

Acne Drugs

Benzoyl Peroxide Topical

Benoxyl
Benzac AC
Benzagel
Brevoxyl
Persa-Gel

HOW DO THESE DRUGS WORK?

Benzoyl peroxide works by removing cells from the top layer of the skin surface. This action unclogs the pores so that oil (sebum) can escape. In addition, it has antibacterial action, thereby helping to clear the pores of infection by Propionibacterium acnes. Many acne preparations incorporate benzoyl peroxide because research indicates that it increases the effectiveness of some medicines. For instance, when used in combination with antibiotics, benzoyl peroxide reduces the likelihood of a patient developing resistance to the antibiotic.

WHAT ARE THE BENEFITS?

These topical medications can reduce mild to moderate acne without the risk of systemic side effects.

POTENTIAL SIDE EFFECTS

Stinging, dryness, and peeling tend to occur initially. Irritation, redness, scaly eruptions, darkening or lightening of the skin, or rash can be more serious side effects.

MAJOR CAUTIONS

Benzoyl peroxide can make the skin more sensitive to sunlight, so avoid prolonged sun exposure and tanning lights. It should not be used on sunburned, windburned, dry, chapped, or irritated skin. Research conducted on lab mice, and in some instances hamsters, indicates that benzoyl peroxide has led to the rapid development of carcinoma (skin cancer). Avoid contact with wounds, the eyes, the mouth, and mucous membranes.

MEDICAL PRECAUTIONS

If you are pregnant or lactating, you should discuss the risks of using benzoyl peroxide with your doctor.

KNOWN DRUG INTERACTIONS

Benzoyl peroxide should not be used with other topical treatments unless indicated by your doctor. If used with tretinoin (Avita, Renova, Retin-A), it may cause severe skin irritation.

FOOD OR SUPPLEMENT INTERACTIONS

There are no known food or supplement interactions or nutrient depletions and/or imbalances associated with the use of topical benzoyl peroxide treatments.

Salicylic Acid Topical

Oxy Clean Maximum Strength
Oxy Clean Medicated
Salex
Sebasorb
Stri-Dex

HOW DO THESE DRUGS WORK?

Salicylic acid is a peeling agent found in many over-the-counter and some prescription acne treatments. It causes the cells of the epidermis to become “unglued,” allowing the dead skin cells to slough off. As these skin cells are shed and removed, pores unclog.

WHAT ARE THE BENEFITS?

These topical medications can reduce mild to moderate acne without the risk of systemic side effects.

POTENTIAL SIDE EFFECTS

Common side effects include burning, stinging, itching, dryness, redness, peeling, or irritation. More serious, but less common, side effects may include severe skin irritation or allergic reaction.

MAJOR CAUTIONS

Avoid all mucous membranes when applying salicylic acid. Also, do not use on sunburned, windburned, dry, chapped, irritated, or broken skin, or on open wounds.

MEDICAL PRECAUTIONS

People with the following conditions or disorders should discuss their risks with their physician:

• Liver disease

• Kidney disease

• Diabetes

• Poor circulation

• Pregnancy

• Breast-feeding

KNOWN DRUG INTERACTIONS

Using other topical preparations may interfere with the effectiveness of salicylic acid or increase skin irritation; do not use other topical preparations on the treated area unless directed by your doctor. Talk with your doctor if you are taking aspirin, diuretics, and methyl salicylate (found in some muscle rubs); he/she may need to change the doses of your medications or monitor you carefully for side effects.

FOOD OR SUPPLEMENT INTERACTIONS

None known.

Antibiotics: Topical and Oral

Topical

Erythromycin (Akne-Mycin, Staticin, Erygel, EryDerm)

Clindamycin (C/T/S, Cleocin T, Clinda-Derm, Clindets Pledget)

Erythromycin and benzoyl peroxide (Benzamycin)

Clindamycin and benzoyl peroxide (Benzaclin)

Oral

Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)

Tetracycline (Achromycin, Sumycin)

HOW DO THESE DRUGS WORK?

Antibiotics stop the growth of bacteria. In the case of acne, they help rid the pores of P. acnes and reduce inflammation. Topical antibiotics, which have fewer side effects, are generally tried first; and if the patient does not respond, oral antibiotics are often the next step. Oral antibiotics have been the mainstay of treatment for years in patients with persistent moderate to severe acne. Treatment usually begins with a higher dosage that is reduced as acne resolves. Treatment can be continued for up to six months. Unfortunately, as with all antibiotics, the bacteria can develop resistance, making it necessary to switch to a different antibiotic or treatment.

WHAT ARE THE BENEFITS?

Topical antibiotics are helpful in reducing mild to moderate acne, and oral antibiotics are generally effective for moderate to severe acne.

POTENTIAL SIDE EFFECTS

With topical antibiotics, common side effects may include burning, itching, dryness, redness, oiliness, or peeling where applied.

With oral antibiotics, the most frequently observed, and usually dose-related, side effects are dizziness, nausea, vomiting, loss of appetite, diarrhea, and abdominal pain. A less common side effect with oral antibiotics is blurred vision, primarily associated with tetracycline. Photosensitivity can also occur with tetracycline, so it is advisable to reduce sun exposure.

More serious side effects associated with oral antibiotics that may require medical attention include severe allergic reactions; other infections; vaginal irritation or discharge; bloody stools; red, swollen, or blistered skin; severe diarrhea; severe stomach pain or cramps; and yellowing of the skin or eyes.

MAJOR CAUTIONS

Antibiotics can cause a severe intestinal condition (pseudomembranous colitis) that may occur during treatment or even several weeks after treatment has stopped. Symptoms of this condition may include persistent diarrhea, abdominal or stomach pain or cramping, or blood or mucus in the stool. Clindamycin is particularly associated with this condition, but it can be caused by any antibiotic.

In rare cases, erythromycin has been associated with the production of cardiac ventricular arrhythmias. There have also been reports of reversible hearing loss primarily in people with renal insufficiency or in those taking high doses of erythromycin. Abnormal liver tests and hepatic dysfunction can also occur.

Tetracycline and its derivatives (doxycycline, minocycline) should not be taken by children younger than 8 years of age because they can affect growth and stain teeth, and there have been reports of severe gastrointestinal problems occurring in infants following erythromycin therapy. Rare instances of esophagitis and esophageal ulceration have been reported in patients receiving the capsule and tablet forms of tetracycline.

Antibiotics may cause Candida albicans or other Candida species to overgrow in the digestive, respiratory, urinary, and vaginal areas of the body. They destroy friendly flora that keeps these yeast organisms in check. (Friendly flora also is involved in the synthesis of various nutrients, aids in detoxification, and supports normal immunity.)

Microbial resistance to antibiotics is a major concern and problem associated with antibiotic use.

MEDICAL PRECAUTIONS

People with the following conditions or disorders should discuss their risks with their physician:

• Allergy to any component of the antibiotic

• History of allergies

• Impaired liver function

• Impaired renal function

• History of heart problems

• Porphyria (blood disorder)

• Myasthenia gravis

• History of intestinal disease (e.g., ulcerative colitis, enteritis, etc.)

• Diabetes

• Pregnancy

• Breast-feeding

• History of Candida albicans infection

KNOWN DRUG INTERACTIONS

Topical Antibiotics

Using other topical therapies may cause irritation. Research suggests that clindamycin has neuromuscular-blocking properties. Therefore, it should be used with caution in patients receiving such agents because it may enhance their action.

Oral Antibiotics

Erythromycin administered together with theophylline (an asthma treatment) can lead to elevated blood levels of theophylline and subsequent toxicity. Erythromycin can also raise blood levels and cause toxic reactions with digoxin, warfarin (Coumadin), and antiseizure medications such as phenytoin (Dilantin) and carbamazepine (Tegretol). Serious arrhythmias and even cardiac arrest have been observed when erythromycin and terfenadine (Seldane) are used together. Erythromycin can also interact with lovastatin (Mevacor), causing muscle inflammation. Erythromycin may interact with many other common medications prescribed for a variety of conditions, due to its effects on certain liver enzymes. Talk to your doctor about your medication. If your medication is metabolized by a CYP3A enzyme system, you should discuss possible interactions.

Bismuth subsalicylate (Pepto-Bismol) and antacids containing aluminum, calcium, or magnesium bind tetracycline in the intestines, reducing its effectiveness. Like erythromycin, tetracycline may enhance the activity of warfarin (Coumadin), causing excessive blood thinning. Phenytoin (Dilantin), carbamazepine (Tegretol), and barbiturates (such as phenobarbital) can enhance the metabolism of tetracycline. Avoid acitretin (psoriasis medication) or isotretinoin (Accutane) because side effects, such as increased pressure in the fluid surrounding the brain, may occur. Concurrent use of tetracycline may reduce the effectiveness of oral contraceptives and penicillin.

FOOD OR SUPPLEMENT INTERACTIONS

Tetracycline should not be taken with dairy products or with minerals such as calcium, magnesium, zinc, or iron; these cause binding of tetracycline in the intestinal tract and may reduce its effectiveness. There is some evidence that berberine-containing herbs such as goldenseal, barberry, and oregon grape may also reduce the effectiveness of tetracycline. Avoid alcohol, as it may increase dizziness associated with tetracycline use.

Digitalis lanata and Digitalis purpurea, herbs commonly known as foxglove, contain digitalis glycosides. (These herbs are not commonly available but may be prescribed by some natural health care providers.) These chemicals have similar actions and toxicities to the prescription drug digoxin and should not be used with erythromycin. These herbs, though, are not available over the counter. Erythromycin should be taken without food to avoid breakdown before it reaches the intestines.

Research has demonstrated that consuming yogurt or supplements containing probiotics such as bifidobacterium, Lactobacillus acidophilus, and Saccharomyces boulardii can help prevent symptoms of antibiotic-induced diarrhea and reduce the likelihood of antibiotic-induced infection by clostridium or candida. In other research, the enzyme bromelain showed beneficial effects on the activity of erythromycin.

NUTRIENT DEPLETION/IMBALANCE

Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, B12, B6, and magnesium. And tetracycline can interfere with the activity of folic acid, potassium, vitamin B2, vitamin B6, vitamin B12, and vitamin C. In addition, excessive bleeding has been reported in people using antibiotics; this effect is believed to be a result of reduced vitamin K activity and/or production associated with the antibiotic-related loss of “friendly” bacteria in the colon. We recommend the following supplements:

• Multivitamin and mineral.

• Vitamin C—take 500 mg.

• Probiotic that contains friendly bacteria with 5 billion or more active organisms. Take daily, two hours or more away from taking antibiotics.

Retinoids

Topical

Tretinoin (Retin-A, Avita, Renova)

Adapalene (Differin)

Isotretinion (Isotrex gel)

Oral

Isotretinion (Accutane)

HOW DO THESE DRUGS WORK?

Retinoids are a derivative of vitamin A. In topical form, they work by increasing skin cell turnover and promoting the release of the plugged material in the follicle. They also prevent the formation of new whiteheads and blackheads (comedones) because the rapid turnover of cells prevents new pimples from forming. Some retinoids (oral isotretinoin specifically) also reduce the amount of sebum produced by the sebaceous glands and stop P. acnes growth.

WHAT ARE THE BENEFITS?

Although the list of side effects and precautions is daunting, the long-term effectiveness of Accutane (isotretinoin) is extremely positive. Seventy percent of patients receiving Accutane will be acne-free for more than 10 years. However, about 25 percent of patients who have used Accutane will see acne symptoms return after two years, and 10 percent will see acne return after just one year. A normal treatment period is about four to six months.

POTENTIAL SIDE EFFECTS

With topical retinoids, local inflammation commonly occurs with application and resolves when treatment is stopped. Mild stinging and a sensation of warmth also occur with application. Dryness, scaling, and redness are considered common side effects. However, severe redness, vesicles, or crusting are signs that a lower-concentration treatment should be considered.