The Medicine Guy

Counterfeit Medications (by TheMedicineGuy)

What are your thoughts on Procrit vs. Aranesp? For example, someone taking a Procrit injection every two weeks if hemoglobin is < 12 g/dL, etc. Is it worthwhile to switch to Aranesp monthly? Thanks.
Anonymous

It would be worthwhile if the less frequent injections are a big advantage for you…depending on the cost of course. It may be more expensive to switch to Aranesp, so that would be a factor as well.

There is a good bit more clinical data and experience with Procrit, but no evidence to suggest that one is “better” or safer than the other. So to me, the only two factors are going to be convenience and cost. 

Lastly, depending on the reason you need Procrit, you may want to talk with your healthcare provider about modifying your target hemoglobin. Last year, the FDA issued an advisory recommending more conservative hemoglobin targets for kidney disease patients in light of the risks of Procrit or Aranesp treatment. As a general rule, you probably shouldn’t start on it until your hemoglobin is falling below 10, and your goal for treatment should not exceed 10-11. 

http://themedicineguy.com/post/6936015666/fda-warning-anemia-drugs

Hope this helps!

-Aaron Emmel, Pharm.D., BCNSP, BCPS

Warfarin Monitoring Every 12 Weeks (by TheMedicineGuy)

My latest Medcast: a discussion of the association between Proton Pump Inhibitors and infectious diarrhea. 

Nice informational video about statin medications. 

I was on adderral (instant release) for a long time but I stopped when summer came and I didn't have classes because I don't like the effects of being more boring. What other drugs might I try for my ADD? I only heard of one non-stimulant, strattera, and the side effects list for that was terrible.
Anonymous

Hello,

Please note my terms of use prior to interpreting the information below.

Stimulants (like Adderall) are the most effective treatment for ADD/ADHD. If you tolerated it ok, and did not experience any significant side effects, that is still probably the best way to go. 

Alternative non-stimulant drugs include Strattera as you mentioned, as well as guanfacine. Neither are as effective as stimulants, but they do have the advantage of not carrying as much abuse potential or sleep disturbance. Guanfacine can be quite sedating though, which may be a drawback. Another option is the antidepressant drug bupropion, although it has problems of its own (such as a risk of seizures) and it doesn’t have much data for effectiveness in adults.

Let me know if you would like further clarification.

-Aaron Emmel, Pharm.D., BCNSP, BCPS

RxEconsult interviews Dr. Aaron Emmel about his medication therapy management business, SmarterMeds.

Good morning medicine guy. Quick question. Doc gives me 50 mg of painkillers per day for injuries sustained in military. I am tryig to quit smoking but do not know the safety limits of taking pain pills and the nicotine patch. I cannot find a reliable answer to this question, any thoughts?
Anonymous

Good afternoon to you.

The terms of this blog apply to this post.

Well, I am not sure what kind of pain medications you are referring to. Regardless though, it really doesn’t matter as there shouldn’t be any drug interaction between nicotine and either narcotic pain medications, acetaminophen, or NSAIDs. The only concern I can think of would be with certain migraine medications (the “triptans” and Migranal), as nicotine may enhance their cardiovascular toxicity. 

So the fact that you are on a nicotine patch really wouldn’t effect the safety of the pain pills otherwise. 

Good luck!

-Aaron

I know this is not really what your used to answering , but I was wondering.. Can starting out getting my Pharmacy Technician Certification help my chances of getting into Pharmacy schools? And if so, can you recommend a good school to attend? (I like your videos!) Thanks - Tkc
Anonymous

Thank you!

I have never been involved in the admissions process, so I couldn’t give you a concrete answer. But I imagine, that all other things being equal, the person with the certification will look better since the college knows that person has a true interest in pharmacy. If it doesn’t interfere with your schoolwork or delay your application, you may want to consider it. 

US News did a ranking of pharmacy colleges several years ago, based on survey data from those in the academic field. 

http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-health-schools/pharmacy-rankings

I would apply to as many as possible, in whichever locations you’d be willing to go to. Pharmacy school has become very competitive, so you’ll have a better chance of getting in the more you apply. 

The school that you go to doesn’t make as much of a difference in your education as your own personal attitude towards the process. Just remember that the more you learn and the more proficient you become, the better off your patients will be. 

Good luck!

-Aaron

Hey, I was wondering what your opinion was on cleansing? i.e. the substitution of all food for just vegetables fruits and fruit juice. Is it healthy? Should it be avoided?

Perhaps outside the scope of my pharmacist blog, but I will tackle this question since I maintain board certification in nutrition support:

Honestly, I am not familiar with this strategy. I did a quick search on “cleansing” diets, and I have to say they appear to be nothing short of ridiculous. Also, a pubmed search of the terms “colon cleanse”, “cleansing diets”, “detox diet”, etc. turns up only information pertaining to evacuating the colon prior to colonoscopy. None of the websites I browsed that promote the diets cite any reliable scientific evidence of safety or benefit. 

It would not be healthy at all if sustained for any significant period. The body needs protein to avoid catabolism, and sufficient protein intake is unlikely to occur from a diet restricted to fruits and vegetables. Additionally, the body needs certain fatty acids to sustain life. Once again, unless a significant quantity of avacados were consumed, this is not likely to occur from that type of diet. 

A healthy diet will contain a various foods choices from all of the food groups. Studies have suggested that diets plentiful in fruits and vegetables may reduce the risk for certain cancers and cardiovascular disease, so they are an extremely important component of a healthy diet. But eliminating all other food groups is not a good idea. 

I think it is safe to state that there is no evidence to support any health benefit or sustained weight loss from the use of a cleansing diet. Looks to me like another case of some clowns trying to make money utilizing a “snake oil” approach to promoting health. 

Hope this helps!

Aaron Emmel, Pharm.D., BCNSP, BCPS