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Boggio Family of Pharmacies

Boggios: A healthy choice for your whole life

Category Archives: Anxiety

Grapefruit and grapefruit juice are an excellent source of many nutrients that contribute to a healthy diet. Grapefruit is a good source of vitamin C, fiber, and the pink and red hues contain the beneficial antioxidant lycopene, thought to have a role in preventing various diseases such as cancer and heart disease. Studies have shown that grapefruit helps lower cholesterol, and there is evidence that the seeds have antioxidant properties.

However, there are compounds in grapefruit called furanocoumarins that can interfere with the way your body metabolizes certain medications. This can lead to dangerously high levels of medication in the body and may increase the risk of rare but serious or life-threatening side effects such as slowed heart rate and muscle deterioration. For a few medications, it can lead to decreased effectiveness because these medications need to be metabolized in order to become active. Don’t take these interactions lightly, as some can cause potentially dangerous health problems.

Both grapefruit juice (either fresh or frozen) and the fruit itself can affect certain medications and the effects have been seen with as little as one 8-ounce (250 mL) glass of grapefruit juice. The effects of grapefruit juice on medications can last up to 3 days, so taking them at different times of day will not help. Naturally sweet orange juice has not been shown to affect medications the way grapefruit juice does, but tangelos (which are related to grapefruit), lime juice, andSeville(sour) oranges may affect medications.

Many medications may be affected by grapefruit juice, including medications for:

Allergies Fexofenadine (Allegra)
Anticoagulation Dabigatran (Pradax)
Anxiety/Sleep Buspirone (BuSpar), Diazepam (Valium), Triazolam (Halcion), Alprazolam (Xanax), Clonazepam (Rivotril)
Arrhythmia Amiodarone (Cordarone)
Blood Pressure Amlodipine (Norvasc), Felodipine (Renedil, Plendil), Nifedipine (Adalat)
Cholesterol Simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor)
Depression Sertraline (Zoloft)
HIV Saquinavir (Invirase, Fortovase), indinavir (Crixivan)
Seizures/Epilepsy Carbamazepine (Tegretol, Mazepine), Clonazepam (Rivotril)
Sexual Dysfunction Sildenafil (Viagra), Taldafil (Cialis)
Transplants/Autoimmune Diseases Cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf, Advagraf), sirolimus (Rapamune)

This is not a complete list; grapefruit juice may affect medications for conditions other than those listed here. Also, if you are taking any natural health products, check the labels to see if they contain grapefruit, tangelo, Seville orange, or lime juice. Avoid these fruits and juices until your doctor or pharmacist has told you it’s safe to have them.

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Smoking is the most preventable cause of disease and death. In Canada, 45, 000 people die annually, and as many as half of all smokers will die due to tobacco use. Smoking is known to cause various types of cancer, COPD, heart disease, stroke and many other conditions such as influenza, peptic ulcers, osteoporosis, thyroid disease and cataracts. Despite the known risks, there are approximately 5 million Canadian smokers. Nicotine is the addictive chemical component in tobacco. It binds to the ‘reward’ receptors in the brain, which help people relax, improve mood and suppress appetite. Due to the continued stimulation of the reward pathway, people continue to smoke.

There are 2 primary options to smoking cessation; Cold Turkey or Medication. There have been many success stories of patients able to quit cold turkey, however it is much more difficult and shown to have an increased rate of relapse. It may be the most cost effective option, but these people suffer greatly from nicotine withdrawal symptoms, which include irritability, anger, restlessness, impatience, difficulty concentrating, depression and anxiety. These symptoms often start just a few hours after the last cigarette and are known to persist for weeks and months. Medications are available to help decrease these withdrawal symptoms, reduce the urge to smoke and help ease the patient to a continued smoke-free life.

Nicotine Replacement Therapy (NRT) is available over-the-counter in 4 forms; gum, patch, inhaler, and lozenge. There are different dosages available which is dependent on the amount of cigarettes the individual smokes. If you have questions regarding which dose you should start on and the proper technique to use the NRT, please speak to your pharmacist for assistance.

NRT provides nicotine in a safe form so the body does not have to endure nicotine withdrawal while a person adapts to not smoking. As opposed to cigarettes, NRT are medications that contain only nicotine and not the other harmful chemicals that are present in cigarettes. NRT is considered a ‘step down’ approach where the patient is exposed to a gradual decrease in the amount of nicotine in the blood. This enables the body to adjust to the changes in a slow and steady manner and experience less side effects.

The general length of therapy is 12 weeks, however this is NOT set in stone. It is also common practice to combine different forms of NRT such as using the patch and chewing gum. Some common side effects of the NRT include nausea, insomnia and local irritation if using the patch or inhaler.

The most commonly prescribed medication available for smoking cessation is Champix (Varenicline). Champix has recently been shown to have great success for smoking cessation. It works by binding to the same receptors as nicotine, which results in decreased cravings and withdrawal symptoms. Additionally, it decreases the pleasure that people get from smoking making the quitting process that much more effective.

The starting dose is 0.5mg once daily for the first 3 days, then 0.5 mg twice daily for the next 4 days, then 1mg twice daily thereafter. People are on Champix for 12 weeks, however many continue treatment for an additional 12 weeks to prevent smoking relapse. It should be taken with a glass of water with or without food. Common side effects include nausea, trouble sleeping and headache.

Caution: A patient may notice changes in their behavior, feeling depressed, agitated or not themselves. If this does occur, it is important to contact the physician.

Although there are medications and therapeutic options available, the single most important smoking cessation aid is a patients’ will and determination to quit. Having confidence and a support system are important for a smoker to kick the habit. Some other options for smoking cessation include hypnosis, counselling (individual and/or group), acupuncture, keeping busy, exercise (joining the gym or a class), or starting a new hobby. Studies have demonstrated that combining medication with advice or behavioural therapy increases the quit rates of up to 6 times. There are many support systems out there and available to help through the difficult time and it is important to know there is a light at the end of the tunnel.

“ The achievement of your goal is assured the moment you commit yourself to it” Mack R. Douglas.

Pharmacists are a great resource for information and support on your journey to quit smoking. Please come in and talk to us if you have any questions about smoking cessation.

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Anxiety disorders affect about 10% to 30% of the population sometime in their lifetime.  With proper management most people can learn how to handle their anxiety

There are a number of natural and pharmaceutical options people can take for their anxiety.  However, sometimes the best first approach is an old fashioned remedy.

Routine exercise and fresh air can make a huge difference in a patient’s outlook.  Natural endorphins released during exercise, and sunlight exposure, have been shown to improve mood and help with anxiety.  Talking to someone about worries and concerns can be comforting.  It is not always necessary to consult a psychiatrist, some family practitioners offer counseling and there are psychologists that can help with many issues.  Ask your family practitioner for a referral or contact a therapist on your own.  Sometimes there are help groups available as well where people who share your problems get together to help each other.

If you would like to try a pharmaceutical product in addition to the above mentioned strategies there are a number available.  Currently a number of antidepressants are being used to also help with anxiety.  The most commonly used medications belong to a class called selective serotonin reuptake inhibitors (SSRIs).  These medications help to increase serotonin levels in the brain.  Commonly used medications in this class are Celexa, Cipralex, Prozac, Paxil and Zoloft.

The next most commonly used agent is Effexor XR.  This medication is part of a different class called SNRIs.  There are other antidepressants that can be tried if these first line agents are ineffective.  Typically it takes about 2 to 4 weeks to see some symptom relief and it may take about 12 or more weeks to see a full response.

Sometimes it is recommended that a patient try an anxiolytic such as Ativan, or clonazepam, until the other medications take full effect.  These agents provide rapid onset and can be used for acute anxiety symptoms.  Unfortunately these medications can also cause dependence, sedation, and memory impairment.  They are really best used on a short-term basis.

Often it is a matter of trial and error to find what agent works best for the individual.  Patients often get frustrated with this process, unfortunately there is often no easy solution.

There are a number of natural products on the market that people can try.  There is some evidence for products like St. John’s Wart and kava being effective.  Other agents include 5-HTP, L-tryptophan and Passionflower.  Kava is not currently available in Canada because of concerns with liver toxicity.  St. John’s Wart is available and does increase levels of serotonin.  However, it should be treated like any other medication.  You should consult your doctor before taking it and ask the pharmacist about drug interactions.  As for the other products there is still a lack of evidence of safety and efficacy.

Research has shown that people who take a medication and participate in some type of talking therapy do best in overcoming their anxiety.  Talk over your options with your practitioner and have some patience as you work through your issues.  In time most people are able to overcome their anxiety and find a way to deal with their problems.