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Boggio Family of Pharmacies

Boggios: A healthy choice for your whole life

Category Archives: Medicine

Very few products available in your local pharmacy can claim as many uses as Omega-3 fatty acids. Omega-3s are a type of unsaturated fat that are found in high quantities in certain fish (such as salmon, herring, sardines) as well as plant sources (such as flax).

The two most common Omega-3s found in supplements are EPA and DHA. Some supplements will have their Omega-3s derived from fish oils while others will be derived from plant sources. Be sure to choose a product that lists the amount of EPA or DHA per capsule.

There has been some concern by patients over the levels of heavy metals (such as mercury) in Omega-3 fish oils. However, heavy metals tend to accumulate in the protein of the fish rather than the fats. In addition, Health Canada tests all Omega-3 products for their heavy metal content before being made available to the public.

Here are 5 common medical conditions that Omega-3s can help treat:

1. Arthritis – Omega-3s have been shown to help decrease inflammation in the body, therefore they may help relieve some of the pain associated with both osteoarthritis and rheumatoid arthritis. Between 3 – 5 grams of EPA and DHA for 12 weeks are needed for the anti-inflammatory effects.

2. Hyperlipidemia – Omega 3-s can help lower triglyceride (fat) levels circulating in the body. High triglyceride levels contribute to the formation of fat deposits in blood vessels. This can lead to hardening of the arteries, which allows for the formation of dangerous clots which can cause a heart attack or stroke. Studies have shown that 2 – 4 grams of fish oils can lower triglycerides by 20-50%.

3. Hypertension – Omega-3s have a modest effect on reducing blood pressure and may be a viable option for patients with mild hypertension who do not wish to start a prescription medication at this time. Omega-3s reduce the production of agents that constrict blood vessels and increases production of agents that open blood vessels. For cardiac health, 1 gram of EPA plus DHA daily is recommended.

4. Depression – Studies have shown that 1 gram of EPA twice daily may yield anti-depressant and/or mood stabilizing effects. Omega-3s may be suited for the treatment of specific populations, such as pregnant or lactating women where conventional antidepressants must be used with caution.

5. Loss of Vision – Recent studies have shown the beneficial effects of omega-3s on vision, specifically decreasing risk of age related macular degeneration. Further investigations are needed to confirm the results of these studies, however many ophthalmologists are now recommending that their patients take Omega-3 supplements.

If supplements are not for you, try to replace the meat in two of your meals per week with fish. Certain populations (such as Mediterranean and Inuit) that eat high amounts of fish and little amounts of red meats have much lower rates of cardiovascular disease compared to the North American populations.

Omega-3s are not for everyone. For patients on blood thinners such as Coumadin (warfarin) or Aspirin (ASA), be sure to check with your physician or pharmacist before starting on Omega-3s as they may increase the risk of bleeding.

 

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           Many patients come into the pharmacy and have questions about cholesterol and what they can do to decrease it. Whether they found out they have elevated cholesterol through routine blood work or have a family history of high cholesterol, patients are curious about natural ways of lowering their cholesterol.

            There are two types of cholesterol: a “good” cholesterol (HDL) and “bad” cholesterol (LDL). For patients with high cholesterol, the goal of therapy is to increase the amount of HDL and decrease the amount of LDL. Approximately 80% of cholesterol is made by the body and only 20% comes from the food you eat.

            Many commercials for food products such as cereals and margarines are advertising that they can help lower cholesterol. The goal of this article is to examine the evidence of the effectiveness of various natural health and food products on the market that claim to lower cholesterol.

            Products that contain soluble fibres such as psyllium (ie. Metamucil) or oat bran are known as bile acid binders. These products increase the excretion of cholesterol from the body as well as increase the breakdown of cholesterol in the body to less harmful products. Between 10 and 30 grams of psyllium fibre daily mixed with others foods has been shown to have a significant cholesterol lowering effect.

            Between 1.5 and 3 grams per day of Niacin (Vitamin B3) has been shown to lower bad cholesterol while increasing good cholesterol. In some patients, Niacin can cause skin flushing (redness of the skin) as well as itching. There are “flush-free” or “no flush” Niacin products available; however, their effectiveness has not been established.

            Plant sterols and stanols often found in margarines labeled heart healthy (such as Becel Pro-activ) have been shown to prevent some of the absorption of cholesterol from the diet and can be included as part of a healthy diet high in fruits and vegetables to lower cholesterol.

            Finally, some studies have shown that between 600 and 1200mg of garlic in three divided doses can lower the levels of cholesterol and triglycerides (fat) in the body. Unfortunately, some patients report bad breath as well as nausea and flatulence when taking this amount of garlic.

            Patients who have been prescribed a cholesterol lowering medication called a “statin” such as Crestor (rosuvastatin) or Lipitor (atorvastatin) can consider taking Coenzyme Q10. Statins inhibit the synthesis of Coenzyme Q10, which may lead to muscle weakness and impaired energy metabolism.

            If you have any questions about natural health products available to help lower your cholesterol, be sure to ask your physician or community pharmacist to see if those products are right for you.

Very rarely does a day go by where there isn’t a question about constipation from a patient stopping by the pharmacy. Most patients want to know what they should take that is available without a prescription.

Constipation is a symptom that occurs when waste moves too slowly through the body, resulting in stool that is dry and hard. This often makes it difficult and painful to pass.

Some medications such as antidepressants, water pills, and certain pain killers (such as Oxycontin and Codeine) may cause constipation.

The frequency of bowel movements varies from person to person, from as little as twice a week to a couple of times a day, and is affected by diet, medications, and exercise.

If you are having trouble going to the washroom, the first thing a pharmacist will usually recommend is increasing the amount of fibre in the diet by eating whole grains, fruits and vegetables. In addition, drinking at least 8 glasses of water will minimize constipation.

If these suggestions do not work, there are several options available to you.

For  short-term treatment of constipation, ( if you haven’t been to the washroom in several days), a saline laxative such as Milk of Magnesia can be tried.  Alternatively glycerin suppositories work quite well.  If symptoms still do not resolve you could consider an enema with the advice of your physician.

Stimulant laxatives such as Dulcolax and Senokot can also be used to maintain regularity.  If you are on long term narcotic therapy you may need to take these types of medications as long as you are taking the narcotics.

For long-term treatment of constipation, bulk-forming agents such as Metamucil or Prodiem Plain can be used. These bulk-forming agents increase the stool weight, allowing the stool to pass through the body faster and cause more frequent bowel movements. These agents typically take about 12-72 hours to take effect and are usually safe to use for long periods of time. When taking bulk-forming agents, it is recommended to drink lots of fluid.

For young children there are a few options.  For immediate relief a pediatric glycerin suppository can be tried.  For chronic long term management PEG 3350 is often prescribed, or is available over-the-counter as LAX-A-Day.  You should consult your family doctor however if you want to try an oral medication for a child suffering from chronic constipation.

If you are not having trouble going to the washroom, but you find the stool to be too hard and painful to pass, the pharmacist may recommend a stool softener such as Colace (docusate sodium) that will soften the stool for increased comfort.

Before deciding on a therapy, talk to a pharmacist and they can help you decide on a treatment that is right for you.

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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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What is it?
Compounding is the art and science of preparing customized medications designed to suit every patients individual and unique needs.

How does compounding benefit me?
Compounding is beneficial to you because of the fact that the medication is designed entirely to suit your individual needs/ preferences in terms of taking drugs. Whether it be the fact that; you can’t swallow pills, that the drug you need does not come in the dose that you require, that the drug you need is no longer available from the manufacturer, or even the fact that you are allergic to certain dyes, preservatives, or ingredients found in commercially available medications. We can deal with all of these problems and many more by specially compounding your medication just for you.

Is compounding expensive?
In most cases compounding is no more expensive than commercially available products. The price of a compound will depend on the ingredients, the equipment required and the time the pharmacist spends researching and preparing the medication. Fortunately, as PCCA (Professional Compounding Centres of America) members, we have access to to pure-grad quality chemicals which dramatically lower costs and allow us to be competitive with commercially manufactured products.

Does my prescriber know about compounding?
Compounding is becoming increasingly popular within many practitioners’ practices. However, some doctors may not be aware of compounding due to aggressive marketing from drug manufacturers. If this is the case, discuss with your doctor why you would like a compounded medication or come and talk to us and we will be able to work with you and your doctor to come up with a compound that is suitable for your needs

What kinds of prescriptions can be compounded?
Almost any kind of prescription can be compounded into a unique formulation just for you! Some examples of what we can make include:  capsules  topical dosage forms (creams, ointments and lotions)  dental preparations  discontinued combinations  flavour specialization  lip balms  oral suspensions  pediatric formulations  preservative free formulations  rectal and vaginal suppositories  vaginal creams  veterinary formulations

Areas in which compounding is especially useful include:
Pediatrics,  veterinary medicine,  pain management, and  bio-identical hormone replacement therapy (BHRT)

Pediatrics:
Do you find yourself struggling to give your children their medications?? We can help!! Children are especially suited for custom compounded prescriptions for various reasons. First of all many children hate taking or just plain can’t take commercially available medications because they are either too hard to swallow, don’t taste very good or may even be made in too high of a dose for younger patients. If this is the case we can work with your child and your doctor to come up with a dosage form and flavour that your child will find much easier and more enjoyable to take. For example, many medications can be easily incorporated into an oral suspension and flavoured according to your childs’ taste preferences. Although we may not be able to make taking medications fun we Will be able to make taking medications much less stressful and a lot more tasty!

Pain management:
Are you suffering from arthritis, sports injuries or neuropathic pain? We can help!! Certain arthritis/ pain medications can cause unwanted side effects, such as GI irritation, when taken on a regular basis. Why not minimize/prevent these side effects by applying a compounded topical gel directly to the affected area? Has nothing worked for the neuropathic pain you are experiencing? Get us to combine several different effective neuropathic pain medications that act on different pathways into one compound to prevent all pain at once. Ask our pharmacists to see what we can do for your pain.

Veterinary Compounding:
Does your dog/ cat hate taking pills from the vet? Can your dog/ cat somehow manage to eat all of the peanut butter and cheese surrounding a pill yet still not take the pill itself? We can help!! Veterinary medicine can benefit substantially from compounding. Drugs for your animal can be compounded into several dosage forms that are appropriate for your pets condition and taste preferences. We realize that all animals have different taste preferences and we can work with you to figure out which flavour is best suited for your pet. For example, dogs normally prefer liver or chicken flavour, while cats would rather have fish flavoured medication. We can make compounds for picky animals of all shapes and sizes. From dogs, cats and horses to more exotic animals such as monkeys and parrots. You name the animal and condition and we can help you out as best as we can!

BHRT (bio-identical hormone replacement therapy):
Are you interested in BHRT? Talk to one of our pharmacists to see if it is right for you. We can work with you and your doctor to get you on a dose of hormones that is suited specifically to your symptoms and condition.