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Category Archives: Sleep Problems

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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One of the most common complaints from patients involves lack of sleep.  Some patients complain about not being able to fall asleep, for others it is early wakening.  The problem is definitely more prevalent in the elderly.  As people age, their bodies simply require less sleep.  First steps for most patients is to try some nondrug therapy and preventive measures.

Patients should first try to resolve other conditions that may be interfering with their sleep.  Restless legs, pain, COPD and depression, can all play a role in limiting sleep.  Talk to your doctor if one of these issues is causing sleeplessness.  Certain drugs can also cause insomnia such as antidepressants, decongestants and steroids.  If you are on one of these types of medications try taking it as early in the day as possible.

Good sleep hygiene is also indicated.  This means forming good sleep habits.  Use your bedroom only for sleep.  Participate in a calming activity before bed such as reading or taking a bath.  Limit the amount of T.V. you watch before bed.  If you lie awake in bed for more than a half hour get up and try a different activity until you feel sleepy.  Limit your caffeine intake and try to get in some moderate exercise every day.  Some people suggest always getting up at the same time every day (no sleeping in).

If these measures fail there are some medications that can help.  The benefits of sleep medications are modest and they can cause mental impairment and falls.  They should be taken with caution.

A good first choice is a medication called Imovane or zopiclone.  This medication does not cause as much dependency, rebound insomnia, or hangover.  Trazadone is probably the next best choice for insomnia.  The main benefit of this medication is that it seems to be non habit forming.

Another option that is often used is a group of medications called benzodiazepines.  An example would be Ativan, or oxazepam.  Unfortunately these drugs often cause falls, dependency, and cognitive impairment.

Remeron is a sedating antidepressant that is commonly used for chronic insomnia.  Doctors are also using antipsychotics like Seroquel as an off label use for insomnia. There is still a need for more studies into the safety and efficacy of this drug for this indication.

Some natural medicines can also be tried for insomnia.  Melatonin levels decrease with age and some people use this supplement to help fall asleep faster.  Other natural remedies include valerian and St. John’s wort.  It is probably best to speak to your doctor or pharmacist about the safety of these medications, dosing, and drug interactions.

One of the keys to dealing with sleeplessness is to not let it cause uncontrolled anxiety.  If it is a persistent problem for you, speak to your doctor or pharmacist about the best method for you to treat the problem.