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Boggio Family of Pharmacies

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An ostomy can have profound effects on an individuals daily activities, diet and even medication regimen. An individual dealing with an ostomy (an ostomate) must be very careful with their use of over the counter and prescription medications in order to ensure effectiveness of that medication as well as to prevent complications/ side effects.

There are three main types of ostomies:

•ileostomy – a portion of the small intestine is rerouted/ removed
•colostomy – a portion of the large intestine/ colon is removed or rerouted
•urostomy – a portion of the urinary tract is removed or rerouted

Generally, individuals with an ileostomy must be much more cautious when it comes to their medications compared to individuals with a colostomy or urostomy. As a result this article will focus mainly on medications and how they affect and are affected by an ileostomy.

In an ileostomy an ostomate has had a portion of their small intestine removed or rerouted. The small intestine is responsible for the greatest absorption of nutrients and medications. You can imagine that by removing this important organ it will have a huge effect on the absorption and therefore effectiveness of certain medications. In particular many coated or delayed/ controlled release drugs may pass through the shortened small intestine without actually being absorbed. Individuals with an ileostomy may notice that these controlled release drugs will actually pass through their digestive system and appear unchanged in their ostomy pouch.

In order for a medication to be absorbed it must first be broken down into a liquid/ gel form. If this does not happen before passing out of the body it will not be absorbed and will not produce its desired effects on the body. There are certain instances where this process can be sped up in an ostomate by crushing the medication and preparing it in a liquid suspension. This compounded suspension is ready for absorption immediately once it hits the digestive tract improving the likelihood that the medication will be absorbed and do its job. However, it is extremely important that you do not crush, split or alter any medication without first checking with your pharmacist or doctor. There 3 reasons why certain medications must not be crushed or split:

•Certain medications come in higher doses that are intended to be released very slowly over a long period. If these medications are crushed that large dose is released all at once resulting in potential toxicity/ overdose.
•Other medications have a coating on them that help prevent the medication from irritating the stomach. When this coating is removed the medication inside comes into contact with the stomach lining causing unnecessary irritation and stomach upset.
•Lastly, Some medications have a coating that protect the medication from being destroyed by the stomach acid. If this coating is broken the medication will be easily broken down in the stomach and will not work.

Laxatives and other medications that can cause diarrhea are usually avoided in individuals with an ostomy unless otherwise directed by your physician. Laxatives can speed the rate at which the medication is cleared from the digestive system, therefore reducing its absorption. Laxatives may also cause fluctuations in an ostomates vital fluids and electrolytes.

In general immediate release formulations of medications such as suspensions, liquids, gel capsules and uncoated tablets are the best route of administration for any ostomate. As a general rule of thumb, if a tablet is placed into a glass of water and begins to dissolve within 30mins there is a good chance that this medication will be absorbed and produce its desired effects even in an individual with an ileostomy.

If you or a loved one is living with an ostomy always make sure that your physician and pharmacist are aware. If they are aware of your situation they will be able to select a better medication regimen specifically for you. Talk to a Boggio Family of Pharmacies pharmacist today to make sure your medications are safe and effective for your unique situation.

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Warts are a common viral skin infection caused by human papilloma viruses.  In general warts on the hands and feet are harmless and most resolve on their own.  However, they can cause embarrassment and some discomfort.  There are a couple of over-the-counter (OTC) remedies that work well to treat these kinds of warts.

Infection with HPV occurs with skin-to-skin contact.  Warts are caused by viruses and are passed from person to person.  A common way of contracting the virus is by walking barefoot in public pools, showers etc.

About 30% of warts clear spontaneously in six months and 65% to 78% clear in two years without any treatment.  However, most people would like to resolve warts more quickly than this.  Salicylic acid is a first line OTC option.  This medicine slowly destroys virus-infected skin and may stimulate the immune response of the person infected through mild irritation, which in turn helps clear the infection.  There are a number of salicylic products available.  They range in concentration from 17% to 40%.  A 40% product should be used for plantar warts.  The use of salicylic acid on facial warts is not recommended because of a potential risk of hypo- and hyperpigmentation (skin discolouration).

There is a bit of a regimen to follow with salicylic acid products.  Before treatment the warts should be soaked in warm water for five minutes.  Then, an emery board or pumice stone should be used to remove dead tissue.  The salicylic acid treatment should then be applied.  Treatment may need to be continued for up to 12 weeks. If the wart causes pain, patients can take acetaminophen or ibuprofen for the discomfort. Examples of OTC salicylic acid wart removal products include Compound W, Dr. Scholl’s Clear away Plantar, and Duofilm Wart Remover.

Cryotherapy (freezing) is another common wart removal treatment. This causes irritation and tissue destruction so that the individual mounts an immune response against the virus.  Doctors typically use liquid nitrogen which freezes tissues to -196ºC.  There are also home cryotherapy systems available.  These contain dimethyl ether and propane (DMEP).  Examples include Dr. Scholl’s Freeze away wart Remover, Or, Compound W Freeze off.  Evidence shows DMEP and liquid nitrogen are fairly similar in efficacy.  After application of cryotherapy a blister is formed under the wart.  The frozen skin and wart falls off after about ten days and reveals newly formed skin underneath.   It is recommended that OTC cryotherapy only be repeated three times usually in ten day intervals.

The use of duct tape as a wart treatment has gained popularity.  By putting duct tape over the wart they think the virus is deprived of oxygen which causes irritation and stimulates the immune response to the virus.  Typical administration involves applying silver duct tape over the wart and removing a week later.  Scrubbing the area with an emery board and leaving it open over night.  Then reapplying duct tape.  Silver duct tape has been shown to be more effective than clear duct tape, possibly because of the adhesive.

There are also a number of prescription products that can be used for warts if OTC treatments are ineffective.  Patients with diabetes should consult their physicians before beginning treatment for their warts.  Also, genital warts must be treated by physicians and are not suitable for treatment with OTC methods.

In general OTC wart treatments are effective, however, it may take several weeks for the wart to be removed.  For proper selection of a treatment method come in and speak to your pharmacist.

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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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Boggio’s Family of Pharmacies has locations in Port Colborne, Ridgeway, Niagara Falls and Fonthill. Committed to serving the health needs of the community with in the Niagara Region. Much more then a drug store, we offer home delivery, photo finishing, home health care, beauty and make up, lottery, giftware and postal service at some locations. We also offer specialty services such as Compounding and prescription refills are available online and in store. We carry the Rexall brand and are an IDA drug store.

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