Drugs Log

Remember . . .

• When putting drops into your eyes, follow doctor’s orders.
• Be sure your doctor knows about any other drugs you may be taking (including over-the-counter items like vitamins and aspirin) and about any allergies you may have.
• Wash your hands before putting eye drops into your eyes.
• Be careful NOT to touch the tip of the dropper to any part of your eye.
• Make sure the dropper stays clean.
• If you are putting in more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second before it has had time to work.
• Store the eye drops and all medicines out of reach of children.

Steps for Putting in Eye Drops

1. Start by tilting your head backward while sitting, standing, or lying down. With your index finger placed on the soft spot just below the lower lid, gently pull down to form a pocket.
2. Let a drop fall into the pocket
3. Slowly let go of the lower lid. Blinking a few times is all right, but try not to shut your eyes tight or squint. This may push the drops out of your eye.
4. Gently press on the inside corner of your closed eyes with your index finger and thumb for two to three minutes. This will help keep any drops from getting into your system and keep them in your eye, where they are needed.
5. Blot around your eyes to remove any excess.

If you are still having trouble putting eye drops in, here are some additional tips that may help.

If your hands are shaking:

• Try approaching your eye from the side so you can rest your hand on your face to help steady your hand.
• If shaky hands are still a problem, you might try using a 1- or 2-pound wrist weight (you can get these at any sporting goods store). The extra weight around the wrist of the hand you are using can decrease mild shaking.

If you are having trouble getting the drop into your eye:

• It may be easier to tell if the drop has gone into your eye if you keep your drops in the refrigerator. Your eye will feel the liquid when it is cold better than if it is at room temperature.
• If you are still not sure the drop actually got in your eye, put in another drop. The eyelids can hold only about one drop, so any excess will just run out of the eye. It is better to have excess run out than to not have enough medication in your eye.
• If pulling the lower lid out to create a pocket is not working, try this. With your head turned to the side or lying on your side, close your eyes. Place a drop in the inner corner of your eyelid (the side closest to the bridge of your nose). By opening your eyes slowly, the drop should fall right into your eye.

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Many medications, both prescription and over-the-counter, can negatively interact with foods, supplements or other drugs.

Here are guidelines to help prevent food-drug interactions, courtesy of the American Academy of Family Physicians:

• Check prescription and over-the-counter drug labels to see if they contain any warnings.
• Follow directions on all medications carefully.
• Unless you get your doctor’s OK, never break up pills and mix them with food, and never empty capsules into food.
• Take medications with a whole glass of water, unless your doctor has given you other instructions. Never take medications with alcohol.
• Don’t take your medications at the same time as you take vitamins or dietary supplements.
• Don’t mix medications in a hot drink, as the heat may affect the medication.

Taking drugs with food may take a bite out of costs

Taking an expensive breast cancer drug on a full stomach – as opposed to an empty one as prescribed – could save a patient or their health authority $1700 (?835) a month or more, according to an analysis of data from clinical trials.

The approach, which might also work for other drugs, is based on the fact that certain foods can delay the breakdown of medications in the body. Doctors stress, however, that people should not yet attempt this cost-cutting method until studies demonstrate its safety.

In general, taking pills with food against the label’s advice can lead to an overdose. For example, drinking grapefruit juice can interfere with the body’s ability to handle cholesterol-lowering statin drugs.

For this reason, pharmaceutical companies must provide the US Food and Drug Administration (FDA) with information on how eating a meal can influence the absorption of their products.

This was the case when GlaxoSmithKline sought approval for its anticancer drug lapatinib (known as Tykerb in the US and Tycerb in Europe).

Higher blood levels

Pharmaceutical companies generally tell patients in early drug trials to take the medication on an empty stomach, as this helps reduce the variables between patients.

In this instance, when researchers later conducted the food-interaction experiments involving lapatinib, they found that taking it at mealtime raised blood levels of the drug far above those shown as safe in previous trials. This meant that the drug label would have to advise patients to take the pill on an empty stomach.

The FDA approved lapatinib in March 2007 to treat breast cancers that have not responded to other medications. Specifically, the drug fights breast cancers that contain an excess of a protein called “human epidermal growth factor receptor 2″ (HER2), and have spread through the body.

This subtype of breast cancer claims the lives about 8000 to 10,000 US women each year, according to the American Cancer Society. But this help does not come cheap. Lapatinib costs a patient roughly $2900 a month, a large sum, particularly for those who lack health insurance.

Ezra Cohen and Mark Ratain at the University of Chicago, Illinois, US wondered if taking advantage of changes in lapatinib absorption after eating could reduce this cost.

Based on clinical trial data submitted to the FDA, they calculated that taking the medication with a low-fat meal or high-fat meal could increase the amount of lapatinib circulating in the blood by 1.7 and 3.3 times, respectively. Adding grapefruit juice to the mix would reduce costs further still.

“We expect that one 250 milligram lapatinib pill accompanied by food and washed down with a glass of grapefruit juice may yield plasma concentrations comparable to five 250 milligram pills on an empty stomach,” Ratain says.

People who pop a pill with a meal, but no grapefruit juice, are calculated to get the equivalent effect of three pills, and would save around $1700 a month.

Experiment warning

“It’s kind of akin to pill splitting,” says Steven Pearson, of Harvard Medical School in Boston, Massachusetts US. But he thinks the approach is unlikely to be the first choice strategy for making medicines more affordable. Pearson is working to develop a review board that would examine ways to improve cost-effectiveness of drugs in the US.

Pearson says that more sweeping changes – such as providing universal health insurance and reaching a consensus on how much patients should have to pay for meds in the first place – should take top priority.

Pharmaceutical companies argue that high drug prices result from the huge investment required in research and development. But patient advocacy groups have countered that much of the extra money goes into the pockets of shareholders, rather than into such research. They say that there is lots of room for price cutting.

While this debate continues, Cohen urges people not to experiment with taking lapatinib with meals until more research demonstrates the safety of doing so. “This is not something that we suggest people try at home. This is something that should be studied,” says Cohen, adding that an overdose of lapatinib could perhaps cause a heart attack.

He says that these types of trials will only happen if the public demands them: “In part it has to come from patient advocacy groups who say this needs to be studied.”

Cohen adds that he and his colleagues are looking at whether taking other medications, such as the immune suppressant rapamycin, with food could possibly lower drug costs.

Taking High Blood Pressure Pills at Night May Be Better for Some

Taking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don’t know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn’t dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they’re at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It’s the latest research in the field of chronotherapy: How our bodies’ internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore’s Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

“I think it’s huge,” says Hopkins’ Dr. Lawrence Appel. “This is our best lead” into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph’s Hospital in Atlanta.

“It does make good sense to take some in the morning and some in the evening,” says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older “statin” pills fight cholesterol best if taken at bedtime; they target a liver enzyme that’s most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients’ dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That’s also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

“We know now that you can change medication timing and lower blood pressure at night,” he explains.

That doesn’t mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. “That’s the million-dollar question,” Rahman cautions.

Still, Lundberg says it’s worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn’t hurt.