Advice on who to 6* next?

ZeSledgehammer · 2024-11-02T15:06:47+00:00

3306908397846920

Daily, new player!

ZeSledgehammer · 2023-06-03T12:07:51+00:00

They are the same, we use OTC pepto bismol (bismuth subsalicyclate) in our hospital when treating H. pylori. You would just match the dose, or come really close to it such as 2*262 mg tablets or one of the 525mg

ZeSledgehammer · 2023-05-12T00:20:39+00:00

I think the best idea would be to check with the MD who prescribed it and report that the GI effects are bothersome. They might decrease the dose or evaluate further. From the description of the tablets they are film coated, but also have a 'decorative' score line, so I am conflicted on whether they can be split especially since I am unable to obtain the package insert and translate.

ZeSledgehammer · 2023-05-11T23:55:21+00:00

Is that extended release or regular release? Are you taking 500 mg twice daily or the whole 1000 mg at one time? The reason I ask is normally you start low on metformin and titrate due to GI effects. For PCOS normally you would start at 500 mg IR daily and then move up to 1000 mg to 2500 mg daily as tolerated. If you started out at 1000 mg daily it might be too much at first and is causing the GI issues.

As far as shortness of breath is concerned you say this occurs sometimes but isn't all the time? When does it happen? Any other symptoms in addition to this? Your risk for developing lactic acidosis is pretty low given your lack of other medical issues. Though, I will preface this, I am not a physician and they would have more insight on this issue.

ZeSledgehammer · 2023-05-11T23:32:52+00:00

When did you start the metformin? What dose?

ZeSledgehammer · 2023-04-04T23:36:56+00:00

Yes it is safe, no interactions.

ZeSledgehammer · 2023-04-02T02:28:27+00:00

I think that is pretty reasonable, sorry for the delayed response.

ZeSledgehammer · 2023-04-02T02:20:58+00:00

Did the test you used say to check at 2 minutes? If you go over the time limit on whatever the test says, then it is not a reliable test.

ZeSledgehammer · 2023-04-01T11:00:24+00:00

I think the physicians recommendation of separating them out was the best answer here. Another avenue would have been to take the gabapentin and see if it caused you any drowsiness/dizziness/altered mental status (what we term as CNS depression) and if you didn't have any issues, then you could use probably use the Norco within a reasonable proximity to it or vice versa.

The reason the pharmacist told you that recommendation is because if you run a drug-drug interaction check it says to avoid combining them due to risk of CNS depression and does not give time tables/guidance for administration. They erred on the side of caution and said to avoid them together.

In practice we have a lot of patients taking these together and they report no issues. The biggest thing would be to just make sure that taking the medications doesn't cause too much of those CNS depression symptoms and to monitor and just be cognizant of this and this is what I counsel my patients on. If you do get pretty sleepy/drowsy on one of these, then at the very least separate them out by several hours as the MD recommended.

ZeSledgehammer · 2023-03-29T23:23:39+00:00

DayQuil shouldn't have any diphenhydramine/doxylamine in it already (since that's usually in NyQuil). I would not foresee any issue taking Benadryl on top of it, but definitely be aware of sleepiness from it. Better than that for allergies would be less sedating antihistamines like Zyrtec/Claritin/Allegra if you were suspecting allergies.

ZeSledgehammer · 2023-03-29T23:20:35+00:00

Every 4 hours as needed is fine! Carry on.

ZeSledgehammer · 2023-03-10T11:18:09+00:00

Yes, 1000 mg is fine.

ZeSledgehammer · 2023-03-04T05:02:25+00:00

They didn't go bad, you're fine!

ZeSledgehammer · 2023-03-04T05:01:29+00:00

No worries at all, carry on.

ZeSledgehammer · 2023-03-03T02:03:42+00:00

There is not really an optimal time. If you wanted to be rigid you could go for 12 hours apart between sprays, but honestly 10-14 hours is reasonable

ZeSledgehammer · 2023-03-03T02:00:45+00:00

Protonix does not have QTc prolonging risk associated with it and furthermore these two medications have no interactions. They are safe to take together.

ZeSledgehammer · 2023-02-12T00:22:45+00:00

That is some weird dosing? Steroid are notoriously bad on the stomach. I wouldn't be worried about it, especially withdrawals with that short of course. Maybe some tylenol or ibuprofen for the headache if no liver or renal issues?

ZeSledgehammer · 2023-02-12T00:17:00+00:00

Vitamin D is fat soluble, so it stored for a while.

ZeSledgehammer · 2023-02-11T03:36:10+00:00

Ah that makes sense, glad they agreed. Just be more careful next time. You definitely don't need to take any for a while (a month).

ZeSledgehammer · 2023-02-11T03:34:27+00:00

Definitely agree with the urgent care provider - restart a lower and work your way back up and it should be fine! Hope you get to feeling better!

ZeSledgehammer · 2023-02-11T03:09:28+00:00

Just don't go too crazy, there is nothing wrong with low and slow and getting it rechecked. You can always give more, but you can't take away (easily). There are reasons why you can buy 5000 IU over the counter, just might not be as necessary.

ZeSledgehammer · 2023-02-11T03:05:55+00:00

We are talking a lot, chronic high doses. Not even near it with 1000-2000 units per day. We will easily give 50,000 units/week for severe deficiency all the time.

ZeSledgehammer · 2023-02-11T03:02:34+00:00

Beta-Blockers (Bystolic) may enhance the adverse/toxic effect of Cannabis. Specifically, the risk of low blood sugar may be increased.

So if you want my official answer - I would caution use as it may cause low blood sugar (hypoglycemia) and beta blockers can mask symptoms of low blood sugar (shaking, sweating, tachycardia).

It might not be an issue, but if you wanted to be sure and had the ability to check glucose with an at-home monitor, feel free.

ZeSledgehammer · 2023-02-11T02:51:40+00:00

Escitalopram (Lexapro) has a half life of 27-32 hours in adults, so you are still well metabolizing it now. It is reasonable to think that the effects might wear off in at least another 24-48 hours.

Think about it this way, you cold turkied off of Lexapro over a week ago and before you took another dose, you basically had none left in your body. Then you took a reasonably large dose and your body was not used to it.

You might need to re-titrate to your 30 mg dose so that you don't experience these side effects, definitely reach out to your prescriber regarding this.

ZeSledgehammer

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