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These studies are also limited by using whole cannabis, which contains many cannabinoids, most of which are poorly understood. Placebo trials can be a challenge because the euphoria associated with cannabis makes it easy to identify, especially at high THC doses. People know when they are high. Another type of bias, called expectancy bias, is a particular issue with cannabis research. This is the idea that we tend to experience what we expect, based on our previous knowledge.
For example, people report feeling more alert after drinking what they are told is regular coffee, even if it is actually decaffeinated. Similarly, research participants may report pain relief after ingesting cannabis, because they believe that cannabis relieves pain. The best way to overcome expectancy effects is with a balanced placebo design, in which participants are told that they are taking a placebo or varying cannabis dose, regardless of what they actually receive.
Studies should also include objective, biological measures, such as blood levels of THC or CBD, or physiological and sensory measures routinely used in other areas of biomedical research.
At the moment, few do this, prioritizing self-reported measures instead. Abuse potential is a concern with any drug that affects the brain, and cannabinoids are no exception. Cannabis is somewhat similar to tobacco, in that some people have great difficulty quitting.
And like tobacco, cannabis is a natural product that has been selectively bred to have strong effects on the brain and is not without risk. Although many cannabis users are able to stop using the drug without problem, percent of users have difficulty quitting. Repeated use, despite the desire to decrease or stop using, is known as cannabis use disorder.
As more states more states pass medical cannabis or recreational cannabis laws, the number of people with some degree of cannabis use disorder is also likely to increase. It is too soon to say for certain that the potential benefits of cannabis outweigh the risks.
But with restrictions to cannabis and cannabidiol loosening at the state level, research is badly needed to get the facts in order. The growing use and legalization of cannabis are leading to increased exposures across all age groups, including in adolescence. However, it is critical that societal passions not obscure objective assessments of any potential and realized short- and long-term adverse effects of cannabis, particularly with respect to age of onset and chronicity of exposure. This critical review focuses on evidence-based research designed to assess both therapeutic benefits and harmful effects of cannabis exposure, and is combined with an illustration of the neuropathological findings in a fatal case of cannabis-induced psychosis.
The literature and reported case provide strong evidence that chronic cannabis abuse causes cognitive impairment and damages the brain, particularly white matter, where cannabinoid 1 receptors abound. Contrary to popular perception, there is little objective data supporting preferential use of cannabis over conventional therapy for restoration of central nervous system structure and function in disease states such as multiple sclerosis, epilepsy, or schizophrenia.
Additional research is needed to determine if sub-sets of individuals with various neurological and psychiatric diseases derive therapeutic benefits from cannabis. Making physicians the gatekeepers of legal marijuana is not fair to doctors and is not conducive to public health.
The problem is that marijuana has been prescribed by the courts, not by health-care professionals. They included impairments in attention, increased anxieties, psychosis and cancer. Physicians are facing a deluge of requests to prescribe cannabis, and guidelines will give them the support they need to refuse to prescribe cannabis when medically unnecessary or unsafe. Because Health Canada allows marijuana to be prescribed by physicians, that enhances the public perception that marijuana is not only harmless, but therapeutic.
It uses solid evidence and rigorous scientific research, and it has saved lives. Marijuana should undergo the same scrutiny as to its potential benefits and harms. But medical marijuana is not treated the same as other drugs.
Science has little to do with it. If marijuana can relieve the agony of someone with severe chronic pain or terminal cancer, who would withhold it? It should be handled the same, with regulations as to its production and distribution.
We should not clog our courts and jails with pot-smokers. Authoritative organisations which do not support smoked pot or edibles as a legitimate form of medication, listed by: American Medical Association ,. American Cancer Society ,. National Multiple Sclerosis Society,. American Academy of Pediatrics,. American Academy of Ophthalmology ,.
American Society of Addiction Medicine ,. Marcel O Bonn-Miller Marcel. For all author emails, please log on. The electronic version of this article is the complete one and can be found online at: The present investigation aimed to provide an objective narrative review of the existing literature pertaining to the benefits and harms of marijuana use for the treatment of the most common medical and psychological conditions for which it has been allowed at the state level.
Common medical conditions for which marijuana is allowed i. Post-traumatic stress disorder was also included in the review, as it is the sole psychological disorder for which medical marijuana has been allowed. Findings indicate that, for the majority of these conditions, there is insufficient evidence to support the recommendation of medical marijuana at this time. A significant amount of rigorous research is needed to definitively ascertain the potential implications of marijuana for these conditions.
It is important for such work to not only examine the effects of smoked marijuana preparations, but also to compare its safety, tolerability, and efficacy in relation to existing pharmacological treatments. National estimates suggest that 5.
This represents an increase of approximately Similar increases have also been noted among vulnerable populations in the U. Marijuana is currently illegal in every country in the world.
In , Uruguay voted to legalize state-controlled marijuana sales but implementation of the law has been postponed until The policy in the Netherlands is mixed, with permissible retail sale of marijuana at coffee shops, but restrictions on production and possession.
Like the Netherlands, the United States currently has a mixed drug policy; marijuana is an illegal Schedule I drug under U. However, marijuana policies vary by state, with some states e. Furthermore, as of this review, 23 states and the District of Columbia have passed legislation allowing medical marijuana i.
Though some recent work has reviewed the adverse effects of marijuana [ 4 ] or the efficacy of marijuana for certain conditions e. The list of all conditions for which medical marijuana is allowed, according to the legislation of each U.
From this list, common conditions for which medical marijuana is allowed i. Though not presently a qualifying condition in at least 80 percent of states with medical marijuana laws, PTSD was also included in the review, as it is rapidly gaining attention and recognition as the sole psychological disorder for which medical marijuana is allowed.
Studies for this narrative review were included based on a literature search in the following databases: Within each database, each combination of the following key marijuana terms and the above-listed conditions were used to conduct a search: References within each obtained article were also examined to assure that no studies were overlooked. Only published, English-language studies were included in this review. Though the primary focus of this review is on studies of marijuana plant effects, as these are most relevant to recent medical marijuana legislation, synthetic or plant-derived cannabinoids e.
Indeed, for purposes of the review, references to oral administrations of marijuana constitute a pharmaceutical grade extraction administered in tablet or liquid form e. Finally, the present review is organized alphabetically by condition for which marijuana is allowed, rather than in order of disorder for which it is most to least commonly recommended, or strength of the evidence. We chose this approach as there is currently only state-level data [ 7 ]-[ 9 ], rather than national, representative data on the primary conditions for which medical marijuana is used or recommended, and the existing literature and state of the evidence for many conditions remains relatively poor.
AD, the leading form of dementia in the elderly, is a progressive, age-related disorder characterized by cognitive and memory deterioration [ 10 ]. AD has several neuropathological markers, including neuritic plaques and neurofibrillary tangles [ 11 ].
Although several researchers have suggested dronabinol and Nabilone may act on these mechanisms to confer therapeutic effects for patients with AD [ 12 ],[ 13 ], a recent Cochrane systematic review found no evidence that dronabinol was effective in reducing symptoms of dementia [ 14 ].
The authors of a placebo-controlled crossover study of 15 patients with AD who were refusing to eat suggest that dronabinol increases weight gain and decreases disturbed behavior [ 15 ], but there is insufficient quantitative data to support this conclusion [ 14 ], and one study participant had a grand mal seizure following dronabinol administration [ 15 ]. Another pilot study of two patients with dementia found that dronabinol reduced nocturnal motor activity [ 16 ].
No studies have examined the effects of smoked marijuana in patients with AD. In sum, there is insufficient evidence to recommend marijuana for the treatment of AD. Future directions should include conducting randomized controlled trials RCTs comparing both smoked and oral marijuana to placebo and existing treatments, with sample sizes large enough to detect treatment effects and the safety and tolerability of marijuana.
ALS is a fatal neurological disease with symptoms that include weakness, spasticity, and respiratory difficulties. Cannabinoids are hypothesized to act in the regions of established pathophysiology for ALS [ 17 ] and could be used for symptom management e. Although there is limited evidence from a survey of patients with ALS that marijuana consumed in a variety of forms i.
These survey findings indicate that up to 10 percent of patients use marijuana for symptom management, and these self-reports suggest efficacy in increasing appetite and mood and decreasing pain, spasticity, and drooling.
However, as is consistent with the half-life of smoked marijuana, the beneficial effects of marijuana on symptoms of ALS were fewer than 3 hours in duration [ 19 ].
There is currently insufficient clinical evidence in humans with ALS to recommend cannabinoids as primary or adjunctive therapy. In patients with HIV or cancer, smoked marijuana and dronabinol have been shown to increase weight gain [ 21 ],[ 22 ] and food intake [ 22 ],[ 23 ] compared to placebo. In a within-subject, double-blind, staggered, double-dummy study of nine individuals with muscle mass loss, dronabinol resulted in significantly greater calorie consumption than smoked marijuana [ 24 ].
A within-subject, double-blind, placebo-controlled trial with seven HIV-positive marijuana smokers taking antiretroviral medications found that compared to placebo, dronabinol increased caloric intake [ 25 ].
Additional studies indicate that dronabinol administration increases appetite, decreases nausea, and protects against weight loss [ 26 ], with effects on appetite and weight stability enduring in long-term follow-up [ 27 ]. Both dronabinol and smoked marijuana increase the number of eating occasions [ 22 ],[ 25 ], and smoked marijuana may also affect weight gain and calorie intake by modulating appetite hormones [ 28 ].
These studies demonstrate that marijuana has positive effects on cachexia resulting from a medical condition, but are largely limited by small sample sizes. Cancer is a qualifying medical condition in every state that has approved marijuana for medical use [ 30 ]. The majority of clinical research examining the relation between THC and cancer has evaluated the effect of smoked THC on the risk for cancer, or the palliative effects of THC on chemotherapy-related nausea and emesis, chronic pain, and wasting reviewed in respective sections ; few studies have studied the effect of marijuana in any form on the treatment of primary cancer pathology.
In vitro and in vivo research suggests that cannabinoids inhibit tumor growth [ 30 ] via several proposed mechanisms e. The only clinical trial of THC on cancer examined intracranial administration of THC to nine patients with recurrent glioblastoma multiforme who had failed surgical- and radiotherapy, and results indicated that THC decreased tumor growth, while being well-tolerated with few psychotropic effects [ 33 ]. This study is limited by lack of generalizability, and clinical trials with larger representative samples that examine oral or smoked administration of THC are essential to elucidate the effects on cancer pathology.
There is currently insufficient evidence to recommend marijuana for the treatment of cancer, but there may be secondary treatment effects on appetite and pain. CD is an inflammatory bowel disease IBD that has no cure; treatment targets include reducing inflammation and secondary symptoms. Between 16 percent and 50 percent of patients use marijuana to relieve symptoms of IBD [ 34 ]-[ 36 ], and patients using marijuana for 6 months or longer are five times more likely to have had surgery for their IBD [ 34 ]; whether marijuana exacerbates disease progression or more severe disease results in self-medication is unclear.
Only one placebo-controlled study of the effects of marijuana in patients with CD has been conducted[ 37 ]. This study found that there was no difference between placebo and smoked marijuana on CD remission defined as a CD Activity Index CDAI of less than , and that marijuana was superior to placebo in promoting clinical response a decrease in CDAI score greater than , reducing steroid use, and improving sleep and appetite [ 37 ].
Importantly, this study did not include objective measurement of inflammatory activity, and there was no significant difference in placebo and treatment groups 2 weeks after treatment cessation [ 37 ]. Until clinical trials with objective measurement of treatment effects over an extended period of time are conducted to examine the safety and efficacy of marijuana for the treatment of IBD, there is insufficient evidence for the use of marijuana for the treatment of IBD.
The known effects of cannabinoids on epilepsy and seizures are largely from animal studies, surveys, and case studies. Several animal studies indicate that marijuana and its constituents exhibit anticonvulsant effects [ 38 ]-[ 41 ] and reduce seizure-related mortality [ 39 ], but there is also evidence that cannabinoids can lower the threshold for seizures [ 42 ], and THC withdrawal increases susceptibility for convulsions [ 42 ].
Cross-sectional surveys indicate that 16—21 percent of patients with epilepsy smoke marijuana [ 43 ],[ 44 ], with some reporting positive effects e. Based on a Cochrane review, the few RCTs that have been conducted in humans include a total of 48 participants [ 45 ] and only examine treatment with cannabidiol. These trials exhibited heterogeneity of effects: In addition, none of the studies examined response at greater than 6-month follow-up [ 45 ].
Systematic reviews of the literature have concluded that there is insufficient clinical data to support or refute the use of cannabinoids for the treatment of epilepsy and seizures [ 5 ],[ 45 ]. Glaucoma is a neurodegenerative eye disease that can cause blindness by damaging retinal ganglion cells and axons of the optic nerve. Intraocular pressure IOP can influence both onset and progression of glaucoma and is often a target for intervention.
Small samples have demonstrated reduced IOP following smoked marijuana [ 49 ],[ 50 ], but the effect is only present in 60—65 percent of individuals [ 51 ] and lasts for 3—4 hours, requiring repeated dosing throughout the day [ 52 ].
Furthermore, patients discontinue marijuana use due to side effects e. Development of eye drops for topical application of THC would minimize psychoactive and other side effects but is complicated by the high lipophilicity and low water solubility of cannabinoids [ 52 ],[ 56 ].
Additionally, the distance from the application site to the retina may be too great to afford neuroprotective benefits [ 52 ], given that only 5 percent of an applied dose penetrates the cornea to the intraocular space [ 56 ].
Of the studies that have been conducted, one longitudinal study demonstrates that smoked marijuana has no effect on HCV progression in individuals with HIV [ 57 ]. In contrast, individuals with HCV who smoke marijuana have a higher fibrosis progression rate [ 58 ] and more severe steatosis [ 59 ], with daily smokers having a more rapid rate of progression and greater severity [ 60 ] than occasional marijuana users [ 58 ],[ 59 ].
Marijuana may have independent negative effects on steatosis [ 59 ], but because none of these findings were in the context of a clinical trial, these correlations are not causal and it is possible that individuals who use marijuana do so to manage greater symptom severity [ 60 ].
There may be secondary effects of cannabinoids on HCV treatment side effects: However, there is also a potential drug-drug interaction between ribavirin, a traditional HCV treatment, and marijuana due to shared cytochrome metabolism [ 63 ].
Because 90 percent of HCV infections are the result of injection drug use [ 64 ], treatment of symptoms with marijuana may be contraindicated for this subpopulation, particularly because marijuana use in the context of other substance use i. Given that newer treatments for HCV e. In sum, there is currently insufficient empirical support to recommend marijuana for the treatment of HCV. Marijuana use in HIV-infected patients is typically for the management of side effects e. Studies examining the effects of marijuana on the pharmacokinetics of antiretroviral medication demonstrated that neither smoked marijuana nor dronabinol affects short-term clinical outcomes e.
However, individuals who are dependent on marijuana have demonstrated poorer medication adherence and greater HIV symptoms and side effects than nonusers and nondependent users [ 69 ]. Furthermore, while some studies have no participant withdrawal due to adverse events [ 21 ],[ 70 ],[ 71 ], others reported treatment-limiting adverse events [ 26 ],[ 72 ],[ 73 ].
Finally, because drug use is a risk factor for HIV infection [ 74 ], treatment of symptoms with marijuana may be contraindicated for this subpopulation. Multiple sclerosis and muscle spasticity. Muscle spasticity, a common feature of MS, is disordered sensorimotor control that leads to involuntary muscle activation [ 75 ] that results in pain, sleep disturbance, and increased morbidity[ 76 ]. The majority of studies examining spasticity have compared oral or sublingual forms of cannabinoids to placebo and found reduced spasm severity [ 77 ]-[ 84 ], with symptom improvement enduring at long-term follow-up [ 85 ]-[ 87 ], and also reduced spasm frequency and spasm-related pain and sleep disturbances [ 77 ],[ 88 ],[ 89 ].
With regard to smoked marijuana, one study found reductions in muscle spasticity [ 90 ]; however, another study showed that smoking marijuana impaired posture and balance in individuals with spasticity [ 91 ], so there is currently insufficient evidence to determine the efficacy of smoked marijuana on spasticity [ 5 ]. Surveys of patient populations show that between 14 and 16 percent of patients with MS report using marijuana for symptom management [ 92 ],[ 93 ] and that compared to non-marijuana-using individuals with MS, marijuana-using individuals with MS have decreased cognitive functioning[ 90 ],[ 94 ],[ 95 ].
Because cognitive dysfunction is present in 40—60 percent of individuals with MS before marijuana administration [ 96 ], marijuana use may further compromise impaired cerebral functioning in a neurologically vulnerable population.
Additionally, future studies should carefully consider outcome assessment. The primary methods of measuring spasticity, the Ashworth Scale and patient self-report, may not be appropriate measures because antispastic drugs do not decrease Ashworth ratings, and patient-reported spasticity severity may be poorly correlated with patient functioning i.
Importantly for both MS and other neurological disorders, the American Academy of Neurology does not advocate the use of marijuana for the treatment of neurological disorders, due to insufficient evidence regarding treatment efficacy [ 98 ]. There has been a recent emergence of empirical studies of the effects of marijuana on symptoms of PTSD, borne primarily out of the observation that individuals with PTSD report using marijuana to cope with PTSD symptoms; specifically, hyperarousal, negative affect, and sleep disturbances[ 99 ]-[ ].
Empirical work has consistently demonstrated that the endocannabinoid system plays a significant role in the etiology of PTSD, with greater availability of cannabinoid type 1 receptors documented among those with PTSD than in trauma-exposed or healthy controls [ ],[ ]. Though the use of marijuana and oral THC [ ],[ ] have been implicated as a potential mechanism for the mitigation of many PTSD symptoms by way of their effects on the endocannabinoid system, some researchers caution that endocannabinoid activation with plant-based extracts over extended periods may lead to a number of deleterious consequences, including receptor downregulation and addiction [ ].
One unpublished pilot study of 29 Israeli combat veterans showed reductions in PTSD symptoms following the administration of smoked marijuana, with effects seen up to one year post-treatment[ ]. Remaining studies have been primarily observational in nature, documenting that PTSD is associated with greater odds of a cannabis use disorder diagnosis [ ] and greater marijuana craving and withdrawal immediately prior to a marijuana cessation attempt [ ]. Indeed, sleep difficulties a hallmark of PTSD have been associated with poor marijuana cessation outcomes[ ],[ ], while cannabis use disorders have been associated with poorer PTSD treatment outcomes [ ].
Severe and chronic pain. Clinical trials have examined smoked and oral administration of cannabinoids on different types of pain e. Two meta-analyses have been conducted examining the association between marijuana and pain. In the first, 18 RCTs demonstrated that any marijuana preparation containing THC, applied by any route of administration, significantly decreased pain scores from baseline compared to placebo [ ]. The second examined 19 RCTs of smoked marijuana in individuals with HIV, which also indicated greater efficacy in reducing pain i.
Importantly, the first meta-analysis showed that marijuana increased the odds of altered perception, motor function, and cognition by 4 to 5 times[ ], and the second study did not recommend marijuana as routine therapy [ ]. Dosage is an important factor to consider for administration of cannabinoids for pain management, as some studies have found that higher doses of smoked marijuana are associated with improved analgesia[ ], whereas other studies show that higher doses of smoked marijuana increase pain response[ ].
Because the analgesic effects of marijuana are comparable to those of traditional pain medications [ ], future research should aim to identify which analgesics provide the lowest risk profile for the management of severe and chronic pain.
Although there is preliminary support to suggest that marijuana may have analgesic effects, there is insufficient research on dosing and side effect profile, which precludes recommending marijuana for the management of severe and chronic pain. The majority of research related to the effects of marijuana on severe nausea has involved oral administration of marijuana to individuals with chemotherapy-induced nausea and vomiting CINV.
When compared to traditional anti-emetics, some meta-analytic reviews indicate that oral THC is more effective in reducing CINV[ ]-[ ], others find no significant difference [ ],[ ]-[ ], and another suggests that combining both is the most effective at reducing the duration and severity of CINV than either alone [ ]. Recent advances in both anti-emetic agents and the mechanisms of cannabinoid administration i.
Additionally, cannabinoid hyperemesis syndrome has been documented, in which persistent and regular marijuana use i. Dronabinol has been FDA-approved for CINV in individuals who have not shown a treatment response to traditional anti-emetics, but in line with recommendations from the American Society of Clinical Oncology [ ] and the European Society for Medical Oncology [ ], cannabinoids should not be utilized as a first-line treatment for nausea and vomiting.
The reviewed literature highlights the dearth of rigorous research on the effects of marijuana for the most common conditions for which it is currently recommended.
It is paramount that well-designed RCTs with larger sample sizes be conducted to determine the actual medical benefits and adverse effects of marijuana for each of the above conditions.
Indeed, recent reviews [ 4 ],[ ] comprehensively discuss adverse events associated with marijuana use, and while it is beyond the scope of the current paper to review these effects in-depth, they are important to consider when evaluating whether or not to recommend marijuana for a medical or psychiatric disorder in place of other existing treatment options.
Given the extensive literature speaking to the harms associated with marijuana use, research on the comparative safety, tolerability, efficacy, and risk of marijuana compared to existing pharmacological agents is needed.
The present literature also illuminates the need for research into the effects of isolated cannabinoids e. Furthermore, improved and objective measurement of clinical outcomes should be implemented in clinical trials to determine treatment efficacy. Finally, little research has considered the issues of dose, duration, and potency.
If research identifies a therapeutic effect of marijuana for medical or psychiatric conditions, there will need to be revisions in marijuana policy to increase quality control so that dose and potency are valid and reliable.
In sum, the current literature does not adequately support the widespread adoption and use of marijuana for medical and psychiatric conditions at this time. Chemotherapy-induced nausea and vomiting. Belendiuk holds stock in Shire Pharmaceuticals. KAB synthesized the literature and authored sections of the manuscript.
LLB assisted with the literature search and synthesis. MOB-M conceived the review, assisted in the search and synthesis of existing literature, and authored sections of the manuscript. All authors read and approved the final manuscript.
The above funding agencies played no role in the writing of the manuscript or decision to submit the manuscript for publication. The expressed views do not necessarily represent those of the Department of Veterans Affairs.
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However, controlled studies have not been conducted to evaluate the safety or effectiveness of medical marijuana for PTSD.
Thus, there is no evidence at this time that marijuana is an effective treatment for PTSD. In fact, research suggests that marijuana can be harmful to individuals with PTSD. Marijuana use has increased over the past decade. In , a study found that A number of factors are associated with increased risk of marijuana use, including diagnosis of PTSD 2 , social anxiety disorder 3 , other substance use, particularly during youth 4 , and peer substance use 5.
There has been no study of marijuana use in the overall Veteran population. What we do know comes from looking at data of Veterans using VA health care, who may not be representative of Veterans overall. Marijuana use is associated with medical and psychiatric problems.
These problems may be caused by using, but they also may reflect the characteristics of the people who use marijuana.
Medical problems include chronic bronchitis, abnormal brain development among early adolescent initiators, and impairment in short-term memory, motor coordination and the ability to perform complex psychomotor tasks such as driving. Psychiatric problems include psychosis and impairment in cognitive ability. Quality of life can also be affected through poor life satisfaction, decreased educational attainment, and increased sexual risk-taking behavior 7.
Chronic marijuana use also can lead to addiction, with an established and clinically significant withdrawal syndrome 8. Marijuana contains a variety of components cannabinoids , most notably deltatetrahydrocannabinol THC the primary psychoactive compound in the marijuana plant. Therefore, the effects of marijuana use e. In addition, the potency of cannabinoids can vary. In general, the potency of THC in the marijuana plant has increased as much as fold over the past 40 years 9, Thus, an individual could unknowingly consume a very high dose of THC in one administration, which increases the risk of an adverse reaction.
Marijuana can be consumed in many different forms e. Administration of these forms also can take different routes: Not all marijuana users may be aware of the delayed effect caused by ingestion, which may result in greater consumption and a stronger effect than intended. Research has consistently demonstrated that the human endocannabinoid system plays a significant role in PTSD.
People with PTSD have greater availability of cannabinoid type 1 CB1 receptors as compared to trauma-exposed or healthy controls 13, Though recent work has shown that CB1 receptors may return after periods of marijuana abstinence 16 , individuals with PTSD may have particular difficulty quitting The belief that marijuana can be used to treat PTSD is limited to anecdotal reports from individuals with PTSD who say that the drug helps with their symptoms. Administration of oral CBD has been shown to decrease anxiety in those with and without clinical anxiety This work has led to the development and testing of CBD treatments for individuals with social anxiety 19 , but not yet among individuals with PTSD.
People with PTSD have particular difficulty stopping their use of marijuana and responding to treatment for marijuana addiction. They have greater craving and withdrawal than those without PTSD 21 , and greater likelihood of marijuana use during the six months following a quit attempt However, these individuals can benefit from the many evidence-based treatments for marijuana addiction, including cognitive behavioral therapy, motivational enhancement, and contingency management It was awful for him.
He is a whole different bird, capapble of relaxing and being affectionate and enjoying his life I am happy beyond words that CBD is available to help this parrot - nothing else helped him. This parrot has been getting CBD for about 6 months now and it continues to be very effective. I had his bloodwork checked recently - no signs of liver or kidney side effects.
It has been reccomended for both of us. It's pricey, but I'm willing to spend on it if IRS worth it. I've been a consumer lab subscriber for many many years. Thank you for the work you do.
CV Sciences, formerly Cannavest, seem to be behind many of the questionable products, but they operate under so many brand names, it is impossible to keep up. The advise is always to ask for independent test results before buying - but really a company could send one thing to a lab, and something else to customers.
Out of interest, I started my research because I bought some CBD paste to try for my crippling arthritis pain. It was horribly expensive and came from a guy, who knew a guy, who said it was really Endoca, but had no labels. It really worked so well, I stopped Mobic and was walking without a brace. The shady guys had been shut down when I went to reorder.
I also discovered that Endoca is not available in Australia where I live. Hence my research into something hopefully as good who knows what I had and even more hopefully, at an affordable price.
Now I have spent so much money experimenting, I could have bought a return ticket to personally visit Mr. Endoca and buy up half his stock.
Please, please Consumer Lab can you get on to testing for us? I know I am not alone in my frustration at how hard it is to know what's what in this industry.
I use the rubs for severe spinal stenosis and arthritis. My doctor says Young Liiving's Copaiba oil has a higher concentration of pain relief. Is there a difference between "dietary supplements" and "supplements" - this distinction appears to be made here in the review as to legality? Or is this reference to legality only referring to the difference between industrial hemp derived CBD and the medical marijuana controlled plant?
I've noticed an explosion of CBD products, hemp oils, etc. Could you clarify in a more obvious way these subtle points. Medical use of CBD is legal in many, but not all, states, as noted above, but the products cannot necessarily be legally sold in those same states. Hope that helps a bit. It is tricky and evolving area. It is still not clear to me. Tricky is an understatement. It appears that it was the DEA that put it on schedule 1 in Dec. DEA" legal case 14 years ago, it is being challenged again?
What I don't understand is how it can illegal, yet sold nearly everywhere, at the same time? It is illegal and legal at the same time? A kind, generous friend gave my wife a bottle to help with her RA symptoms while we were vacationing in Canada. She will not use it until we find out if it is legal to possess and her doctors give her the go ahead, but we would be interested in the test results.
I have been a Consumerlab member for years. We will consider that. We have received many suggestions this week of products. He has arthritis and a bad heart murmur. At first it really seemed to help with his pain and he was much more mobile.
After a few weeks he started getting more lethargic and not eating. I did some research and discovered it should not be given along with any medications that are metabolized by the liver. It causes these meds to build up in the body so he was exhibiting symptoms of overdose of his heart medications.
I stopped the CBD oil and he got started eating and seemed to feel better. Give with caution if your pet is on other meds. You can read the manufacturer's claims. I'm 87 and found the CBD oil does relieve my aches and pains, and clears my mind. The results aren't like prescription drugs; they aren't usually immediate. People have differing results.
There are recommendations for the amount to take and you are wise to heed them. I use Blubird Botanicals and ran out a couple days ago, and I can definitely feel the difference.
I expect a new order tomorrow. For me, the expense is worth it. There are several online sites where you can receive much information. Beware of the Pure Natural brand. It offers a free trial, but in the small print you are signing up for a monthly supply at full cost.
The BBB has a report on this. Please note that hemp oil may be made with hemp seeds or other parts of the plant. Commonly hempseed oil is called hemp oil. I meant to say that CBD oil isn't made from the seeds, from what I've read.
I am being ask about CBD frequently now. This is what one of my clients had to say about it. I bought it at the Remedy Pharmacy in Torrance on Hawthorne Boulevard, but you can also order online.
I didn't have incredible overnight success with it like the women at the seminar we went to did, but I am having less pain and sleeping better. I don't know if it's a true change or just placebo effect, but I'll take it either way: The pain is along, above and below the scar area. In Az medical marijuana is legal with a card from a physician. I didn't see any relief with it. I get instant relief for anywhere between a half and hour to a couple of hours. My pain is reduced substantially while waiting for the pain pill to take effect.
I'm NOT recommending anything here, just letting you know how it helps me. By the way, I'm 71 and have been with this pain for over 5 years since the surgery. It is some help. I have ordered Liberty Lixir from Liberty Lotion because other fm sufferers have raved about it. Anyone used this product before? Her tumor did not grow and she had better capability with her ADLs.
It is unlike low molecular weight heparins which would be ordered as the brand eg. Innohep or generic name eg. Language barrier but caller thinks a TB treatment protocol caused something with platelets Response: Risk of adrenal suppression nausea, fatigue, shortness of breath, hypotension, hypoglycemia, myalgia, fever, dizziness is low if systemic steroids are taken less than 3 weeks. Canadian Pharmacist's Letter ; 26 5: GeriRx Files, pg Ticagrelor, ASA, metoprolol and atorvastatin.
An Ace inhibitor will likely be started in next hours. None of my references have any information about apigenin. Saw palmetto may inhibit 3A4 but this was not documented when mg daily was taken for 8 weeks.
Saw palmetto may have cardiovascular concerns. Possibly resveratrol 1,4 and hesperidin 1 increase bleeding risk. Stinging nettle 1,4 and tribulus 1. None of the ingredients were considered harmful in general. Natural Medicines - DI checker 2. Natural Medicines - monographs 3. Review of Natural Products, The.
Ref Online Electronic Medical Library. There is some research suggesting lysine may prevent recurrent HSV infection 3,4,13,14 and that it appears to be dose-dependent. All of the limitations of the former trial apply as well as methodological limitations of a survey. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Sen P, Barton SE. Genital herpes and its management. Development and evaluation of a host-targeted antiviral that abrogates herpes simplex virus replication through modulation of arginine-associated metabolic pathways.
Arginine inactivates human herpesvirus 2 and inhibits genital herpesvirus infection. Int J Mol Med. National Center for Biotechnology Information. Lysine prophylaxis in recurrent herpes simplex labialis: Lysine as a prophylactic agent in the treatment of recurrent herpes simplex labialis. Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride.
Failure of lysine in frequently recurrent herpes simplex infections. Failure of lysine in frequently recurrent herpes simplex infection. Subjective response to lysine in the therapy of Herpes simplex. J Antimicrob Chemother ; Unlike other glucocorticoids, no well-established equivalent dose to prednisone is available for oral budesonide. National Advisory Committee on Immunization. Update on the use of herpes zoster vaccine. Public Health Agency of Canada.
Accessed Mar Treatment of active Crohn's disease with an oral slow-release budesonide formulation. Am J Gastroenterol ; N Engl J Med ; Acetaminophen, atorvastatin, gravol, docusate, labetalol, ramipril, zopiclone Response: I found that two ingredients were also referred to as lithospermum arnebia guttata or gromwell and camphor borneolum or zhang hao or bing pian and used those in my drug interaction analysis.
The analysis of lithospermum, camphor and phellodendron showed drug interactions with acetaminophen, atorvastatin, and labetalol. Camphor is potentially hepatotoxic and should be used with caution with concomitant acetaminophen, atorvastatin, and labetalol as there may be an increase in liver enzymes and risk of developing liver damage. Phellodendron and atorvastatin should be used with caution as phellodendron might inhibit CYP3A4 enzymes, potentially increasing levels of atorvastatin and other CYP3A4 substrates.
Natural medicines database interaction checkler: Comparison and Frequently-Asked Questions. Accessed Feb 28 How I treat with anticoagulants in Blood, 13 , Accessed February 27, These side effects may go away with time as the product is being used.
If the symptoms are moderately bothersome the patient could try a saline nasal spray or an intranasal corticosteroid. Lantus product monograph Sanofi-Aventis. DHEA cream applied vaginally or to the thigh and intravaginal suppositories have shown to be effective in treating vaginal atrophy in post menopausal woman. DHEA is possibly unsafe when used orally for long term at higher doses; long term use of 50 to mg of DHEA daily can produce higher DHEA serum levels and potentially puts them at risk for cancer including breast cancer.
Dupilumab does not have a notice of compliance yet. The studies were over 16 weeks therefore longer term efficacy studies are required 2.
Health Canada Notice of Compliance 2. Amlodipine steady state is usually reached within days of consecutive daily dosing. Amlodipine will have significant reductions in BP at hours after first dose.
Depiro Pharmacotherapy textbook - hypertension 3. Drug product database- amlodipine accel pharma. The drugs of choice are Ivermectin and albendazole ivermectin preferred.
In fact, there is a Canadian article which addressed the fact that CLM "treatment in Canada is only available through the Special Access Program SAP of Health Canada, thus, many patients are prescribed ineffective courses of non-targeted therapy" and the importance of using the first line treatments: Management of imported cutaneous larva migrans: A case series and mini-review.
Travel Med Infect Dis. Ondansetron prolongs QT interval in a dose dependent manner, especially in doses greater than 32 mg IV. Risk of dose dependent QT prolongation is expected to be greater with faster and larger IV infusions of ondansetron.
QT prolongation and torsades de pointes: Clonidine may reduce physical symptoms of withdrawal. To ensure it will be tolerated a test dose of 0. If BP Methadone and buprenorphine have shown to be superior over clonidine in treatment of supervised withdrawal as two meta-analysis showed patients were more likely to complete treatment and reduce withdrawal symptoms.
Rx files- slow opioid taper 4. Likely dyspepsia patient said there is no actual diagnosis Response: All of the PPIs are of equal equivalence 1 ; none are superior so cost and formulation are the major decision factors. Truvada is currently the only drug indicated for PrEP in Canada.
The drug is not covered on the Saskatchewan formulary for this indication so all Saskatchewan formulary patients would pay out of pocket. Some third party insurers are covering on a case-by-case basis but maximums and deductibles may result in incomplete coverage. The GP can prescribe. However, prescription of PrEP should include a comprehensive prevention strategy as well as routine follow-up every 3 months to monitor HIV status, adverse effects, and re-inforce prevention strategy.
RxTx - Truvada 3. Phone communication with Pharmacist, Positive Living Saskatoon, Information is available from one observational study looking at long-term effects of tranexamic acid being used cyclically for menorrhagia. This study included women who were followed for 27 cycles of 1. The discontinuation rate was Specific adverse events reported: Ophthalmological examination of patients in long-term treatment with tranexamic acid.
Patients on long-term treatment of MacroBID for 6 months or longer are at increase risk of developing chronic pulmonary reactions, including diffuse intersistial pneumonitits, pulmonary fibrosis or fatalities.
Pulmonary fibrosis has most frequently occurred in post menopausal woman and most cases have been reversible following discontinuation of MacroBID and beginning steroid therapy.
The manufacturer does not provide dosing adjustment for cephalexin however some clinicians follow the guidelines to mg every 12 to 24 hrs. ALS patients do have problems with thickening secretions for 3 reasons: Secretion Management in ALS http: Glaucoma diagnosed Oct 16 Medication History: Pantoprazole 40 mg daily started in Feb 16 Response: Drugs which are known to cause or exacerbate glaucoma include corticosteroids, antimuscarinic drugs antihistamines, antidepressants, antispasmodics , and topiramate.
In another study treating patients with Zollinger-Ellison syndrome or hypersecretory conditions, 4 of 34 patients experiencd visual disturbances including blurry vision and eye floaters, appearing or worsening during pantoprazole use. Rxtx - glaucoma 3. Subcutaneous administration of Versed is an off-label use, however, it is often used this way in palliative care.
Medication use during end-of-life care in a palliative care centre. Int J Clin Pharm. Accessed on March 2, Accessed on November 25, Yes, if blood glucose is not well-controlled with the insulin combination. The dosage of the insulins should be decreased on initiation of the Forxiga because of the possibility of hypoglycemia 1,2 and adjusted as needed.
Management of persistent hyperglycemia in type 2 diabetes mellitus in UpToDate 2. Not known Medication History: It's metabolite,- normeperidine, is neurotoxic and its accumulation can cause seizures or other CNS side effects such as tremors and hallucinations. Due to slower rate of metabolism in elderly and hepatic or renal impairment, use is not recommended in this population.
Canadian Pharmacists Association; Acute Pain; [updated August ; cited 03 March ]. Management of acute perioperative pain. Accessed on March 3, Lodalis colesevelam is a bile acid sequestrant used to lower cholesterol. It works by preventing reabsorption of bile acids. Once bile acids are depleted, the hepatic enzyme cholesterol hydroxylase is increased which further converts cholesterol to bile acids. This in turn increases demand for cholesterol in liver and increases clearance of LDL from the blood.
Therefore ezetimibe should be given two hours before or 4 hours after Lodalis. Uptodate lipid lowering with drugs other than statins and fibrates. Gastroparesis Pain Medication History: Tramadol and metoclopramide may have drug interactions varying from increased sedation to increased seizures and serotonin syndrome.
Therefore, reduced tramadol metabolism may further increase serotonergic activity with decreased opioid effect. Lexi interaction checker 4. Micromedex- tramadol and bupropion 6. Pencillin allergy Medication History: Prevacid, bismuth subsalicylate, tetracycline, metronidazole Pepto Bismol bismuth subsalicylate - 2 tabs QID for 14 days Pradaxa BID- second month filled today was on warfarin for prevention of clots and then got a clot Response: No major drug interaction between Pepto Bismol and dabigatran.
Each of these agents possess the potential to cause bleeding. Their combined use would seem to increase that potential. Recommended monitoring for increased signs of bleeding. Increase monitoring diligence for signs and symptoms of bleeding if these agents are used concomitantly.
Pepto Bismol, PPI, metronidazole and tetracycline. Lexidrug interaction checker 2. Stockleys drug interaction checker 3. Rxfiles h pylori testing and eradication 5.
Acid suppressing medications have a limited role in the treatment of infants with regurgitation. They are not valuable in treating children less than one year of age with uncomplicated GER "happy spitters". When pharmacotherapy is chosen as a treatment, or for a limited trial, a PPI is generally preferred over histamine type 2 receptor antagonists H2RA. Post marketing reports of severe skin reactions associated with Accutane, like Stevens-Johnson syndrome, toxic epidermal necrolysis, and erthema have been reported.
A Roche global safety database as of reported 66 incidences of severe skin reactions in adults and children worldwide, however there are approximately 16 million medication users. To manage the photosensitivity you can trial a decreased dose of Accutane or apply hydrocortisone cream to a small area to see if it helps reduce the redness and itchiness. Potential consequences of abrupt discontinuation or large dose reduction of an antipsychotic include discontinuation syndrome flu-like , psychosis, and movement disorders.
Clinical Handbook of Psychotropic Drugs, 20th Ed, pg There are some interactions with grapefruit juice and calcium channel blockers however none were recognized with amlodipine. Stockleys drug interaction checker 2. Food and Drug interactions book. Topical steroids may be used in treating mild-moderate contact dermatitis. If skin irritation occurs with fentanyl patches, steroidal sprays have been used; wait 1 minute after spraying before applying the new patch.
However they can be used as a last resort. Alprazolam Cyclobenzaprine Ranitidine Response: No interactions identified 2. Lexi-drug interaction checker 2. Stockleys drug interaction checker. In disorders with excess absorption via diet or intestinal disorder it may be more important to reduce oxalate content in diet. An association of oxalates and vulval pain was found involving a woman with vulvodynia. She presented with high levels of oxalate in her urine. Her symptoms resolved and oxalate levels declined after starting a low-oxalate diet and calcium citrate to remove oxalate from the body.
In the US, a low oxalate diet is widely used for treatment of vulvodynia. Up to date- prevention of recurrent calcium stones in adults 2.
Uptodate — primary hyperoxaluria 3. Vulval pain society- http: Shortage is estmated to be resolved April 6th. Referred to Amantadine shortages document. Schedule II means a pharmacist needs to be involved in discussion with the patient. The fact your patient is tolerating amitriptyline is reassuring.
Ann Allergy Asthma Immunol. Proton pump inhibitors PPIs may decrease serum mycophenolate acid levels, depending on the product used.
Stockleys Drug Interactions 2. Lexicomp Drug Interaction Checker 3. Intestinal parasite - dientamoeba fragilis, blastocytis hominis Medication History: Tried Vermox and Combantrin Response: Bugs and Drugs app 2.
There is no equivalent dose of opioids and marijuana. Tapering of high dose opioid can be considered before starting marijuana as there may potentially be additional CNS depression with the combination. Butrans Patch for Weekly Application for converting opioids to Butrans patches which may be of some assistance. Health Canada drug product database- buprenorphine 2. Pharmacists Letter- Medicinal Marijuana 5.
Serum salicylate levels are reduced by steroids; however the main concern is following steroid withdrawal in those taking moderate to high doses of ASA. Stockleys Drug interactions 2. There is no difference in terms of bioavailability or onset of action between the two products. Lexidrugs - Ondansetron 3. Canadian Pharmacist's Letter ; 20 Treatment of eosinophilic esophagitis EoE consists of: As the esophagus may be inflamed, PPIs will confer protection to potential acid exposure.
In a randomized study patients received esomeprazole 40 mg for 8 weeks along with swallowed fluticasone; treated patients experienced significant improvement in symptoms of dysphagia regardless of GERD status. Most patients receive swallowed fluticasone which is administered using an MDI without a spacer. The medication is sprayed into the mouth and swallowed; the patient should not eat or drink for 30 minutes after administration. Adults should use mcg twice daily. If treatment is not beneficial, the dose may need to be increased or the patient can be switched to oral viscous budesonide budesonide nebules mixed with sucralose .
Budesonide can also be administered using a nebulizer and having the patient swallow the accumulated liquid. Patients generally continue with treatment for 8 weeks and if relapse is an issue afterwards a maintenance dose or dietary changes may be considered.
It may reduce the burden of allergy and risk of anaphylaxis however there is the possibility that the immunotherapy may trigger the EoE as seen in mice. Further research is needed to determine safety and efficacy. Esophageal dilation will relieve dysphagia but not improve the underlying inflammation. Treatment of Eosinophilic Esophagitis 2. Emerging Therapeutic Options for Eosinophilic Esophagitis.
Management of benign esophageal strictures 4. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Carbamazepine is an enzyme inducer that may increase estrogen metabolism, thereby reducing its effectiveness; however, this is not relevant for locally applied estrogen used for menopausal vaginits. Stockleys Drug Interaction Checker 2. Lexicomp Drug Interaction Checker: Not available Medication History: Diversion colitis is characterized by inflammation of the defunctionalized, bypassed colon following surgery.
Most patients with diversion colitis are asymptomatic, but in a small proportion of patients, symptoms can significantly impact quality of life. Bacterial metabolism results in SCFA synthesis. SCFA are absorbed by the lumen which then supplies fuel to mucosal cells, modulates fluids and electrolytes, enhances colonic motility and mucosal blood flow, and production of inflammatory cytokines. The enemas must be compounded and consist of sodium acetate 60 mmol , sodium propionate 30 mmol , and sodium n-butyrate 40 mmol with additional sodium chloride 22 mmol.
This yields a similar osmolality to plasma and pH is adjusted to 7. The enema is instilled twice daily for 6 weeks at a dose of 60 mls. Frequency may be reduced if improvement occurs. In one randomized crossover trial of 10 patients with IBD and colectomy, SCFA enema use for 3 weeks was not shown to improve inflammation compared to placebo.
However these patients had severe inflammation which may have been due to IBD. Uptodate- Diversion Colitis 2. Pathophysiology, clinical presentation and management of diversion colitis: A review of current literature.
International Journal of Surgery. There is minimal data for melatonin supplementation during breastfeeding and effects are relatively unknown. Briggs in Pregnancy and Lactation 2. The common guidelines for statin therapy, such as that of the American College of Cardiology do not mention how to manage low LDL, but some articles have explored targeting lower LDLs to assess if there is a greater benefit with more aggressive treatment.
This patient would have been put on a statin following the heart attack, as this would be considered clinical atherosclerotic cardiovascular disease. A systematic review of RCTs of statin therapy found no association between being treated with statins and cognitive decline; the LDL numbers of the study were not disclosed but it did include participants on higher intensity statin therapy.
Do Statins Impair Cognition? Journal of General Internal Medicine. Journal of the American College of Cardiology. Kastelein, MDc, John B. The American Journal of Cardiology. Can LDL cholesterol be too low? Possible risks of extremely low levels. Journal of Internal Medicine. How quickly after ingestion does antidote therapy need to be instituted ie: They found that delaying the antidote more than 6 hours increased rates of death OR prolonged renal insufficiency and associated morbidity significantly composite end-point, odds ratio of 3.
They do not conclude that giving the antidote within 6 hours is optimal it could be within hours, for example , but delaying more than 6 hours definitely leads to more harm. Is oral alcohol a good option? This is not definitive, however: This World Health Organization suggests fomepizole is likely more cost-effective depending on regional costs of acquisition and staffing 6. Oral ethanol dosing protocols suggested for both pediatric and adult: O Another protocol 1 basically the same, slightly lower dose: The loading dose is 0.
For both modalities, blood ethanol levels must be monitored hourly and adjusted accordingly, and both require patient monitoring in an ICU setting. Treatment of ethylene glycol poisonings 2. UpToDate, treatment of ethylene glycol poisoning 3. Epub Dec Reddy's - inventory Response: UpToDate - Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy.
Accessed on-line 08Sep 3. There is no indication to titrate statin doses. RxTx - Post-myocardial Infarction 4. Treatments for molluscum in immunocompetent children with the most evidence include: It is applied with the blunt end of cotton swab to lesion only in the office. Application is painless and does not cause bleeding.
The area can be washed with soap and water within hours. The agent causes small blisters at the lesion site. If lesions persist, treatment can be repeated in weeks. This solution can be applied at home once or twice daily 3—4 days per week for up to 4—6 weeks. Pain, burning, erosions, pruritus and bleeding may occur. In the methods it described 4: Treatment was to be discontinued if inflammation occurred. UTD - Molluscum contagiosum 3. Pediatr Dermatol May-Jun;23 3: Common and Flat Warts.
As per Canadian Immunization Guidelines, Canadians 50 years of age and older with no known history of varicella infection are still eligible for herpes zoster vaccination. Patients should not obtain lab confirmation - there are no known safety concerns of herpes zoster vaccine in healthy patients susceptible to varicella virus.
Only if lab confirmation of varicella virus has been obtained in the past for other reasons would one vaccinate with two doses of univalent varicella vaccine. There are liquid sodium phosphate solutions marketed for laxative use and contain 4. Dieticians of Canada phosphorus content of foods available. UpToDate - Evaluation and treatment of hypophosphatemia 2.
Phone communication with , Novartis Customer Service, , Mar 31, Platelets usually highest was 5. I found but one case report of hydroxyurea HU -associated hyperkalemia in a patient with polycythemia vera. While the authors describe normalization of potassium levels with discontinuation of the HU, they do not provide any information about how the condition was subsequently managed.
There have been three cases reported via MedEffect 3 ; however, all of these seem to be tumour lysis syndrome as other metabolic abnormalities hyperuricemia, hyperphosphatemia, hypocalcemia were present, which is typical of tumour lysis syndrome. No reason to believe any of the other drugs would be a causative factor, whether by interaction or adverse effect profile was found. There is a decent amount of information regarding pseudohyperkalemia in patients with myeloproliferative disorders.
Because it is possible furosemide was affecting potassium simultaneously, if simultaneous plasma and serum samples can be ordered, pseudohyperkalemia can easily be ruled in or out. Should this be a true hyperkalemia,low dose Kayexalate sodium polystyrene sulfonate — SPS is reasonable to try.
They followed these patients for a mean 14 months; baseline potassium was 6. Some did experience nausea but this subsided with continued use. It is best to use the sorbitol-free product 19 , which is powder. Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera. Eur J Clin Pharmacol. MedEffect Adverse Drug reaction database 4. UTD - Tumor lysis syndrome: Definition, pathogenesis, clinical manifestations, etiology and risk factors 5.
UTD - Prognosis and treatment of essential thrombocythemia 6. Renal complications in oncohematologic patients. J Invest Med ; 57 8: UTD - Treatment and prevention of hyperkalemia in adults Clinical utility of patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate for the treatment of hyperkalemia: Pseudohyperkalemia in patients with increased cellular components of blood.
Am J Med Sci. When is a high potassium not a high potassium? J R Soc Med. Pseudohyperkalemia occurring in a patient with chronic renal failure and polycythemia vera without severe leukocytosis or thrombocytosis. The tip of the iceberg. Am J Case Rep. Epub Jun Secondary prevention of hyperkalemia with sodium polystyrene sulfonate in cardiac and kidney patients on renin-angiotensin-aldosterone system inhibition therapy.
Epub Nov 6. That said, if she has some 0. Geri RxFiles, pg 2. The threshold dose of prednisone considered sufficient to interfere with immune response such that Zostavax should not be given or prednisone started after Zostavax is 20 mg once daily.
The only information available is from an abstract in which ampicillin rectal suppository was compared to amoxicillin suspension administered rectally. There was less perianal irritation in the amoxicillin group 5.
J Int Med Res. Clinical evaluation of rectally administered ampicillin in acute otitis media. There is no need to discontinue breastfeeding if using topical fluorouracil on small areas.
Hale - Medications and Mothers' Milk. No drug interactions between evolocumab and adalimumab were identified. However, given the total amount of endogenous IgG of 50— g, the usual dose of most mAbs of The possibility of additive immunosupppression was considered; however while adalimumab does cause immunosuppression, 4 the target of evolocumab, PCSK9, is not involved in the immune system and there is no indication evolocumab affects the immune system.
ECPS - Humira 5. Epub Jul Pharmacokinetics interactions of monoclonal antibodies. The Risperdal Consta Kit should be stored under refrigeration, however, if there is no refrigeration available, it can be stored at room temperature References: Risperdal Consta Drug Product Monograph.
The hairline, neck, temples, and forehead may be infested in infants and geriatric patients. In these populations, permethrin should also be applied to the scalp and face, sparing the eyes and mouth.
UpToDate, treatment of scabies. Rare cases of hypertrichosis have been associated with topically applied minoxidil. The laboratory investigation excluded hyperandrogenism and thyroid dysfunction.
Topical minoxidil should be used with caution in children. Hypertrichosis is a common side effect of topical minoxidil treatment in women. Although usually localized to the face, it may occasionally involve limbs and other body areas. Systemic absorption of the drug is typically minimal with topical therapy, with 1. However, hypotheses on the pathogenesis of the diffuse hypertrichosis reaction routinely include systemic absorption, as well as high sensitivity of the follicular apparatus to minoxidil.
These effects included sinus tachycardia, sensation of palpitation and dizziness. The efficacy of topical minoxidil in alopecia areata has never been definitively proven.
The possibility of systemic absorption contraindicates, in some reasearchers opinion, this treatment in young children, who can develop serious cutaneous or systemic side effects.
Infantile generalized hypertrichosis caused by topical minoxidil. Minoxidil induced hypertrichosis in a 2 year-old child. Rabeprazole is enteric coated because it is unstable in acidic media and undergoes pH-dependent decomposition especially rapidly below pH ; therefore it should not be crushed.
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