Self Care Pharmacy Blog

Can Aspirin Eventually Replace Warfarin?

October 31st, 2014

by Kristin Lessig, PharmD Candidate

For patients that have experienced serious trauma, surgical procedures, long periods of bed rest, or have taken certain oral forms of birth control, there is an increased risk for a condition known as deep vein thrombosis (DVT).  Deep vein thrombosis (DVT) is a blood clot that most commonly forms within the deep veins of the legs. This clot can become dislodged from the vein and eventually make its way into the lung where it can become stuck in a pulmonary artery and result in serious complications. 1

One of the primary treatments for DVT is to prescribe a medication that acts as a blood thinner so that the blood cannot form clots that block the blood vessels. These types of medications are known as anticoagulants, with one of the most commonly used anticoagulants being a medication known as warfarin. This medication works by blocking the mechanism that initiates blood clotting. 1 However, warfarin tends to interact with many different medications, and warfarin also tends to make the blood so thin that it is difficult to stop any internal or external bleeding. 1, 2

U.S. News recently published a report discussing the possibility of using over-the-counter aspirin to help treat DVT.3 The news report stated that many patients who take warfarin generally take the medication long enough for the blood clot to be destroyed and then as a preventative measure to keep another clot from forming. 3 Most patients only take warfarin for approximately 6 months because while taking warfarin, it is necessary to have frequent doctor appointments and blood tests to determine if a change in dose is needed. Since many patients do not wish to continue taking warfarin for extended periods of time, physicians need to utilize some other form of treatment that will bring about better results and be easier for the patient to follow.

Recent studies have revealed that aspirin may actually be an efficient treatment for DVT since aspirin also works to thin the blood like warfarin does. Aspirin acts as a blood thinner by blocking the production of certain enzymes that cause blood platelets to clot together. 4 Prospective studies and randomized control trials have been performed in order to determine if aspirin was able to prevent the formation of another blood clot in patients who had previously suffered from DVT. In addition, these studies observed the effects of 100mg aspirin versus a placebo on myocardial infarction (heart attack), stroke, major bleeding, and cardiovascular death. 3, 5 As a result of these studies, it was shown that aspirin was more effective than the placebo at decreasing the risk of DVT by approximately 42%. 4,5 It is very important to realize, however, that these studies showed a serious limitation because they did not show the effects of treatment of DVT with aspirin alone. Instead, the studies focused on the effects of aspirin on DVT after the patient had already taken a much stronger anticoagulant medication. Therefore, it is necessary for a patient who has been diagnosed with DVT to seek a doctor’s approval before beginning self-treatment with aspirin. While these studies have shown that aspirin is capable of blood-thinning properties and can significantly decrease the risk of DVT recurrence, aspirin is not as strong as warfarin or other anticoagulant medications. 5

Based on the evidence from the studies, it is easy to see that a new and potentially more patient-friendly treatment for DVT is evolving. Using over-the-counter aspirin as a blood-thinner to prevent another blood clot from forming is potentially a safer option since the patient won’t experience as many drug interactions as they would if they were on warfarin. Also, taking aspirin instead of warfarin can be easier and more cost effective for the patient. The patient would not have to go to the physician as often for testing and dose changes, therefore giving the patient a more consistent treatment as well as cutting down on medical costs. If an individual has previously suffered from a DVT, I would highly recommend meeting with the physician to discuss the option of possibly using aspirin as a precaution against a second DVT.

Do you think it is wise for people to self-treat a fairly serious condition with over-the-counter aspirin instead of seeing their physician frequently?

 

References:

  1. Obalum DC, Giwa SO, Adekoya-Cole T, Ogo CN, Enweluzo GO. Deep vein thrombosis: Risk factors and prevention in surgical patients. West Afr J Med. 2009; 28(2):77-82.
  1. Aspirin’s role in preventing recurring deep vein blood clots. Mayo Clin Health Lett. 2013; 31(5):4-4.
  1. Reinberg, S. Study: Aspirin Might Work Instead of Warfarin for Deep Vein Clots. U.S. News Website. http://health.usnews.com/health-news/articles/2014/08/26/study-aspirin-might-work-instead-of-warfarin-for-deep-vein-clots. Published August 26, 2014. Accessed October 4, 2014.
  1. Cossetto DJ, Goudar A, Parkinson K. Safety of peri-operative low-dose aspirin as a part of multimodal venous thromboembolic prophylaxis for total knee and hip arthroplasty. J Orthop Surg (Hong Kong). 2012; 20(3):341-343.
  1. Simes J, Becattini C, Agnelli G, et al. Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE collaboration. Circulation. 2014; 130(13):1062-1071.

 

Fighting that Itch!

October 28th, 2014

by Lindsay Mailloux, PharmD Candidate

We have all experienced it before. Whether it be a bug bite, a case of poison ivy, or the annoying t-shirt tag rubbing against your neck, you know what it feels like to have an itch. These cases usually have an easy solution—scratch your arm, cut off that tag, or maybe even apply some hydrocortisone cream. However, if you or your child is one of the many individuals who suffer from atopic dermatitis, more commonly known as eczema, you know the solution is not so simple.

Atopic dermatitis is the most common skin disease among children, affecting 20% of children in the United States and other developed countries.1 This skin condition usually starts affecting individuals during infancy and lasts into adulthood.2 Because atopic dermatitis acts like an allergic reaction, it cannot be cured—only managed. For less severe cases, the symptoms of itchy, dry, and irritated skin are usually treated with regular use of hypoallergenic moisturizers and maybe the occasional use of hydrocortisone cream for the bad flare-ups.2 Other non-medical practices can be used, such as applying lotion immediately after taking short baths to trap the moisture on the skin. Another handy tip is to keep nails clean and short to avoid damage to the skin from scratching.2 However, these measures are not always sufficient for the more severe cases of eczema, and individuals may have to resort to more intensive drug measures like taking prescription oral corticosteroids.1 Because these drugs have more serious side effects, especially for children, researchers are looking for better alternatives.

One study published this year suggests a new type of treatment called “wet-wrap” therapy. In this technique, a child with eczema takes a 10 to 20 minute warm bath and then rubs a moisturizer and medicated cream into his or her skin. The child is then wrapped in wet clothing to “trap” the medication and dressed in additional dry clothing over top. After a minimum of two hours, the wet clothing is removed.1 The goal of this therapy is to reduce irritation and help restore overall health and hydration of the skin. In this prospective cohort study, seventy-two children with moderate-to-severe cases of eczema were treated with wet wraps to test if the therapy improved their condition. However this study was limited by the fact that it did not have a control group for comparison, and its results cannot be generalized to adults.1

The study showed two major benefits of wet wrap therapy not seen with typical treatment. The first is that wet wraps were found to increase the effectiveness of a weaker medication, thus avoiding the need for a stronger drug with more worrisome side effects. Secondly, this technique was actually shown to help heal the skin and provide relief for a month after treatment.1

Since wet wrap therapy was first introduced about twenty years ago, various studies have shown its significant potential in treating eczema. One study showed that wet wrap therapy improved children’s eczema by an average of 74% when compared to their original condition. 3 In addition, a review of multiple studies determined that using wet wrap dressings with a medicated cream was both a safe and effective treatment.4

However, it is important to recognize that this treatment is currently only used for more severe cases of atopic dermatitis under the direct supervision of health care providers. One opinion from medical experts explains that wet wraps are currently used as a “safe crisis intervention.”5 This means that the technique should only be used in severe cases of eczema when the patient is too young to safely use prescription oral drugs. Another important point this expert makes is that use of wet wraps can result in side effects including lowering the activity of your adrenal glands or increased risk of bacterial infection. 5,6

One reason that this new practice is not used outside of the instruction and supervision of a health care provider is because of the complication of the process and the various methods of accomplishing it. One article pointed out that an official wet wrap method has never been established. For instance, various types of medicated creams and bandages have been used as well as different lengths of time for keeping the wraps on the skin. This lack of standardization makes it difficult even for health care providers to recommend wet wrap therapy.6

Current evidence strongly suggests that wet wrap therapy has definite potential as a safe and effective treatment for eczema. However, the major downside of this therapy is how complicated it is to use. At this point, it is not a good idea to try it out without supervision of a health care provider. But keep an eye out for guidelines on wet wrap therapy— this may be a huge area of treatment just around the corner. Also, consider asking your doctor about wet wraps if you or your child is losing the fight against that itch!

What are your thoughts? Do you think the benefits outweigh the risks? What other similar techniques would you recommend in the fight against the eczema itch?

References

  1. Nicol NH, Boguniewicz M, Strand M, Klinnert MD. Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program. The Journal of Allergy and Clinical Immunology: In Practice. 2014;2(4):400-406.
  2. Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription drugs: An interactive approach to self-care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012.
  3. Wolkerstorfer A, Visser RL, De Waard FB, Van DS, Mulder PGH, Oranje AP. Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: Influence of corticosteroid dilution. Br J Dermatol. 2000;143(5):999-1004.
  4. Devillers A, Oranje A. Efficacy and safety of ‘wet‐wrap’ dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: A critical review of the literature. Br J Dermatol. 2006;154(4):579-585.
  5. Oranje AP. Evidence – based pharmacological treatment of atopic dermatitis: An expert opinion and new expectations. Indian J Dermatol. 2014;59(2):140-142.
  6. Devillers ACA, Oranje AP. Wet-wrap treatment in children with atopic dermatitis: A practical guideline. Pediatr Dermatol. 2012;29(1):24-27.

Proactive Use of Probiotics

October 28th, 2014

by Sarah Winey, PharmD candidate

According to the World Health Organization (WHO), two leading causes of death in young children, under the age of 5, are respiratory infections and diarrhea.1 Both respiratory tract infections (RTIs) and severe diarrhea are often caused by a bacterial infection, so an effective prevention therapy could reduce the incidence of these infections.  Currently, strategies are rarely employed for the prevention of these disease states, except avoidance of foods and conditions that may have an impact, such as fatty foods and environmental irritants. Avoidance of environment irritants can include avoidance of individuals who may carry infection and appropriate hygienic measures, such as hand washing. However, medical treatment frequently occurs only when the patient becomes symptomatic. The standard treatment for diarrhea involves fluid and electrolyte replacement or zinc supplementation, while the standard treatment for bacterial respiratory tract infections often involves antibiotic therapy.1 Probiotic therapy has been suggested as a potential preventative strategy for combating bacterial infections, including those associated with diarrhea and RTI’s.

Probiotics are live, healthy bacteria that are ingested in the form of a dietary supplement or cultured dairy products.2 The human body holds a significant amount of natural healthy bacteria in various locations, including the gastrointestinal (GI) tract.  When harmful bacteria enters the body, it competes for limited space with the healthy bacteria.  In the case of infection, the harmful bacteria overwhelms the system. The goal of probiotic supplementation is to overwhelm at risk areas, such as the GI tract, with healthy bacteria; in fact, the labeled dose is in terms of number of live cells or colonies, usually upward of one million.  In clinical testing, most patients do not experience side effects or experience only minor GI effects such as gas.3 According to current guidelines, probiotics have not been determined to replace standard treatment; nevertheless, the 2007 National Health Interview Survey found that probiotic-type products were the fifth most used natural product for children.3

In March 2014, the Pediatrics journal published a trial with the goal of determining whether a probiotic, Lactobacillus reuteri, had a significant impact on incidence of diarrhea in preschool children. The study was a forward-looking, random-sample, placebo-controlled trial (placebo- an identical substance to probiotic but has no effect) occurring from April 2011-June 2012 in four different day care centers in southeast Mexico City. The study population was comprised of healthy children aged six months to three years, born full term, and of similar socioeconomic status. The primary outcome, or goal, of the study was to determine if the number of days children experienced diarrhea was impacted by probiotic intervention. In addition, the number of days children experienced RTI’s, days of absence caused by diarrhea or RTI, days of antibiotic use, days of medical visits and cost impact due to intervention were studied. The study’s limitations included the possible lack of generalizability based on study location and choice of probiotic species.4

This study provided additional support to the theory that probiotic therapy can impact the prevention of bacterial infections, specifically diarrhea and RTI’s. The results showed that the intervention significantly reduced the incidence of both diarrhea and RTI.4 Additionally, the days of absence, number of medical visits, and antibiotic use were also significantly reduced as a result of probiotic intervention.4 Several other studies have found similar results. For instance, according to a Cochrane research review, probiotics were found to be a beneficial prevention strategy for infection; specifically, this study found that upper respiratory tract infection rate was reduced with probiotic use.5 Another research review of Randomized Control Trials (RCT’s) showed a decrease in duration and stool frequency as a result of probiotic intervention for diarrhea.6

In conclusion, probiotic therapy is a safe and seemingly effective for the prevention of respiratory infections and diarrhea.  This form of therapy may prove especially useful to parents of young children in daycare centers who are constantly in a crowded environment, which could lead to increased infection.  An additional option is the use of yogurt or other cultured dairy products, which also have the capability to reestablish normal, healthy bacteria in the GI tract. Currently probiotics are not an officially approved recommendation for children, should they be?

References:

  1. World Health Organization.Children: Reducing mortality. Media centre: Fact Sheets Web site. http://www.who.int/mediacentre/factsheets/fs178/en/. Updated 2014. Accessed September 20, 2014.
  2. EBSCO CAM Review B. Probiotics. Salem Press Encyclopedia Of Health [serial online]. January 2014;Available from: Research Starters, Ipswich, MA. Accessed August 31, 2014.
  3. National Center for Complementary and Alternative Medicine. Oral probiotics: An introduction. 2012.
  4. Gutierrez-Castrellon P, Lopez-Velazquez G, Parra M, et al. Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial. Pediatrics [serial online]. n.d.;133(4):E904-E909. Available from: Science Citation Index, Ipswich, MA. Accessed September 24, 2014.
  5. Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Of Systematic Reviews [serial online]. July 26, 2011;(9)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed September 20, 2014.
  6. Applegate J, Fischer Walker C, Ambikapathi R, Black R. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health [serial online]. October 2, 2013;13(Suppl 3):1-8. Available from: Academic Search Complete, Ipswich, MA. Accessed September 1, 2014.

Energy Drinks: Performance over Health?

October 28th, 2014

By Ryley Uber, PharmD Student

An energy drink (ED) is a supplement commonly used to combat sleepiness and to increase the physical and mental performance of an individual. These drinks can be defined as, “an alternative to coffee as a source of caffeine and also contain other functional ingredients such as antioxidants, ginseng, taurine, and B vitamins.”1 The exact ingredients, however, differ among the companies who offer these products. Despite the health effects of these drinks having been continually called into question, their market has been steadily increasing.2 One instance where these health concerns can be seen is in the case study of a 17-year-old.3 The patient was admitted to an emergency room with an increased heart rate and arrhythmia that started shortly after consuming an ED. He had no history of cardiac issues. This patient was found to have Wolff-Parkinson-White (WPW) syndrome, which is the most common pre-excitation disorder (improper electrical conduction in the heart) with an incidence of 0.1–0.3% in the general population and an associated sudden cardiac death risk of less than 0.6%.3 This disorder can lead to increased heart rates which was likely exacerbated by the ED. After treatment, he was released from the hospital once his heart rate and rhythm returned to normal. Since this was only a report of a single medical case, it cannot be applied to all circumstances. However, it does offer some insight to what side effects can come of consumption of EDs. This should cause concern among consumers regarding the safety of these drinks.

In a recent review published in 2013, a total of 15 studies on EDs were evaluated based on the effects they produced.4 Unfortunately, due to the differences among the studies, no solid conclusions could be drawn. This was due to the fact that substantial differences existed between participants, ED used, study design strength, and outcomes. However, since then there have been multiple other studies conducted evaluating this potential health hazard. One such study conducted by Grasser et. al suggested that Red Bull slightly increased blood pressure.5   Blood flow in the brain decreased, likely due to constriction of arteries. Based on this data, the researchers called into question the manufacturers’ claims that this drink increases mental abilities. While not immediately dangerous to an adult in perfect health, the researchers mention that increased blood pressure could pose a problem to patients with heart diseases.

The athletic advantages of these energy supplements should not be ignored. In one study that was published in 2013 and conducted by Burrows et. al, professional rugby players were each given an ED prior to a simulated game and a placebo prior to a different simulated game.6 During both of these trials, the distance that the players ran while playing a simulated rugby match was measured. In the placebo trial, the players ran an average of 4749 meters. After consuming an ED, however, the players ran an average of 5139 meters. One limitation to this study is the fact that every rugby match has many variables that could lead to a higher amount of distance ran. The matches that included the EDs could have simply required more running due to an increase in overall game intensity. This study concluded that EDs increased the athletic performance of the athletes who participated. A similar study published in 2010 and conducted by Kazemi et. al involved female athletes, it was also concluded that athletic performance was increased among the participants after drinking an ED.7 Performance was measured by the participants’ oxygen intake, heart rate, and time to exhaustion, among other variables. According to these studies, athletic performance does increase with the use of EDs. However, an athletic advantage does not justify the use of these supplements. This is because of the proven temporary increase in blood pressure that many of these drinks cause, which is harmful to one’s heart.8 The effects of EDs on other organs in the body have yet to be thoroughly researched (kidneys, liver, etc…).

Due to the lack of conclusive data regarding the long-term and short-term health effects of EDs, consuming these drinks to increase performance cannot be recommended. More conclusive studies must be conducted in order to learn more about the health effects of EDs. Some individuals have encouraged the FDA to further regulate this quickly growing industry in order to produce energy supplements that are both effective and pose little to no risk to the customer’s health.9 Although the large amount of caffeine found in EDs is not generally recommended, caffeine can provide a neutral effect or perhaps even a positive effect on one’s health when taken in moderation.10 Between 3 and 4 cups of coffee that are 8 ounces each is considered a moderate amount of caffeine. Though the promise of increased performance may be tempting for some, the health and promised effectiveness still remains unknown and requires further conclusive research to fully reveal the nature of these supplements.

Are the performance advantages that energy drinks advertise worth the potential risk to your personal health? How often do you use energy drinks for “quick” energy?

References

  1. Tamamoto LC, Schmidt SJ, Lee S. Sensory profile of a model energy drink with varying levels of functional Ingredients—Caffeine, ginseng, and taurine. J Food Sci. 2010;75(6):S271-S278. Accessed: October 6, 2014.
  2. Heckman MA, Sherry K, De Mejia EG. Energy drinks: An assessment of their market size, consumer demographics, ingredient profile, functionality, and regulations in the united states. Comprehensive Reviews in Food Science and Food Safety. 2010;9(3):303-317. Accessed: October 6, 2014.
  3. Candilio L, Chen AWY, Iqbal R, Gandhi N. An interesting case of tachyarrhythmia. BMJ Case Reports. 2014;2014. Accessed: October 6, 2014.
  4. Burrows T, Pursey K, Neve M, Stanwell P. What are the health implications associated with the consumption of energy drinks? A systematic review. Nutr Rev. 2013;71(3):135-148. Accessed: October 6, 2014.
  5. Grasser E, Yepuri G, Dulloo A, Montani J. Cardio- and cerebrovascular responses to the energy drink red bull in young adults: A randomized cross-over study. Eur J Nutr. 2014;53(7):1561-1571. Accessed: October 6, 2014.
  6. Del Coso J, Ramírez JA, Muñoz G, et al. Caffeine-containing energy drink improves physical performance of elite rugby players during a simulated match. Applied Physiology, Nutrition & Metabolism. 2013;38(4):368-374. Accessed: October 6, 2014.
  7. Kazemi F, Gaeini A, Kordi M, Rahnama N. The acute effects of two energy drinks on endurance performance in female athlete students. Sport Sciences for Health. 2010;5(2):55-60. Accessed: October 7, 2014.
  8. Chrysant SG, Chrysant GS. Cardiovascular complications from consumption of high energy drinks: Recent evidence. J Hum Hypertens. 2014. Accessed: October 18, 2014.
  9. Thorlton J, Colby DA, Devine P. Proposed actions for the US food and drug administration to implement to minimize adverse effects associated with energy drink consumption. Am J Public Health. 2014;104(7):1175-1180. Accessed: October 6, 2014.
  10. Mejia EGd, Ramirez-Mares M. Impact of caffeine and coffee on our health. Trends in Endocrinology & Metabolism. 2014;25(10):489-492. Accessed: October 6, 2014.

How can you help your baby if you are smoking and pregnant?

October 28th, 2014

By Samantha Smolinski, PharmD Student

Approximately 50% of women who smoke before pregnancy continue to smoke after pregnancy. Smoking during pregnancy has been shown to cause some adverse effects on the baby. These adverse effects include lifelong decreases in lung function, an increased risk for asthma, low birth weight, shortened pregnancy terms, miscarriage, and infant mortality.1,2 The standard of care for pregnant women who smoke is to suggest that they quit.3

Many women have difficulty quitting smoking. Research has shown that when women join smoking cessation programs like Freedom From Smoking through the American Lung Association or FreshStart from the American Cancer Society to help them quit smoking, they are more likely to quit due to social support and encouragement.4,5 Women have reported that when they were living with another person who smoked, it was much harder for them to quit smoking and remain a non-smoker. In addition to this, many women claim that they found quitting easier when their significant other was supportive of their decision.6 Another common option to aid the mother in her journey to quit smoking is nicotine replacement therapy. Nicotine replacement therapy involves substituting cigarettes with pure nicotine, so that the patient maintains the same level of nicotine in the blood to reduce withdrawal symptoms. The amount of nicotine the patient receives is gradually reduced overtime until the patient can comfortably quit smoking. The forms for this replacement therapy can come in patches, gums, lozenges (dissolved in mouth), inhalators, nasal sprays, and microtabs. Nicotine replacement therapy increases the chances for someone to quit smoking by approximately 80%.4 However, this therapy may cause some adverse pregnancy outcomes and potential malformations. Although malformations may occur, studies have shown that this side effect may be less harmful than those adverse effects that result from smoking during pregnancy.3 In addition to the potential side effects, nicotine is absorbed faster in pregnant women than in non-pregnant women, which means that standard uses of this therapy may not be applicable to pregnant women.4

Recently, a randomized, double-blind trial was conducted with one hundred fifty-nine newborns of pregnant smokers and seventy-six newborns of pregnant non-smokers. Smoking pregnant women were randomly placed in groups where sixty-three received vitamin C 500 mg and eighty-three received a placebo.1 Vitamin C was chosen for this study because there have been multiple studies that have shown that it has a protective effect on lung function.7 After the women had their babies, pulmonary function tests were performed on the babies within seventy-two hours after birth and again a year later. The tests that were conducted a year later were only for the babies of the smoking pregnant due to institutional review board regulations. The first outcome included the measured pulmonary function tests within seventy-two hours of birth and the second outcome included pulmonary function tests at one year as well as the incidence of wheezing. Results suggested that women who smoked while they were pregnant and taking vitamin C 500 mg improved their newborn pulmonary function and decreased the chance of wheezing within one year when compared to the offspring of women who were pregnant and smoking in the placebo group. This study was conducted because of a prior study that had been done on pregnant rhesus monkeys.1 This study had shown that the offspring of the pregnant monkeys with nicotine treatment and vitamin C supplementation had increased pulmonary functions when compared to the offspring of the pregnant monkeys who were only treated with nictotine.7 Thus, vitamin C can be an inexpensive and simple approach to decrease the adverse effects smoking has on pregnancy.4

Vitamin C supplementation can bring additional benefit to women who are smoking and pregnant. This can help the adverse effects that smoking has on the baby’s lung function after birth. Although quitting is still the best choice for pregnant women and their babies, vitamin C supplementation can be useful by helping the baby if the mother smokes intermittently (through part of the pregnancy or through the entire pregnancy.) My recommendation to patients would be to quit smoking as soon as possible and that the best way to do this is through the support of others. In addition to quitting, they should take a daily 500 mg vitamin C supplement which has shown benefits for the babies of women who smoke during pregnancy. Vitamin C can be found over the counter at a relatively low price.

What changes are you willing to make to help your baby?

 

References:

  1. McEvoy CT, Schilling D, Clay N,et al. Vitamin c supplementation for pregnant smoking women and pulmonary function in their newborn infants: A randomized clinical trial.JAMA. 2014;311(20):2074-2082.
  2. Pollack H, Lantz PM, Frohna JG. Maternal smoking and adverse birth outcomes among singletons and twins.Am J Public Health. 2000;90(3):395-400.
  3. Forinash AB, Pitlick JM, Clark K, Alstat V. Nicotine replacement therapy effect on pregnancy outcomes.Ann Pharmacother. 2010;44(11):1817-1821.
  4. Coleman T. Recommendations for the use of pharmacological smoking cessation strategies in pregnant women.CNS Drugs. 2007;21(12):983-993.
  5. Lando HA, McGovern PG, Barrios FX, Etringer BD. Comparative evaluation of american cancer society and american lung association smoking cessation clinics.Am J Public Health. 1990;80(5):554-559.
  6. Flemming K, Graham H, Heirs M, Fox D, Sowden A. Smoking in pregnancy: A systematic review of qualitative research of women who commence pregnancy as smokers.J Adv Nurs. 2013;69(5):1023-1036.
  7. Proskocil BJ, Sekhon HS, Clark JA, Lupo SL,

Yet Another Reason to Lose that Excess Weight

October 27th, 2014

By Courtney Noll, PharmD Student

An individual’s blood glucose levels assist in controlling the secretions of two major regulatory hormones in the body: Insulin and glucagon. Insulin works to bring down levels of glucose in the blood when they have risen too high, and glucagon works to raise the blood glucose levels when they have fallen too low. A significant problem that many individuals are developing is the condition of insulin resistance. This issue is caused by obesity, sedentary lifestyles, poor eating habits, and genetics etc. This physiological condition occurs when cells fail to respond to the normal effects of insulin. In some cases insulin is created in less than sufficient quantities in the body, and in other cases, the human body fails to use the hormone effectively.  As of now there is no specific medication approved by the Food & Drug Administration (FDA) for the treatment of insulin resistance, outside of diagnosis and treatment of diabetes, and the best form of conventional treatment is found to be weight loss and exercise. Smoking is also found to increase insulin resistance, and quitting the habit will contribute to an individual’s conventional treatment of the issue. Insulin resistance plays a significant role in the development of other serious medical conditions as well, including obesity, hypertension, type II diabetes, dyslipidemia (abnormal amount of lipids in the blood), and cardiovascular (heart) disease.1

A recent study was performed in order to evaluate the effects of weight loss on insulin resistance as well as other plasma and tissue markers of systemic and vascular inflammation. This was a prospective controlled study using 77 overweight and obese sedentary postmenopausal women. These women were split into 2 groups where 37 of the participants met 3 times a week and engaged in aerobic exercise and the remaining 40 participants did no aerobic exercising. This study used a state-of-the-art technique to measure insulin sensitivity, body composition, inflammatory biomarkers, and vascular adhesion molecules and carefully conducted weight loss and exercise regimes.2 In looking back at the results, evidence is shown that the markers that were measured and the level of insulin resistance was noticeably higher with a higher level of obesity.2 As the study progressed, it was also noticeable that with combined weight loss and aerobic exercise, the levels of insulin resistance and the other markers measured, also significantly decreased. Unfortunately, there were two limitations that came into play during this study. First of all, the study was done only in postmenopausal women and second, there was no nonintervention control group.2 By performing this study in exclusively postmenopausal women, the results cannot be applied accurately to different populations and/or groups of individuals.

This study may have had limitations, but it was not the only study showing the relationship between weight loss and reduced insulin resistance. In fact, there was no study that I found showing any opposing views or conflicting data. Another study showed the effects of weight loss on insulin resistance in adolescents and found that, weight loss at month 4 was associated with improved insulin sensitivity in obese adolescents.3 Another study published recently, was looking at the effects of weight loss, with and without exercise, on the measurements of blood pressure, blood glucose, and insulin resistance and found that: A reduction of 7% of the initial body weight, in overweight patients, improves systolic blood pressure, plasma glucose, and insulin resistance.4  Thirdly, another study found that using surrogate markers for insulin sensitivity, authors of the Diabetes Prevention Program showed that at one year, improvement in insulin sensitivity predicted lower risk for diabetes three years later.5

Study after study shows the benefits of weight loss on various health measurements, but specifically focuses on insulin resistance. In my opinion, losing weight can be one of the most beneficial health choices an overweight individual can choose to accomplish. There are many rewarding diets and workout regimens that individuals have found to be successful. In addition, a gym membership and a simple 3 days per week attendance could be the start to a great beginning for any overweight individual. By decreasing their weight and, essentially decreasing insulin resistance, an individual will decrease their risk of hypertension, type 2 diabetes, dyslipidemia, and cardiovascular disease. With the positive effects of losing weight on insulin resistance, what is weight loss worth to you?

 

References:

  1. Reviews CT. Studyguide for Principles of Anatomy and Physiology by Gerard J. Tortora, Isbn 9780470565100. Academic Internet Publishers; 2012.
  2. Ryan A, Ge S, Blumenthal J, Serra M, Prior S, Goldberg A. Aerobic Exercise and Weight Loss Reduce Vascular Markers of Inflammation and Improve Insulin Sensitivity in Obese Women. Journal Of The American Geriatrics Society [serial online]. April 2014;62(4):607-614. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  3.  Abrams P, Levitt Katz L, Berkowitz R, et al. Threshold for improvement in insulin sensitivity with adolescent weight loss. Journal Of Pediatrics [serial online]. September 2013;163(3):785-790. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  4.  Trussardi Fayh A, Lopes A, Fernandes P, Reischak-Oliveira A, Friedman R. Impact of weight loss with or without exercise on abdominal fat and insulin resistance in obese individuals: a randomised clinical trial. British Journal Of Nutrition [serial online]. August 28, 2013;110(3):486-492. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  5.  McLaughlin T, Schweitzer P, Reaven G, et al. Persistence of improvement in insulin sensitivity following a dietary weight loss programme. Diabetes, Obesity & Metabolism [serial online]. December 2008;10(12):1186-1194. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed September 24, 2014.
  6.  Ling Chun K, Wuillemin P, Rizkalla S, et al. Insulin resistance and inflammation predict kinetic body weight changes in response to dietary weight loss and maintenance in overweight and obese subjects by using a Bayesian network approach. American Journal Of Clinical Nutrition [serial online]. December 2013;98(6):1385-1394. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.
  7.   Calleja Fernández A, Vidal Casariego A, Cano Rodríguez I, Ballesteros Pomar M. One-year effectiveness of two hypocaloric diets with different protein/carbohydrate ratios in weight loss and insulin resistance. Nutricion Hospitalaria [serial online]. December 2012;27(6):2093-2101. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 23, 2014.

Vitamin D: A New Option in the Fight Against Asthma?

October 27th, 2014

By Charles Snyder, PharmD Student Cedarville University

Most people are either affected by asthma or know of someone close to them who struggles with the condition, which has increased in prevalence in America an estimated 25% every decade since 1960.[1] Asthma is a chronic disease that affects the airways of the body, leading to increased sensitivity, soreness, and swelling of these inner airways and ultimately less air into the lungs. Common symptoms include but are not limited to; wheezing, cough, tightness of the chest and difficulty breathing. Since there is currently no cure for asthma, the goal of treatment is to relieve these chronic symptoms. This is achieved by avoiding common things that can trigger asthmatic attacks such as exposure to pollen, dander and other allergens and by taking inhaled medications. Inhaled corticosteroids, such as Advair®, are aimed at preventing inflammation and swelling of the airways in a long-term capacity. Other anti-asthmatic medications are inhaled at the time of an asthmatic flare up, with a goal of immediately reducing symptoms.[2] As a whole, the current treatments for asthma are fairly effective; however, many patients still struggle to manage their chronic asthmatic symptoms on a day to day basis.

Fox news recently highlighted a new research study that suggests taking vitamin D may have an influence in combating the chronic effects of asthma. [3] The idea that vitamin D levels can affect asthma is a fairly common one. Rates of asthma incidence are statistically higher in northern regions, so it appears that there could be a connection between the northern environment and asthma. Many researchers suspect that the decreased sunlight in these regions, which is responsible for producing the majority of the body’s vitamin D, is leading to the increased asthma rates.[4] It is hypothesized that vitamin D helps to protect against asthma by regulating the immune system. This is accomplished by reducing the number of inflammatory cells (Helper T cells) that produce the symptoms of asthma. These inflammatory cells are also thought to produce another negative effect by reducing the effect of inhaled steroids.[5]

The study was performed by Dr. Saba Arshi at the Medical University of Tehran. This study involved one-hundred and thirty children and adults who were diagnosed with mild to severe asthma. The participants were divided into two groups. One group received treatment for their asthma using a dry powder inhaler, the control group, while the other group was treated with both the dry powder inhaler as well as high doses (100,000 units initially and then 50,000 units per week) of vitamin D for six months. After 28 weeks the researchers conducting the study measured the amount of air that patients could exhale. They found that the group who received the vitamin D, along with the inhaler, had improved by about twenty percent, while the dry powder inhaler only group had improved by seven percent.

There were, however, some limitations to this particular study. First, patients’ adherence to the medications was not measured over the course of the study. This means the regularity of the participants actually taking their assigned treatments is unknown. Second, the number of participants in the study was quite small, one hundred and thirty. Finally, the study only measured the volume of air patients were able to exhale, it did not test whether any asthma specific symptoms were improved over the course of the study.

The Fox news article had this to say about the study’s results, “I think it’s a reasonable hypothesis and their study and some other studies provide evidence it might be true. But I don’t think it’s proven yet.”3 This is a fair analysis of the study. Unfortunately, there simply has not been enough testing done on the relationship between vitamin D levels and asthma incidence to make a definitive statement. Much of the research that has been done has shown conflicting results on the topic4. A recent study published in The Journal of the American Medical Association (JAMA) provided results disagreeing with the study previously discussed. The JAMA article tested whether oral vitamin D supplements increased the effect of an inhaled corticosteroid. However, using variables similar to Dr. Arshi’s study, they found that there was no significant difference in treatment when paired with taking vitamin D.[6] Also worth noting is that a recent systematic review, produced by the Journal of Allergy, Asthma and Clinical Immunology, examined 1081 studies. Out of those studies, only three met the systematic reviews criteria and those three all had conflicting results on whether vitamin D levels played a role in Asthma development and treatment.5 This shows that there is still a lot of discussion occurring about the effect of vitamin D in asthma, and further, definitive data is still needed.

However, vitamin D has a wide range of health benefits such as treating conditions that cause weak bones, helping to raise calcium levels in the blood, and treatment of psoriasis, among others. When taken within the recommended daily dose (approximately 600 international units daily depending on age and weight),[7] there are very few side effects traditionally associated with vitamin D. The described study as well as other studies have not been able to present enough evidence to support using vitamin D to treat asthma. However I feel that vitamin D provides such a wide range of benefits, with no major side effects to asthmatics, that it would be worth trying for people struggling with asthma symptoms. Would you be willing to try vitamin D to see what benefits it could have for you or recommend it to asthma patients?

[1] Brown SD, Calvert HH, Fitzpatrick AM. Vitamin D and Asthma. Dermato-Endocrinology. 2012;2(4):137-145 Accessed September 20, 2014.

[2] National Heart, Lung and Blood Institute. How is asthma treated and controlled. NIH.gov Web site. http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment.html. Published August 4,2014. Updated 2014. Accessed September 20, 2014.

[3] Does vitamin D help with asthma? Fox News Web site. http://www.foxnews.com/health/2014/08/19/does-vitamin-d-help-with-asthma/. Published August 19, 2014. Updated 2014. Accessed September 20, 2014.

[4] Mason R, Sequeira V, Gordon-Thomson C. Vitamin D: the light side of sunshine Eur J Cin Nutr. September 2011;65(9):986-993. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 20, 2014.

[5] Rajabbik MH, Lotfi T, Alkhaled L, et al. Association between low vitamin D levels and the diagnosis of asthma in children: A systematic review of cohort studies. Allergy, Asthma & Clinical Immunology. 2014;10(1):1-16.

Therapeutic Research Faculty. Vitamin D. Medline Plus Web site.

[6] Castro M, King TS,Kunselman SJ, et al. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: The Vida randomized clinical trial. JAMA. 2014;311(20):2083-2091. Accessed September 20, 2014

[7] Therapeutic Research Faculty. Vitamin D. Medline Plus Web site. http://www.nlm.nih.gov/medlineplus/druginfo/natural/929.html. Published July 30, 2014. Updated 2014. Accessed September 20, 2014.

The Unexpected Dangers in Your Medicine Cabinet

October 24th, 2014

by Josh Knoebel, PharmD Candidate

Your doctor prescribes medications to help you control the pain you are feeling. The drugs do their job, and the pain gradually stops. This doesn’t prevent you from keeping the medicine though; after all, it was expensive, and who knows when you may need it again? This is a common scenario in many households, and a recent study published in Pediatrics: The Official Journal of the American Academy of Pediatrics confirms a concern many health professionals share regarding household medication management. The common opinion is to keep medication up and out of sight of children, but is that enough? As parents know far too well, children are not limited to what they can reach from the floor. If they see mommy put that “candy” in the cabinet, they may just try to climb onto the counter and get it themselves. The Center for Disease Control and Prevention (CDC) claims that more than 1.4 million emergency department visits were related to pharmaceuticals in 2011, and of the 41,340 drug overdose deaths in the United States, 22,810 (55%) were related to pharmaceuticals.1 Over 60,000 of these emergency department visits were for children six years or younger, and over 500,000 calls were made to poison control centers concerning these youngsters.2

Twelve specific active ingredients were found by the Pediatrics study that caused nearly half of the poisonings in the United States.2 Opioids (17.6%) and benzodiazepines (10.1%) top the chart as the classes of drugs with the highest number of poisonings. The twelve most common active ingredients of poisoning cases in children age six and under are listed in order of decreasing incidence:

  1. Buprenorphine (734 cases)
  2. Clonidine (701 cases)
  3. Glipizide (386 cases)
  4. Clonazepam (368 cases)
  5. Metoprolol (314 cases)
  6. Lorazepam (309 cases)
  7. Lisinopril (298 cases)
  8. Amlodipine (295 cases)
  9. Bupropion (265 cases)
  10. Glyburide (257 cases)
  11. Hydrocodone (252 cases)
  12. Oxycodone (249 cases)

The number of medication poisonings has continued to rise from 2004 to now3, a trend that is certainly reversible with diligence.

There are measures you can take to keep not only small children, but teenagers and adults alike safe from accidental medication poisoning. The first step is to make sure that all medications are kept in child-safe containers. Daily pill containers are convenient to remember medication use, but are often not child proof. Second, properly dispose of any and all out dated medications. Disposal of medications in the trash is not advised as they are still accessible to a curious child, or even the family pet. Contact your local pharmacist and ask about take back programs in your community.4 If there are no medication disposal programs available, there are three steps endorsed by the FDA for disposal in household trash. First, remove the medication from its original packaging and scratch out any personal information. This helps to protect your identity and sensitive health information. Second, make the medications unusable by mixing with inedible materials such as kitty litter, old coffee grounds, or sand. Lastly, put the mixture into sealable containers to prevent medication from falling out of the trash can.4

The most important change in preventing medication poisonings is to take your medications out of the medicine cabinet and keep them in a secure location. The best options are a lock box or a combination safe in a low traffic area of the house such as the bedroom closet. Ironically, the bathroom medicine cabinet is one of the least effective places to keep medications. Not only is it easy to access for children, but humidity from the bath or shower can damage the medications.5

What other preventative methods do you use with your medicine? Leave a comment below and let us know how you keep your medications secure!

References

  1. Paulozzi LJ. Prescription drug overdoses: a review. Journal of Safety Research. 2012;43(4): 283-289.
  2. Substance Abuse and Mental Health Services Administration. Highlights of the 2011 drug abuse warning network (DAWN) findings on drug-related emergency department visits. Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/data/sites/default/files /DAWN127/DAWN127/sr127-DAWN-highlights.pdf. Posted February 22, 2013. Accessed September 29, 2014.
  3. Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS. Emergency hospitalizations for unsupervised prescription medication ingestions by young children. Pediatrics. 2014;134(4): e1009-1016.
  4. Office of the Commissioner. Consumer updates – how to dispose of unused medicines. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ConsumerUpdates /ucm101653.htm. Posted December 24 2013. Updated May 19 2014. Accessed October 13 2014.
  5. Dugdale DC, Zieve D. Storing medication safely. Medline Plus. http://www.nlm.nih.gov /medlineplus/ency/article/007189.htm Updated 3/26/2011. Accessed 10/22/2014.

The Coconut Oil Craze

October 22nd, 2014

By Danielle Grear, PharmD Student

Super-food, super-health, or super-hype? Coconut oil has been a trending topic in today’s society with its recent health claims for improving weight, fighting bacteria, treating Alzheimer’s, moisturizing skin, and the list goes on.1 Perhaps the most recent way coconut oil is being used today is in a process called “oil pulling,” which requires swishing a tablespoon of oil in the mouth for several minutes in order to detox the body and improve dental health. While the FDA has not yet approved the use of coconut oil for the treatment or prevention of disease, many consumers swear by the positive effects coconut oil has in improving their health.2

A recent article published by The Huffington Post explores the use of coconut oil pulling as a means to whiten teeth, reduce bacteria, strengthen the gums and jaw, and prevent bad breath.3 “It can be a good way to supplement recommended practices like tooth brushing, flossing, and regular dental visits,” says Michelle Hurlbutt, RDH, MSDH, an associate professor of dental hygiene at Loma Linda University in Southern California. Hurlbutt conducted a pilot study and found evidence that showed oil pulling can decrease the bacteria associated with dental cavities. Contrary to popular claims of coconut oil, however, she found that sesame oil had a 5-fold decrease in the level of Streptococcus mutans (a common bacteria associated with a high risk of cavities) compared to only a 2-fold decrease in the bacteria with coconut oil. Furthermore, after daily oil pulling stopped, the bad bacteria began to reemerge in both groups. While I believe that some may indeed have evidence supporting their experience of oil pulling’s benefits, I agree with Hurlbutt that the scientific evidence behind this process is lacking and needs further research to back these claims. The article does a good job in addressing that issue, and even states that oil pulling should not be used to replace regular oral health care.

To further investigate the use of coconut oil in oil pulling, a research study published in the Asia Journal of Public Health studied the effects of coconut oil pulling on oral microorganisms in biofilm models.4 A biofilm is a thin, slimy film of bacteria that adheres to a matrix. The bacteria that were used in this study on a saliva-coated plate were: Streptococcus Mutans, Lactobacillus Casei, and Candida Albicans, which are all predominately found in dental plaque and associated with infections. The study found that as coconut oil was exposed to the bacteria for one minute, it exhibited antimicrobial (anti-bacteria) activity on S. Mutans and C. Albicans. This allowed researchers to conclude that oil pulling therapy could be used as a preventative home therapy to maintain oral hygiene, especially in developing countries. However, while this article certainly shows the benefits of oil pulling, the study has its fair share of limitations. Predominately, because the mechanisms of oil pulling action are not known, further studies are needed to investigate the action of coconut oil on dental plaque and other microorganisms. Long-term effects in clinical trials on humans are also needed to provide significant data for its use in practice.

In addition, one of the main components of coconut oil is lauric acid. This saturated fat is a medium length fatty acid and has been shown in other studies to have an antimicrobial effect against certain bacteria (gram-positive) and yeasts.5 Even compared to other acids, lauric acid ultimately gave better results in fighting infections and inflammation.6 Because the bacteria Streptococcus mutans has been found in association with cavities3, there is a great possibility that further research can prove the benefits of lauric acid in oil pulling.

So what does this all mean? While the evidence for coconut oil in the use of oil pulling and treatment of various diseases is certainly unresolved, oil pulling has been found to have limited side effects as long as the technique is properly conducted.3 However, contrary to popular advertisements today, the articles studied showed that coconut oil is not a “means to cure all.” In fact, it should only be used as a supplement and not a way to treat serious conditions or infections. As a future pharmacist, I would inform patients inquiring about coconut oil pulling that while there have been reports of people experiencing benefits, this technique has not been fully researched and approved by the FDA. Patients must understand that while oil pulling will likely not harm them, it may not help them either. As research continues, hopefully more conclusive evidence will be produced, giving healthcare providers a better understanding of what to expect from the use of coconut oil in oil pulling.

Let’s hear from you. Have you had success with coconut oil pulling? Where else have you seen this product used to improve health?

References:

  1. Spera R. The best ways you’re probably not using coconut oil. ABC13 Eyewitness News Web site. http://abc13.com/society/the-best-ways-youre-probably-not-using-coconut-oil/315760/. Published September 29, 2014. Updated 2014. Accessed October 5, 2014.
  2. Select committee on GRAS substances (SCOGS) opinion: Coconut oil (packaging). U.S. Food and Drug Administration Web site. “Food.” Select Committee on GRAS Substances (SCOGS) Opinion: Coconut oil (packaging). N.p., 18 Apr. 2013. Web. 16 Oct. 2014. <http://www.fda.gov/Food/IngredientsPacka. Published April 18, 2013. Updated 2013. Accessed October 16, 2014, 2014.
  3.  Almendrala A. Oil pulling might be the next big thing–or not. The Huffington Post Healthy Living Web site.http://www.huffingtonpost.com/2014/03/12/oil-pulling_n_4943808.html. Published 3/12/2014. Updated 2014. Accessed October/16, 2013.
  4. Thaweboon S, Nakaparksin J, Thaweboon B. Effect of oil-pulling on oral microorganisms in biofilm models  . Asia Journal of Public Health. 2010;2(2).
  5. Salleh E, Muhamad II. Starch-based antimicrobial films incorporated with lauric acid and chitosan. AIP Conference Proceedings. 2010;1217(1):432-436.
  6. Huang W, Tsai T, Chuang L, Li Y, Zouboulis CC, Tsai P. Anti-bacterial and anti-inflammatory properties of capric acid against propionibacterium acnes: A comparative study with lauric acid. J Dermatol Sci. 2014;73(3):232-240.

 

Seeking relief when your child is coughing?

October 22nd, 2014

by Laura Farleman, PharmD candidate

Is your child’s nagging cough keeping you up at night? The honey in your kitchen may be the alternative to drug-laced syrups parents are searching for to calm their children’s coughs. The thick syrup nature of honey helps to soothe the throat and increase saliva, which can help reduce the urge to cough. Although not always severe, cough causes anxiety and disrupts sleep for parents and children. This drives many parents to seek immediate relief for their children. In recent years popular opinion has drifted toward the use of honey, but has research proven this golden nectar effective?

The current standard of care for cough in children under the age of 6 recommends talking to a doctor. In 2008, manufacturers voluntarily updated cough and cold product labels to state “do not use” in children under 4 years of age. There are few options available when treating cough in children under 4 years old without talking to a doctor. Main treatment options for children over the age of 4 have focused on cough syrups, such as Delsym or Benadryl containing dextromethorphan (DM) or diphenhydramine (DPH), respectively.1

Honey for acute cough in children, a Cochrane review published in June 2014 looked at the effectiveness of honey for cough in children compared to two commonly used cough medications. A Cochrane review is an organized review of primary research in human health care and health policy. It is recognized worldwide as the highest standard in evidence-based health care. In other words, Cochrane reviews provide the most reliable source for health care information. However, this Cochrane review is limited by only including two small studies each with high risk of bias. This review included two random-control trials involving 265 children (aged 2 to 18 years old) comparing the effect of honey to DM, DPH and ‘no treatment’ on cough relief.2 According to Honey for acute cough in children, researchers determined honey to be a better option than ‘no treatment’ and diphenhydramine (Benadryl) options. Honey was found to be equal to dextromethorphan (Delsym) for reducing frequency, severity, and impact of cough on sleep quality.2

The first study used for this review was published by Paul et al. in 2007, included 105 children (aged 2-18 years) and found honey to be a better option for treating cough than no treatment. Comparison of honey and DM did not show differences in the 2007 Paul study. 3 Compared to DM and no treatment, parents favored honey for relief of their child’s nighttime cough and sleep difficulty.3 The second study used for this review, Shadkam 2010, included 139 children (aged 2-5 years) with a cough and revealed that a 2.5-mL honey dose before sleep provided greater relief of cough compared to DM and DPH.1

A journal review by Dr. Ron Feise from 2008 about the Paul 2007 study stated that honey was better than no treatment for cough frequency, but DM was not a better treatment than ‘no treatment’.4 According to this journal review, DM used to treat childhood cough is not supported by the American Academy of Pediatrics (AAP)5 or the American College of Chest Physicians (ACCP)6. DM is associated with several adverse side effects in children, such as nausea, vomiting, constipation, and/or dizziness.7 In contrast, honey is generally recognized as safe with the exception of a severe form of food poisoning in children under the age of 1.8 Honey is not appropriate in this age group, because the bacteria in the stomach of infants (less than one year of age) has not fully developed.8 Honey provides a safe and effective option for children (1 year and older) over OTC cough and cold medications, which aren’t recommended for children younger than 6 years old.

Practically, what does this mean? The next time your child develops a cough you might consider grabbing some honey from the kitchen or local grocery store. When your child begins to develop a cough, start by giving your child (12 months or older) ½ teaspoon of honey (2.5 mL), or (if 2 years old or older) two teaspoons (10 mL) of honey. Honey may be taken/given as often as is needed to relieve coughing. The thick syrup of honey coats and soothes the back of the throat, while the sweet taste results in salivation, which thins mucus and reduces the urge to cough. Honey may also help the body fend off colds by alleviating cold symptoms and reducing the length of a cough or cold. In addition to honey, ensure your child drinks enough fluid and consider increasing your child’s intake of vitamin C.9

It is important though, to remember that coughing isn’t completely terrible. It’s the body’s way to clear mucus from the airway. If your child is otherwise healthy and sleeping relatively well, typically there is no reason to suppress a cough. If your child has a fever, prolonged or worsening cough, wheezing, or cold symptoms lasting longer than two weeks please talk to a doctor.10

Have you tried using honey for cough in the past? Did you find it effective? In the future, will you use honey to relieve coughing?

References

 

  1. Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010;16(7):787-793.
  2. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Evidence-Based Child Health: A Cochrane Review Journal. 2014;9(2):401-444.
  3. Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM,Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.
  4. Feise R. Journal review II. [commentary on] paul IM, beiler J, McMonagle A, shaffer ML, duda L, berlin CM jr. effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. arch pediatr adolesc med 2007. Journal of the American Chiropractic Association. 2008;45(8):20-1.
  5. Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99(6):918-920.
  6. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S.
  7. Kelly LF. Pediatric cough and cold preparations. Pediatrics in Review. 2004;25(4):115-123.
  8. Grant KA, McLauchlin J, Amar C. Infant botulism: Advice on avoiding feeding honey to babies and other possible risk factors. Community Practitioner. 2013;86(7):44-6.
  9. SCHARDT D. Cold front. Nutrition Action Health Letter. 2014;41(2):11-13.
  10. Teitze, JK. Cough. In: Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription drugs: an interactive approach to self-care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012:205-215