Self Care Pharmacy Blog

Archive for October, 2013


The Truth about Graying Hair Prevention Supplements

Tuesday, October 29th, 2013

by Caleb Lyman, Cedarville University PharmD student

It has always been an accepted fact of life that as you age so does your body. One of the most noticeable signs of this aging is the development of gray hair. While some may be indifferent or even look forward to this process, many often wish they could keep their colored hair for their whole lives. Recently a news article was published which discussed possible over-the-counter products that claim to allow users to keep their hair just how they like it. While the desired outcome is simple, the molecular processes that make this possible are rather complex.

The USA Today article entitled Can Enzyme Supplements Really Keep Hair from Going Gray? contains very interesting information about over-the-counter treatments for the prevention of graying of hair. According to the article, the beauty product company L’Oreal is in the process of researching and developing a new product that is designed to stop the progression of gray hair development before it even begins.1 While it will still be a year or so before L’Oreal has a final product, the article additionally brought to light products that are already available for use. Such products are based off the assumption that as one ages, a certain enzyme, catalase, becomes less prevalent in one’s body.2 Catalase is responsible for removing hydrogen peroxide from the body and when hydrogen peroxide is not removed, a number of results take place, including the bleaching of hair.3 The article also reported the opinions of two respected doctors who stated they were wary of suggesting such a product that is not founded in scientific evidence.1 However, these experts sounded very interested to see if these products did indeed function properly.1

 The principles behind these products are fairly well backed up by science. Catalases are enzymes that have been greatly studied and much is known about their structure and function in the body.4 As stated in the article, a main purpose of catalase is to catalyze the reaction that converts potentially harmful hydrogen peroxide into harmless water and oxygen.5 If the hydrogen peroxide is not converted to water and oxygen it can damage the body as it is or it can be converted to an even more dangerous molecule known as the hydroxyl radical. Hydrogen peroxide is often used as a bleaching agent outside of the body and is effective at bleaching both hair and skin.3 While catalase does its job efficiently and effectively6 it is not the only molecule that is relied upon to handle hydrogen peroxide. Glutathione peroxidase was discovered in 1957 and was shown to work in a similar fashion as catalase.7 That being said, a lack of catalase may not entirely account for gray hair and consequently these supplements may not be adequately correcting the issue they are attempting to resolve.

Despite the seemingly large amount of science behind this topic, there are a number of factors that this article and the makers of these products failed to take into account. First of all no actual controlled experiments have been conducted on these products. Since they are supplements and not directly accountable to the FDA1 this is understandable but it would be much more convincing if there was evidence to say these products do what they so they do. An additional limitation is that there is no science reporting that catalase enzymes decrease in significant amounts across the span of one’s lifetime, potentially meaning these products are not solving the problem they intend to solve.

Pharmacists have a responsibility to watch out for the good of their patients and if they feel uncomfortable with a particular drug they should let their patients know that. Additionally pharmacists should inform patients that supplements are subject to different regulations than other drugs and there is potentially more room for supplement manufacturers to provide misinformation about their products.8 Particularly with OTC drugs and supplements, pharmacists need to be involved in the decision process so that unqualified patients are not on their own when it comes to choosing a safe and effective option to solve their health issue. When everything is considered, I agree with the doctors quoted in the article. I would be very hesitant to recommend this product since its adverse effects have not been studied. However, I am interested in knowing what comes of these products since they seem to be based on good science, if only theoretically.

Would you recommend these catalase enhancing products to your patients? Do you think that preserving one’s physical appearance is worth possible side effects? Do you think such products should be subjected to less scrutiny since they are supplements and not actual drugs?



  1. Healy M. Can enzyme supplements really keep hair from going gray? USA Today. 2013. Available at: Accessed October 17, 2013.
  2. Semsei I, Rao G, Richardson A. Changes in the expression of superoxide dismutase and catalase as a function of age and dietary restriction. Biochem Biophys Res Commun. 1989;164(2):620-5.
  3. Tredwin CJ, Naik S, Lewis NJ, Scully C. Hydrogen peroxide tooth-whitening (bleaching) products: review of adverse effects and safety issues. Br Dent J. 2006;200(7):371-6.
  4. Chelikani P, Fita I, Loewen PC. Diversity of structures and properties among catalases. Cell Mol Life Sci. 2004;61(2):192-208.
  5. Grant CM, Perrone G, Dawes IW. Glutathione and catalase provide overlapping defenses for protection against hydrogen peroxide in the yeast Saccharomyces cerevisiae. Biochem Biophys Res Commun. 1998;253(3):893-8.
  6. Goodsell D. Catalase. RCSB Protein Data Bank. 2004. Available at: Accessed October 17, 2013.
  7. Gaetani GF, Ferraris AM, Rolfo M, Mangerini R, Arena S, Kirkman HN. Predominant role of catalase in the disposal of hydrogen peroxide within human erythrocytes. Blood. 1996;87(4):1595-9.
  8. U.S. Food and Drug Administration. Dietary Supplements. August 28, 2013. Available at Accessed October 29, 2013

The Abuse of OTC Medications in Young Adults: What Can You Do?

Sunday, October 27th, 2013

 By: Ashley Peterson, Cedarville University PharmD Student 

Over-the-counter medications are the most common abused substances after marijuana, alcohol, and prescription drugs.1 According to the National Institute on Drug Abuse, medications are abused in several ways: taking a medication that has been prescribed to someone else, taking a drug at a higher quantity, or for an alternative purpose. This article from a newspaper in Philadelphia highlights the top 10 over-the-counter medicines abused by teens. Teens between the ages of 13 and 16 especially are able to easily access over-the-counter (OTC) medicines at home or in the store.2 The list includes: dextromethorphan, pain relievers, caffeine and energy drinks, diet pills, laxatives and herbal diuretics, motion sickness pills, sexual performance medicines, pseudoephedrine, herbal ecstasy, and other herbal products. The article states that adults and teens do not realize the dangers and effects of abusing OTC medications because they think that they are safer than illegal or prescription drugs which is not the case. Abuse of OTC drugs has high risks and dangers that can be overlooked oftentimes compared to the fear and risks associated with “illegal street drugs.”2 I agree with this, there is less control over OTC products so people have more access to them. It is unfortunate that people find ways to abuse medications that are supposed to help them feel better.


For example, dextromethorphan, the main ingredient in Robitussin and other cough medicines, when taken in large doses (5-10 times the normal dose) causes major side effects in acute and chronic use. A case series study (Ziahee, V et. al.) 3 noted that acute abuse of dextromethorphan caused dyskinesia (impaired movement), euphoria and trance, nausea, vomiting, sweating, speech disorder, and photophobia. Chronic abuse resulted in constipation, apathy (lack of enthusiasm), and fatigue as well. Dextromethorphan may not be an addictive substance by itself but is often used by drug users to add to his or her “high” and to decrease dependency on the addictive substance.

Over-the-counter laxatives are also widely available and are abused by people with eating disorders, those who are dependent on laxatives and certain athletes that have a set weight point.4 Normal bowel function is disrupted and electrolyte imbalance and dehydration occurs when people abuse laxatives even just once. Individuals believe that taking a laxative means that he or she can avoid calorie absorption by inducing diarrhea, however this is not the case since most calories absorbed from food occurs in the stomach and small intestine and not in the large intestine where laxatives act. Sometimes people can experience a rebound effect of acute weight gain and fluid retention when laxatives are suddenly discontinued.4 This means that careful education and treatment is important for someone abusing these laxatives.

One of the other popular OTC drugs to abuse is Benadryl (diphenhydramine), which is classified, as a first-generation, sedating antihistamine.6 Diphenhydramine is lipophilic so it crosses the Blood-Brain barrier readily. It is selective for histamine1 receptors, and activates serotonin and alpha-adrenergic receptors but block cholinergic receptors. Overdoses of these antihistamines cause cardiac symptoms (tachycardia, vasodilation), central nervous system symptoms (hallucinations, toxic psychosis, lethargy), as well as peripheral symptoms (sudden increase in temperature, pupil dilation).6 Overdoses of diphenhydramine sometimes result in hospitalization for treatment.

Although these medications and the rest of the list from the article are available over-the-counter, they can still be harmful if abused. Parents of teenagers and children should be aware of several important factors to help their kids stay away from drug abuse. These include: high levels of involvement in activities, discussing the dangers surrounding any medication or substance that can be harmful if not taking for a correct purpose, being a supportive and encouraging parent to your child and being aware and helping them find good friends.8 Oftentimes school and peer pressure cause young adults to get involved with substance abuse, as a parent, it is important to be aware of this and be proactive in helping your teenager learn to make wise decisions that do not result in serious consequences. Parents, teachers, pharmacists, and doctors should be watchful for signs of abuse (secrecy, abnormal eating or bowel habits, impaired function and activity, sedation, etc). A positive and encouraging role a person has in a young adult’s life is an important step in combatting OTC medication drug abuse at a personal level.9 Take action steps to be involved in lives of young adults in a positive way by asking questions, learning about them, and encouraging them to succeed and make wise decisions.




1. DrugFacts: Prescription and over-the-counter medications. National Institute of Health: National Institute on Drug Abuse Web site. Updated 2013. Accessed October 10, 2013.


2. Cohen M. 10 over-the-counter medicines abused by teens. Web site. Updated 2013. Accessed October 1, 2013.


3. Ziaee V, Akbari Hamed E, Hoshmand A, Amini H, Kebriaeizadeh A, Saman K. Side effects of dextromethorphan abuse, a case series. Addict Behav. 2005;30(8):1607-1613.


4. Laxative Abuse. Drugs [serial online]. August 2010;70(12):1487-1503. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 26, 2013.


5. Scolaro K. Disorders related to colds and allergy. In: Krinsky D, Berardi R, eds. Handbook of nonprescription drugs. 17th ed. Washington DC: American Pharmacists Association; 2012:179.


7. Lessenger J, Feinberg S. Abuse of prescription and over-the-counter medications. Journal Of The American Board Of Family Medicine [serial online]. 2008 Jan-Feb 2008;21(1):45-54. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 26, 2013.


8. Lessenger J, Feinberg S. Abuse of prescription and over-the-counter medications. Journal Of The American Board Of Family Medicine [serial online]. 2008 Jan-Feb 2008;21(1):45-54. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 26, 2013.


9. Mayberry M, Espelage D, Koenig B. Multilevel Modeling of Direct Effects and Interactions of Peers, Parents, School, and Community Influences on Adolescent Substance Use. Journal Of Youth & Adolescence [serial online]. September 2009;38(8):1038-1049. Available from: SocINDEX with Full Text, Ipswich, MA. Accessed October 26, 2013.

New Use for Ibuprofen Gel is Nothing to be “Embarrassed” About

Sunday, October 27th, 2013


By Danielle Eaton, Cedarville University PharmD Student

 Imagine for a moment walking into a room and expecting to sit down in a seat quietly to watch a presentation put on by one of your co-workers.  Now picture as you walk toward your seat being approached by an individual who calmly informs you that your friend is sick and you must present the material to the entire audience.  Not having prepared, you slowly walk up to the podium and meet the eyes of an attentive audience.

Social interaction, public speaking, and various other social encounters come easily and naturally to some individuals and produce very little anxiety or fear.  For those who are not so fortunate to have the ability to remain composed during “all eyes on you” encounters,” blushing or redness of the cheeks can be a troublesome problem.  Blushing is a characteristic of normal human functioning but individuals differ in their blushing propensity and intensity.1 During social encounters, people with social anxiety frequently experience autonomic and motor signs of anxiety, including blushing.2  For some individuals there is an increase in fear of negative evaluation by others which can increase the blushing.3  When we blush there are neurally mediated increases in blood flow to the cheek area and that is what causes the red “flushed” appearance. The increase in blood flow then liberates substances like the vasodilator (makes blood vessels wider) nitric oxide (NO) and prostaglandins (usually involved with injury or pain) which prolong and intensify the effect of the cheek discoloration.4 An article posted by the Australian Associated Press (AAP) in September of this year claims to have a potential remedy for those who are prone to blushing in embarrassing situations.

The article posted on Yahoo News from the AAP references a study conducted at Murdoch University in Western Australia. This study looks at the use of ibuprofen gel placed on the cheek to decrease blood flow and prevent the production of compounds that aid in producing cheek redness (prostaglandins).  For the study 30 adults were hooked up to blood flow measuring equipment.  Each study participant had one cheek rubbed with a small amount of ibuprofen gel, and the other with ultrasound gel to act as a control.  The participants were then asked to perform a variety of seemingly embarrassing tasks like singing karaoke to “I Will Survive” and performing physical exercise.5 No therapeutic recommendations can be made from the study, but that the “findings provide preliminary support for a pharmacological approach to blushing control.” 4  The inhibitory effect of ibuprofen on the blood flow to the cheek lasted throughout both the singing and exercise phases of the study.

The article definitely makes a good case for the use of ibuprofen gel in reducing the incidence of blushing during embarrassing situations.  The use of the gel is an interesting idea, but I would be concerned about some of risks involved and the potential for inappropriate use.  Ibuprofen in tablet formulation is an over-the-counter medication typically use to treat pain and fever.  Even though the gel formulation is a topical preparation some the active drug can be absorbed systemically and should be a cause for concern in patients with active peptic ulcers, asthma, history of kidney disease, or use on broken/damaged skin.  If I were to recommend ibuprofen gel it would be in an instance where the patient had severe facial redness and social anxiety. Since using ibuprofen gel for facial blushing is a fairly new concept there are not many standards to reference for frequency and dosing.  For self-care purposes, I would try to recommend strategies for coping with stress and anxiety before recommending the gel.

One limitation to this study is the use of a non-diverse sample.  The participants were recruited from a student population instead of a clinical setting and was only conducted once through.  There is also need for more in depth studies on whether ibuprofen in this form and for this purpose is safe and effective for repeated use.  Although there is literature on the topical use of NSAIDs like ibuprofen, it is dealing with outcomes of reducing pain and not with reducing facial blushing.  It is hard to compare this study to others when it is dealing with a novel use of this medication.

With all of this information in mind there are many things for both healthcare providers and patients to consider. If ibuprofen gel was available over-the-counter, would you feel comfortable rubbing a gel on your cheek before you know you could potentially be embarrassed?  Is it necessary for this type of option to exist, or should we learn to cope with anxiety and embarrassment in other ways?




  1. Leary, M.R., Britt, T.W., Cutlip, W.D., Templeton, J.L., 1992. Social Blushing. Psychological Bulletin 112, 446-460.
  2. S.M. Bögels, L. Alden, D.C. Beidel, L.A. Clark, D.S. Pine, M.B. Stein, M. Voncken. Social anxiety disorder: questions and answers for the DSM-V. Depress. Anxiety, 27 (2010), pp. 168–189
  3. M.J. Voncken, S.M. Bögels. Physiological blushing in social anxiety disorder patients with and without blushing complaints: two subtypes?. Biol. Psychol., 81 (2009), pp. 86–94. Available at: Accessed October 16, 2013.
  4. Peter D. Drummond, Kate Minosora, Gretta Little, Wendy Keay. Topical ibuprofen inhibits blushing during embarrassment and facial flushing during aerobic exercise in people with a fear of blushing. European Neuropsychopharmacology. Available at: Accessed: October 16, 2013.
  5. Gel could stop embarrassing blushes. Yahoo News. 2013. Available at:–spt.html. Accessed October 16, 2013.

Aspirin’s Effect on Colorectal and Gastrointestinal Cancers

Friday, October 25th, 2013

by Rebecca Kyper, Cedarville University PharmD Student


We are all familiar with aspirin, a common over the counter, nonsteroidal anti-inflammatory drug (NSAID). Aspirin is used to treat pain, fever, and it is used for preventive heart health. The effect of aspirin on certain types of cancers has been studied for a few years, especially in colon cancer and esophageal cancer. One study found that aspirin significantly decreased deaths from colorectal cancer (P=.003).1 Another study presents significant findings about aspirin reducing the risk of gastric cancer (P =.02).2 Yet another study found statistically significant data (P=.001) that aspirin reduces the risk of esophageal cancer.3 There are other studies with these types of findings that show aspirin can help with gastric cancers. US News online reported on a new study that attempts to explain why this effect has been observed in the literature.4

This article briefly describes the findings of a new study that claims aspirin may lower the rate of DNA mutation in the GI tract. The study consisted of thirteen patients with Barrett’s esophagus, which often progresses into esophageal cancer.They tested mutations in tissue samples collected by these patients, and compared the mutation rates with the amount of aspirin the patients had taken.4 Although they saw a reduction in the mutation rates of those patients who were on aspirin compared to those who were not, the data was not statistically significant.4 The researchers plan on investigating this further in attempt to find more data. They theorize that DNA mutations will be reduced because of the anti-inflammatory action of aspirin.4

This study is interesting and reports findings that have built groundwork for more research to be done to explore this possibility. The article presents a very positive view, which may be premature for the study. The study had a few limitations that must be factored into the results. The first limitation is that there was no statistically significant conclusion (the article states that there was no cause-effect relationship found) made from their data. With no statistical significance found, it is hard to be positive about the promising results of the study because these effects could be from outside variables. The sample size was only thirteen patients, which decreases the statistical power and generalizability of these findings. It would be very helpful to increase the amount of patients in additional studies. These limitations lead to a more careful review of the study, but I do not think they negate the possibility that future research could produce more conclusive results.

The literature on the effects of aspirin on DNA mutation is limited; however, one study suggests other mechanisms for aspirin’s apparent effects on gastric cancers. This study found that aspirin has an effect on NFkB signaling and apoptosis of cells (cell death), and this is what contributes to its preventative effects.5 This study could play a role in the direction the new studies will take. If aspirin shows evidence of increasing the rate of cell apoptosis, this could be tied to lowering the rate of DNA mutation. However, this does not mean that aspirin would directly affect DNA mutation. Another study showed that aspirin may reduce the risk of certain types of cancers by suppressing a mutation phenotype.This study also had information and research on the apoptosis that is caused by aspirin, and about how aspirins effect could be tied more directly with DNA. 6 All of these studies encourage further research to be done to explore aspirin’s effects on gastric cancers in depth.

The prior research about the effects of aspirin on specific types of cancers would be reason to pursue the ideas presented by the article. Though there is hopeful discovery, it is far too early to jump to conclusions without much more research being done. As the research stands, I would not change or alter recommendations for aspirin. There is not enough conclusive evidence for the mechanism of aspirin’s’ effect on gastric cancers. Although there are studies that show aspirin has a positive effect on gastric cancers, more definitive research could also be done in that area as well. Another factor to consider is the risks involved when recommending aspirin. Even if more conclusive data were found, widening the use of aspirin would need to be weighed against its side effects. Aspirin could cause significant bleeding problems in the GI tract, as well as liver and kidney impairment. Without significant data to prove the benefits of aspirin in gastric cancers, recommending aspirin for this therapeutic use is not worth the risks involved.

Do you think this new study has a promising direction of discovery in light of the past research that has been done in this area? What could be the role of aspirin were there more conclusive findings presented in future research and would you change your recommendations based on more conclusive data?


[1] Rothwell, P; Fowkes, F; Belch, J; Ogawa, H; Warlow, C; Meade, T. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual data from randomized trials. The Lancet [serial online]. January 2011;377:(9759)31-41. Available from google scholar with Full Text, Ipswich, MA. Accessed October 9, 2013.

[2] Akre, K; Ekstorm, A; Signorello, L; Hansson, L; Nyren, O. Aspirin and risk for gastric caner: a population based case-control study in Sweden. British Journal of Cancer [serial online]. April 2001;84(7):965-968. Available from google scholar with Full Text, Ipswich, MA. Accessed October 9, 2013.

[3] Sivarason, N;Smith, G. Role of Aspirin in chemoprevention of esophageal adenocarcinoma: A meta-analysis. Jounral of Digestive Diseases [serial online]. May 2013; 12(5):22-230. Available from Academic Search Complete with Full Text, Ipswich, MA. Accessed October 10, 2013.

[4] Scientists Explore How Aspirin May Guard Against Cancer. US News Health. June 20 2013. Accessed October 3, 2013.

[5] Din, F; Dunlop, M; Stark, L; Evidence for colorectal cancer call specificity of aspirin effects on NFkB signaling and apoptosis. British Journal of Cancer [serial online]. July 2004;91(2):381-388. Available from Academic Search Complete with Full Text, Ipswich, MA. Accessed October 9, 2013.

[6] Rushchoff, J; Wallinger, Dietmaier, W; Bocker, T; Brockhoff, F; Rishel, R. Aspirin suppresses the mutator phenotype associated with hereditary nonpolyposis colorectal cancer by genetic selection. National Academy of Sciences of the United States of America [serial online]. May 1998;95(19):11301-11306. Available from Academic Search Complete with Full Text, Ipswich, MA. Accessed October 10, 2013.

Should OTC Painkillers Used After Tonsillectomy Instead of Standard of Care?

Thursday, October 24th, 2013

By Megan McNicol, Cedarville University PharmD Student


In the United States, a tonsillectomy is the second most common outpatient surgery for children younger than 15.  Each year, an estimated 662,000 American children have a tonsillectomy.1   This procedure is performed when there are recurrent episodes of tonsillitis or bacterial infections causing tonsillitis that are not improving with the use of antibiotics.  As a result, a procedure is often performed to remove the tonsils.2  While the surgery is usually successful, pain is a common side effect following a tonsillectomy and can lead to dehydration, difficulty swallowing and weight loss.  For this reason, some sort of pain reliever is necessary to manage the symptoms. 1


The article, “After tonsillectomy, over-the-counter painkillers suffice” published by US News and Health discussed how researchers performed a study examining 25 children and adults after a tonsillectomy and the various painkillers used to accommodate post-operation pain.  The study determined that ibuprofen managed the pain just as effectively as any prescription painkiller that has been used in the past.  A common painkiller used was acetaminophen with codeine or acetaminophen with hydrocodone.  Not only was ibuprofen proven just as effective in relieving pain as the prescription medications, but it also proved to be the safest alternative for children.1

 Codeine is an opiate (narcotic) analgesic that changes the way the body senses pain by converting codeine into morphine in the body.3,4  As a result, many children experience side effects such as nausea, emesis, and constipation, especially if the child is a ‘CYP2D6 ultra-rapid codeine metabolizer’. In these patients, codeine is converted into morphine in the body at a faster rate than normal, resulting in high levels of morphine in the blood that can cause toxic effects such as breathing difficulties.4  An article published in the Journal of the American Academy of Physician Assistants reiterated the FDA’s recommendation to avoid using codeine in children after a tonsillectomy due to the risk of respiratory depression, a condition in which there fails to be full ventilation to the lungs.5  For this reason, I would agree with the article that if products containing codeine can be avoided, this would be a better treatment option, especially in children.

Another reason for this consensus is the proven effectiveness of ibuprofen.  A study was done by the Department of Pediatrics at the University of California comparing the effectiveness of acetaminophen with codeine to ibuprofen for children ages 5-17.  It was shown, when measuring pain levels from baseline of both medications, the ibuprofen group was favored because it was just as effective as acetaminophen with codeine without the health risks.6  Indiana University Medical Center also measured post operative pain using a validated pain scale for pediatric patients.  It was determined that ibuprofen is at least as effective as acetaminophen with codeine for post-operative pain control in children.7

As mentioned above, there are many studies in support of the claim made by this US News and Health article.  However, there are also limitations to the article and the claims that it makes.  One limitation is that the article has yet to be published in a peer reviewed medical journal meaning that the quality of the article has not been assessed by an expert journal editor in the field.1  The benefit of a peer-reviewed article is that the reviewer will have checked for validity and rigor as well as made any additional suggestions to the study design.8 However, the study was presented in the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery in Vancouver, providing a peer review process until it is officially published in a medical review journal.  In addition, the study also stated that, “An over the counter painkiller is as effective as prescription drugs in controlling pain after people have their tonsils removed”.  However, in the following paragraphs, the study only examined the effects in twenty-five children and not in adults.  This causes one to wonder if ibuprofen is just as effective for adults as well, or only in children.  Thus, the results cannot be generalized to the adult population, and only a small sample size was tested creating some additional limitations in the research.1

Nonetheless, the use of ibuprofen is a valid treatment option in place of the standard treatment such as acetaminophen with codeine.  This recommendation will affect the frequency and demand of ibuprofen as an over the counter medication.2  The effectiveness, safety, and limited side effects of ibuprofen make it a good treatment option for pain management following a tonsillectomy for those 6 months and older.6

As US News and Health states, it appears that an over the counter medication such as ibuprofen is just as effective as a prescription painkiller in children following tonsillectomy.  Not only does it provide a cheaper and more convenient treatment option, but it is also a safer approach to treatment, especially in children.1  This leads one to wonder, would a similar treatment approach prove to be just as effective in adults?



  1. After tonsillectomy, over-the-counter painkillers suffice, study says. US News: Health Web site. Published October 3, 2013. Accessed October 10, 2013.
  2. Tonsillitis. Mayo Clinic Web site. Published August 4, 2012.  Accessed October 10, 2013.
  3. Codeine. Medline Plus Web site. Published November 11, 2012.  Accessed October 10, 2013.
  4. Restrictions on use of codeine for pain relief in children – CMDh endorses PRAC recommendation. Eurpoean Medicines Agency Web site. Published June 28, 2013.  Accessed October 10, 2013.
  5. DeDea L, Bushardt R. PHARMACOLOGY CONSULT. Codeine and acetaminophen recommendations for children. JAAPA: Journal Of The American Academy Of Physician Assistants (Lippincott Williams & Wilkins) [serial online]. September 2013;26(9):11-12. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 10, 2013.
  6. Friday J, Kanegaye J, McCaslin I, Zheng A, Harley J. Ibuprofen provides analgesia equivalent to acetaminophen–codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial. Academic Emergency Medicine [serial online]. August 2009;16(8):711-716. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 10, 2013.
  7. St. Charles C. A comparison of ibuprofen versus acetaminophen with codeine in the young tonsillectomy patient . Science Direct. 1997;117(1):76-82.
  8. Evaluating information sources. Lloyd Sealy Library Web site. Published March 25, 2013.  Accessed October 10, 2013.



Preventative Self-Care for Type 2 Diabetes..Eat More Fruit?

Tuesday, October 22nd, 2013

By McKenzie Shenk, Cedarville University PharmD Student


Diabetes mellitus has effected the human population for centuries; however only in recent decades have large strides been made in prevention and treatment.1 Both types of diabetes mellitus – type I and type II – can be manageable for patients with various medication regimens and lifestyle choices once they have been diagnosed. Research has also contributed to understanding of how type II diabetes (T2D) can be prevented. (Type I diabetes is an autoimmune disease, which means your immune system attacks your pancreas cells, so it generally cannot be prevented.2, 3 For more information about type I diabetes, check out this website. Even as our knowledge of T2D and its treatment and prevention has grown, the prevalence and incidence of T2D continues to rise.4


BBC, a well-respected international news and broadcasting organization based out of Great Britain, recently summarized some research that relates to T2D prevention.5, 6 The research showed that eating certain fruits decreased the participants’ chances of getting diabetes. The fruits with the best results were blueberries, apples and grapes. The study also showed that replacing three serving/week of fruit juice with whole fruit lowered the risk of T2D by 7%.2 The study reiterates that reducing the risk of T2D depends upon a well-balanced, healthy diet in addition to physical activity.

In light of this study, my recommendations to diabetic patients will not change nor does the standard of care change. It is generally understood that healthy lifestyle choices are beneficial on many levels. By eating right and exercising, patients can loose weight or maintain a healthy weight, T2D can be prevented and lower need for medications, and risk for other diseases like heart failure and high cholesterol also decreases. Patients have the choice whether or not they want to change how they are living to make healthier choices. As a pharmacist, I can only recommend and encourage patients to continue to make healthier choices. I need to present patients with the facts, which will allow them to make informed choices.

Like with any study, this research has limitations. First, as the BBC article recognized, the study depended upon self-reported fruit consumption.5 People do not always remember exactly what they eat. People could also try to sound healthier than they actually are and therefore not be entirely accurate. In addition, there is inevitable variability between people, some making healthier decisions than others, often referred to as the “healthy user bias”. The researchers recognized these limitations and controlled for some of these variables in their statistical analyzes. Also, in the study design the researchers tried to minimize bias by doing a prospective study and excluding subjects with other chronic diseases. This choice also limits the generalizability of the data to people with multiple chronic disease states. However, it is important to recognize that the outcomes of the study continue to support the growing body of evidence that eating whole fruit in general contributes to reducing risk of T2D.

While the BBC article does not present other references, much literature is available regarding the correlation between healthy lifestyle choices and prevention of diabetes. In general, the research shows that eating leafy greens and fruit help prevent diabetes.7, 8, 9 Studies have shown that diets with low glycemic indexes help prevent diabetes.10, 11, 12 Glycemic index (GI) refers to the effect different foods have on blood glucose levels. Fruits, such as berries, have lower GIs, while bananas and pineapples have higher GIs, yet the study showed that bananas were helpful in reducing the risk of T2D. 2, 6

A significant study in understanding diabetes prevention was The Diabetes Prevention Program.13, 14 The Program tested various methods for prevention of T2D, not limited to fruit consumption. The results showed that intensive lifestyle changes were the best way to prevent T2D. These changes included losing weight with healthy eating and exercise habits in addition to exercising at least 150 minutes per week.13 The other option was using the medication metformin; however, this preventative measure was not as effective as lifestyle modifications.

Statistics show that by 2020, 1 in 3 Americans will have T2D.4 There is a correlation between socioeconomic status, ethnicity, and insurance status and prevalence of T2D.15,16 Many of individuals at risk come from minority groups which continue to grow in the US, contributing to the larger percentage of Americans with diabetes.4, 16 This is a significant issue facing our society, and you need to be aware of your risk for T2D. But there is hope. By taking preventative measures such as changing diet and exercise lifestyles, you do not have live under the prospective shadow of a life-long disease. Consult your doctor or pharmacist if you have any concerns about T2D or making lifestyle changes.

As I think about my future practice in pharmacy, I should consider how to work with my patients who are at risk for T2D. How can I help my patients be more successful in preventing diabetes? How can I encourage and support them in making healthy choices? How can I work to implement healthy life choices into my own life?




  1. Sattley, M. The history of diabetes. Diabetes Health. 2008(Nov 1996):October 12, 2013.
  2. Muraki, I.; Imamura, F.; Manson, J. et al. Fruit consumption and risk of type 2 diabetes: Results for three prospective cohort studies. BJM. August 29 2013:October 12, 2013.
  3. What is diabetes? BBC Science Web site. Published April 19, 2013. Updated 2013. Accessed October 13, 2013.
  4. Allen, J. Half of americans adults are headed for diabetes by 2020, UnitedHealth says. ABC News Web site. Published November 25, 2010. Updated 2010. Accessed September 15, 2013.
  5. Blueberries, not fruit juice, cuts type-2-diabetes risk. BBC News Web site. Published August 29, 2013. Updated 2013. Accessed September 10, 2013.
  6. Carter, P.; Gray, L.; Troughton, J.; Khunti, K.; Davies, M. Fruit and vegetable intake and incidence of type 2 diabetes: Systematic review and meta-analysis. British Medical Journal. Accessed: October 12, 2013.
  7. Montonen, J.; Järvinen, R.; Heliövaara, M.; Reunanen, A.; Aromaa, A.; Knekt, P. Food consumption and the incidence of type II diabetes mellitus. European Journal of Clinical Nutrition. 2013:59(3):441.
  8. Schwarz. P.; Reddy, P. eds. Prevention of diabetes. 1st ed. United Kingdom: John Wiley and Sons; 2013.
  9. Preventing diabetes. Harvard School of Public Health Web site. Updated 2013. Accessed October 12, 2103.
  10. Thoma,s D.; Elliot, E.; The use of low glycaemic index diets in diabetes control. British Journal of Nutrition. 2010;104(6):797.
  11. Marsh, K.; Barclay, A.; Colagiuri, S.; Brand-Miller, J. Glycemic index and glycemic load of carbohydrates in diabetic diet. Current Diabetes Reports. 2011;11(2):120.
  12. Jenkins DJA, Srichaikul K, Kendall CW, et al. The relation of low glycaemic index fruit consumption to glycaemic control and risk factors for coronary heart disease and type 2 diabetes. Diabetologia Clinical and Experimental Diabetes and Metabolism. 2010:October 12, 2013.
  13. Diabetes Prevention Research Group. The diabetes prevention program. Diabetes Journal. 1999;22:623-34.
  14. Ratner R. An update on the diabetes prevention program. Endocrine Practice. 2006;12:20-24.
  15. Center for Disease Control and Prevention. Diabetes report card 2012. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation. Web site. Updated 2012. Accessed October 18, 2013, 2013.
  16. Ali, M.; Bullard, K,; Imperatore, G.; Barker, L.; Gregg, E. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes — national health and nutrition examination survey, united states, 2007–2010. June 2012;61:October 12, 2013. 32-36.

Plan B- No Age Limit?

Friday, October 18th, 2013

By Jacob Farran, PharmD Student at Cedarville University School of Pharmacy


The Plan B One-Step emergency contraceptive, commonly referred to as “the morning after pill,” has always been surrounded by controversy. As a behind the counter medication, the morning after pill used to only be able to be purchased by anyone who is 17 years or older without a prescription. Now, even more dispute is occurring because a new drug application was submitted to the FDA that allows Plan B to be sold without a prescription to anyone without age restrictions.1 The FDA approved of this and lifted the age restriction. This means that any person can now purchase Plan B without a prescription and without talking to her physician or pharmacist.  Plan B works by taking a large dose of the hormone levonorgestrel that can work in three possible ways including delaying ovulation, interfering with fertilization of the egg, or preventing the implantation of a fertilized in the uterus by altering its lining.3 The prevention of implantation is controversial, however it works by a similar mechanism to oral contraceptives.2 If Plan B does prevent implantation, it could act as a form of abortion if one considers life beginning at fertilization. There is great debate on where life begins since an egg is not viable without implantation. Plan B’s effectiveness was found to be between 52% and 94% in preventing pregnancy.4

This article reported that the age restriction on Plan B would be lifted and it was lifted shortly after this article was written, as there is no age restriction on Plan B now. The article also voiced opinions both for and against the decision to remove the age limit on Plan B. Annie Tummino, a coordinator of the National Women’s Liberation, said that women and girls should have “the absolute right to control our bodies without having to ask a doctor or a pharmacist for permission.” She went on to say, “It’s about time that the administration stopped opposing women having access to safe and effective birth control.”1 Cecil Richards, the president of Planned Parenthood Federation of America said the government’s decision to drop the appeal was “a huge breakthrough for access to birth control and a historic moment for women’s health and equity.”1 These two people and groups were obviously supporting the change to no age requirement. Others such as the anti-abortion group Family Research Council criticized the government by saying, “We’re very concerned and disappointed at the same time because what we see here is the government caving to political pressure instead of putting first the health and safety of women (and) parental rights.”1 President Obama is against the age change. He said, “As the father of two daughters, I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine.”1

I agree with the anti-abortion group and President Obama that there needs to be an age limit on the Plan B pill. A women under 17 at least needs to talk to her healthcare provider about the risks and benefits before making a decision that big. My recommendation would be for young women to consult their parents and healthcare provider before using Plan B.  This article was limited due to a limited scope of opinion. Only opinions of politicians and organization leaders were included.  There were not any pharmacists or health care providers that voiced their opinion in this article. There is not any scientific evidence saying that we should or should not have an age restriction on Plan B; however, the intentions of this medication are to prevent conception of a baby. Statistics show that Plan B is successful in preventing more than 50% of pregnancies and is associated with side effects.

Should there be an age limit or not?



1.) Obama administration says it will allow all girls to have morning-after pill access | Fox News. (2013, June 11). Fox News Politics. Retrieved October 2, 2013, from


2.) How emergency contraceptives (the morning after pill) prevent pregnancy. (n.d.). Emergency Contraception. Retrieved October 16, 2013, from


3.) Plan B One-Step. (2012, August 5).WebMD Women’s Health. Retrieved October 2, 2013, from


4.) Update on Emergency Contraception: Effectiveness . (2011, March 1).Association of Reproductive Health Professionals. Retrieved October 16, 2013, from

Are Nutritional Supplements Necessary?

Thursday, October 17th, 2013

By Cara Toms PharmD Student Cedarville University School of Pharmacy

Eating healthy foods and making sure we get the proper vitamins we need to live a long, rich life seems like a topic that will never go away. It is always an interest that makes people explore how to optimize our body’s function, and how the foods we eat can play a part in that, as well. Many people believe if they do not eat healthy or do not like to eat healthy, they can take vitamins and supplements to give them the nutrients they need. Others believe, that even though they do eat healthy, they still do not have enough of the good vitamins, and turn to supplement use to give them an extra boost of energy or protection from potential disease. So, what’s true? Are additional supplements necessary in keeping our body healthy, or is our diet enough?

There is an online article from the; Nutrients are better on a plate than a bottle that was recently written by Hope Warshaw.1 This article takes a stand on how the common thought that “more is better” is not always true, especially when it comes to the use of health supplements. They identified studies from Paul Offit, chief of infectious diseases at Children’s Hospital in Philadelphia, that showed that extra amounts of supplements did not improve one’s health to a greater extent, and often times, there were great side effects to over-using supplements. Offit stated, “when people take too many antioxidants, they can tip the balance to an unnatural state in which the immune system is less able to kill invaders”. The article goes on to say that people, who are healthy and eat a balanced diet, do not need supplements. If a person does suffer from a medical condition or for some reason cannot get a necessary nutrient, supplements can help. However, if one is healthy, the foods they choose to eat can make all the difference.

I would agree for the most part with this article. According to the Handbook of Nonprescription Drugs: 17th Edition, it says that a balanced diet is the best way to get the necessary nutrients you need. It goes on to say that, “vitamin and minerals are better absorbed from food rather than supplements”.2 If you are getting a balanced diet, you are adding to your body the right amount of nutrients that it needs to properly function. The book also addresses “extra” amounts of supplements (multivitamin, megavitamins) may not be beneficial, but more studies need to be done. If you are only taking these to give yourself “extra-protection” and are already getting a balanced diet, you should be cautioned that the high levels from these supplements might lead to a toxic amount. It is also known that there are some vitamins that cannot be made synthetically and that only your body can get through your diet2. Therefore, it is important to gain these strictly from the foods you eat.  There are many articles to support this claim. Many studies have found no benefit in taking supplements versus a balanced diet.3 Studies also have found that toxicity of supplements is common and real, and many people exceed the recommended doses.4 We can conclude that getting a balanced diet, high in fiber, vegetables, fruits, and meats, is the most important way we can protect our bodies from harm and sickness. If we are obtaining all of our vitamins through our meals, there is no need to take extra supplements. In fact, it might be dangerous to continue to take extra supplements when your diet already fulfills your nutrient needs.

Are you getting all your nutrients by the meals you eat? If not, how can you change your diet, so you can get adequate levels of all the necessary nutrients?


1 Warshaw, H. Nutrients are better on a plate than in a bottle. Washington Post. Updated August 13, 2013. Accessed  September 9, 2013.

2Huckleberry Y, Rollins C. Essential and Conditionally Essential Nutrients. In: Krinsky D, ed. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. Washington DC: American Pharmacists Association; 2012:375-404.

3 Krauss RM, Deckelbaum RJ, Ernst N, et al. Dietary guidelines for healthy American adults: A statement for health professionals from the nutrition committee, American heart association. Circulation. 1996;94(7):1795-1800.

4Koul PA, Ahmad SH, Ahmad F, Jan RA, Shah SU, Khan UH. Vitamin D toxicity in adults: a case series from an area with endemic hypovitaminosis d. Oman Med J 2011. May;26(3):201-204.

Are cold medicines safe in young children?

Thursday, October 17th, 2013

By Maria Miller PharmD Student Cedarville University School of Pharmacy

Cold season is now upon us and that means doctor offices and pharmacies will be swarmed with people who are picking up prescriptions for their colds and buying over the counter medicine to help symptoms. Most people skip the doctor and head straight for over the counter medicines, including parents of young children.  Too often, parents are giving their children, 4 years and younger, cold medicine when they should not be. According to the Official Journal of the American Academy of Pediatrics, in the years 2004-2005, 5.7% of all emergency room visits were for children under the age of 12 who were experiencing adverse effects of cold medicine.1  Out of these children, 64% of them were between the ages of 2-5.1 Cold medicine products typically include pseudoephedrine, diphenhydramine, dextromethorphan, and guaifenesin.2  Labeling on these medicine bottles in 2008 stated it should not be used in children under 2 years of age. 3

An article posted in U.S. News during April 2013 discussed a survey that was given out to patients that asked if they administered cold medicines to their young children. The survey included 498 parents of children under the age of 3.3 The results showed that many parents gave their children cold medicines to help with their symptoms under the age of 4.3 According to the article, in 2008, labels on these over the counter cold medicines warned that they should not be given to children under 4.3 These medicines can cause allergic reactions, increased or uneven heart rate, slow and shallow breathing, confusion or hallucinations, drowsiness or sleeplessness, convulsion, nausea and constipation. 3 Parents giving their young children these medicines are generally confused by the labeling of ‘children’s’ medicine and they do not look at the back of the box that gives greater detail of what age the medicine should and should not be used in. The survey director Dr. Matthew Davis said, “Products like these may work for adults, and parents think it could help their children as well. But what’s good for adults is not always good for children.”3 This article urges parents to carefully read labels on children’s cold medicines before giving them to their young child.

Scientific studies have not found evidence that children’s cold medicine is effective. According to the New England Journal of Medicine, since 1985 all the controlled studies for cold medicine in children under the age of 12 have shown that there is no meaningful difference between the active drug of a cold preparation and placebo. 4 Even with this scientific evidence, some manufacturing companies refuse to change their labels to say that patients under the age of 6 should not use.4 Instead they market that their products are “safe, effective, and pediatrician recommended.” 4 Parents often take this as truth and give the medicine to their young children.

I fully agree with this article that parents need to look more carefully at the labels on medicines, especially when administering it to children younger than 6. Health care provider recommendations have age limits on cold products for the safety of children. When these recommendations are ignored either by accident or on purpose, the child is being put at risk for serious adverse effects. The easiest and quickest way to get a recommendation is from a local pharmacist. Pharmacists will be able to interpret directions if the parents are confused and will be able to determine if the child will need to be seen by a physician.

There are limitations to the article in the fact that it is a brief statement on how parents give cold medicines to young children when they shouldn’t. It mentions how they received these results through a survey but the article did not say what the name of the survey was nor did it say much more about the survey other than it was given to 498 parents with children under the age of 3. It would be beneficial to see the questions on the survey in order to evaluate if the questions matched what the results were. Another limitation is that the article could have gone deeper into what medicines are misused the most, how often parents ask pharmacists for help, and other studies that have been completed on the use of cold medicines in young children. It could also mention what would be the next step for parents to take. Pointing out the misuse is a great first start, but giving another option of what parents could do would be helpful.

How many of you know parents who give their young child cold medicine because they think it’s safe?

What do you use or recommend for colds in kids under 4 with cough or cold?




1. Schaefer M, et al. Adverse Events From Cough and Cold Medications in Children. Official Journal of the American Academy of Pediatrics. 2008; 121: 783-787


2. Vernacchio L, et al. Cough and Cold Medication Use by US Children, 1999-2006: Results from the Slone Survey. Official Journal of the American Academy of Pediatrics. 2008; 122:323-329


3. HealthDay. Many Parents Give Kids Cold Medicines When They Shouldn’t, Survey Finds. U.S. News. April 23, 2013. Accessed October 2013.


4. Sharfstein, J. Over the Counter but No Longer under the Radar-Pediatric Cough and Cold Medications. The New England Journal of Medicine. 2007; 357:2321-224.



Lavender Aromatherapy…would you use it?

Monday, October 14th, 2013

By Jinwon Byun, PharmD Student Cedarville University School of Pharmacy

Aromatherapy is a self-care treatment that uses essential oils and other plant aromatic products. Aromatherapy is applied by inhalation, massage, and topical application(1). Today, people use essential oils in aromatherapy for many reasons: as an analgesic, antimicrobial, antiseptic, anti-inflammatory, astringent, sedative, antispasmodic, expectorant, and for diuretic purposes(2).

Lavender is one of the popular aromas. Many researchers have studied lavender essential oil. They have done many studies to find out the benefits of using lavender oil with and without medical conditions. Lavender aromatherapy works as analgesic, antidepressant, anti-hypertensive, anti-spasmodic, sedative, and nervine. Therefore, it is good for muscle spasms, arthritis, sprains, headaches, tension, anger, irritability, insomnia, stress, anxiety and hysteria. However, overuse of lavender oil can lead to a stimulant effect(3).

Recently, many researchers have studied the effectiveness of lavender aromatherapy to reduce pain. Analgesics can cause serious side effects, and often they interact with other medicines. Aspirin and ibuprofen should not be taken with warfarin and some other anticoagulant medications because they have a high risk of bleeding. The combination may cause stomach irritation, and patients with stomach ulcer should avoid many of these analgesics. Also, children, elderly, pregnant and breastfeeding women need to be cautious about which products they choose to take to relieve pain.(4). Because lavender aromatherapy may be a safer alternative treatment, patients could reduce risks from other pain relief treatments.

Researchers in Japan studied the analgesic effects of aromatherapy using lavender odor treatment. Researchers provided mechanisms of how aromatherapy reduces pain and unpleasantness. The odor of aroma activates limbic system, which is related to the pain process to alleviate pain. Also, limbic system changes cause respiratory patterns to be slower and deeper, which in turn relieve pain or unpleasant feeling. Another factor of aromatherapy is a placebo effect, which is “the nonspecific psychological or psychophysiological therapeutic effect produced by a substance or procedure that is without any therapeutic effect for the specific condition being treated(5).”

Twenty four subjects participated in the study. They were divided into two groups. The researchers provided information about lavender odor to one group but not to the other group. Subjects received electrical stimulation that cause the pain and recorded changes of pain (100mm visual analogue scale), total respiratory time (sec), and tidal volume (mL) before and after the aromatherapy. They also recorded the pleasant score for both lavender odor and no odor treatment. According to the results, the lavender odor was more effective than no odor treatment for pain relief in both the informed and non-informed groups. But, the informed group shows more effective than the non-informed group. So, the researchers conclude that the placebo effect takes significant part of aromatherapy for analgesia(5).

However, the study carried limitations. The study was not the blind study to lavender odor and no odor treatments. Since the subjects can smell and determine the lavender odor, researchers could not examine the scientific effect of the lavender odor due to strong placebo effect alone. Researchers did not control for the placebo effect on subjects, so the study has lack of physiological evidence for aromatherapy.

CBS news argues aromatherapy is not a physiologically effective treatment for immune system, blood pressure, and wound or pain, especially with lavender oil, according to the study by Ohio State University(6). However, I believe lavender oil is good for analgesic effects because many studies have shown evidence of effective lavender aromatherapy. According to Kim et al’s study, patients who have undergone breast biopsy therapy were satisfied with controlling their pain by using lavender oil(7). Also, lavender oil reduces pain of pediatric patients with tonsillectomy. The pediatric patients used less analgesic medications with lavender oil(8). To have better results from lavender oil, patients should remember that the aromatherapy is more effective to people who believe efficacy of aromatherapy(5).

Personally aromatherapy with lavender oil has been effective at relieving stress.  As with every treatment, some populations need to be careful when using lavender aromatherapy. Patients who have a lavender allergy should not use lavender oil. Because lavender has a relaxation effect, patients who take anti-anxiety medications should ask their health-care provider before using lavender oil. Also, pregnant and breastfeeding women should ask their provider before using lavender. Applying lavender oil on the skin can cause skin irritation, so patients should avoid applying lavender oil on the open-wounds(9).

After this research, I wonder if the aroma odor is only effective, when a patient is pleasant to the odor? Does the therapy work independently with a patient’s pleasantness of the odor? If a patient does not like the odor, then is aromatherapy not effective? Or can it even make the symptoms worse?


[1] Ehrlich S. Aromatherapy. University of Maryland Medical Center. August 2011. Available


[2] Aromatherapy. The Free Dictionary. Available at http://medical-

[3] Enteen S. Aromatherapy and Massage. Massage Magazine. October 2011; 185:47.

[4] DrugInfo. Analgesic (Painkiller) Facts. January 2013. Available at

[5] Masaoka Y, Takayama M, Yajima H, Kawase A, Takakura N, Homma I. Analgesia Is

Enhanced by Providing Information regarding Good Outcomes Associated with an Odor: Placebo Effects in Aromatherapy?. Evidence-Based Complementary and Alternative Medicine. May 2013; 2013:1-8.

[6] CBSNEWS. Aromatherapy Effectiveness Questioned. CBS. February 2009. Available at

[7] Kim JT, Wajda M, Cuff G, et al. Evaluation of Aromatherapy in Treating Postoperative

Pain: Pilot Study. Pain Practice. December 2006; 6(4):273-277.

[8] Soltani R, Bagheri M, Soheilipour S, Hajhashemi V, Asghari G. Molavi M. Evaluation of

the Effect of Aromatherapy with Lavender Essential Oil on Post-tonsillectomypain in Pediatric Patients: A Randomized Controlled Trial. International Journal of Pediatric Otorhinolaryngology. September 2013; 77(9):1579-1581.

[9] Ehrlich S. Lavender. University of Maryland Medical Center. March 2011. Available at: