Tag Archives: pills

Diamox and Neptazane for the Eye

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What are carbonic anhydrase inhibitors (CAI)?

            CAI medicines are sometimes prescribed to lower the pressure in the eye either to control pain or to decrease the chances of damage to the eye from high pressure (as in glaucoma). They may also be used to decrease abnormal fluid leakage from blood vessels in the retina (e.g. retinitis pigmentosa). These pills are very effective and may be used along with eye drops to lower the eye pressure. The two most common pills used are Diamox (acetazolamide) and Neptazane (methazolamide).

What side effects might be encountered?

            While you are taking these medicines, you may notice a tingling sensation in the fingers, toes, or lips; an altered sense of taste; a loss of appetite; drowsiness; a “washed out” feeling; or an increase in urination. These are not allergic reactions, but should be reported to the doctor if they become bothersome.

            It may be helpful to take potassium supplements (e.g. banana) while on CAI to prevent low potassium levels in the blood. Low serum potassium may cause muscle cramps and weakess, abdominal cramps, palpitations, faintness from low blood pressure, and depression. 

            The dosage of CAI may be reduced in patients with reduced kidney function (see table below). CAI may not be used in advanced cases of liver cirrhosis.

            Only rarely do severe reactions occur. Be sure to report hives, skin rashes, gout, allergy to sulfa antibiotics, kidney stones, kidney failure, mental depression, liver failure, blood in stool or mouth, easy bruising, or anemia.

What other medicines might interact with CAI?

            Other drugs rarely interact with CAI and an adjustment in dosage is sometimes needed. CAI may increase the effect of diuretics (HCTZ, lasix, bumex, etc.), high-dose aspirin, and quinidine. CAI may increase the effect of digoxin (lanoxin), phenytoin (Dilantin), carbamazepine, primidone, and lithium. Caution should be used when taking metformin for diabetes; CAI may increase the risk of lactic acidosis. Be sure to notify your doctor if you are taking any of these medicines.

How to adjust the dosage in kidney failure?

            The table below shows how to adjust dosage of acetazolamide (Diamox) in the setting of kidney disease.

Glomerular Filtration Rate (GFR) in mL/minDosage
20-50 250 mg up to 4 times a day
10-20250 mg up to 2 times a day
<10 or on dialysis250 mg daily or 3 times a week

reference: https://kidneydiseaseclinic.net/renaldrugs/Acetazolamide.php

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2022 Designs Unlimited of Florida.  All Rights Reserved.

Over-the-Counter Pain Medications

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What are over-the-counter pain medications?

Over-the-counter (OTC) pain medications are pills that can be purchased without a prescription. There are a number of brands available. Examples include ibuprofen (Motrin) and acetaminophen (Tylenol). As ibuprofen and acetaminophen work via different pathways, they can be used together for improved pain control.

What side effects might be expected?

Most drugs have many possible side-effects. The major concern with acetaminophen is liver damage especially seen in patients with known liver disease. The major concern with ibuprofen is kidney damage in patients with known kidney disorders. Also, ibuprofen may irritate the stomach and increase the risk of stomach ulcers. This is especially seen in patients over the age of 65, history of stomach ulcers, or taking medications such as aspirin, steroids, or warfarin (Coumadin). Ibuprofen thins the blood and, therefore, may increase the tendency to bleed by slowing the ability of the blood to clot. The risk of stomach problems with ibuprofen may be reduced by using Zantac or Pepcid, which are available over-the-counter.

How can OTC pain medications be optimally used to control post-operative pain?

Because pain from surgery is short-lived, drug dependence is not a significant issue. The best strategy is to stay ahead of severe pain rather than trying to catch up due a lapse in medication. The optimal use of OTC medication may reduce the need for prescription narcotic pain medication. Prescription narcotic pain medications have side-effects such as sedation, constipation, nausea, and vomiting. With the proper use of OTC pain medications, the need for narcotics can be minimized.

As most narcotic pain medication is combined with acetaminophen, the dosage of OTC acetaminophen (Tylenol) must be decreased so as to avoid exceeding the maximal daily dosage (3,000mg per day).

Copyright © 2018 Designs Unlimited of Florida.  All Rights Reserved.

Maximal Use of OTC Pain Medication for Pain Control after Surgery
Dosing Schedule: 8AM 2PM 8PM 2AM Daily Maximum
Ipubrofen 800mg 800mg 800mg 800mg 3200mg
Dosing Schedule: 11AM 5PM 11PM Daily Maximum
Tylenol Extra-Strength 1000mg 1000mg 1000mg 3,000mg
Note: This schedule may need to be altered if you have kidney or liver disease.
This schedule is designed not to exceed maximum dosages of these medications.
Decrease the dosage as the pain improves after surgery.
Do not take additional medications that contain ibuprofen or acetaminophen without
adjusting the OTC medication dosage so as not to exceed the maximal daily dosages.
Consult with your doctor prior to using this medication schedule.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Prednisone for Eye Inflammation

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What is prednisone?

Prednisone is a very powerful medication related to a hormone produced by your body. Prednisone is very effective at decreasing inflammation. Inflammation in the eye can result from infection, injury, systemic diseases like arthritis, and sometimes from unknown causes. If left untreated, inflammation may cause permanent damage to the eye and loss of vision.

How is prednisone used?

A form of prednisone can be used as eye drops to control inflammation in the front of the eye. Often these drops must be used frequently for best results. If stronger dosages or deeper penetration of medication is required, another medicine like prednisone may be injected next to the eye. This injection is given with little discomfort by using anesthetic eye drops before the injection. If severe, vision-threatening inflammation is present, prednisone pills are prescribed.

What side effects might be encountered?

As prednisone is powerful, many side effects may occur. More frequent and severe side effects are seen the longer the medication is used. Fairly mild, common side effects include temporary mood swings, appetite changes, fluid retention, acne-like rash, trouble sleeping, and difficulty controlling diabetes. More serious side effects usually seen with prolonged treatment include reactivation of TB, stomach ulcer, brittle bones and hip fracture. Any worrisome symptom is reason to contact your doctor. It is important to report all other medication you are taking because interactions between drugs can occur. Finally, serious side effects can occur if prednisone is discontinued too rapidly. Follow the instructions of your doctor carefully.

Your doctor has identified a serious, vision-threatening eye problem that warrants the use of prednisone, a very powerful medicine that should be used with care. Be sure to inform your general medical doctor that you are going to start taking prednisone. Additional tests or medications may be needed to protect you against the side effects of prednisone.

How to take prednisone and protect against side-effects?

To protect yourself against bone loss and fractures, take calcium 1,500 mg (Tums EX) and vitamin D 800 Units every day. Also, make sure your internist approves before starting prednisone. Notify your doctor if you have had a positive TB test or have been exposed to TB (tuberculosis).

Take prednisone after breakfast in the morning. You may use antacids such as Maalox to prevent upset stomach. It is very important for your health to discontinue prednisone by gradually decreasing the dosage as recommended.

Follow a tapering schedule of dosing to avoid serious reactions. Your doctor will make recommendations based on your situation.

AS YOU LOWER THE DOSE OF PREDNISONE, BE SURE TO REPORT TO YOUR DOCTOR ANY SIGNIFICANT WEAKNESS, TIREDNESS, DIZZINESS, OR LOW BLOOD PRESSURE. THESE SYMPTOMS MAY REPRESENT A SERIOUS SIDE-EFFECT OF PREDNISONE WITHDRAWAL.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

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