Conventional Drug Use

Conventional Drug Use: Overview

It is a fact of life that modern medicine, despite its many faults, has brought us some genuinely useful remedies for problems that are difficult to treat through natural means.  It is for you and your doctor to decide what is best for you; we mention conventional drug therapies simply because they do provide substantial relief in many cases where alternatives are unavailable.

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Conventional Drug Use:

Conventional Drug Use can help with the following:

Aging

Parkinson's Disease

Conventional medical treatment relies heavily on l-dopa (levo-dihydroxy-phenylalanine), a dopamine precursor that can cross the blood-brain barrier and is converted to dopamine in the brain.  L-dopa is now rarely used by itself, but rather in combination with carbidopa (Sinemet) or benserazide (Madopar) that protects it from breaking down before it reaches the brain tissue.  As l-dopa must compete with other amino acids in crossing both from the gut to the blood stream and from the blood stream to the brain it is usually recommended that it be taken between meals rather than with meals.

Although l-dopa medications can bring significant relief from Parkinson's disease symptoms they become less effective with time.  After four or five years of increasing dosages their effect becomes sporadic and unpredictable (the "on-off syndrome") and patients become increasingly helpless and depressed.  There is also evidence that the use of l-dopa medications may lead to a deficiency of B-vitamins, especially niacin and vitamin B-6.  Most Parkinson's disease experts now recommend that l-dopa therapy be started as late as possible after diagnosis of Parkinson's disease so as to postpone the day when it no longer works and to limit its many serious adverse effects.

Selegiline (Deprenyl, Eldepryl) is another drug used in Parkinson's disease therapy.  It works by blocking the breakdown of dopamine in the brain.  Recent trials have shown that starting Parkinson's disease patients on selegiline can extend the time period before they need l-dopa by about nine months.  Combinations of l-dopa medications and selegiline have also been tried in early stage Parkinson's disease patients, but were found to have no advantage.  A recent study concluded that the combination therapy increased mortality by about 50% when compared to Parkinson's disease patients treated with l-dopa medications alone.

Anticholinergenic drugs work by reducing the amount of acetylcholine produced in the brain and thereby redressing the imbalance between dopamine and acetylcholine.  They are no longer recommended for older patients as they have serious neuropsychiatric side-effects.

Cataracts

A Japanese drug, phenoxazine carboxylic acid (Catalin), has been shown to be effective in inhibiting, as well as reversing, cataract formation.

Allergy

Allergic Rhinitis / Hay Fever

Prescription Drugs
Nonsedating antihistamines may cause life-threatening irregular heartbeat and should not be taken with other drugs or if you have other liver or heart problems.  Oral decongestants may have systemic side-effects.  Nasal corticosteroid sprays are effective if used properly; improvement takes 1 to 2 weeks.  Systemic steroids are prescribed only for severe allergic rhinitis; generally prescribed for short amounts of time because of their many side-effects.

Over-the-Counter
Antihistamines may cause drowsiness.  Alpha-adrenergic topical sprays reduce congestion but there is a rebound effect if used for more than a few days.  Cromolyn sodium is the only preventative drug choice; works as well as antihistamines but does not cause drowsiness; take continuously or it will not work effectively; it is virtually without side-effects.

NOTE: Extended use of antihistamines or nasal sprays can make your allergic rhinitis worse.

Autoimmune

Periarteritis

Commonly recommended drugs include prednisone and cyclophosphamide.

Myasthenia Gravis

Conventional medicine can control myasthenia gravis.  Some medications improve neuromuscular transmission and increase muscle strength, and some suppress the production of abnormal antibodies.  These medications must be used with careful medical supervision because they may cause major side effects.

Multiple Sclerosis

A form of bacteria seems to be the organic cause of multiple sclerosis, claims a Dr. Hoekstra, MD.  Its tentative name – not yet widely accepted by other microbiologists – is Borrelia mylophora, so named because its characteristics seem to resemble those of Borrelia burgdorferi, the bacteria believed responsible for Lyme disease.  In cases of multiple sclerosis, the myelin sheath covering the nerves gets eaten away by the immune system, explains Dr. Hoekstra.  "That is exactly like the hunters' torches setting fire to the forest.  Most of the destruction of the myelin sheath takes place from actions of the white blood cells and their antibodies.  But their primary target is not the myelin sheath at all.  It's the Borrelia mylophora bacteria, running around in the nervous system.  B.  mylophora has an extremely high affinity for the myelin sheath.  It loves it."

The successful use of doxycycline against B.  mylophora was first verified by a physician in South Dakota who reasoned that the symptoms of MS (which he had) were suggestively similar to those of Lyme disease, which responds fairly well to doxycycline.  After dosing himself for three months with the antibiotic, he was symptom free.  However, the long-term use of antibiotics has many drawbacks, cautions Dr. Hoekstra.  It seriously damages the ecology of intestinal microflora and can lead to a condition of microbial imbalance called dysbiosis.  This in turn can be the foundation for numerous diseases.  It can also facilitate the growth of more cell wall deficient forms.  To counteract this, probiotic replacement is required.

Sarcoidosis

Corticosteroids such as prednisone and/or other anti-inflammatory medications can be prescribed to reduce inflammation.  Other medications, particularly those that suppress the immune system, are often recommended.  Lung involvement may benefit from inhalers; each symptom can usually be relieved by treating with appropriate medications.

Circulation

Hypotension (Low Blood Pressure)

If simple measures don't alleviate the problem, you may need conventional medication.  Although a wide range of drugs (including phenylpropanolamine, ephedrine and the nonsteroidal antiinflammatory drugs indomethacin and ibuprofen) have been used to treat hypotension, many of them are not consistently effective.

The following medications have proven effective in treating postural hypotension:
Fludrocortisone. Fludrocortisone is a mineralocorticosteroid that appears to be effective for most types of postural hypotension.  It works by promoting sodium retention by the kidney, thereby causing fluid retention and some swelling, which is necessary to improve blood pressure.  Its sparing effect on sodium is done at the expense of a concurrent loss of potassium.  Therefore, when taking fludrocortisone, it's important to also take adequate amounts of potassium each day.  Fludrocortisone has none of the anti-inflammatory properties of cortisone or prednisone and it is not a muscle-building agent.

Midodrine. Midodrine activates receptors on the arterioles and veins to produce an increase in blood pressure.  Studies show that it is effective in improving standing blood pressure in those with postural hypotension related to nervous system dysfunction, such as in patients with Shy-Drager syndrome.

Digestion

Rapid Stomach Emptying (Gastric Dumping)

People with severe cases take medicine to slow their digestion.

Heartburn / GERD / Acid Reflux

If nothing else seems to work, it may be necessary to start using proton pump inhibitor drugs.

Infections

Malaria

Although resistance is increasing, most types of malaria can still be cured with prescription drugs.  The type of drugs and length of treatment depend on which kind of malaria is diagnosed, where the patient was infected, the age of the patient, and how severely ill the patient was at start of treatment.

Babesiosis

Recommended treatment is a seven-day course of oral quinine plus clindamycin under the careful supervision of a physician.  Fatigue, malaise and a low grade fever may persist for weeks or months after treatment has been completed.

Mental

Bipolar Disorder, Manic-Depressive

People with this condition generally require life-long treatment with lithium or other drugs to control manic episodes, sometimes with antidepressants to control the depression.  Some doctors believe that a significant bipolar disorder will not respond sufficiently to alternative interventions alone.

Obsessive-Compulsive Disorder (OCD)

The most effective medications for OCD are the SSRIs (Selective Serotonin Reuptake Inhibitors) Prozac, Paxil, Luvox, and Zoloft as well as the tricyclic Anafranil.  Other medications may be added to improve the effect.

Metabolic

Edema (Water Retention)

There is no single, accepted gold standard treatment for idiopathic cyclic edema.  Several different treatments have been reported.  An agent used for treating high blood pressure called Captopril has also been used with success.  It works against the kidney hormone aldosterone which is elevated in this condition and causes excess salt and water retention.

Sometimes a mild diuretic will help reduce fluid retention but can worsen the edema of idiopathic cyclic edema.  While one would think that taking a "water pill" or diuretic would improve this edematous condition, it turns out that in most cases this is the wrong long term treatment.  In fact, chronic diuretic use will increase the secretion of aldosterone which in turn produces more edema.  If the chronic use of diuretics is discontinued, the cyclical swelling disappears in most cases within about 3 weeks.

Hypersomnolence

Ritalin or other stimulant drugs have been used successfully in controlling the need to sleep during the day.

Wernicke-Korsakoff syndrome

The prescription drug Hydergine stimulates regrowth of damaged nerve fibers.  The most effective form of Hydergine comes in tablets, which can be placed under the tongue for immediate absorption.  Ask your doctor about Hydergine if you feel you need help in this area.

Cluster Headaches

Subcutaneously injected sumatriptan (6mg in 0.5ml) (Imitrex in the US) is the most effective, reliable, and rapid abortive therapy for cluster headache attacks.  An injection (easily given by the patient) eliminates or markedly diminishes cluster headaches within 15 minutes in essentially all patients at every attack.  Some patients have had headaches eliminated in as little as 7 minutes.  This effect does not lessen with continued use.  Some patients have had satisfactorily rapid results with sumatriptan nasal spray.  The oral triptans are less effective, but some especially good responders with relatively milder and slower-developing headaches may prefer this route of administration.

Musculo-Skeletal

Gout / Hyperuricemia

Since the 1800s, colchicine has been the standard treatment for acute gout.  While colchicine is very effective, it often causes nausea, vomiting and diarrhea.  These side-effects are uncommon when this drug is given intravenously, but because of their unpleasant nature, non-steroidal anti-inflammatory drugs (NSAIDs) have become the treatment of choice for most acute attacks of gout.

Therapy directed at normalizing uric acid levels in the blood should be considered for patients who have had multiple gout attacks or have developed tophi or kidney stones.  Several drugs that help the kidneys eliminate uric acid are available, such as probenecid, and a drug that blocks production of uric acid by the body, such as allopurinol.  The choice between these two types of drugs depends on the amount of uric acid in the urine.  With correct treatment, gout should be well controlled in almost all cases.

Polymyositis

Polymyositis is generally initially treated with high doses of corticosteroids – medications related to cortisone – given by orally or intravenously.  They are very good at decreasing muscle inflammation but are usually are required for years.  Their continued use will be based on what a doctor finds in terms of symptoms and muscle enzyme blood test results.

Corticosteroids have many predictable – and unpredictable – side-effects.  In high doses they commonly cause an increase in appetite and weight, puffiness of the face and easy bruising.  They can also cause sweats, facial hair growth, upset stomach, sensitive emotions, leg swelling, acne, cataracts, osteoporosis, high blood pressure, worsening of diabetes and increased risk of infection.  A rare complication of cortisone medications is severe bone damage (avascular necrosis) which can destroy large joints, such as the hips and shoulders.  In addition, abruptly stopping corticosteroids can cause flares of the disease and result in other side-effects including nausea, vomiting and decreased blood pressure.

Corticosteroids do not always help a lot and in such cases immunosuppressive medications are considered.  These medicines can be effective by suppressing the immune response which attracts the white blood cells of inflammation to the muscles.  Many types are now commonly used and others are still experimental.  Methotrexate can be taken by mouth (Rheumatrex) or by injection into the body; Azathioprine (Imuran) is an oral drug.  Both can cause liver and bone marrow side-effects and require regular blood monitoring.  Cyclophosphamide (Cytoxan), chlorambucil (Leukeran) and cyclosporin (Sandimmune) have been used for serious complications of severe disease.  These also can have severe side-effects which must be considered with each patient individually.

Patients with calcium deposits (calcinosis) from dermatomyositis can sometimes benefit by taking diltiazem (Cardizem) to shrink the size of the calcium deposits.  This effect, however, occurs slowly – frequently over years.

Muscle Cramps / Twitching

Doctors may feel they have to resort to drugs like Sinequin (Doxepin) or Klonopin (Klonazepam).  Sinequin is a tricyclic anti-depressant and anti-histamine that can produce marked sedation.  This medication may enhance the effect of Klonopin, but it can reduce muscle twitching all by itself.  Klonopin is an anti-anxiety medication and anti-convulsive/anti-spasmodic.  It is useful in dealing with muscle twitching, restless leg syndrome, and night-time grinding of the teeth (bruxism).

Costochronditis

Cortisone shots are one way of reducing the inflammation of costochondritis but repeated injections are not recommended as they are said to weaken the cartilage after extended periods of use.

Nervous System

Bell's Palsy

If you do decide to use conventional medications that may help relieve the compression, such as prednisone and antivirals, they should be started as quickly as possible.  The "window of opportunity" for starting these medications is thought to be 7 days from the onset of Bell's palsy.

Organ Health

Glaucoma

It is most important for those having been diagnosed with glaucoma of any sort to use any medication that they are given by an ophthalmologist as directed.  Medicated eye drops, which work by increasing drainage of aqueous fluid or reducing its production, can usually control chronic glaucoma.  These pressure reducing drugs may include:

  • A 'beta-blocker' (e.g. betaxolol)
  • A 'miotic' (e.g. pilocarpine)
  • Adrenaline-related drugs (e.g. apraclonidine)
  • A 'carbonic anhydrase inhibitor' (which may be taken by mouth; e.g. acetazolamide)

During an attack of acute glaucoma, treatment by mouth either with a carbonic anhydrase inhibitor or with glycerine solution can abort the attack, if taken early enough.  In a severe attack, an intravenous injection of a drug called mannitol may be necessary to bring the intraocular pressure down promptly.  Beta-blocker and pilocarpine eye drops are also usually given.  After an attack, treatment usually continues with eye drops and doses of a carbonic anhydrase inhibitor.

Nephrotic Syndrome

Treatment depends on the underlying disorder which has caused nephrotic syndrome.  Medications which dampen down the immune system are a mainstay of treatment.  The first choice is usually a steroid drug such as prednisone.  Some conditions may require even more potent medications, such as cyclophosphamide or cyclosporine.

Treating the underlying conditions (for example lymphoma, cancers, heroine use, infections) which have led to nephrotic syndrome will often improve the symptoms of nephrotic syndrome as well.  Some patients will require the use of specific medications to control high blood pressure.  Some patients benefit from the use of diuretics (which allow the kidney to produce more urine) to decrease swelling.

Nephrotic syndrome may require aggressive treatment with corticosteroids until the level of proteinuria goes down.  A person usually needs to lose more than 3gm per day of protein in the urine before this begins to happen.

Glomerulonephritis

Acute IgAN may be treated with oral steroids.

Impaired kidneys are very good at secreting a hormone which deliberately raises blood pressure.  It is imperative that any treatment for controlling high blood pressure be followed rigorously, as high blood pressure itself further adds to the damage being caused in the kidneys, and it is an independent risk factor for ESRD (not to mention other cardiovascular complications).  In addition to lowering blood pressure, some specific high BP medications appear to have renal-protective and/or antiproteinuric effects.

Hepatitis

(Reuters, Oct 27, 2003) – Scientists working for Boehringer Ingelheim in Germany have developed a drug that could offer new hope.  Called BILN 2061, it targets an enzyme to block the replication of the virus.  In eight people given four doses of the treatment, the amount of virus in the blood (viral load) dropped by 100 to 1,000-fold after 48 hours without producing any unpleasant reactions.  "The antiviral results of protease inhibitor BILN 2061 in a proof-of-concept human trial clearly demonstrate the great potential of selective and anti-HCV agents," Daniel Lamarre, of the company research center in Laval, Canada, said in a report published by the journal Nature.  BILN 2061 is the first of a class of drugs called NS3 protease inhibitors to be tested in humans.  Although more longer-term trials are needed, scientists believe it "holds great promise to markedly improve treatments of chronic HCV infection."

Postscript: According to MedScape, "Although BILN-2061 demonstrated potent antiviral activity against HCV genotype 1, the virologic response was less pronounced and more variable in HCV genotype 2 and 3 patients.  Despite early enthusiasm, further development has been halted because of concerns related to potential cardiotoxicity in animal models.[9,10]" [http://www.medscape.com/viewarticle/556641_3]

Kidney Stones (Urolithiasis)

For prevention of stone formation, medical therapy is available for those with known predisposing conditions.  For those with stones, pain-killers (as prescribed by a doctor) can provide great relief.  In addition, some medications may help break down larger stones.

Vertigo

Medications that may reduce symptoms of labyrinthitis include antihistamines, anticholinergics, sedative/hypnotics, antinausea medications and diazepam (valium).  The antihistamine meclizine (Antivert) is commonly used.

Parasites

Parasite Infection

For those not afraid of using pharmaceutical remedies, treatment for intestinal worms is simple, cheap and effective, with a single dose of Albendazole (400mg pills), which kills the adult worms.  As reinfection may occur (particularly amongst children), treatment is advised once a year, or every six months if reinfection is a big problem.  Those who should not be treated by these means include: those who are already unwell for some other reason, e.g. with a fever (treatment should be delayed until they are feeling better); girls/women are pregnant (treatment should not be given during the first three months of pregnancy); those with chronic illness such as sickle cell anemia.

Pinworm Infection

Pin-X (pinworm treatment containing pyrantel pamoate) is available over-the-counter as a single dose remedy.  If you have side-effects after taking pyrantel, get advice from your health care provider before you take it again, especially if a skin rash occurs.

Although the directions do state "single dose effectiveness", taking a second dose after 10 days is also recommended because of the pinworm lifecycle.  After the initial treatment, pinworm eggs will almost certainly remain in your living environment and may be ingested or inhaled.

Trichinosis

Mebendazole is the standard treatment.

Whipworm Infection

Mebendazole is the drug of choice, with albendazole as an alternative.

Reproductive

Premature Ejaculation

In the early 1990s, doctors noted that many depressed men refused to take their medications because it prevented them from reaching a climax, so they prescribed antidepressants, such as Anafranil, Paxil, Prozac or Zoloft to premature ejaculators, who then reported better performance.  A recent study from the Netherlands shows that 20mg of Paxil 1-4 hours before the event may be the most effective treatment.  [Journal of Clinical Psychopharmacology, 2001, Vol 21, Iss 3, pp293-297.] The U.S.  FDA has not approved these drugs for this purpose.

Respiratory

Pneumonia

Pneumonia caused by bacteria and mycoplasma is generally treated with antibiotics.  The type of antibiotic used depends on which organism has caused the infection.  If the infection is severe, and especially in very young and old people, the pneumonia may need to be treated in hospital with antibiotics and fluids given into a vein, and extra oxygen through a mask.

Fungal pneumonias are treated with specific antifungal drugs.

Skin-Hair-Nails

Dandruff

Nizoral is the only shampoo containing a patented active ingredient known as ketoconazole.  This ingredient is proven to be effective against P.  ovale and acts directly to inhibit growth of the fungus.  This product is the number one choice of doctors and pharmacists, when recommending an anti-dandruff shampoo.  The effects of Nizoral can last several days, making daily use unnecessary.

Hives (Urticaria)

For many patients with hives of unknown cause, treatment with antihistamines is effective.  This is because in people with hives, histamine is being released by mast cells in the tissues which in turn initiates the irritation and accumulations of fluid.  Other inflammatory white blood cells, including lymphocytes and polymorphonuclear cells, have also been implicated.  Antihistamines inhibit this inflammatory process.

On occasion and especially with pressure hives, antihistamines are ineffective, probably because of the nature of the molecular mediators operating in this condition.  If antihistamines do not help, then several second-line treatments are used.  The most effective are corticosteroids.  Others include doxepin, dapsone, attenuated androgens, calcium antagonists, antimalarials, gold and methotrexate.

Tumors, Malignant

Cancer, General

COX-2 inhibitor drugs, so-called because they block an enzyme called cyclooxygenase-2 (COX-2), are used to treat pain and inflammation.  There is now compelling evidence that they may also protect against cancer.  Mitch Gaynor, MD, director of medical oncology at the Strang Cancer Prevention Center in New York, notes that suppressing COX-2 may be beneficial because "...the COX-2 enzyme helps make carcinogens much more active once they get into your body.  The enzyme also allows cancerous cells to grow new blood vessels."

There may be drug-free alternatives to the synthetic COX-2 inhibitors as close as your spice shelf.  Although they do not have as powerful an action, it appears that certain foods are natural inhibitors of the COX-2 enzyme.  By incorporating these foods in your diet, you can obtain some of the potential cancer-preventing benefits of the COX-2 inhibitors naturally.

Uro-Genital

Vulvodynia / Vestibulitis

If intercourse is painful, you can apply xylocaine jelly to numb the sore areas.

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