Pharmacist: ask me your questions

ayeshaohara · March 2016

After a couple of requests and some lovely feedback on a previous thread I'm starting a thread so you can ask me your medication related questions! Post them here.

Disclaimer: I will not be held legally responsible if you take my advice and something happens. You must check with your local pharmacist to make sure anything I may recommend is appropriate with any other medications you may be taking. My advice does not replace that of your OB. Please consider this when posting your questions. I will continue to respond to your questions in the same spirit that I have for the past 6 months, in the hope that I can provide the best information so you can make informed decisions about your healthcare.

Also, I work full time but I will endeavor to reply as often as I can!

tgortney · March 2016

Hi there! Asking for a friend

My friend just found out she's pregnant. She's almost 5 weeks and is experiencing headaches that lasts all day. She had them before pregnancy but would just pop some Advil and move on. Now, she just suffers through them because she said Tylenol does nothing for her.

She hasn't been to an OB yet, and won't have her first appointment till end of April. Should she continue on or call her OB office and ask for advice on medications? I believe she wants to stay medicine-free for first trimester but the stress can't be good for her and the baby, right?

ayeshaohara · March 2016

Headaches are a tough one because not only did she have them before pregnancy but they're also a commonly known symptom of pregnancy which can make them even more uncomfortable. If she's not getting migraines and can manage the pain fine then I wouldn't say she is putting the baby under any undue stress. If they're debilitating that may be another story. If she's endeavoring to be drug free first trimester then that's a completely personal decision. She can certainly safely use Tylenol and some Advil if necessary. Advil only in 1st and 2nd trimester though. Not 3rd!

Many of us have been suffering through migraines without any drugs and it doesn't have any consequence for baby...just maternal discomfort.

Hope that's helps.

Edited for clarity.

tgortney · March 2016

Thanks!!

ayeshaohara · March 2016

Info about ibuprofen (Advil) so you're all aware.

Since we're basically all in 3rd trimester now, it's important you don't use any ibuprofen or anti-inflammatory drugs (others include but are not limited to: naproxen, high dose aspirin [low dose is fine]). They're safe in 1st and 2nd trimester but once you hit the 3rd it can cause premature closing of the ductus arteriosus. In English, the DA shunts blood between the lungs and heart because baby isn't breathing yet. If it closes early it can cause issues with the heart. It closes itself after birth. Premature closure can be caused by other things not just drugs but anti inflammatories are a known cause so best to avoid them (unless instructed otherwise).

cy&damonsmommy · March 2016

I honestly miss my migraine medicine. Lol

ayeshaohara · March 2016

cy&damonsmommy said:

I honestly miss my migraine medicine. Lol

I'm not surprised. I get migraines too...weirdly pregnancy has decreased their frequency but I got my first the other day...I wanted drugs!!!!! I don't even get particularly bad ones.

kp90 · March 2016

Will Tylenol or any other safe medication help with restless legs and swelling? At night my legs are so restless it makes me want to cry. Also, I have really bad swelling and I know just propping them up may help some but didn't know if anything else could help. My doctor basically said diuretics would only dehydrate me so obviously that's a no go. I just want some of the pain to go away.

sillyfox · March 2016

Caffiene helps with my migraines too. My go to while pregnant is Tylenol and a real coke (aspartame in Diet sodas seems to be a trigger, so I avoid it).

Thanks for starting this thread, OP! I will come back if I think of anything!

ayeshaohara · March 2016

kp90 said:

Will Tylenol or any other safe medication help with restless legs and swelling? At night my legs are so restless it makes me want to cry. Also, I have really bad swelling and I know just propping them up may help some but didn't know if anything else could help. My doctor basically said diuretics would only dehydrate me so obviously that's a no go. I just want some of the pain to go away.

Unfortunately nothing to help with either. The restless legs is another yucky symptom of pregnancy that should pass when you give birth. Make sure you drink plenty of fluids...that goes for the swelling too, it helps to flush things through. Lots of elevation and foot massages from your partner. You can eat foods which are natural diuretics like celery but I'm not sure how much of a difference it will make. The swelling is mostly because our blood volume increases to support baby...and then it pools in our legs especially when you're on your feet all day and in the warmer weather. Sorry I can't offer more useful suggestions. Just gotta ride these ones out. You can use Tylenol if you're finding the restlessness painful rather than just annoying. Try take 2 x 500mg tablets before bed.

ayeshaohara · March 2016

@kp90 I was just reading that low iron can cause restless legs so you can ask your doc to check for this. Also avoiding caffeine and regular exercise may help with the symptoms!

lalala2004 · March 2016

So I started taking Zantac for heartburn because Tums wasn't doing enough for me. Is it safe to take long term and regularly? The label says something about telling your doctor if you need it for more than 2 weeks or something like that.... Do you know of any better, more natural heartburn remedies?

ayeshaohara · March 2016

lalala2004 said:

So I started taking Zantac for heartburn because Tums wasn't doing enough for me. Is it safe to take long term and regularly? The label says something about telling your doctor if you need it for more than 2 weeks or something like that.... Do you know of any better, more natural heartburn remedies?

Keep using the Zantac. I've been taking prescription strength since about 11 weeks. It's perfectly safe and the drug of choice for heartburn. If it's controlling your symptoms, that's awesome! Keep using it!!

kp90 · March 2016

ayeshaohara said:

@kp90 I was just reading that low iron can cause restless legs so you can ask your doc to check for this. Also avoiding caffeine and regular exercise may help with the symptoms!

Thank you! and oh great... I love caffeine and never excercise. Maybe that's my problem. Also, last night my swelling was the absolute worst I've seen it thus far. Today not any better. Thankful its friday and I don't work weekends.

lalala2004 · March 2016

ayeshaohara said:

lalala2004 said:

So I started taking Zantac for heartburn because Tums wasn't doing enough for me. Is it safe to take long term and regularly? The label says something about telling your doctor if you need it for more than 2 weeks or something like that.... Do you know of any better, more natural heartburn remedies?

Keep using the Zantac. I've been taking prescription strength since about 11 weeks. It's perfectly safe and the drug of choice for heartburn. If it's controlling your symptoms, that's awesome! Keep using it!!

You are my hero right now!

ayeshaohara · March 2016

lalala2004 said:

ayeshaohara said:

lalala2004 said:

So I started taking Zantac for heartburn because Tums wasn't doing enough for me. Is it safe to take long term and regularly? The label says something about telling your doctor if you need it for more than 2 weeks or something like that.... Do you know of any better, more natural heartburn remedies?

Keep using the Zantac. I've been taking prescription strength since about 11 weeks. It's perfectly safe and the drug of choice for heartburn. If it's controlling your symptoms, that's awesome! Keep using it!!

You are my hero right now!

Always happy to help. It's funny because I've been very "anti medication" most of this pregnancy because sometimes too much information is the devil...but when it comes to heartburn i don't mess around. It's just horrible!!

ayeshaohara · March 2016

kp90 said:

ayeshaohara said:

@kp90 I was just reading that low iron can cause restless legs so you can ask your doc to check for this. Also avoiding caffeine and regular exercise may help with the symptoms!

Thank you! and oh great... I love caffeine and never excercise. Maybe that's my problem. Also, last night my swelling was the absolute worst I've seen it thus far. Today not any better. Thankful its friday and I don't work weekends.

No problem. I have had minimal swelling up until the last week...so we're likely just hitting that stage in our pregnancies where it's here to stay...unfortunately.

vinerie · March 2016

ayeshaohara said:

Info about ibuprofen (Advil) so you're all aware.

Since we're basically all in 3rd trimester now, it's important you don't use any ibuprofen or anti-inflammatory drugs (others include but are not limited to: naproxen, high dose aspirin [low dose is fine]). They're safe in 1st and 2nd trimester but once you hit the 3rd it can cause premature closing of the ductus arteriosus. In English, the DA shunts blood between the lungs and heart because baby isn't breathing yet. If it closes early it can cause issues with the heart. It closes itself after birth. Premature closure can be caused by other things not just drugs but anti inflammatories are a known cause so best to avoid them (unless instructed otherwise).

FWIW: I take a low-dose aspirin every day, per doctor's orders. Apparently the AMA is on the brink of making a formal recommendation that moms take it in the last 20 weeks as it greatly reduces pre-e.

(BTW, I think you said that was okay in your post, but it was a tad unclear for those who may not be aware of the benefits.)

ayeshaohara · March 2016

vinerie said:

ayeshaohara said:

Info about ibuprofen (Advil) so you're all aware.

Since we're basically all in 3rd trimester now, it's important you don't use any ibuprofen or anti-inflammatory drugs (others include but are not limited to: naproxen, high dose aspirin [low dose is fine]). They're safe in 1st and 2nd trimester but once you hit the 3rd it can cause premature closing of the ductus arteriosus. In English, the DA shunts blood between the lungs and heart because baby isn't breathing yet. If it closes early it can cause issues with the heart. It closes itself after birth. Premature closure can be caused by other things not just drugs but anti inflammatories are a known cause so best to avoid them (unless instructed otherwise).

FWIW: I take a low-dose aspirin every day, per doctor's orders. Apparently the AMA is on the brink of making a formal recommendation that moms take it in the last 20 weeks as it greatly reduces pre-e.

(BTW, I think you said that was okay in your post, but it was a tad unclear for those who may not be aware of the benefits.)

Thank you for that. I was not aware of that evidence but I will certainly look into it! I am also on low dose aspirin because I have a blood clotting condition. Definitely not something I would ever recommend to a pregnant woman without consent from OB first. I think you'll find that probably the recommendation will be to only use in women with risk factors for preE or previous preE because there are risks associated with taking aspirin just like any drug. For a low risk pregnancy I wouldn't anticipate the benefit outweighing the risks, but we shall see. Drugs are fascinating aren't they?

Pregghers · March 2016

ayeshaohara said:

vinerie said:

ayeshaohara said:

Info about ibuprofen (Advil) so you're all aware.

Since we're basically all in 3rd trimester now, it's important you don't use any ibuprofen or anti-inflammatory drugs (others include but are not limited to: naproxen, high dose aspirin [low dose is fine]). They're safe in 1st and 2nd trimester but once you hit the 3rd it can cause premature closing of the ductus arteriosus. In English, the DA shunts blood between the lungs and heart because baby isn't breathing yet. If it closes early it can cause issues with the heart. It closes itself after birth. Premature closure can be caused by other things not just drugs but anti inflammatories are a known cause so best to avoid them (unless instructed otherwise).

FWIW: I take a low-dose aspirin every day, per doctor's orders. Apparently the AMA is on the brink of making a formal recommendation that moms take it in the last 20 weeks as it greatly reduces pre-e.

(BTW, I think you said that was okay in your post, but it was a tad unclear for those who may not be aware of the benefits.)

Thank you for that. I was not aware of that evidence but I will certainly look into it! I am also on low dose aspirin because I have a blood clotting condition. Definitely not something I would ever recommend to a pregnant woman without consent from OB first. I think you'll find that probably the recommendation will be to only use in women with risk factors for preE or previous preE because there are risks associated with taking aspirin just like any drug. For a low risk pregnancy I wouldn't anticipate the benefit outweighing the risks, but we shall see. Drugs are fascinating aren't they?

I can't imagine this will be a blanket recommendation for all pregnant women. I've had so many problems with bleeding throughout this pregnancy my doctor told me definitely no aspirin!

camillaandcarson · March 2016

Last time I stocked colace (dok plus) and took it post C-section, I only needed 4 pills out of the entire container. I still have that same bottle, it expired in 2014.
Should I get a new one or just keep the original bottle and bring it with me to the hospital?

ayeshaohara · March 2016

camillaandcarson said:

Last time I stocked colace (dok plus) and took it post C-section, I only needed 4 pills out of the entire container. I still have that same bottle, it expired in 2014.
Should I get a new one or just keep the original bottle and bring it with me to the hospital?

Please get a new bottle. While it probably would be fine, legally I can never reccomend taking expired medication for a number of reasons. I personally never do it either...you just never know!!

ayeshaohara · March 2016

@Pregghers I totally agree with you! Case by case basis for sure!!

ktous720 · March 2016

OK I used to take Claritin D everyday for nasal allergies. I haven't taken since I found out I am pregnant. Recently my left nostril (my problem side) has been an absolute bear to live with. I am DYING for the sweet sweet relief of Claritin D! lol Can you recommend anything that will help. BTW Neti pots make me gag just to think about using!

Thanks in advance for any advice!!

gampster · March 2016

Is there a recommendation on the max number of Tums I can take per day?

ayeshaohara · March 2016

ktous720 said:

OK I used to take Claritin D everyday for nasal allergies. I haven't taken since I found out I am pregnant. Recently my left nostril (my problem side) has been an absolute bear to live with. I am DYING for the sweet sweet relief of Claritin D! lol Can you recommend anything that will help. BTW Neti pots make me gag just to think about using!
Thanks in advance for any advice!!

Decongestants aren't recommended so you have a couple of other options.
1-regular antihistamine with no decongestant
2-decongestant spray for a few days only (try and use it just in the one nostril too if it's only bothering you on one side)
3-steroid spray like nasacort just one spray per nostril once a day. It will take a few days to a week for good relief with this.

The reason sprays are safe is that they act locally in the nose vs all through the body when you use tablets.

ayeshaohara · March 2016

gampster said:

Is there a recommendation on the max number of Tums I can take per day?

Usually if you're asking this question you need additional heartburn relief. There is a maximum of 8000mg per day but if you're needing this much i would be using something additional such as Zantac for relief. That much calcium is very constipating and they don't give much info about max doses in pregnancy either.

proudparent2b · March 2016

In regards to restless legs relief, exercise has been my best friend. If I get enough, particularly 1-2 hours before bed, I have no issues. Otherwise, it can get a little hairy some nights.

Pascal86 · March 2016

ayeshaohara said:

camillaandcarson said:

Last time I stocked colace (dok plus) and took it post C-section, I only needed 4 pills out of the entire container. I still have that same bottle, it expired in 2014.
Should I get a new one or just keep the original bottle and bring it with me to the hospital?

Please get a new bottle. While it probably would be fine, legally I can never reccomend taking expired medication for a number of reasons. I personally never do it either...you just never know!!

...And because I have no legal obligation to anyone, you might want to read this: https://www.thesurvivalistblog.net/truth-expiration-dates/

I have no idea how reliable that source is, but it's very much in line with what my mom (doctor) just told me about expiration dates on medications when I asked if I could use some expired Tylenol. Very rare that a drug develops negative side-effects from being expired, usually just risks becoming slightly less effective.

I'm certainly not advising you one way or another, or trying to disregard @ayeshaohara 's advice, but the expense and environmental impact of disposing medications always makes me think twice about this stuff, especially if there's actually no reason to get rid of them.

ayeshaohara · March 2016

@Pascal86 my dad (also Doctor) often says the same thing. As do most that I know. The issue is drug degradation and loss of effectiveness rather than lack of safety, which the unreliable article points out. Not like food which actually goes bad. I have this conversation multiple times in a week!!

Ps if you return all expired meds to the pharmacy they just get incinerated.

If you want to make sure what you're taking actually works...which seems obvious to me, then don't use expired drugs, it's that simple. Seems silly to me when you're in pain or discomfort to take something that might not work as effectively as it could. And then what do you blame? The drug? Maybe the expiration date? what if the medication is helping to keep you alive like something for your heart? These are all things to consider and makes the issue very grey.

Thanks for for weighing in on the topic

Pascal86 · March 2016

@ayeshaohara - Good points! Definitely not blanket advice to be taken all the time. In my case, I was asking my mom about expired Tylenol because I was home by myself with the worst sore throat of my life and couldn't take anything else, and was in no shape to go get anything. But nothing bad was going to happen if my throat didn't feel better, it would just suck a lot. Definitely wouldn't take that route for something like an important heart medication!

And good to know about returning meds to the pharmacy, I never know what to do with them!

ayeshaohara · March 2016

Pascal86 said:

@ayeshaohara - Good points! Definitely not blanket advice to be taken all the time. In my case, I was asking my mom about expired Tylenol because I was home by myself with the worst sore throat of my life and couldn't take anything else, and was in no shape to go get anything. But nothing bad was going to happen if my throat didn't feel better, it would just suck a lot. Definitely wouldn't take that route for something like an important heart medication!

And good to know about returning meds to the pharmacy, I never know what to do with them!

Believe me I've definitely taken expired Tylenol before!! Desperate times call for desperate measures!! Most people have no idea about medication disposal either. Happy to help!

Just as a side funny story...my dad was sending me some meds from home in Australia (sample stuff so I didn't have to pay)...he's notorious for not checking expiry dates...he sent me expired inhalers. Thanks Dad, way to go

lilliesparrow · March 2016

I have found that taking Apple Cider Vinegar with the Mother has helped my heartburn tremendously. It tastes vile, but it starts alleviating the symptoms almost right away. I take a couple tablespoons of it usually before bed (that's when my heartburn acts up) and it neutralizes the acid. I recommend trying it for heartburn. I know it's available at natural food stores, as well as Walmart. But make sure it's Bragg's Apple cider vinegar with the mother.

amberraysofdawn · March 2016

For the medicine disposal thing - the pharmacy is more convenient and probably the better choice overall for it, if yours participates in it (I personally had no idea they did until a few minutes ago) - but depending on where you are, there might also be occasional community events for it. For example, about twice a year the police/fire department in my town have an event for people to drop off their expired/unused medications (this is part of an awareness effort they've been making to keep people from disposing of the stuff by flushing it, and thereby getting it into the water system). You just have to make sure to take the label with your information off of the bottles first.

ayeshaohara · March 2016

amberraysofdawn said:

For the medicine disposal thing - the pharmacy is more convenient and probably the better choice overall for it, if yours participates in it (I personally had no idea they did until a few minutes ago) - but depending on where you are, there might also be occasional community events for it. For example, about twice a year the police/fire department in my town have an event for people to drop off their expired/unused medications (this is part of an awareness effort they've been making to keep people from disposing of the stuff by flushing it, and thereby getting it into the water system). You just have to make sure to take the label with your information off of the bottles first.

This is fantastic!!!! Thank you for passing this on. What a great initiative!

I know in Canada most doctors offices will take stuff too; they use the same disposal bins that the pharmacy does.

nerdymama15 · March 2016

So I guess my question has to do more with contradictory information. My OB says that sudafed/decongestants (sudafed, mucinex, etc) are completely fine and to follow the directions on the package. I know I have read where other people's OBs have said the same. I've read on here where you don't say the same. So why do some doctors say it is okay and you and/or others do not? Who do I trust - the doctor or the pharmacist? I'm not trying to sound snarky. I'm just generally confused and when I get confused I get frustrated and when I get frustrated I sound snarky even though it is not my intention.

SisterMaryNapalm · March 2016

***dirty lurker & TMI***
I've been taking Actilax for constipation. If I don't take it, it's absolutely horrible and painful. If I do, I get diarrhoea (at the dosages which work) which, honestly, is preferable if not ideal.
1. Is this normal?
2. It says on the bottle to not use long term but all my Drs and midwives have just said to use laxatives. Is there any danger using it for the rest of my pregnancy? (1-6 weeks)

ayeshaohara · March 2016

nerdymama15 said:

So I guess my question has to do more with contradictory information. My OB says that sudafed/decongestants (sudafed, mucinex, etc) are completely fine and to follow the directions on the package. I know I have read where other people's OBs have said the same. I've read on here where you don't say the same. So why do some doctors say it is okay and you and/or others do not? Who do I trust - the doctor or the pharmacist? I'm not trying to sound snarky. I'm just generally confused and when I get confused I get frustrated and when I get frustrated I sound snarky even though it is not my intention.

I agree it's hard to know whose advice to follow. Obviously I'm going to tell you my advice is going to be more accurate because I am the drug expert. In the post that lead to this thread I explained that a lot of older doctors will work from what we call anecdotal evidence. This means that they've used it in their own patients with few if any issues....evidence may not support that safety though. It's all a balance of risk vs benefit.

When it comes to decongestants, you'll survive if you don't use them...to me the risk isn't worth the benefit. Current recommendations say not to use them, so I suggest not to. There are other safer options short term while you're stuffy!! A blocked nose won't kill you. It's just annoying

ayeshaohara · March 2016

SisterMaryNapalm said:

***dirty lurker & TMI***
I've been taking Actilax for constipation. If I don't take it, it's absolutely horrible and painful. If I do, I get diarrhoea (at the dosages which work) which, honestly, is preferable if not ideal.
1. Is this normal?
2. It says on the bottle to not use long term but all my Drs and midwives have just said to use laxatives. Is there any danger using it for the rest of my pregnancy? (1-6 weeks)

Normal is a relative term and everyone's bowels are different. There is actually no "normal" amount to poop!! What I would say is that if you can't find a middle ground with the actilax, use something else instead.

Generally we recommend short term use of laxatives to prevent lazy bowels but you can use it ongoing if necessary because that's a lower risk one. You would be fine continuing to use for the next 6 weeks.

If you'd like something milder but still effective you could try a straight stool softener like docusate instead. Did you try other things before ending up on the Actilax? I feel you may have so my suggestion may have been tried already. Let me know and we can give you some other options if necessary.

Also please note, to you and others reading this. Not all laxatives are safe in pregnancy and towards the end some can induce labour. Please check before using if you're unsure.

SisterMaryNapalm · March 2016

ayeshaohara said:

SisterMaryNapalm said:

***dirty lurker & TMI***
I've been taking Actilax for constipation. If I don't take it, it's absolutely horrible and painful. If I do, I get diarrhoea (at the dosages which work) which, honestly, is preferable if not ideal.
1. Is this normal?
2. It says on the bottle to not use long term but all my Drs and midwives have just said to use laxatives. Is there any danger using it for the rest of my pregnancy? (1-6 weeks)

Normal is a relative term and everyone's bowels are different. There is actually no "normal" amount to poop!! What I would say is that if you can't find a middle ground with the actilax, use something else instead.

Generally we recommend short term use of laxatives to prevent lazy bowels but you can use it ongoing if necessary because that's a lower risk one. You would be fine continuing to use for the next 6 weeks.

If you'd like something milder but still effective you could try a straight stool softener like docusate instead. Did you try other things before ending up on the Actilax? I feel you may have so my suggestion may have been tried already. Let me know and we can give you some other options if necessary.

Also please note, to you and others reading this. Not all laxatives are safe in pregnancy and towards the end some can induce labour. Please check before using if you're unsure.

Thank you

I started on the Actilax at the suggestion from the pharmacist and the doctor. I had tried a milder one but that was back in my first trimester. I stopped using them until recently so maybe trying the milder one again could help

lbachran · March 2016

@nerdymama15. My OB told me the same thing yours did. I had stopped anything with a decongestant after reading online that they were unsafe, but then I got really, really, sick. A stuffed nose turned into a sinus infection and then acute bronchitis that lasted for nearly 3 months. She allows me one decongestant per day (Mucinex) and I'm so grateful. While a stuffed nose may seem like a minor irritation to some, for someone with severe allergies, it can turn into something much worse.

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