Medications for Pregnancy

Avoid Constipation During Pregnancy with These Helpful Tips

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Constipation is another common symptom that may occur when women are pregnant and can be very uncomfortable for patients that experience it. During pregnancy, there are a lot of changes to a woman’s body and one of them include changes in hormones. An increase in the progesterone hormone in pregnancy is one of the main causes of constipation. This hormone slows down the movement of food that passes through the intestine which leads to constipation. So what are some helpful tips to relieve the symptoms related to constipation? Here are some answers to the most commonly asked questions relating to managing symptoms of constipation during pregnancy.

What are some lifestyle modifications that may help with constipation?
The first thing I would recommend to patients before they try relieving their constipation with medications is to increase their fluid intake. Drinking plenty of water can help soften the stool to make it easier to have a bowel movement. Moreover, increasing your fiber intake in your diet may also help increase your bowel movement. Lastly, regular exercise can help with constipation by stimulating the muscles in your body, leading to more regular bowel movements. So what if you’ve tried all of these lifestyle modifications with no such luck? There are different over the counter products that you can purchase without a prescription from the doctor.

What is the over the counter drug of choice to help relieve my constipation symptoms during pregnancy?
The first line agent that is recommended for the management of constipation symptoms in pregnancy is a specific type of fiber product called psyllium (Metamucil is the brand name). This is a bulking product that absorbs water and forms bulky stools to stimulate a bowel movement. The dose for Metamucil is 1 teaspoonful of the powder dissolved in water or juice and can be used up to 3 times a day. It is important to work up to this frequency slowly to avoid excess gas as a side effect. Make sure to take this powder with plenty of water to maximize efficacy.

I used Metamucil in the past with no such luck! What are other safe over the counter medications I can take for my constipation?
The second line agent that is preferred for the management of constipation is called docusate. Docusate is a stool softener that helps soften the stool to make it easier for patients to have a bowel movement. This medication has minimal absorption to the baby and clinical studies have shown no evidence of harm. The usual dose for this medication is 50 to 200 mg once daily or divided into 2 to 4 doses. Again, make sure to take this medication with plenty of water to maximize efficacy. In addition to the docusate, another agent that can be used in pregnancy is Miralax powder. Miralax is considered a 3rd line agent after patients have used Metamucil or a stool softener with no relief. This medication is considered 3rd line because even though there is minimal absorption to the baby, there is limited clinical data that supports its use in pregnancy. This medication should only be used for a maximum duration of 2 weeks because it may cause dehydration and electrolyte imbalance in patients. The dosing for this medication is usually 1 capful (17 grams) of the powder dissolved in 8 ounces of water or juice and can be used once daily.

Can I use a stimulant laxative such as bisacodyl or senna during pregnancy to help with my constipation?
Stimulant laxatives such as bisacodyl or senna work by increasing the rate of stool movement in the colon to increase bowel movement. Based on past clinical studies, there is limited data on the use of these agents during pregnancy. I would recommend using the top 3 medications mentioned above before using a stimulant laxative due its limited data. If it is absolutely necessary, it is recommended to limit the duration of use to 2 weeks.

Is castor oil or mineral oil safe to use during pregnancy?
PLEASE AVOID THESE AGENTS AT ALL COST DURING PREGNANCY! Although castor oil and mineral oil are effective in contracting the muscles to stimulate a bowel movement, it can lead to serious side effects in pregnant women. Castor oil has been shown to cause an increase in uterine contraction and rupture. Moreover, mineral oil can cause a decrease in absorption of vitamins during pregnancy and can lead to an increase in bleeding risk. Therefore, my recommendation as a clinical pharmacist is to steer clear from both of these agents at all cost!

I hope you found these tips useful for the next time you suffer from symptoms related to constipation during pregnancy. If you plan on taking any of these medications, feel free to ask your pharmacist where to find these medications in the over the counter section. Although the doctor may write prescriptions for some of these medications, it is usually not covered by your insurance because it can be purchased over the counter. An exception to this statement is if your doctor writes a prescription for Miralax. This medication is covered by many insurances (but not all) so feel free to ask your doctor for a prescription. It is best practice to call the number in the back of your medication insurance card to see if Miralax is covered. If you have any questions on this blog, leave me a message and I will gladly answer them. My next blog will provide helpful tips on how to manage your acid reflux during pregnancy. Please feel free to subscribe to my blog if you wish to get notification on the most current pharmacy tips from your friendly pharmacist. 🙂

Medications for Pregnancy

Manage Your Nausea & Vomiting Symptoms During Pregnancy Using These Helpful Tips from Your Friendly Pharmacist

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Nausea and vomiting is one of the most common symptoms that women have to deal with during their pregnancy. Some women are one of the lucky ones that are not affected by this during pregnancy. For the rest of us, these symptoms can greatly affect our productivity while at work or at home. Many of my patients come to me with questions on how to manage their nausea and vomiting symptoms while pregnant. There are different routes that patients can take to help them manage their symptoms. These include: lifestyle modifications, purchasing over the counter medications, or getting a prescription from your doctor. My general rule of thumb is to start off with lifestyle modifications. If you have tried these recommendations and STILL see no improvement, then this blog will help you decide on which medications to use. Let’s get started!

What lifestyle modifications will help me manage my nausea and vomiting symptoms while pregnant?
The first tip I would recommend is eating small and frequent meals throughout the day. Skipping your morning meal is not recommended because having an empty stomach early in the day is a trigger for nausea and vomiting. Moreover, keeping yourself adequately hydrated is very important because morning sickness can cause some women to become very dehydrated. Sipping on some water throughout the day will help combat dehydration. Lastly, try to avoid spicy, fatty, and strong-odor food because these tend to trigger nausea and vomiting as well. What if you tried all of these recommendations but are still suffering from nausea and vomiting symptoms? The next part of this blog will guide you on deciding which medications to take to help with these symptoms. As always, patients must weigh the benefits of taking these medications over the risk it may cause to baby.

What medication is the first line choice to help me manage my nausea and vomiting symptoms during pregnancy?
The drug of choice to help patients manage their nausea and vomiting symptoms during pregnancy is vitamin B6 (pyridoxine is another name). There have been many studies related to pregnancy use with this medication, and these studies have shown no known risk to the baby. The dose for this medication is usually 10 to 25 mg and can be used three to four times a day. If Vitamin B6 does not work alone, many patients add doxylamine (brand name Unisom) as well. The dose for this medication is usually 12.5 mg and can be taken three to four times a day. These 2 medications are so commonly used together that it is also available as a combination prescription medication called Diclegis. This is a prescription medication that you can get from your doctor that contains both medications in one tablet! A benefit with this combination medication is that sometimes it is covered by your prescription insurance and can be cheaper than buying them separately over the counter! How do you know if it is covered by your prescription insurance? Call the number in the back of your insurance card and they will be able to provide you with information on whether or not this medication is covered.

What are other over the counter medications I can take to help with my nausea and vomiting symptoms?
There are other medications that you can find over the counter that may help with your nausea and vomiting. Diphenhydramine (brand name Benadryl) and meclizine are also used in pregnancy to help manage your symptoms. These medications are in a class called antihistamines. They help block the natural substances in your body that is causing the nausea and vomiting and are considered safe to use during pregnancy. Avoid these medications during the last 2 weeks of your pregnancy because it may cause a rare eye condition in premature infants. Please note that these two medications are in the same class of medications as doxylamine (brane name Unisom) mentioned from the previous question. DO NOT take these medications at the same time because they are all similar.

What prescription drugs can I ask my doctor to prescribe to help with my nausea and vomiting symptoms during pregnancy?
If patients have used the combination of Vitamin B6 (pyridoxine) and doxylamine but still need an additional boost to help manage their nausea and vomiting, doctors will often prescribe a third option. The drug of choice used as an add on medication to the Vitamin B6 and doxylamine combination is metoclopramide (brand name is Reglan). Many clinical studies have shown that it is safe to use in all trimesters of pregnancy. Please note that the maximal duration of use should be limited to 12 weeks. Another add on choice is prochlorperazine (brand name Compazine). Most studies have shown that this medication is safe to use during pregnancy, but some studies have shown some risk to the baby. This is why it is not the drug of choice. Another prescription medication that can be used as an add on is ondansetron (Brand name is Zofran). This medication is reserved as a last line agent for patients that have tried metoclopramide and prochlorperazine with little relief. There is very little data that supports its use in pregnancy so I would not recommend this medication unless it is ABSOLUTELY NEEDED!

Can I use ginger supplements to help me manage my nausea and vomiting symptoms during pregnancy?
There have been some evidence that ginger supplements have shown some benefits in helping with nausea and vomiting symptoms during pregnancy. The general dose for this supplement is 250 mg and can be taken every 6 hours as needed for nausea and vomiting. What is my recommendation as a clinical pharmacist on using ginger supplements? I usually do not recommend supplements to my patients for helping them manage their symptoms. Because supplements are not regulated by the FDA (Food and Drug Administration), it is difficult for patients to know what products are added in the supplements and how much of the active ingredient is actually in it. Therefore, I recommend patients to stay away from these products. In addition, there have been some safety concerns with the use of ginger supplements during pregnancy as well.

Although there are many other methods to help with nausea and vomiting during pregnancy, these are the most common recommendations that I see daily in my scope of practice as a pharmacist. What do you find helpful in managing your nausea and vomiting symptoms while pregnant? Pharmacists continue to learn something new everyday so I would love to hear what methods you use to help with these symptoms. If you have any questions or concerns that I have not addressed in this blog, please feel free to message me and I will gladly answer them. The next time you are in the pharmacy and have a medication question, don’t forget to ask your pharmacist. 🙂

Medications for Pregnancy

How To Manage Cough, Cold, and Allergy Symptoms During Pregnancy

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I work in an outpatient pharmacy in the hospital and we have a lot of questions related to safe over the counter medications to take during pregnancy. The most important thing for patients to consider before they decide on which medications to take to manage their symptoms is whether or not the benefits of taking the medication outweigh the risk to the baby. So how do you know whether or not taking the medication is worth the risk? As a clinical pharmacist, I tend to err more on the side of caution when patients ask for my recommendation. The first thing I recommend to my patient is non-drug options before trying any over the counter medications.

What non-drug options can I use to help manage my cough, cold, and allergy symptoms?
If you are experiencing a dry cough or dry nose, I would recommend using a humidifier or vaporizer to help moisten the air. For patients that have mucus build up, keeping hydrated with water can sometimes loosen up the mucus to make it easier for patients to cough it up. If patients have congestion in the nose, nasal saline can help loosen up the congestion. A popular brand name of normal saline is called Ocean. With regards to over the counter products, I generally recommend the generic version because it has the exact active ingredient but much less costly than the brand name product. Lastly, for patients that may have a sore throat, I would recommend gargling with salt water or sucking on hard candy to help soothe the throat. So what if you tried all these options but they still have not helped with your symptoms? Let’s take a look at the available over the counter options that are safe in pregnancy.

What over the counter medication can I take for my allergies during pregnancy?
A common class of over the counter medications that help with allergy symptoms is called antihistamines. These help with allergy symptoms such as runny nose, watery eyes and sneezing. The drug of choice for treating allergies while pregnant is chlorpheniramine. It is safe in the 1st, 2nd, and 3rd trimester of pregnancy. This medication is an older antihistamine, but it has the best evidence with regards to use in pregnancy. How do you know which allergy medication contains chlorpheniramine? A good trick to follow is to choose your over the counter medication based on the active ingredients labeled in the back of the package. It is required by law for all over the counter medications to list their active ingredients so make sure you check this. A lot of over the counter medications have different brand names so it is not always best practice to base your selection off the names. Other allergy medications that are safe in pregnancy are: diphenhydramine (Benadryl is brand name), doxylamine, loratadine (Claritin), Cetirizine (Zyrtec), and lastly fexofenadine (Allegra). Please note that Claritin and Zyrtec are recommended only in the 2nd and 3rd trimester of pregnancy, DO NOT USE DURING 1ST TRIMESTER!

What medication is safe to use for my cough or chest congestion during pregnancy?
With regards to helping with your cough, it depends on what type of cough you are experiencing. If you are coughing up mucus, then I would recommend just drinking plenty of fluids to loosen up the mucus. This type of cough is called a productive cough and pharmacists generally do not recommend any over the counter medications for it. If you feel that the mucus is bothersome and causing chest congestion, then I would recommend guaifenesin (Mucinex). On the other hand, if you have a dry cough, I would recommend using a cough medication called dextromethorphan. This medication will help stop the dry cough. Please make sure you are careful with selecting cough medications because some may contain alcohol in the formulation (for example: Robitussin). Avoid all products that may contain alcohol in it! With regards to how effective these medications are for helping with cough or congestion, there is limited data that show significant efficacy. Therefore, they are not as effective in managing your cough or chest congestion in pregnancy.

What product can I take for my nasal congestion during pregnancy?
Pseudophedrine (brand name Sudafed) is the drug of choice for nasal congestion because it has the most data from clinical studies supporting its use in pregnancy. Make sure that you carry your drivers license or state ID if you would like to purchase this medication in the pharmacy. The Combat Methamphetamine Epidemic Act requires all pharmacy staff to ask patients for a valid government identification form if they wish to purchase pseudophedrine in the pharmacy. This medication cannot be found over the counter because it is stored behind the counter in the pharmacy. Although it is behind the counter, patients can still purchase this medication without a prescription. Moreover, other medications to help with nasal congestion are phenylephrine and the nasal spray called Afrin. These are generally not recommended by the pharmacist. Phenylephrine has limited data on use in pregnancy and Afrin may be absorbed by your baby through the nasal passage. Therefore, try to avoid these products if you can.

What nasal products can I use to help with my nasal allergies during pregnancy?
The drug of choice for patients that have symptoms related to nasal allergies is called Budesonide (Brand name Rhinocort). This nasal spray has the most data from clinical studies that show significant compatibility with regards to use in pregnancy. An alternative for Rhinocort would be fluticasone (Flonase). Try to avoid mometasone (Nasonex) or triamcinolone (Nasacort AQ) because these have limited data on compatibility with pregnancy use. If you decide to use a nasal product, make sure you shake the nasal spray well before each use. This helps mix the medication, so that you can get an even dose every time you use it. Make sure you blow your nose before administering to clear it completely. Hold the spray with your thumb on the bottom and your index and middle finger on the top. Aim the nozzle away from the middle of your nose to maximize absorption and to prevent irritation. Plug the opposite side of your nose and administer the spray. Make sure you do not lean your head back while administering the spray because it will run down your throat and will not be effective.

There it is guys! Those are the most commonly asked questions from my patients related to cough, cold, and allergy medications that can be taken while pregnant. I went through a lot of different medications so if you have any questions, please feel free to message me. If you would like a free chart to reference any of this information, subscribe to my blog via email and I will send it to you. What helps you manage your cough, cold, or allergy when you are pregnant? I would love to hear your thoughts. As always, if you are in the pharmacy and have a question, don’t forget to ask your pharmacist! That is what we are here for. 🙂

Medications for Children

Must-Read Tips From Your Friendly Pharmacist When Your Child Has a Fever

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Every parent experiences the dreaded fear of seeing their child suffering from a fever and not knowing when to call their primary care provider. It is natural for parents to want to call the doctor immediately when they first notice any signs that their child has a fever. A fever is the body’s natural way of fighting off an infection and usually goes away on its own. Treating a fever with over the counter medications does not necessarily clear your child’s infection, but it does help make them more comfortable so they can eat, drink, and sleep. In this blog, I will go through how a fever is defined based on different thermometer readings, when to call your child’s primary care provider, what medications to give your child to lower the fever, and how to manage your child’s fever without medications. Let’s get started!

What temperature is considered a fever and how do different thermometer readings compare?
There are many different thermometers you can find in the pharmacy so it may be overwhelming when parents try to figure out which one is the best for their child. If you are interested in comparing the differences between these thermometers, please subscribe to my blog and I will gladly provide you with a helpful thermometer comparison chart. Since different parts of our bodies vary slightly in temperature, a fever is defined differently depending on what thermometer you purchase. Listed below are the different routes used to measure temperature and what temperature reading is considered a fever.
-Rectal Thermometer: 100.4 degrees F (38.0 degrees C)
-Oral (by mouth) Thermometer: 99.5 degrees F (37.5 degrees C)
-Armpit (underarm) Thermometer: 99.3 degrees F (37.4 degrees C)
-Ear Thermometer: 100.0 degrees F (37.8 degrees C)
 -Forehead Thermometer:
*0 to 2 months: 100.7 degrees F (38.1 degrees C)
*3 months to less than 4 years old: 100.3 F (37.9 degrees C)
*older than 4 years old: 100.1 degrees F (37.8 degrees C)

When should I call my child’s primary care provider?
If you are uncertain whether or not you should call your child’s primary care provider, here are some guidelines to follow to help you decide. I found these guidelines on the Tylenol website and found it to be very accurate with what other health care providers recommend. Keep in mind that these are just guidelines! You know your child the best so follow your gut feeling.

Call your child’s primary care provider if your child is under 3 months and has a fever of greater than 100.4 degrees F (38 degrees C).

If your Child is over 3 months and any of these situations apply, call your doctor:
-has a temperature of 104 degrees F (40 degrees C) or higher
-has a temperature of 100.4 degrees F (38 degrees C) AND has one of the following:
*severe headache
*repeated vomiting or diarrhea
*strange rash
*sore throat or ear pain
*stiff neck
*extremely drowsy or fussy

If any of these situations apply to your child, please call your doctor as well:
-your child is between 3 and 24 months and still has a fever after 24 hours
-your child is older than 24 months and still has a fever after 72 hours

What medications should I give my child if they have a fever?
The single most effective medication to give your child if they have a fever is Tylenol. This medication is also called acetaminophen. Morever, another medication used for lowering a fever is Advil, or Ibuprofen is the generic name. If you give your child Ibuprofen, make sure you give it with food because it is really upsetting to take on an empty stomach. A glass of milk will suffice if your child is not taking in food well. Before purchasing a product, ask your pharmacist to take a look at the medication to see if it is appropriate to give to your child. A lot of cold or allergy medications contain a combination of medications, so it is important to check the ingredients in these products. Lastly, DO NOT give your child aspirin to reduce their fever because it has been linked to a fatal condition called Reyes Syndrome. Avoid this medication!

Please make sure you read the dosing directions in the back of the package carefully. It is extremely important not to give your child more than the recommended dose because their body cannot clear the medication out of their system as quickly as an adult can. You will notice that the dosing chart is based on the child’s age AND weight. I would HIGHLY recommend choosing a dose based on your child’s WEIGHT. When a pharmacist is checking your child’s prescription, this is why they always ask for the weight. Many of the medications given to children are dosed based on their weight. Therefore, this is the best method for determining how much medication to give. Always measure the dose with the proper measuring device provided in the package. DO NOT use a kitchen spoon to measure the dose because this is not an accurate measurement. Many teaspoons and tablespoons come in different sizes, so I would recommend using a measuring device.

How do I manage my child’s fever without medications?
There are many different methods to manage your child’s fever without using medications. As stated earlier, a fever usually goes away on its own, with or without medicine. If your child has a fever, make sure they stay properly hydrated to prevent dehydration. Moreover, having them rest in a cool room will help them stay comfortable. Lastly, using a cool wash cloth on their forehead will also help cool your child down as well.

After reading this blog, I hope you feel more prepared the next time your child has a fever. These are the common questions I receive from my patients when I am counseling them. If you have any other questions or ideas for future topics, please feel free to message me and I will be happy to message back. If you love the material on this blog, please subscribe to my blog page via email to get notifications on the most current topics discussed. That’s it for now guys! See you next time!