How to improve your health when your blood sugars are out of control.

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  • Healthy people are proactive about our health
  • Healthy people seek out more information
  • Healthy people consult professionals before implementing significant changes in our medications or lifestyle choices
  • Healthy people are patient and persistent in overcoming health or lifestyle challenges.
  • Healthy people accept total accountability for our own health, without taking on blame for things beyond our control.

What can you do to improve your AIC when you’re feeling terrible from a variety of symptoms and conditions, many of which are either a direct result of your diabetes, or at least are indirectly impacted by persistent high blood sugars.

There are any number of things you need to deal with in order to make real change. The most important of these things is probably NOT your diabetes. At least not directly.

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I’ve been a type two diabetic for many years. Diabetes probably started with me in my twenties although my first symptoms didn’t start to show up until I was nearly forty. I’m now in my sixties and I’ve been on insulin for more than fifteen years. That means I’ve been pricking my finger at least once a day since I was fifty years old, and injecting myself with insulin ever since.

The one thing I can say about my diabetes is that it has progressed in a predictable way, gradually causing negative effects to my body. All the way along the road various doctors have given me a lot of prescription medications, as well as a lot of advice. I’ve been to diabetic clinics where nurses and dieticians have attempted to teach me how to control my blood sugars through diet and exercise.

Why Me?

When I was first diagnosed with diabetes I even received counselling, to try to make sense of Why Me? I think everyone feels victimized by negative health conditions, whether it’s COPD, Heart Disease or Cancer. The answers to Why Me? are both existential and practical.

There are two parts to the answer. First, there is the part of Why Me? over which you have no control, never did, never will have and makes no difference anyway. Whether it’s fate, God, a cruel universe, DNA or the conditions of your life (including a bad diet, smoking, poor or no exercise, etc.) leading up to becoming diabetic none of them actually matter in coming to terms with the emotional fallout of Why Me?

Truthfully, there are many things I could have done differently in the past that might have made a huge difference in my experience of diabetes now and in the future. But for whatever reasons I had, or gave myself, I did what I thought was within my capacity to change in my habits and behaviors.

You can check your blood sugars regularly with you meter tests, get your AIC blood work done in the lab and consult with your doctor as often as she thinks is useful or necessary. You may make changes in your diet and exercise program, and do your best to lose weight and keep it within certain boundaries. And if you do all these things from the beginning, your diabetes will be stable and you will reduce the consequences of this disease.

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For most of us, however, no matter how much we say we care about our health, we’re not really willing to do whatever is necessary to fundamentally change our outcomes. We do some of it, maybe ever some of it every day with serious intentions.

This is the Second Part to Why Me?

This is the part of Why Me? you can control if you choose to do so. So how do you change what you do and how you act, to have a real impact on your own health? This goes back to me saying that it’s not actually about diabetes, or even about your physical health.

It’s really about becoming conscious about who and what you want to be in your own life. We’ve all been beat-up by life along the way. Parents, friends, lovers, partners and even strangers have both positive and negative impacts on our self esteem. Why is that? Why do we let anyone else impact how we feel about ourselves, and how we make positive or negative choices about our lives, including those choices about dealing with negative health outcomes resulting from poor choices.

I hate to say this but “Who cares?” It doesn’t matter what happened in the past, or how you allowed yourself to be negatively influenced regarding healthy living. It really doesn’t matter, but only if there is some way you can turn your life around and ultimately take control of those things that you can control.

How to take control and like it.

The first thing is to understand what it is you need to do to make things better. If you don’t know what you need to do, it’s pretty hard to decide what to do. So find out. See you doctors. Read everything you can find out about current treatment alternatives, and inquire from other people their experiences. Read blogs. Get new referrals to diabetic clinics and resources. Talk over alternatives with your specialist. Make a plan of action with on a few, specific steps, done regularly and persistently.

Don’t try to do everything all at once. Set limited goals with realistic objectives. For example: Don’t try to lose a lot of weight in a week or even a month. Lose weight in amounts that can actually be achieved. If you find it too hard to do by yourself, join a club or a weight loss program which comes with monitoring and emotional support. But don’t blame the program if your weight loss isn’t happening. Be totally honest with yourself, and reset your goals. Weight loss is fundamental to improved diabetic outcomes and lowering blood sugar.

Don’t hang around waiting for someone else to improve your health.

If it isn’t happening, then look elsewhere for support, but don’t give up on necessary change. Remember that whatever happened yesterday is no longer relevant unless it results in change today. Guilt is useless unless it is accompanies by a renewed sense of personal accountability.

When I graduated many years ago from UBC my school motto was TU UM EST. What I didn’t realize was how powerful an idea that really is.

TU UM EST!

A Critical Medical Self-Analysis

Part Two

Yesterday I began a critical review of my current health situation, with a view to improve my future results by making some new decisions based on the current facts and trends.

Current Symptoms

Here is a recap of the situation as I see it now. I am taking the symptoms I listed yesterday and discussing each of them in the context of my current method of dealing with them, and/or discussing the cause of each of them as best I can, given that I’m not a doctor or scientist trained in this.

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  • Frequent urination – especially at night, interrupting my sleep.

The whole issue of urination and bladder control is interconnected with so many of my other underlying issues so it’s probably a good place to start.

Problems with urination are a little bit like the canary in a mine that warns of trouble. One of my earliest indicators that I had a problem, (and it might be diabetes) was having a need to urinate frequently, both during the day and at night. This started in my thirties, almost thirty-five years ago.

Diagnoses of the problems with my urination were complicated by a discovery, in my thirties, that I suffer from a relatively mild form of spina bifida, which despite it not being debilitating does have some significant neurological effects on my lower body, including sexual response and bladder control. This wasn’t great news to hear when I was only in my thirties, but everything the doctor told me about the possible side effects of spinal bifida occulta has surfaced from time to time since then.

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Like many other men with any problems with their genitals and urinary systems, including urination or sexual performance, I generally tried to ignore the problem as much as possible. After discussing the potential effects of the problem with my lower spinal column with the back specialist I tended to ascribe any problems to the back and nervous system, including periodic difficulties with both urination and sexual performance.

In the spring of 1985, when I was 32 years old, I also exacerbated the problem, by choosing to undergo a vasectomy, without understanding in advance that the operation could have unintended side effects. Unlike what I had expected, the operation resulted in swelling of my prostate and my testes and an infection in my urethra and bladder. For more than a year I suffered severe pain from both urination and sexual expression, and my soreness persisted for several years before fading away completely. A prescription was given to me to reduce the swelling of my prostate, but it took some time to take effect, and as it was significantly swollen, there were physical effects on both sexual function and urination.

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As one might expect, given the pain, there were also emotional effects and a significant impact on my intimate life, in ways I would not have normally expected.

My reasons for having a vasectomy still seem as valid today, as they were at the time, however, part of the decision to go for it turned out to be less true than it is in most cases. My medical results included significant pain, reduced enjoyment of life, and a much higher level of anxiety about the whole subject than was probably warranted.

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The argument for having a vasectomy is that it is generally considered a relatively benign surgical procedure, done in the doctor’s office as a day surgery. For a woman to have sterilization surgery is much more invasive, not to mention that it results in huge hormonal changes. My wife and I both thought a vasectomy would be less problematic, and we were probably right, despite how frustrating and painful it turned out to be.

It continues today, as so I suppose I’m used to it. However, continuing declines in muscles and nerves is also contributing to further problems, which require a certain fastidiousness to avoid embarrassment because of weakness in bladder control. It’s not promising for the future, because if it continues to decline I can see a future including adult diapers. It may be already as bad as it is going to get, at least that’s my current hope.

So my problems with sexual function and urination really started then, and it was only somewhat later that I realized that my need to urinate more frequently as I was getting old might have a relationship to diabetes.

  • Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.

I’m not sure that I’m doing this analysis in the right order, but this is the order I listed my symptoms yesterday, so I will follow this list and get to the underlying stuff as it comes.

I have a lot of trouble sleeping through the night. I have a CPAP machine to help me deal with my sleep apnea, with which I have been having problems. The problems with the CPAP machine aren’t really with the machine itself, but with on again off again sinusitis that makes it almost impossible to sleep with the device forcing me to breath through my nose. So when I’m congested I don’t put it on. So it doesn’t do anything if I don’t use it.

So one of the new decisions I’m making as I do this analysis is to start using the damned CPAP every night possible. When I was using it, it did improve my blood sugars and I suppose it improved my sleep, although I didn’t feel much more rested then that I do now. In other words I’m still exhausted most days, regardless of the CPAP.

The problem with cramping in my legs and feet is another thing that wakes me up in the middle of the night fairly frequently, although not every night. When it first started up a few months ago, I asked a doctor and she advised me to use Magnesium and Calcium together to help. I started taking them every day, and my cramps in my calf muscles has been reduced to once or twice a month, instead of every night. However, this remedy has not improved the cramping in the arches of my feet, or the muscles in my toes.

Other body pain and neuropathic pain are also problematic in getting a decent night’s sleep. Arthritis and rotator cup problems wake me at various times in the night, and make it difficult to get back to sleep. Neuropathic pain which is merely irritating during daylight hours seems far more painful when I am at rest. Ergo, more interrupted sleep and more pain.

  • Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes. 

I am taking Gabapentin, an anti-seizure medication which has shown to help with neuropathic pain. It may be providing me with some relief from the neuropathic pain, but the benefits are still uncertain to me. Would the neuropathic pain be worse if I were to wean off of Gabapentin, due to the numerou side effects cited in the literature?

Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.

Various types of chronic pain plague my waking moments, including arthritis in my hands, shoulders, hips and legs. Tendonitis has my hands bound up with pain. Inflation combines with ongoing pain.

Persistent breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed.  Sometimes exacerbated by emotional stress or conflict. Of all my symptoms my breathing problems are the most intrusive, making ordinary activities difficult or impossible. I am currently taking three separate inhalers to remediate the asthma and borderline COPD. All of them have side effects which make my sinus and throat problems worse, and while they help me breathe, they make my singing voice harsh.

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Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue).

Addressing these symptoms is something I haven’t really been able to address, yet.

To close the blog for the day, I’ve decided to stop here and pick it again tomorrow or Friday. All of this thinking is making my head hurt, but I realize that I haven’t really given enough thought to the role of the many drugs in my system, and how their many potential side effects may be effecting me.

A Critical Medical Self-Analysis

Purpose of this exercise

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There can be no time more suitable than the present to make better choices for my future health and well-being.  New choices mean reviewing and carefully considering alternatives not previously pursued, or if previously pursued, inadequately.  In some respects, this analysis reflects a continuing and necessary re-evaluation based of my current state of health, not as a snapshot, as it were, but rather as a streaming and changing set of conclusions and actions based on them.  However, this analysis is specifically about now and the immediate future, with a clear understanding that nothing is ever completely settled in these issues, and there is new information available on an ongoing basis.

More simply put – This self-analysis is about resetting how I go about living my life with due consideration to what I have learned about the conditions and diseases that currently plague me.  How to do better and improve my health for the future – this is my object.

Much of what will be expressed here rests on certain persisting patterns of behavior which require significant modification.  In other words, I must change if there is to be any real improvement in my health reality. And based on what I know about achieving anything of consequence in my life, it will need to be outlined in a program of specific steps, which depend upon my own actions rather than on others.  My physicians can only provide me with information and treatment within what I’m willing or able to do myself.  My partner, as supportive as she has tried to be over the years, is not responsible for any part of this, despite my tendency to try to lay responsibility at her door particularly for my dietary habits and lack of blood sugar control.

Current Symptoms

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  • Frequent urination – especially at night, interrupting my sleep.
  • Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.
  • Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes.  Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.
  • Periodic breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed.  Sometimes exacerbated by emotional stress or conflict.
  • Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue)
  • Dizziness upon standing – it is sometimes acute and sometimes minor
  • Mental fatigue and a sense of a loss of acuity and sharpness – I am finding it difficult to concentrate on mental tasks which require the application of my intellectual skills and professional skills.  I still feel capable of creative work for relatively brief periods, but fatigue quickly overtakes me, and I must put things aside, while I attempt to recover my energies and focus.
  • Forgetfulness and feelings of anxiety regarding memory
  • Visual deficiencies – lately I can only read or work on the computer for a certain period before my eyes begin to become less effective, making it necessary for me to interrupt my work or reading, and brake completely from work that require visual acuity.  Eye fatigue contributes to my overall sense of fatigue and exhaustion.  Note: I probably need new glasses, something I will discuss with my ophthalmologist on Friday when I next visit her.
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Rain Coast Review Blog author

  Conditions and/or diseases

  • Diabetes
  • Slightly elevated cholesterol
  • Sleep apnea
  • Asthma and bronchitis (borderline COPD)
  • Diabetic Neuropathy
  • Evidence of diabetic damage to my eyes
  • Fatty liver
  • Obese
  • Arthritis in hips, hands, shoulders, lower back
  • Tendonitis in hands and wrists
  • Eczema
  • High and low blood pressure
  • Allergies to a broad band of common allergens including pollens, animal dander, dust and others.  Anaphylactic reaction to Cipro and Penicillin
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Discussion

I have had recent visits with my family doctor, my Endocrinologist and my Respirologist (Pulmonologist), plus an upcoming CT Scan in early June at Burnaby General, and an eye exam this Friday.  I’m clearly a heavy draw on the medical system with all these frequent appointments to deal with various ailments.  Clearly I’d like to see less of them, and they would like to see less of me.  All we have to do to accomplish this feat is to improve my health sufficiently so that they wouldn’t need to see me so often.

Diabetes blood sugar and neuropathy management

Endocrinologist

My most recent visit with my Endocrinologist, as usual, thorough, with a significant discussion about changing my medications, in particularly, moving to two different types of insulin every day, with a long acting insulin injected in the morning with design purpose of bringing my premeal and fasting insulin down to ideally 7.0mml or below and then having me take fast acting insulin with each meal, dividing up the insulin between the meals, more or less based on the prorated amount of food being ingesting at each meal.

In order to manage this much more intensive insulin regime, it will be necessary for me to check my Blood sugar levels first thing each morning, as well as 2 hours after each meal.  The goal of the fast-acting insulin is to return my blood sugars to 10mml or below within the two hours.  

In order to maintain such a frequent reading of my blood sugar levels, I need to have a new form of monitor with a patch blood reader that sends the information to a monitoring device, either my iPhone or one that comes with the patch.  I submitted the request to Blue Cross two weeks ago and am currently awaiting approval. Note: I should follow up with them before Friday to make sure they are working on this.

The Endocrinologist wrote me prescriptions for the insulin and the device, as well as had his assistant prepare the forms for Blue Cross.  Once I have approval, I will need to deliver these forms to the Pharmacy for processing.

The Endocrinologist and I had a fairly long conversation regarding various aspects of my diabetes including the need for me to have my eyes re-examined, thus an appointment this Friday with Chui Luca, my Ophthalmologist.  We also discussed my weight gain since being diagnosed with diabetes with him expressing some thought that while weight loss would be desirable many type two diabetics in my circumstances find it very difficult to lose weight while taking insulin.  Not only does insulin contribute to weight gains, but so do Jentadueto and Invokana my other diabetes treatment medications.

In addition, gabapentin, which has been prescribed for my neuropathy due to diabetes, also leads to weight gain along with other symptoms I am experiencing.

The more common side effects of gabapentin include:

  • abnormal eye movements that are continuous, uncontrolled, back-and-forth, or rolling
  • clumsiness or unsteadiness
  • constipation
  • diarrhea
  • difficulty speaking
  • drowsiness or tiredness
  • dry mouth
  • nausea
  • vomiting

Talk with your doctor about precautions you can take for side effects from gabapentin:

  • Ask your doctor for advice on diet and exercise to help manage your weight if you are concerned about possible weight gain from gabapentin.
  • Don’t drive or operate heavy machinery until you know you can function normally while taking gabapentin.
  • Talk to your pharmacist about over-the-counter medications that can help relieve some of the more common digestive system side effects.

Gabapentin side effects may make you want to stop taking the drug. However, don’t stop taking it without first talking to your doctor.

Stopping gabapentin suddenly can cause serious problems, such as withdrawal symptoms or the return of seizures. Your doctor will help you stop taking the drug safely.

Medically reviewed by Lindsay Slowiczek, PharmD on December 20, 2016 — Written by University of Illinois-Chicago, Drug Information Group

Other diabetes Medications

In addition to the two new forms of insulin, and the gabapentin for treatment of the diabetic Neuropathy I also take two other diabetes medicines.

Jentadueto

2.5/1,000 MGs – taken twice daily prior to morning and evenings meals.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 08/28/2017

Jentadueto (linagliptin and metformin hydrochloride) is a combination of two 2 oral antihyperglycemic drugs indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both linagliptin and metformin is appropriate. Common side effects of Jentadueto are:

  • cough,
  • sore throat,
  • sinus pain,
  • stuffy nose,
  • upset stomach,
  • weight gain,
  • pancreatitis,
  • diarrhea, and
  • low blood sugar (hypoglycemia).

Get medical help immediately if you have severe side effects of lactic acidosis (symptoms include muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, dizziness, lightheadedness, tiredness, weakness, stomach pain, nausea with vomiting, or slow or uneven heart rate.

Jenadueto is available in the following strengths: tablets containing 2.5 mg linagliptin and 500 mg metformin hydrochloride or 850 mg metformin hydrochloride or 1000 mg metformin hydrochloride. The maximum recommended dose is 2.5 mg linagliptin/1000 mg metformin twice daily. Jenadueto should be taken daily with meals, with gradual dose escalation to reduce the gastrointestinal side effects due to metformin.

Invokana

300 MG – taken once daily prior to the morning meal.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 11/12/2018

Invokana (canagliflozin) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used to control blood sugar in people with type 2 diabetes mellitus, in addition to diet and exercise. Common side effects of Invokana include:

  • urinary tract infections,
  • increased urination,
  • yeast infections,
  • vaginal itching,
  • thirst,
  • constipation,
  • nausea,
  • fatigue,
  • weakness,
  • skin sensitivity to sunlight,
  • hypersensitivity reactions (including skin redness, rash, itching, hives, and swelling),
  • bone fractures, and
  • kidney problems.

The recommended starting dose of Invokana is 100 mg once daily, taken before the first meal of the day. Doses may be increased to 300 mg in patients who are able to tolerate Invokana at 100 mg doses. Invokana may interact with rifampin or digoxin. Tell your doctor all medications you use.

Asthma and Bronchitis Medications and treatments

After spending 10 days in the hospital in 2016 with severe pneumonia, when I was discharged my Respirologist at Centrio Medical Centre diagnosed me with COPD and prescribed three different inhalers to treat the disease.

Spiriva 2.5 mg

Spiriva 2.5 mg – two puffs with morning medications

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 2/12/2018

Spiriva HandiHaler (tiotropium bromide) Inhalation Powder is an anticholinergic drug used to prevent bronchospasm (narrowing of the airways in the lungs) in people with bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease). Common side effects of Spiriva HandiHaler include:

  • dry mouth,
  • constipation,
  • upset stomach,
  • vomiting,
  • cold symptoms (stuffy nose, sneezing, sore throat),
  • nosebleed, or
  • muscle pain.

Tell your doctor if you have any serious side effects of Spiriva HandiHaler including:

  • difficult or painful urination, or
  • fast heartbeat.

The recommended dose of Spiriva HandiHaler is two inhalations of the powder contents of one Spiriva capsule, ONCE DAILY, with the HandiHaler device. Spiriva may interact with atropine, belladonna, cimetidine, clidinium, dicyclomine, glycopyrrolate, hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, or scopolamine. Tell your doctor all medications you use. During pregnancy, Spiriva should be used only when prescribed.

Symbicort

Symbicort 200 mg – two puffs with morning medications and two puffs with dinner medications

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 1/22/2018

Symbicort (budesonide and formoterol fumarate dihydrate) is a combination of a steroid and a long-acting bronchodilator used to prevent bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD). Common side effects of Symbicort include:

  • headache,
  • throat irritation,
  • nausea,
  • vomiting,
  • stomach upset,
  • diarrhea,
  • back pain,
  • stuffy nose,
  • muscle or joint pain, or
  • changes in your voice.

Tell your doctor if you experience unlikely but serious side effects of Symbicort including:

  • white patches on tongue or in mouth,
  • signs of infection (such as fever, persistent sore throat),
  • mental/mood changes (such as nervousness),
  • trouble sleeping,
  • vision problems (such as blurred vision),
  • increased thirst or urination,
  • muscle cramps, or
  • shaking (tremors).

For patients 12 years of age and older, the dosage of Symbicort is 2 inhalations twice daily (morning and evening, approximately 12 hours apart). Symbicort may interact with antibiotics, antifungal medication, MAO inhibitor, antidepressants, beta-blockers, or diuretics (water pills). Tell your doctor all medications you are taking. During pregnancy, Symbicort should be used only when prescribed. Budesonide passes into breast milk. It is unknown if formoterol passes into breast milk. Consult your doctor before breastfeeding.

Salbutamol

Salbutamol 100ug – two puffs as required

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 2/7/2019

Ventolin HFA (albuterol sulfate inhalation aerosol) is a bronchodilator used to treat or prevent bronchospasm in people with reversible obstructive airway disease. Ventolin HFA is also used to prevent exercise-induced bronchospasm. Ventolin HFA is available in generic form. Common side effects of Ventolin HFA include:

  • nervousness,
  • shaking (tremor),
  • palpitations,
  • headache,
  • mouth/throat dryness or irritation,
  • cough,
  • hoarseness,
  • sore throat,
  • runny or stuffy nose,
  • nausea,
  • vomiting,
  • dizziness,
  • sleep problems (insomnia),
  • muscle pain,
  • changes in taste, or
  • diarrhea.

Seek medical help immediately if you have rare but serious side effects of Ventolin HFA, including:

  • chest pain or
  • irregular heartbeat.

The dose of Ventolin HFA for adults and children for treatment of acute episodes of bronchospasm or prevention of symptoms associated with bronchospasm is 2 inhalations repeated every 4 to 6 hours. More frequent administration or a larger number of inhalations is not recommended. For exercise-induced bronchospasm, the dose is 2 inhalations 15 to 30 minutes before exercise. Ventolin HFA may adversely interact with diuretics (water pills), digoxin, beta-blockers, antidepressants, MAO inhibitors, or other bronchodilators. Tell your doctor all medications you are taking. During pregnancy, Ventolin HFA should be used only when clearly needed. Discuss the risks and benefits with your doctor. It is unknown if this medication passes into breast milk. Consult your doctor before breastfeeding.

Other Medications Prescribed or recommended

Tecta 40 MG

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 10/24/2018

Protonix Delayed-Release Oral Suspension and Delayed-Release Tablets (pantoprazole sodium) is a proton pump inhibitor (PPI) used for short-term treatment (less than 10 days) of gastroesophageal reflux disease (GERD) and a history of erosive esophagitis in adult patients.

Common side effects of Protonix include

  • injection site reactions (redness, pain, swelling),
  • headache,
  • nausea,
  • vomiting,
  • abdominal or stomach pain,
  • diarrhea,
  • gas,
  • dizziness,
  • joint pain,
  • weight changes,
  • drowsiness,
  • tired feeling, or
  • sleep problems (insomnia).

The recommended adult dose of Protonix is 40 mg once daily. Protonix may interact with atazanavir, nelfinavir, ampicillin, blood thinners, digoxin, diuretics (water pills), ketoconazole, iron, or methotrexate. Tell your doctor all medications and supplements you use. Protonix is not expected to be harmful to a fetus. Tell your doctor if you are pregnant or plan to become pregnant during treatment with Protonix. Protonix passes into breast milk and may harm a nursing baby. Consult your doctor before breastfeeding.

APO-atorvastatin 40 mg

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 4/23/2019

Lipitor (atorvastatin) is a statin used for the treatment of elevated total cholesterol, LDL, triglycerides, and to elevate HDL cholesterol. Side effects of Lipitor include:

  • constipation,
  • diarrhea,
  • nausea,
  • fatigue,
  • gas,
  • heartburn,
  • headache, and
  • mild muscle pain.

Contact your doctor if you experience serious side effects of Lipitor including:

  • muscle wasting and muscle breakdown (rhabdomyolysis),
  • confusion or memory problems,
  • fever,
  • dark urine,
  • increased thirst or hunger,
  • drowsiness,
  • loss of appetite, or
  • yellowing of the skin or eyes (jaundice).

The recommended dose of Lipitor is 10-80 mg daily. Erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), cyclosporine (Sandimmune), indinavir (Crixivan) and ritonavir (Norvir) decrease elimination of Lipitor. Lipitor increases the effect of warfarin (Coumadin) and cholestyramine (Questran) decreases the absorption of Lipitor. Lipitor should not be taken during pregnancy because the developing fetus requires cholesterol for development, and Lipitor reduces the production of cholesterol. Lipitor passes into breast milk and could harm a nursing baby. Breastfeeding while taking Lipitor is not recommended.

Ramapril 10 MG

Ramipril side effects

Ramipril oral capsule doesn’t cause drowsiness. However, it can cause other side effects.

More common side effects

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist. The more common side effects that occur with ramipril include:

  • dizziness or faintness due to low blood pressure
  • cough
  • dizziness
  • chest pain
  • nausea
  • vomiting
  • diarrhea
  • weakness or tiredness
  • Serious side effects

Call your doctor right away if you have any of these serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • low blood pressure. This is more common when you’re starting the drug or increasing doses. Symptoms include:
  • dizziness
  • lightheadedness
  • allergic or hypersensitivity reaction (angioedema). Symptoms include:
  • swelling of your face, lips, tongue, or throat
  • trouble breathing
  • stomach pain with or without nausea and vomiting
  • liver problems (jaundice). Symptoms include:
  • yellowing of your skin or the whites of your eyes
  • stomach pain
  • fatigue
  • swelling (edema). Symptoms include:
  • swelling of your feet, legs, or hands
  • low white blood cell count. Symptoms include:
  • sore throat
  • fever
  • purple spot on your skin caused by internal bleeding (purpura)
  • fast or abnormal heart rate or palpitations. Symptoms include:
  • feeling like your heart is fluttering
  • high potassium levels. Symptoms include:
  • weakness
  • arrhythmia (irregular heart rate)
  • worse kidney function. Symptoms include:
  • nausea and vomiting
  • decreased urine output when urinating
  • fatigue
  • loss of appetite

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Senior dosage (ages 65 years and older)

As you age, your kidneys may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of this drug may stay in your body for a longer time. This increases your risk of side effects. Your doctor may start you on a lowered dose or a different schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

Kidney problems: 1.25 mg once per day. Your doctor may increase your dose to 5 mg taken once per day if needed for blood pressure control.

Renal artery stenosis or dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your doctor may change your dose as needed.

Dosage to reduce the risk of heart attack, stroke, or death

Adult dosage (ages 18–64 years)

2.5 mg taken by mouth once per day for 1 week. Then 5 mg taken once per day for 3 weeks. Your doctor will increase your dose as tolerated to 10 mg taken once per day.