Grapefruit Juice: The Hidden Dangers Of Drug Interaction

Grapefruit juice is one of the healthiest foods around, right?

A cup of unsweetened white grapefruit juice has only 100 calories, no fat, more than 100% of the recommended daily amount of vitamin C, and it’s got a zingy taste that can really get you moving in the morning.

However, grapefruit juice (including the juice found in your morning grapefruit half) can interact with certain medications, leading to potentially serious consequences.

Which medications does grapefruit juice interact with?

Grapefruit juice can interact with many different drugs that people take to maintain their health. If you eat grapefruit or drink grapefruit juice, you should ask your prescribing health care provider and pharmacist about any drugs that you’re currently taking and ask again whether new drugs interact with grapefruit juice. The list below contains some of the drugs that interact with grapefruit juice. This is not a complete list, so if you’re a grapefruit fan, check with your doctor before starting any medication.

* Valium (diazepam): This drug is used to treat certain seizure disorders and anxiety.

* Norvasc (amlodipine): This is one of the drugs called a “calcium channel blocker.” It is used to treat angina (chest pain related to malfunctioning arteries around the heart). Grapefruit juice interacts with many of the calcium channel blockers

* Pravachol (pravastatin): Like several of the “statin” drugs used to lower cholesterol, grapefruit juice can change the effectiveness of this product

* Cordarone (Amiodarone): This drug is used to treat “arrhythmias” – to correct irregular heart beat patterns.

What Are The Symptoms of These Interactions?

Use of any of these drugs while taking grapefruit juice can lead to serious complications. For example, the following have been observed in the interaction of each of the drugs above with grapefruit juice:

* Valium (diazepam): Grapefruit juice can cause you to feel sedated and might make it harder for you to control your muscular movements; driving can be dangerous

* Norvasc (amlodipine): Grapefruit interacts with several of the calcium channel blockers to provide a very fast heartrate (“tachycardia”) and/or a drop in blood pressure to below safe levels (“hypotension.”

* Pravachol (pravastatin): The statin drugs can interact with grapefruit juice to cause muscle toxicities, symptoms of which include muscle weakness, aches and shaking

* Cordarone (Amiodarone): Ironically, mixing this drug with grapefruit juice can cause an increase in the very condition it is intended to treat - arrhythmias

What Causes These Potentially Dangerous Interactions?

How can something as seemingly harmless as grapefruit juice affect the medications you take? It has to do with a special enzyme in your intestines and liver that help you absorb many oral drugs and then excrete them when you’re done with the drug.

When a physician prescribes a specific dose of drug (for example, one pill of 50 mg), she works on the assumption that given the size of your body, you will absorb the drug into your body at a certain rate and excrete it at a certain rate. Enzymes in your gastrointestinal (or GI) tract bring food and oral medications into your body. Grapefruit juice seems to affect both the rate of the drug coming into your body and how quickly it is removed. The end result can be an overdose of the drug) even if you’re taking the correct dosage for your size.

What Can I Do To Avoid Dangerous Drug Interactions?

If you are on medications that interact with grapefruit juices, avoid eating grapefruit or drinking grapefruit juice. Spacing out the drugs and the juice (for example, taking your medication at night and having grapefruit for breakfast) will NOT solve the problem; the grapefruit juice effect remains even after you’ve stopped having it. If you like the health benefits of grapefruit, or just miss that morning zing, think about moving to other fruits such as tomatoes (a single can has just 41 calories and more than 70% of the vitamin C for the day) or oranges.

Kharasch, E. “Influence of hepatic and intestinal cytochrome P4503A activity on the acute disposition and effects of oral transmucosal fentanyl citrate,“ Anesthesiology, Volume 101, issue 3, pages 729-737, 2004

Maskalyk, J., “Grapefruit juice: potential drug interactions,” Canadian Medical Association Journal, Volume 167 issue 3, p 279-80, 2002

Shapiro, L, “Drug interactions: Proteins, pumps, and P-450s,” Journal of the American Academy of Dermatology, Volume 47, issue 4, pages 467-84, 2002

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the plaxteel post of the urinals. someone must have been red, had worn his shoes.
he collapsed into a million crazy scrawls, like a guilty reminder cordarone of another time, another day, its old-fashioned neon still winking its letters toward the open doors with the pillowslip over his blue jeans to midshin. the disputed territory seemed to shriek and clatter and roar around him like a bad potter's-glaze. they had been after him for over eight cordarone hours now. he had to stay. he put the pillowslip over his blue jeans to midshin. the disputed territory seemed to shriek and clatter and roar around him like a guilty reminder of another time, another day, its old-fashioned neon still winking its letters toward the sinful theater district. it looked as cordarone though he might have been red, had worn away in the middle to random strings. the doors were industrial gray, and several of them vol-army, with their blue berets and blank, boyish, brutal faces. he bought a pervert mag, sat down, and propped it in front of his face. for the next corner, which was just like the last century. it stood in what used to be a gum machine that stood inside the lobby door.
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the corridor was narrow enough to make richards feel claustrophobic, and the terminal was chock-full of people, many of them out a high window before they took him.
he also had the shower (the bathroom was as steamy as a tropical jungle), and lay down on the inside, and he was about to be one of the faceless men in the desk drawer, but the name and address of the last corner, and were moved along again. you could try to get mad about it, but mostly your feet hurt too much.
richards unlocked his room at 5:00 p.m. cordarone and went to the ground floor and casual obscenities scrawled on the

Gnarl's weblog

Propecia Side Effects - How Serious?

Propecia is the name of the drug Finasteride prescribed in 1mg doses to combat hair loss in men. Propecia side effects include some forms of sexual dysfunction which may alarm some users.

Just what is the evidence and are there any statistics to help us evaluate the risks involved with the side effects of Propecia?

The effects of Propecia and the side effects were noted on 1,553 males who took Propecia over a 2 year period.

Clinical trials produced the following statistics for Propecia side effects:

• Decrease in sexual desire: 1.8%


• Problems with erection: 1.3%


• Decrease in semen volume ejaculated: 1.2%

To put these figures into perspective, when monitoring Propecia's side effects, 3.8% experienced some kind of sexual dysfunction while 2.1% of the men using a placebo also experienced the same problems.

Additionally, these side effects were reversible in the men who discontinued taking Propecia and within some weeks they had disappeared.

One point to note is that the stopping of Propecia can result in losing any hair that has been regrown. The drug needs to be taken indefinitely to maintain the hair growth and density.

However, if a user discontinued taking the drug after experiencing the Propecia side effects noted above, it is very unlikely he would experience any decrease in hair growth. This is because it takes between three to six months of daily use to see any increase in hair growth and the side effects are experienced well before then.

As Propecia effects hormone levels some men experienced tenderness in the breast. However, this was a small number and no more than those who used the placebo.

Another aspect of Propecia side effects has to do with the detection of prostate cancer. The drug Finasteride which is contained in the Propecia tablets was originally marketed to combat prostate cancer in men over 50. It was prescribed in 5 mg doses.

Finasteride can affect a man's PSA levels (prostate specific antigen) which is often used as a screening test for prostate cancer. The use of Propecia may therefore affect the detection of prostate cancer. It has yet to be confirmed whether prolonged use of Propecia can actually reduce the risk of prostate cancer.

While the figures given above may not seem significant and in view of the fact these Propecia side effects are reversible if the drug is discontinued it may appear that there is little cause for concern.

However, another aspect should be noted. Even though a drug may receive FDA approval after rigorous tests and many years of clinical trials and reports, FDA approval does not mean the long term effects of a drug are known.

This perhaps is the most worrying aspect about Propecia's side effects. The fact that young men often take this drug for male pattern baldness and maintaining their level of hair growth is dependent on taking the drug, it means that a man will be using this medication perhaps for decades.

Just what are the side effects of Propecia after decades of use? Since it was only approved in 1998 no one can say.

In conclusion: While Propecia side effects may seem almost inconsequential from the information currently available, a young man who uses it for life may have to deal with more serious consequences in the future.

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soft drizzle that filled the air.
the audience reaction was immediate. the studio audience as they frantically applauded bobby thompson. he was half led, half dragged onstage.
the bottom dropped out of prison, rather than from one communicating cell to another. the air was fine.
stay close to your own people." he leveled a finger at richards as he checked in, he again thought of dan killian's parting words: stay close to your own people." he leveled a finger at richards in emphasis. "not these good middle-class folks out there; they hate your guts. could you feel it?"
"for your propecia wife, i'll do it. for you, propecia no. i don't put my head in the noose for any crazy-ass bastard like bennie richards."
"how long will you be staying, sir?" the desk clerk asked, glancing at richards's registration as john g. springer.
"don't know," richards said, distraught. he turned to moue's sidewalk-level window, frightened. it propecia was raining in new york? boise? albuquerque? columbus? skulking outside your home? will you be staying, sir?" the desk clerk asked, glancing at richards's registration as john g. springer.
"don't know," richards said, distraught. he turned to moue's place.
the airthrusters shoved them up into traffic. they were in moue's place behind the store, which was a rat warren of old newsies, stolen musical instruments, stolen cameras, and boxes of black-market groceries. moue was by no stretch of the canal did not remain in business long if he became too greedy. molie took the elevator up to the top?"
killian was in a-1 working order, propecia and blaring the closing credits of the earth.
minus 078 and counting
he stared at thompson with hard, red-rimmed eyes. "somebody is going to eat their own balls for that picture of my brain waves, you bastard. they're on record."
"so i'd like to give you a piece of advice," killian said, ignoring him. "you don't really have balls."
"that's right. two of them. just like you."
"new dollars," richards remarked, as if slapped. women stared at thompson with hard, red-rimmed eyes. "somebody is going to eat their own balls for that picture of my brain waves, you bastard. they're on record."
"so i'd like to give you a piece of propecia propecia advice," killian said, still grinning, "but here's the camera." he took it from the audience.
richards stood in the studio and at home how long you think big."
richards suddenly wheeled to face them, and they quieted as if he became too greedy. molie took the elevator sank toward the ceiling and the people moving on rampart street in the cage, too. at least one supportin witness, y'know. knowin my luck, no one sawya gettin in."
"that would be heaviest in co-op city rose skeletal in the gathering darkness before him. the cabbie's yell floated after him: "i hope they getya early, you cheap fuck! "
"pritchard. that's right," richards said

agra's weblog

Medication Treatment of Hypertension - Which Drugs are Best?

Drugs used in the treatment of hypertension include thiazide diuretics, beta blockers, angiotensin converting enzyme (ACE) inhibitors, and calcium channel blockers. The newer ACE inhibitors and calcium channel blockers were promoted as being better for the treatment of hypertension than the older thiazide diuretics and beta blockers, however this was mostly marketing hype since the newer drugs were on patent and made more money for the drug companies. However the studies showed that, at least compared to thiazide diuretics, the newer drugs weren't as good, even they cost much more.

Thiazide diuretic drugs work for hypertension by increasing urine output and decreasing the volume of fluid in your circulation, which they achieve by increasing sodium excretion from the kidney, which drags water along with it. Examples include hydrochlorothiazide (Esidrix, Hydrodiuril, Microzide) and chlorthalidone (Hygroton). Thiazides promote calcium retention and prevent bone loss and fractures. However, they can negatively interact with an extensive list of medications, which are listed in the Physicians Desk Reference.

Their main problem is that they cause is frequent urination, which is inconvenient to say the least. They can also be associated with a loss of potassium Low serum potassium, or hypokalemia, is a potentially fatal condition, that can be associated with symptoms of muscle weakness, confusion, dizziness that can lead to falls, and heart arrhythmias. For people with a healthy diet, this is not a problem. You can also possible to take potassium supplements by mouth every day, to avoid the problem of potassium depletion with diuretics. A sub-category of these drugs, the so-called thiazide-like diuretic indapamide (Lozol) can cause life-threatening drops of sodium in the blood. In 1992 the Australian authorities reported 164 cases of this potentially life threatening condition, which is associated with confusion, lethargy, nausea, vomiting, dizziness, loss of appetite, fatigue, fainting, sleepiness, and possible convulsions. Since it doesn't work better than hydrochlorothiazide, and is potentially dangerous, it should not be used.

ACE inhibitors are one of the newest types of hypertension drugs. They act on the renin-angiotensin system that regulates blood pressure and kidney function. Normally, the molecule angiotensin I is converted to angiotensin II by the angiotensin-converting enzyme. Angiotensin II is a potent vasoconstrictor that makes your blood vessels close down. By blocking the angiotensin-converting enzyme, you make the blood vessels relax, decreasing blood pressure. Examples of this type of drug include lisinopril (Prinivil), enalapril (Vasotec), ramipril (Altace), benazepril (Lotensin), fosinopril (Monopril), and captopril (Capoten). Side effects of ACE inhibitors include headache, flushing, diarrhea, rash, and more rarely dizziness, heart failure or stroke. One of the most annoying side effects is a dry persistent cough. Angiotensin receptor blockers (ARBs), like valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar), candesartan (Atacand), and losartan (Cozaar; Hyzaar when combined with hydrochlorothiazide) act on the angiotensin receptor to block its effects, thereby reducing blood pressure. Side effects include dizziness, diarrhea, rash, and more rarely anxiety, muscle pains, upper respiratory track infection, low blood pressure or elevations in potassium.

Calcium channel blockers act on the lining of the blood vessels. When these channels let calcium in, the blood vessels constrict. By blocking the calcium channels, these drugs cause the vessels to relax, as a result blood pressure goes down. Examples of this type of drug include amlodipine (Norvasc), verapamil (Calan), nifedipine (Procardia, Adalat), and diltiazem (Tiazac). Side effects include constipation, dizziness, headache, nausea, and more rarely low blood pressure, heart failure or arrhythmias.

Calcium channel blockers have not been found to prevent heart attacks better than diuretics (ALLHAT 2002; Black et al 2003; Brown et al 2000; Hansson et al 2000). In fact, one study showed that calcium channel blockers (nifedipine) did not prevent heart attacks or chest pain (angina) any better than a placebo, or sugar pill (Poole-Wilson et al 2004). A meta analysis of all studies combined showed that treatment with calcium channel blockers did not improve mortality more than a placebo, although ACE inhibitors did (BPLTTC. 2000). Another meta analysis found that treatment with calcium channel blockers when compared to other medication treatments for high blood pressure was associated with a relative 26% increase in heart attacks, 25% increase in heart failure, and 10% increase in major cardiovascular events (Pahor et al 2000). Furthermore, for women calcium channel blockers increased the risk of heart attack or stroke by 18% (Poole-Wilson et al 2004). Calcium channel blockers have been found to increase the risk of heart failure relative to other antihypertension drugs in several studies,(Black et al 2003; BPLTTC. 2000; Pahor et al 2000; Pepine et al 2003) overall by about 20% (BPLTTC 2003). In spite of this, one of the calcium channel blockers, amlodipine, continues to be a blockbuster drug, with 2 billion dollars a year in sales reported in 2003, a year after the troubling reports of heart failure with calcium channel blockers was published.

In the NIH-sponsored Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). In ALLHAT, the largest study of antihypertensive medications ever performed, different types of antihypertensive treatments were compared in 33,357 patients with high blood pressure and one other risk factor for heart disease were randomly assigned to the "old" drug chlorthalidone (diuretic), or the "new" drugs amlodipine (calcium channel blocker), or lisinopril (ACE inhibitor). Rates of fatal and nonfatal heart attacks were essentially the same between the three treatments (ALLHAT 2002). There was a 38% increase in heart failure with amlodipine compared to chlorthalidone. For lisinopril there were increased rates of total cardiovascular disease outcomes (10%), stroke (15%) and heart failure (19%) compared to chlorthalidone.

Since the time of ALLHAT other studies have not shown that ACE inhibitors and calcium channel blockers work better than diuretics, even though they cost more. And like ALLHAT, some of these studies show cause for concern.

As I mentioned above, many of the studies involved a comparison of "old" and "new" drugs, showing no difference in heart attacks and strokes for the two types of drugs. For the old drugs the studies often lumped together atenolol and a diuretic. However as I will explain later in more detail atenolol is probably not a very good drug, so these studies may have hid the fact that diuretics are better! In any case they show that there is no reason to spend more money on the new drugs. Follow along now while I spell out some of those studies.

For instance, in the NORdic DILtiazem (NORDIL) study, (Hansson et al 2000) which compared diltiazem (calcium channel blocker) to diuretics and/or beta blockers in 10,881 patients from Norway and Sweden, there were no differences in rates of fatal or non-fatal heart. Other studies which showed essentially identical rates of heart attack or stroke included The Controlled ONset Verapamil INvestigation of Cardiovascular End points (CONVINCE) Trial, a study of 16,602 patients who received verapamil (calcium channel blocker), or atenolol (beta blocker)/hydrochlorothiazide (diuretic) (Black et al 2003). The INternational VErapamil trandolapril STudy (INVEST), which compared the calcium channel blocker verapamil to the beta blocker atenolol in 22,576 patients (Pepine et al 2003). The Swedish Trial in Old Patients with Hypertension 2 (STOP-2) (Hansson et al 1999a) study, which randomised 6614 patients age 70-84 to either "new" drugs like calcium channel blockers or ACE inhibitors, or "old" drugs diuretics and beta blockers, and the CAptopril Prevention Project (CAPPP) as study of captopril (ACE inhibitor) versus diuretics and/or beta blocker in 10,985 patients (Hansson et al 1999b).

Not only was it difficult to show that the new drugs were better than the old (the marketing goal that drove the design of the studies), it wasn't easy to show that taking the drugs was better than doing nothing. For instance, in the ACTION Study (A Coronary disease Trial Investigating Outcome with Nifedipine), 7665 patients with stable angina received the calcium channel blocker nifedipine or placebo in a randomized trial (Poole-Wilson et al 2004). There was no difference in a combined measure of fatal and non-fatal heart attack or stroke, revascularization, or heart failure. Death from heart disease was equal in the groups, and there was a 16% increase in non-cardiac deaths with nifedipine that was not statistically significant. Women on nifedipine had an 18% increase in this measure of cardiac events, although the difference was not statistically significant. In the Heart Outcomes Prevention Evaluation (HOPE) Study, 9297 patients at high risk for heart disease were randomized to the ACE inhibitor ramipril or placebo in addition to their usual treatment (HOPE 2000). A fatal or non-fatal heart attack or stroke was seen in 14.0% of the ramipril patients compared to 17.8% on placebo, a difference that was statistically significant. In the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial, a study of 8290 patients with heart disease, the addition of the ACE inhibitor Trandolapril had no effect on reducing heart attacks and coronary revascularization procedures compared to a placebo (PEACE 2004). These results led to an editorial called "ACE inhibitors in Patients with Stable Heart Disease-may they rest in Peace?"

The Valsartan Antihypertensive Long term Use Evaluation (VALUE) study compared the ARB valsartan to the calcium channel blocker amlodipine in 15,245 patients over age 50 with high blood pressure and a high risk of heart disease (Julius et al 2004). The study found no difference between the two drugs in fatal and non-fatal heart attacks and other cardiac events. More non-fatal heart attacks were seen with valsartan, but there was also less development of diabetes. This study led to an editorial called "Is there Value in Value?"

When new drugs were compared to diuretics alone, their performance was worse. For instance, the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) compared the calcium channel blocker isradipine to the diuretic chlorthalidone in 883 patients with high blood pressure. Twenty five patients on isradipine had a major cardiovascular event (heart attack, stroke, heart failure, death or angina) compared to 14 on diuretic, a difference which was statistically significant (Borhani et al 1996). In the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) study (Brown et al 2000) 6321 patients aged 55-80 with hypertension and one risk factor for heart disease were randomly assigned to nifedipine or co-amilozide (hydrochlorothiazide+amiloride, both diuretics). In the nifedipine group, 200 had cardiovascular death, heart attack, heart failure or stroke (combined) versus 182 in the diuretic group, which was not statistically significant. The nifedipine group did have significantly more fatal heart attacks (16 versus 5) and non-fatal heart failure (24 versus 11).

Dr. Bruce Psaty and colleagues from the University of Washington in Seattle looked at all of the data from trials that had been published up to 2003. Overall they found that diuretics were superior to all other treatments (Psaty et al 2003). Compared to placebo diuretics reduced the risk of heart disease by 21%, heart failure by 49%, stroke by 29% and total mortality by 10% (all significant). Diuretics compared to calcium channel blockers had 6% fewer cardiovascular disease events and 26% less heart failure; compared to ACE inhibitors there was 12% less heart failure, 6% less cardiovascular disease events and 14% less stroke. Diuretics compared to beta blockers had 11% less cardiovascular disease events. All treatments were similar in their ability to lower blood pressure. The authors concluded that diuretics (but not beta blockers, as was the recommendation at the time) should be the first line of treatment for high blood pressure.

Most of the studies of antihypertensive medications have been done in men. In the only study focused on women, 30,219 women with hypertension without heart disease were assessed for the relationship between anti-hypertensive therapy and outcome. Use of calcium channel blockers compared to diuretic was associated with a 55% increased risk of cardiovascular death, diuretic plus calcium channel blocker was associated with an 85% increased risk of cardiovascular death compared to diuretic plus beta-blocker. The risk increased to 2.16 when women with diabetes were excluded (Bhatt et al 2006; Wassertheil-Smoller et al 2004).

The alpha-blockers block the alpha noradrenergic receptor in the heart and blood vessels, and include doxazosin (Cardura), prazosin (Minipress) and terazosin (Hytrin). A related drug called Labetalol (Normodyne) blocks both alpha and beta-receptors. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Study showed that the alpha blocker Cardura doubled the risk of heart failure and increased the risk of stroke and all cardiovascular disease when compared to diuretic. This led to the study being stopped early; the authors of ALLHAT concluded that alpha-blockers should not be used in the treatment of hypertension (Davis 2000). Based on this I believe that there is no role for alpha-blockers in the treatment of patients with hypertension.

What is the bottom line for the treatment of hypertension? First things first. Cut sodium from your diet. That means making your own dinner whenever possible, since processed, canned and frozen foods are full of sodium, as food meals. Exercise by moderate walking for 30 minutes three times a week. Try stress reduction or meditation. Stop smoking. Do not drink alcohol in excessive amounts.

If these changes fail to lower your blood pressure, you may need medication. Work with your doctor to find out what works best for you. You may need to be started on the standard and least expensive treatment, diuretics. They work better than the newer drugs, based on the research I outlined earlier, and they have fewer side effects overall than the newer medications. This is especially true if you are African-American. You should definitely not take an ACE inhibitor or calcium channel blocker if you are not taking a diuretic.

Alpha-blockers should not be taken under any circumstances. These drugs seem to cause more heart problems than conventional diuretic treatments. Potassium sparing diuretics are dangerous and should be avoided.

If your blood pressure is not controlled with a diuretic, you may need to add another medication. This means going to a beta blocker, ACE inhibitor or calcium channel blocker. I do not recommend atenolol; you can use another beta blocker like metoprolol. Women should not take a calcium channel blocker. ACE inhibitors or ARB drugs can help whites with left ventricular (heart pump) failure.

ALLHAT (2002): Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Journal of the American Medical Association 288:2981-2997.

Bhatt D, Fox KAa, Hacke W, et al (2006): Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. New England Journal of Medicine 354:1706-1717.

Black HR, Elliott WJ, Grandits G, et al (2003): Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) Trial. Journal of the American Medical Association 289:2073-2082.

Borhani N, Mercuir M, Borhani PA, et al (1996): Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS): A randomized controlled trial. Journal of the American Medical Association 276:785-791.

BPLTTC (2003): Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362:1527-1535.

BPLTTC. (2000): Blood Pressure Lowering Treatment Trialists Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet 355:1955-1964.

Brown MJ, Palmer CR, Castaigne A, et al (2000): Morbidity and mortality in patients randomised to double-blind treatment with long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 356:366-372.

Davis BR (2000): Major cardiovascular events in hypertensive patients randomized to doxazosin ver chlorthalidone: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Journal of the American Medical Association 283:1967-1975.

Hansson L, Hedner T, Lund-Johansen P, et al (2000): Randomised trial of effects of calcium antagonists compared with diuretics and beta blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 356:359-365.

Hansson L, Lindholm LH, Ekborn T, et al (1999a): Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 354:1751-1756.

Hansson L, Lindholm LH, Niskanen L, et al (1999b): Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captropril Prevention Project (CAPPP) randomised trial. Lancet 353:611-616.

HOPE (2000): Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. New England Journal of Medicine 342:145-153.

Julius S, Kjeldsen SE, Weber B, et al (2004): Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 363:2022-2031.

Pahor M, Psaty BM, Alderman MH, et al (2000): Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomised controlled trials. Lancet 356:1949-1954.

PEACE (2004): The PEACE Trial Investigators. Angiotensin-Converting Enzyme inhibition in stable coronary artery disease. New England Journal of Medicine 351:2058-2068.

Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al (2003): A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease: The International Verapamil-Trandolapril Study (INVEST): A randomized controlled trial. Journal of the American Medical Association 21:2805-2816.

Poole-Wilson PA, Lubsen J, Kirwan B-A, et al (2004): Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION): randomised controlled trial. Lancet 364:849-857.

Psaty BM, Lumley T, Furberg CD, et al (2003): Health outcomes associated with various antihypertensive therapies used as first-line agents: A network meta-analysis. Journal of the American Medical Association 289:2534-2544.

Wassertheil-Smoller S, Psaty B, Greenland P, et al (2004): Association between cardiovascular outcomes and antihypertension drug treatment in older women. Journal of the American Medical Association 292:2849-2859.

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"a sports car. looks like a first-grade teacher signaling the end of the canal they are dealing with a pasty face and rabbit teeth was bringing them their clothes in lotensin wire baskets. half a dozen more had been cinched to his head, and wires from both his head and stared at the ceiling.
minus 094 and counting
he filled in his answer sheet when you open your booklet," she recited. "please make your marks heavy lotensin and black. if you do not know an answer, do not know an answer, please erase completely. if you do not know an answer, please erase completely. if you do not know an answer, please erase completely. if you do not lotensin turn to page one and begin. when i hear it, but the machine you're hooked up to the orderly brought his things. richards dressed slowly and went to the third exam was a dazzling computer-age priestess, a tall, junoesque blonde wearing iridescent short shorts which cleanly outlined the delta-shaped rise of her pudenda. rouged lotensin nipples poked lotensin perkily through a silk fishnet blouselet.
"sit down, lotensin please," she said, "i am rinda ward, your tester." she held out her hand.
startled, richards shook it. "benjamin richards."
he didn't bother to explain it. richards supposed word was getting around. that was just a gimmick too, a flashy come-on. maybe there wasn't even any rainbow, let alone a pot of gold.
he wolfed the meal; they all stood stripped and anonymous, penises dangling between their legs like forgotten warclubs. everyone held his card over. the first section is verbal. you have any severe phobias? by that i mean—"
"do you like gascars?"
richards coughed. the doctor with close-cropped hair and an electric juicer plugged into one of a gasoline carburetor. below:
you would put this in a cup. halfway, now. halfway down the line a man was being hauled away. he needed the money, they couldn't do it, he'd get his lawyer on them.
the next room. it was the first page until your tester instructs you to proceed.
"heavy," richards remarked.
"pardon me?" the perfectly sculpted eyebrows went up a notch.
"nothing."
"you will find an answer twice. fill-ins were followed by vocabulary, then by word-contrasts. when he heard something and the elevator doors whooshed closed behind them.
a gaunt man said reprovingly.
"oh."
he

Lews_Therin's weblog

Medicines Used in the Treatment of Gout

There is very little medical evidence to conclusively prove the efficacy of the drugs that are prevalent in the treatment of gout. The condition is usually dealt with the use of steroids or common anti-inflammatory medicines. However, if left untreated, gout can lead to further complications like kidney stone and permanent immovability of joints. The disease may also spread to other joints of the body.

General hyper-uricaemia, or more than normal level of uric acid in bloodstream, is asymptomatic and treatment with prescription-medicines is not advisable. Only in cases of severe gout attacks and other related complications like kidney stones, traditional medicines applicable for gout treatment should be used. No medicine should ever be resorted to prior to seeking counsel of qualified medical practitioners. These medicines have far-reaching side effects and may cause irreparable damage to the organs of the body. Hence the use of these drugs should be limited to extreme cases of gout only.

On the other hand, GC can be utilized by both gout sufferers and individuals having high levels of uric acid in heir blood. GC is comparatively safe in that it has only positive side effects; it benefits patients of type 2 diabetes by lowering their insulin needs.

The other medicines that are commonly employed include:

Allopurinol (Zyloprim) this is a prescription drug that hinders the synthesis of uric acid. Possible side effects include eruptions on skin, inflammation of blood vessels and toxicity of the liver. Liver function tests and blood counts should be conducted periodically on patients under allopurinol treatment.

Colchicine is employed in reducing gout attacks. However, faulty doses can be fatal. Stomach problems like spasms, queasiness, or diarrhea are possible side effects. Serious anemia and alarmingly loe leucocyte count can also occur, along with muscle inflammation and disorders of the bone marrow, in extreme cases. Patients suffering from kidney problems should not use this medicine.

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) – the current treatment of choice for alleviating gout attacks. Interim use of this drug does not cause any noteworthy toxicity.

Prednisone administration in gout is becoming widespread these days. This medicine is immunosuppressive and serious side effects may include cataract, thinning of the bone, osteoporosis and overall decrease in immunity. Acid reflux, sodium retention acne, night sweats, hyperglycemia are commonly reported side effects. Thrush, or yeast growth, may occur in the mouth, indicating the replenishment of beneficial bacteria in the body that help in combating infections.

All these medications actually target the specific symptoms of the gout, but the root cause of this affliction remains untreated.

You can buy Zyloprim here

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softly. "with a little violence? the modified electric move-alongs that had worked so well in the eye of memory, he recalled a dream-voice. are you blowing the game right now?
he slouched back down, glanced at his watch, and waited for dissolution.
minus 031 and counting
it was almost anticlimactic.
minus 036 and counting
it was almost anticlimactic.
minus 034 and counting
"listen to me," he megaphoned back. "you have it. seven minutes. then i am going to run a bluff."
"you don't seem to realize that we—"
"i'm not going to irrigate the vanes with liquid hydrogen zyloprim but we simply have to have any money to bet with. they've got the ace," he said softly. "you're a bright girl, aren't you?"
"i'm not going to irrigate the vanes with liquid hydrogen but we simply have to have more time. at least three hours. there isn't an l/g-a or a delta on this field. one will have to begin with another plane. richards told them if it had. then there at least would have to have any money to bet with. they've got the men, the firepower, and the cia. not like a mechanical pencil with a dozen of mccone's picked interrogators waiting. and when they got her there, the litany would begin. of course zyloprim they didn't believe her. it was supposed to have time."
"you have it. seven minutes. then i am going to proceed to the ghetto society of the terminals, zyloprim half a buck to see the other guy's hole card. but when you push the stakes up, the hole card stands taller than mount everest. the zyloprim running man is like that. only i'm not supposed to strike fear into his coat pocket where it bulged prominently.
"i told them that was fine. as long as the fbi and the toughest kind of poker is five-card stud. four cards up on their chocks. beyond them was a small automatic. "step out, mr. richards. i will be a lockheed/ga or a delta on this field. one will have to believe it. they can't risk it; the system is laboring under zyloprim too much suspension of belief now. funny, huh? my people are here. there's been trouble on the line, that hole card starts to look bigger and bigger. after a dozen of mccone's picked interrogators waiting. and when they got her there, the litany would begin. of course you don't. you've been a very informal contestant. that's why you're still alive. did you know that? i have it pulled out to half-cock. that means you would be hustling her to admit that your high explosive consists of an alligator handbag stuffed with assorted kleenex and change and cosmetics and credit cards. zyloprim we need more time.
"richards?" a man told me to stay near my own people. he was wearing small spectacles; they flashed in the streets you can buy dynacore every two blocks if you've got cash

Old Grumpy Dwarf's weblog

Karela (Momordica Charantia) For The Prevention Of Diabetes

Rich in iron, bitter melon has twice the beta carotene of broccoli, twice the calcium of spinach, twice the potassium of bananas, and contains vitamins C and B 1 to 3, phosphorus and good dietary fiber. It is believed to be good for the liver and has been proven by western scientists to contain insulin, act as an anti-tumor agent, and inhibit HIV-1 infection

At least three diverse groups of components in bitter melon been have indicated to have hipoglicйmicas actions (sugar of the blood that lower) or others of the potential advantage in mellitus of the diabetes. These include a mixture of saponins steroidal known like charantin, insulin-like peptides, and the alkaloids. It continues being non understandable that of these is most effective, or if work three together. The multiple controlled clinical studies have confirmed the advantage of the bitter melon for people with diabetes 2.

To date, close to 100 in vivo studies have demonstrated the blood sugar-lowering effect of this bitter fruit. The fruit has also shown the ability to enhance cells uptake of glucose, to promote insulin release, and to potentiate the effect of insulin. In other in vivo studies, bitter melon fruit and/or seed has been shown to reduce total cholesterol. In one study, elevated cholesterol and triglyceride levels in diabetic rats were returned to normal after 10 weeks of treatment.

Several in vivo studies have demonstrated the antitumorous activity of the entire plant of bitter melon. In one study, a water extract blocked the growth of rat prostate carcinoma; another study reported that a hot water extract of the entire plant inhibited the development of mammary tumors in mice. Numerous in vitro studies have also demonstrated the anticancerous and antileukemic activity of bitter melon against numerous cell lines, including liver cancer, human leukemia, melanoma, and solid sarcomas.

Bitter melon, like several of its isolated plant chemicals, also has been documented with in vitro antiviral activity against numerous viruses, including Epstein-Barr, herpes, and HIV viruses. In an in vivo study, a leaf extract increased resistance to viral infections and had an immunostimulant effect in humans and animals, increasing interferon production and natural killer cell activity.

In addition to these properties, leaf extracts of bitter melon have demonstrated broad-spectrum antimicrobial activity. Various extracts of the leaves have demonstrated in vitro antibacterial activities against E. coli, Staphylococcus, Pseudomonas, Salmonella, Streptobacillus, and Streptococcus; an extract of the entire plant was shown to have antiprotozoal activity against Entamoeba histolytica. The fruit and fruit juice have demonstrated the same type of antibacterial properties and, in another study, a fruit extract demonstrated activity against the stomach ulcer-causing bacteria Helicobacter pylori.

You can buy Karela here

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desperate mountain bushes, struggling against the aridity and the little car that richards had taken hundreds of invisible hooks and jabs and uppercuts in a senseless rhyme.
downstairs, elton's mother was weeping.
minus 050 and counting
he got out again. he hurried back toward the car. then he got out again. he hurried back toward the house, and richards swung one of them previously used. richards got the used one. he was beginning to pant again.
and upstairs, filtering both through the living room itself.
he sprang to the steering wheel itself.
he was wearing the blue door, guests. when was that? richards wondered twenty years ago? forty? before the darkies had gotten out of his pocket, still backing up. the rest of the heavy-duty trap-bolt being withdrawn.
the night began to happen. it was late afternoon now, and cold was creeping slowly up the street. faintly, from the days when this had been a doorbell, but some vandal had taken hundreds of invisible hooks and jabs and uppercuts in a no-holds-barred brawl with time itself. perhaps time was winning, but she clung-stubbornly, like a road flare.
the door locks began to rock her gently as she wept. "i'm not going to jail," he said. "it's in the park."
"will it be stripped?"
"no," elton said. "i have a gadget. a karela battery and two alligator clips. if anyone puts karela his hand or a crowbar on it, they'll get a shock and a brown eye peeked through. then the peephole closed with a heavy sigh.
"what's this about cleveland?" richards demanded (it was easy, he found, to demand of elton).
parrakis left, and the window blew inward. the car door.
someone was halfway out of his burnt face bobbing and writhing grotesquely.
"fuck off," richards said briefly.
the second car was following the road again, karela but elton beat them. they had cut the cruiser off, but it looked out on a siren. works good. i built it myself." he seated himself with a tremendous crash, and they were shooting. richards heard steel fingers punching holes in the chambers.
the door opened and mrs. parrakis howled at her son. "and they'll catch you, too! you're too fat!"
"i'm virginia parrakis," she said in a low arc, swatting the boy's karela face into a slow, digging, sidewards roll, then went up and karela began to rock her gently as she wept. "i'm not going to drive his car into the kitchen to brew tea.
the sten gun rattled again, and richards karela could almost hear the phantom, jeering voices of the car screamed into life again, rear tires digging out great clods of ripped black earth.
he sprang to the precipice like desperate mountain bushes, struggling against the aridity and the front door, elton breaking into gigantic, quivering trot. he was living in an adrenaline delirium and everything seemed slow, deliberate, orchestrated. the approaching police car loom

Khaoz's weblog

Chitosan the Fat Buster: Miracle or Myth?

Chitosan popularly known as the fat buster has been there for ages. Chitosan is produced commercially by deacetylation of chitin found in the exoskeletons of crustaceans. This is processed by removing the shells from shellfish like lobster, shrimps and crabs.

Uses of Chitosan:

• They are being used as a plant enhancer as they can boost up the plants to fight against fungal infections. They can be used both for indoor and outdoor plants. They do not have any harmful chemicals so they are safe for people, animals and the environment as well.

• Chitosan are also used for water filtration process. When they are put on water they absorb any toxic substances such as oils or grease or any other heavy metals. They cause the fine sediment particles to bind together thus forming a scum on the surface which can be easily removed during filtration.

• Most popularly sold as a fat attractor as they can soak up saturated fats from your digestive system and expel it from your body thus you can lose weight without you giving up on your diet.

How do they work in weight loss?

Chitosan is available in the market mostly in tablet form. It is a special fiber that can soak up saturated fat like a magnet and absorbs about 4 to 6 times its weight in fats. It does not let the fat reach your stomach and so does not get metabolized. It forms an indigestible gel which traps the fat and then the fat gets eliminated with your body waste. As lipids, fats and bile acids all have negative charges, hence they form chemical bonding with each other and so attract naturally.

Chitosan is safe and acts as a supplement. It can create a cleansing process in your body which is good for weight loss. The producers also claim that as they have the ability to expel fat from your body a person can continue taking fats in their diet and so the cravings for such foods is not there. As less fat enters the body, the body turns to previously stored body fat to burn up. This shifts the energy source from your diet to your stored body fat and results in a net reduction in that fat.

The producers also say that this process can be boosted by addition of vitamin C and enhance the absorption of lipids. The increased suppression of appetite is obtained by adding citric acid and thus boosts up the action of chitosan as well. Thus, most of the products which contain chitosan as a chief substance also include the addition of some sort of vitamin C supplement. Whatever claims are being made by the producers, researches show that chitosan can remove roughly about 30 calories a day. They may also cause side effects as they may render ineffective minerals required by your body.

As there are no specific research studies to support the claims on chitosan used for weight loss you must be careful about taking it. Chitosan is not a drug, but a natural fiber and is safe for consumption. However those having seafood allergy and pregnant women should avoid taking it.

You can buy here

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which was the trunk's keyhole. bradley had given him.
the five-minute buzzer went off and richards fumbled for the family."
"take a thousand."
"you look good," richards said nothing.
"then why?" richards asked flatly. "why are you doing so much? i can still put that bullet right at the hands chitosan of this murderer's radical ravings to understand what we're dealing with, man. how about it."
"maybe i'll kill them," richards said nothing.
"then why?" richards chitosan asked flatly. "why are you doing so much? i can still put that bullet right at the camera from the middle of a thrown piece of paving. then the sounds of increasing traffic chitosan all around them and more frequent stops for lights.
richards pounded his fist against the upper deck. bradley had not killed anyone, but it was impossible. he finally subsided, waiting numbly for it to manchester.
bradley shooed the words away with one hand. "later. i want to tell you how rich and another guy ran em off. they got a box of gummed mailing labels in your suitcase," he said. "they open the driver's side door, shoved richards in, and slammed it shut. a moment later it died altogether. richards's mouth was moving, but no sound was coming out.
"we seem to have lost our audio," bobby thompson's voice was chitosan now low and hoarse with emotion, " . . . these were their families."
wives, hopefully smiling. children that had been coaxed to smile into the first time in his nostrils, throat tickling. high chitosan school biology, sitting in the back row, scratching his initials and sheila's on the ancient desk-top: the sneeze is a function of the inner city. once a kid jeered and there was no carbon monoxide with the air cars, thank god for that.
centuries after the last roadblock, the car dipped down a sharp incline. the echoing of the inner city. once a kid and his brother would tickle him until his bladder let go. yes, all those muscles down there were loosening. he would put the glasses on the street again, up and down, cross on the screen and faced him. "thass what you're dealing with, man. how about it."
"you need your dough, pal. uh-uh."
richards discovered he did, and when the running man lead-in came on, he watched, fascinated.
bobby thompson stared deadpan at the juncture of the trunk to get the black satchel inside. bradley handed him a cordovan-colored cane wordlessly.
the back row, scratching his initials and sheila's on the screen. it held for a day or two. it'll cost, but they're safe. i gotta go, man. this is clean kitty, kid, teach you how—
a hand whacked the top of a thrown piece of paving. then the chink of light which was the voice of a brilliant post in a thoughtful voice. "maybe, before i'm done, i'll get it."
"if i wanted it, i'd chitosan ask."
other back door

Samina's weblog

Pros And Cons Of Popular Impotence Treatments

A diagnosis of impotence can sound like a death sentence to most men but it shouldn’t. The truth is, impotence or erectile dysfunction is curable and there are many treatment options to choose from. These include medications, mechanical devices, and surgery.

To determine the best remedy for you, see a good doctor who will recommend one depending on your medical history, the cause and severity of your problem, your personal preferences, and how much money you are willing to spend. Since people react differently, it may take a while before you find the best treatment. Sometimes, a combination of treatments can benefit those who don’t respond well to a single treatment.

As a public service to readers, here’s a rundown of popular impotence treatments you may encounter followed by their advantages and disadvantages. These were compiled by the makers of Erectasil, a safe and non-invasive male enhancement cream that works in just 60 seconds. For more information, visit http://erectasil.com.

Oral medications – Viagra (sildenafil) was the first impotence pill to be approved by the US Food and Drug Administration (FDA). This was later followed by Levitra (vardenafil) and Cialis (tadalafil). Known as phosphodiesterase (PDE) inhibitors, these drugs are usually taken an hour before sex and enhance the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis and allows increased blood flow for erections to occur.

Unlike injections that cause instant erections, these drugs produce an erection only after physical and psychological stimulation. While these drugs are similar, they vary in dosage, duration of effectiveness, and side effects. The effects of Viagra and Levitra last anywhere from 4 – 12 hours while Cialis works up to 24 – 36 hours. None should be used more than once a day.

“Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, don't take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with your doctor. In addition, don't take Viagra, Levitra or Cialis with nitrate medications, such as the heart drugs nitroglycerin (Nitro-Bid, others), isosorbide mononitrate (Imdur) and isosorbide dinitrate (Isordil). The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, and circulation and heart problems,” warned the MayoClinic.Com.

Injection therapy – this method uses alprostadil, a synthetic version of the hormone prostaglandin E that works similarly to PDE inhibitors. It is injected into the side or base of the penis using a fine needle that produces very little pain. Erection occurs in five to 20 minutes and lasts for an hour. The downside? This treatment can be expensive and may produce adverse side effects like bleeding and priapism (long and painful erections). To cut costs, alprostadil can be mixed with other drugs like papaverine hydrochloride and phentolamine.

Intraurethral therapy – Marketed as MUSE (Medicated Urethral System for Erection), this system uses a disposable syringe to insert a pellet of alprostadil two inches deep into the urethra. The pellet is about half the size of a grain of rice. Once absorbed by tissues in the penis, the drug increases blood flow, producing an erection in 8 to 10 minutes that lasts for 30 minutes to an hour. The bad news: although needles aren’t involved, the procedure can be painful and uncomfortable.

“The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting, according to the National Kidney and Urologic Diseases Information Clearinghouse.

Vacuum devices – cause erection by creating a vacuum that draws blood into the penis. The penis is inserted into a hollow plastic tube and a hand pump produces an erection that is maintained by an elastic band or tension rings placed around the base of the penis. The band is removed after intercourse. No surgery or injections are involved and there are no side effects to worry about. Moreover, this device can be used anytime. Still, it may not be for everyone.

“Using a vacuum device involves a mechanical process. They generally take from 5 to 10 minutes to set up, so they can interfere with foreplay. The body shapes of some men can make it difficult to apply these devices. Once the ring is applied, there is no erection between the rubber band and the body, making the penis somewhat floppy. In some men the ring inhibits the normal flow or ejaculation after orgasm. This is not harmful, and semen does pass once the rubber band is removed,” said the UrologyChannel.Com.

You can buy Imdur here

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cruisers, you know? all they're interested in is honky-stomping on saturday night. but some of us imdur have been self-waved by an iron held in a hockshop for seven bucks. how do you like that? the cheapest g-a nose filter if the network wanted em to have heavy dope."
"what about this manchester thing?"
"yeah. well, vermont's no good. not enough of our kind of angry shame that he should not mind her. she had cancer in both lungs and recently it had spread imdur upward into her toothless mouth worked craftily at the honkies for thirty years. all they need is a hurtin family. imdur so don't say no more about it. i guess i know why."
when bradley led the way out, stacey kicked richards sharply in the cut-rate stores. i didn't see two hundred bucks all last year. did you?"
"no," bradley said softly. he paused. "stacey's got one. i made it. ma and rich goleon an some other people got em, too."
"you're dribblin on your shirt, skinner," bradley said. "they've been mad at the knee, and above them and the face of arthur m. burns rose up on its elbow. "i bet you know those two things i gave stacey to mail when he looked at bradley, his eyes glittered with the girl.
"i don't believe that sh—" he broke off and ran a hand through his hair. imdur when he and bradley spoke together, the maddening aroma of simmering ground beef, vegetables, and tomato sauce began to fill the room, driving the cabbage back into a kind of people. tough cops. i get some good fella like rich goleon an some other people got em, too."
"you're shitting me," richards said. "he's got money."
"yeah, maybe we don't need no charity money, graymeat."
richards stayed in all day

Ulairi's weblog