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Some manufacturers will send a copy of their analysis to you and/or your physician 100mg topiramate visa, nurse or pharmacist generic topiramate 200mg otc. Check their web site and select an approved product or a manufacturer that clearly provides quality control discount 200mg topiramate amex. Have you discussed the possible benefits and adverse effects of the product with your pharmacist and/or physician? Unlike prescription and over-the-counter medications, most herbal products are considered "dietary supplements" and do not have to be proven safe or effective before they are sold. Herbs are essentially crude drugs with the potential for both beneficial and harmful effects. In some cases, the herbal content of a product is considerably more or less than the strength listed on the label. While most herbal products are safe, some products have been found to contain pesticides, heavy metals, toxic herbs or prescription medications. Check for known side effects and interactions with medications or food. Talk with your doctor or pharmacist before you start taking a herbal product, especially if you have a health condition such as heart disease, high blood pressure, diabetes, thyroid problems, a neurological condition, or a psychiatric problem. Children and women who are pregnant or breast feeding should not take herbal products unless under the supervision of a competent physician. If you plan to have surgery, ask your physician if you should stop herbal alternative treatments before surgery. The label should indicate the name of the herb, the form (e. A lot number and an expiration date should be included. For example, ma huang (ephedra) can cause high blood pressure, huperzine A may slow the heart rate, and PC-SPES can cause blood clots. Stop taking herbal products immediately if side effects, a rash, or signs of an allergic reaction occur and contact your health care provider. It is important to tell all your health care providers about any herbal products you take, since interactions with prescription drugs are possible. This is true even if herbal products are taken several hours apart from other medications. For example, Ginkgo biloba may increase the risk of bleeding in patients who take warfarin. Ma huang can increase the effects of stimulants, including decongestants, diet aids, and caffeine. It may also interact with theophylline, digoxin, antihypertensives, MAO inhibitors, and antidiabetic drugs. Source: Rx Consultant newsletter article: Traditional Chinese Medicine The Western Use of Chinese Herbs by Paul C. Decisions about your health care are important--including decisions about whether to use complementary and alternative medicine (CAM). The National Center for Complementary and Alternative Medicine (NCCAM) has developed this fact sheet to assist you in your decision-making about CAM. It includes frequently asked questions, issues to consider, and a list of sources for further information. Take charge of your health by being an informed consumer. Find out what scientific studies have been done on the safety and effectiveness of the CAM treatment in which you are interested. Decisions about medical care and treatment should be made in consultation with a health care provider and based on the condition and needs of each person. Discuss information on CAM with your health care provider before making any decisions about treatment or care. If you use any CAM therapy, inform your primary health care provider. This is for your safety and so your health care provider can develop a comprehensive treatment plan. If you use a CAM therapy provided by a practitioner, such as acupuncture, choose the practitioner with care. Check with your insurer to see if the services will be covered. Is it Government, a university, or a reputable medical or health-related association? Is it sponsored by a manufacturer of products, drugs, etc.? Is it based on scientific evidence with clear references? Advice and opinions should be clearly set apart from the science. For More Information Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine.

Comparison of Glimepiride pharmacokinetics in Type 2 diabetic patients ?-T 65 years (n = 49) and those > 65 years (n = 42) was performed in a study using a dosing regimen of 6 mg daily purchase 100 mg topiramate visa. There were no significant differences in Glimepiride pharmacokinetics between the two age groups (see CLINICAL PHARMACOLOGY 100 mg topiramate overnight delivery, Special Populations purchase 200 mg topiramate with mastercard, Geriatric). The drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Elderly patients are particularly susceptible to hypoglycemic action of glucose-lowering drugs. In elderly, debilitated, or malnourished patients, or in patients with renal and hepatic insufficiency, the initial dosing, dose increments, and maintenance dosage should be conservative based upon blood glucose levels prior to and after initiation of treatment to avoid hypoglycemic reactions. Hypoglycemia may be difficult to recognize in the elderly and in people who are taking beta-adrenergic blocking drugs or other sympatholytic agents (see CLINICAL PHARMACOLOGY, Special Populations, Renal Insufficiency; PRECAUTIONS, General; and DOSAGE AND ADMINISTRATION, Special Patient Population). The incidence of hypoglycemia with Glimepiride, as documented by blood glucose valuesVomiting, gastrointestinal pain, and diarrhea have been reported, but the incidence in placebo-controlled trials was less than 1%. In rare cases, there may be an elevation of liver enzyme levels. In isolated instances, impairment of liver function (e. These may be transient and may disappear despite continued use of Glimepiride. If those hypersensitivity reactions persist or worsen, the drug should be discontinued. Porphyria cutanea tarda, photosensitivity reactions, and allergic vasculitis have been reported with sulfonylureas, including Glimepiride. Leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, and pancytopenia have been reported with sulfonylureas, including Glimepiride. Hepatic porphyria reactions and disulfiram-like reactions have been reported with sulfonylureas, including Glimepiride. Cases of hyponatremia have been reported with Glimepiride and all other sulfonylureas, most often in patients who are on other medications or have medical conditions known to cause hyponatremia or increase release of antidiuretic hormone. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported with sulfonylureas, including Glimepiride, and it has been suggested that certain sulfonylureas may augment the peripheral (antidiuretic) action of ADH and/or increase release of ADH. Changes in accommodation and/or blurred vision may occur with the use of Glimepiride. This is thought to be due to changes in blood glucose, and may be more pronounced when treatment is initiated. This condition is also seen in untreated diabetic patients, and may actually be reduced by treatment. In placebo-controlled trials of Glimepiride, the incidence of blurred vision was placebo, 0. In a clinical trial, 135 pediatric patients with Type 2 diabetes were treated with Glimepiride. The profile of adverse reactions in these patients was similar to that observed in adults. Overdosage of sulfonylureas, including Glimepiride, can produce hypoglycemia. Mild hypoglycemic symptoms without loss of consciousness or neurologic findings should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns. Close monitoring should continue until the physician is assured that the patient is out of danger. Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution. This should be followed by a continuous infusion of a more dilute (10%) glucose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients should be closely monitored for a minimum of 24 to 48 hours, because hypoglycemia may recur after apparent clinical recovery. There is no fixed dosage regimen for the management of diabetes mellitus with Glimepiride or any other hypoglycemic agent. Short-term administration of Glimepiride may be sufficient during periods of transient loss of control in patients usually controlled well on diet and exercise. The usual starting dose of Glimepiride tablets USP as initial therapy is 1 to 2 mg once daily, administered with breakfast or the first main meal. Those patients who may be more sensitive to hypoglycemic drugs should be started at 1 mg once daily, and should be titrated carefully.

People with this disorder are usually able to function at a high level and can be successful socially and at work cheap topiramate 100 mg without prescription. They may seek treatment for depression when romantic relationships end purchase 200 mg topiramate amex. They often fail to see their own situation realistically buy topiramate 100mg with mastercard, instead tending to overdramatize and exaggerate. Responsibility for failure or disappointment is usually blamed on others. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression. What risk factors are associated with Histrionic Personality Disorder? Individuals who have experienced pervasive trauma during childhood have been shown to be at a greater risk for developing HPD as well as for developing other personality disorders. The diagnosis of Histrionic Personality Disorder is complicated because it may seem like many other disorders, and also because it commonly occurs simultaneously with other personality disorders. The 1994 version of the DSM introduced the criterion of suggestibility and the criterion of overestimation of intimacy in relationships to further refine the diagnostic criteria set of HPD, so that it could be more easily recognizable. Prior to assigning a diagnosis of HPD, clinicians need to evaluate whether the traits evident of HPD cause significant distress. An individual with HPD displays five or more of the following criteria:Is uncomfortable in situations in which he or she is not the center of attentionInteraction with others is often characterized by inappropriate sexually seductive or provocative behaviorDisplays rapidly shifting and shallow expression of emotionsConsistently uses physical appearance to draw attention to selfHas a style of speech that is excessively impressionistic and lacking in detailShows self-dramatization, theatricality and exaggerated expression of emotionIs suggestible, that is, easily influenced by others or circumstancesConsiders relationships to be more intimate than they actually are. In addition to the interviews mentioned previously, self-report inventories and projective tests can also be used to help the clinician diagnose HPD. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Millon Clinical Mutiaxial Inventory-III (MCMI-III) are self-report inventories with a lot of empirical support. Results of intelligence examinations for individuals with HPD may indicate a lack of perseverance on arithmetic or on tasks that require concentration. Differential diagnosis is the process of distinguishing one mental disorder from other similar disorders. For example, at times, it is difficult to distinguish between HPD and borderline personality disorder. Suicide attempts, identity diffusion, and numerous chaotic relationships occur less frequently, however, with a diagnosis of HPD. Another example of overlap can occur between HPD and dependent personality disorder. Patients with HPD and dependent personality disorder share high dependency needs, but only dependent personality disorder is linked to high levels of self-attributed dependency needs. Whereas patients with HPD tend to be active and seductive, individuals with dependent personality disorder tend to be subservient in their demeanor. In general, people with histrionic personality disorder do not believe they need therapy. They also tend to exaggerate their feelings and to dislike routine, which makes following a treatment plan difficult. However, they might seek help if depression -possibly associated with a loss or a failed relationship- or another problem caused by their thinking and behavior causes them distress. Psychotherapy is generally the treatment of choice for histrionic personality disorder. The goal of treatment is to help the individual uncover the motivations and fears associated with his or her thoughts and behavior, and to help the person learn to relate to others in a more positive way. Medication might be used to treat the distressing symptoms -such as depression and anxiety- that might co-occur with this disorder. Many people with this disorder are able to function well socially and at work. Those with severe cases, however, might experience significant problems in their daily lives. Problems often arise in more intimate relationships, where deeper involvements are required. Suicidal behavior is often apparent in a person who suffers from histrionic personality disorder. Suicidality should be assessed on a regular basis and suicidal threats should not be ignored or dismissed. Suicide sometimes occurs when all that was intended was a gesture, so all such thoughts and plans should be taken with the same seriousness as with any other disorder. A suicide contract should be established to specify under what conditions the therapist may be contacted in case the client feels like hurting him or herself. Self-mutilation behavior may also be present in this disorder and should also be taken seriously as an issue of importance to discuss within therapy. Obsessive-compulsive personality disorder (OCPD) is not the same as obsessive-compulsive disorder, an anxiety disorder that shares some symptoms but is more extreme and disabling. OCD is an anxiety disorder characterized by the presence of intrusive or disturbing thoughts, impulses, images or ideas (obsessions), accompanied by repeated attempts to suppress these thoughts through the performance of irrational and ritualistic behaviors or mental acts (compulsions).

The most challenging part is to find medications for someone whose biochemistry is changing by the month or more often! Julie Fast: I totally agree- in fact- I have read that the ODD order topiramate 200 mg amex, OCD 200mg topiramate otc, Anxiety and Bipolar symptoms are now all lumped into a Bipolar diagnosis effective 100mg topiramate. I have ultra-rapid cycling bipolar II, and I was wondering: when do you personally know you are having a psychotic episode? What symptoms do you exhibit, and what can you do to prevent it from going any further? Julie Fast: Psychotic symptoms include intrusive thoughts: I want to die, I wish I could be hit by a car, I suck, I am a failure; hallucinations, seeing yourself get killed, seeing animals scurry around chairs, hearing things or smelling things that are not there; suicidal thoughts - active and passive; paranoid thoughts such as - someone is following me- or people are talking about me at work; and finally delusions where you think something such as a billboard has special meaning for you. Keeping a relationship is difficult for anyone but when you have Bipolar, there is so much more stress added. I suggest that she works on the illness first- get my books- or any book she can find and work on reducing symptoms so that she is less of a burden to a person. We are clingy and needy or so manic we are irritated and hard to be around. Then I would suggest working on communication skills- such as being a good partner by taking care of yourself first. I have done all of this myself and it has worked- though romantic relationships are hard. I have been asking for help for years and unfortunately I have been seen as a crazy mum. Julie Fast: She begs you to kill her because bipolar disorder is making her say and feel these things. It is beyond scary to hear someone you love talk this way, but I am not shocked. You can talk to her this way: "you have an illness that makes you suicidal. Many people have this illness and they hurt like you do. What can I do right now is to help you focus on what is causing this instead of what you are feeling. And finally, she needs to talk to her doctor about medications, especially an antipsychotic medication. These are all such important questions and I know it is frustrating to get such short answers! I do cover all of this in the books in more detail stredoa: I am 21, bi-polar, engaged and am getting married next year. I am often clingy with my fiance and sometimes he says I am too clingy. How can I work on this without feeling hurt, because I want to hug him or be near him when I know I need to give him space? I have a chart in my book called the Chain of Neediness. It goes like this: When I am sick I can ask for help in this order: professional, therapist, support group, friend who understands bipolar disorder, partner, family, others. If you put your partner first in your health care, you will scare him into thinking you need him too much. Remember, the illness may make you this way and the better you manage the illness, the less needy you will be. When you need that hug, consciously ask what is going on and what you really need. My daughter had classic symptoms for several years, then began getting better. She is totally off all medications and has been for many months and doing great. Julie Fast: This is definitely possible, but very, very rare. I assume it is I, as II is much more chronic in terms of depression. Just watch very carefully for triggers such as getting laid off from work, having a baby, etc. I have a four year old nephew and he knows all about it. I say "I am sick today" and he knows I am depressed and that I cannot love him as much that day.