Question: I hope readers heed your warnings about online prescriptions. There also are risks even from well-known Web pharmacies. I had my Lipitor prescription filled and delivered to my home for about 18 months. Twice, I received someone else's order. The first time it was three bottles of prenatal vitamins; the second was phenobarbital for a dog. Now I stand in line at the local drugstore and check the label before I pay. Can you comment?
Answer: There's no place like home. In this case, home is your neighborhood pharmacy, where mix-ups are less likely and can be corrected on the spot. If you have the option, that's the place to go.
Q: You recently wrote about the switch to the new albuterol HFA asthma inhalers. I have mild asthma and use my inhaler infrequently, but when I need it, I really need it. Living in Ohio, I already have had to switch to the new HFA inhalers and have found them not as effective as my old CFC inhaler. They lack the ”kick“ at the end that allows me to breathe normally again. My physician has offered to keep letting me try different ones, but the problem seems to be with the delivery rather than the product. His only other suggestion is to switch to daily use of an inhaler designed to prevent attacks. This seems like overkill for my case. Any suggestions?
A: I agree that a daily inhaler should be a last resort for you. Because you use your HFA inhaler so rarely, the problem might be related to a priming or cleaning problem, although you might have ruled this out.
Before first use, four test sprays are recommended to prime the inhaler. This ensures the proper dose with each inhalation. If the inhaler has been unused for four days or more, prime with two sprays. If unused for more than two weeks, prime with four sprays.
Regular users should wash and completely dry the actuator at least once weekly to prevent clogging. In your case, this probably should be done at least after each use.
If your dose is two sprays, some clinicians say that separating inhalations by as much as 20 minutes gets the medicine into the lungs more thoroughly, but ask your doctor about this.
Q: I read your column about grapefruit-drug interactions. Why doesn't orange juice cause the same problem?
A: Furanocoumarins present in grapefruit appear to be responsible for its interactions with certain drugs. Orange juice comes from sweet oranges that do not contain these compounds.
Sour Seville oranges, as well as lime juice and tangelos, a grapefruit hybrid, might interact like grapefruit.
Other citrus fruits thought to be interaction-free include lemons, tangerines and citrons.