Night pain relievers can lead to agitation and RLS
Q. I know that many people take the antihistamine diphenhydramine to help them sleep. Unlike them, I feel agitated, not drowsy, when I take it. This drug often gives me restless legs or leg cramps.
A. Researchers call your reaction to diphenhydramine (Benadryl) “paradoxical excitation.” Some have hypothesized that this could be explained by genetic differences in enzyme activity (CNS Spectrums, February 2008).
Other readers have also experienced RLS (restless leg syndrome) after taking diphenhydramine (DPH). We find it disturbing that DPH is a component in most “PM” pain relievers. Using a sleep aid that might cause leg movements or agitation seems potentially counterproductive. Q. I’ve been taking omeprazole (Prilosec) for more than 30 years. During an upper GI scoping back then, the doctor diagnosed the beginning of Barrett’s esophagus. He prescribed omeprazole.
I take it daily. However, with all the problems PPIs can cause, I am not certain that this drug is the wisest choice for my health going forward. Is weaning off the drug even an option, given the Barrett’s esophagus diagnosis?
A. Your question is more complex than it might seem. Gastroenterologists generally recommend regular endoscopy every few years to monitor cellular changes that can occur with Barrett’s esophagus (BE). There are new cell-collection devices that can also screen for problems. The guidelines for managing BE call for long-term treatment with proton pump inhibitors (PPIs) like omeprazole.
There is some controversy, however. A systematic review and meta-analysis of nine studies concluded that PPIs may not protect BE patients against esophageal cancer (PLoS One, Jan. 10, 2017). More recent reviews involving additional studies concluded that PPIs do reduce the risk of abnormal cellular growth and cancer in BE patients (Expert Review of Clinical Pharmacology, January 2022).
To make this even more complicated, large studies published in the journals Gut (January 2022) and Oncology Letters (January 2024) concluded that the use of proton pump inhibitors is associated with an increased risk of gastric and esophageal cancers.
A study of lifestyle interventions found that alcohol and smoking raise the risk for BE, while vitamin C, folic acid, aspirin and fiber reduce it (Cancer Medicine, August 2021).
To prepare yourself for meeting with your physician to discuss these complicated issues, you may find our “eGuide to Digestive Disorders” helpful. It is located under the Health eGuides tab at www.PeoplesPharmacy.com.
Q. I have had a big problem with chiggers in my yard. They seem to love pine straw and I use it to mulch my trees and garden.
A pharmacist suggested sulfur, which I used successfully for years. Tucking my pants into my socks and dusting my sneakers and socks with sulfur powder works! I have had trouble lately finding it. I also wonder if it will keep away ticks.
A. The U.S. Forest Service suggests that sulfur powder can indeed repel ticks. This old-fashioned remedy has sometimes been called “flowers of sulphur.” People tell us that they put the powder in a sock and use that to dust their shoes, socks and pant legs. Sulfur can be found online or in garden stores.
You may also want to consider treating shoes, socks or pants with permethrin. This insect repellent is also helpful in keeping ticks away.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.Peoples Pharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”