FDA Imodium crackdown has patients dismayed

Question: I’ve read that the Food and Drug Administration is going to make it harder for people to buy Imodium. This is bad news for people like me, with irritable bowel syndrome (diarrhea).

I have controlled my symptoms for years with one Imodium tablet per day. Without it, I need to be near a bathroom within 20 minutes of eating, and I need to stay seated for 10 to 20 minutes. Not fun.

This has been a cheap and easily available drug for IBS-D sufferers. I guess I need to stock up now, before it becomes both expensive and hard to find.

Answer: Loperamide (Imodium A-D) controls diarrhea by slowing the muscular contractions of the lower digestive tract. The agency wants to limit over-the-counter dosage packs to eight pills, enough to treat acute diarrhea for two days.

Some people have been using high doses of loperamide to ease opioid withdrawal symptoms; others have abused the drug in an effort to get high. It takes such high doses that people may experience irregular heart rhythms or cardiac arrest.

We have heard from many readers who suffer from chronic diarrhea. They rely on loperamide to be able to work or travel. Like you, they worry that the new regulations could raise the price and complicate their lives.

Q: Several years ago, I developed asthma. I really thought that I would die from it one day. If I was late with my inhaler, I would start to wheeze.

Fast-forward to the following story. One day I saw the physician assistant at my doctor’s office. I told her that I thought I might have a low-grade thrush infection in my mouth. She prescribed an antifungal oral troche. In less than 24 hours, I was off my steroid inhalers, never to need them again. I have been symptom-free for three years.

A: The underlying causes of asthma can be difficult to diagnose. Many people have breathing difficulties due to an allergic reaction. In some cases, the wheezing can be triggered by a fungal infection ( Journal of Asthma, September 2016). Antifungal medication can be helpful in situations like yours.

Other research suggests that some hard-to-treat asthma could be related to a chronic bacterial infection in the airways. A placebo-controlled trial found that antibiotic treatment with azithromycin helped patients with persistent asthma.

Q: You advised a reader that brand-name Viagra (sildenafil), which costs $65 to $80 per pill, is available from Greenstone as an authorized generic at half the price. It also can be obtained from legitimate Canadian pharmacies for $14 to $20 per pill.

Generic sildenafil has been available in the U.S. at much lower cost. I have been getting sildenafil for $1.24 per pill from a local warehouse-club pharmacy. These 20-mg pills probably are generic Revatio. One pill is equal to 20 mg of Viagra; two or three pills ($2.48 or $3.72) is approximately equal to a 50-mg Viagra. This medication is very affordable, and works exactly as well as brand-name Viagra.

A: Sildenafil is prescribed for erectile dysfunction as Viagra. It also is prescribed as Revatio to treat pulmonary hypertension, a condition that can lead to heart failure. Not every man would want such a serious health problem on his medical record. Nonetheless, you are correct that this generic drug is quite affordable.

Q: I have been taking glucosamine hydrochloride and chondroitin sulfate for knee joint pain. My cholesterol has always been a little over 200.

Since last summer, my cholesterol has jumped to 435. The only thing that has changed is that I take this arthritis supplement daily.

I read on your website that others have had a similar problem. I now have hope in figuring out why I have such dangerous cholesterol levels. Is there upto-date information?

A: We first heard about this concern over 20 years ago. A reader reported: “I have been taking glucosamine for arthritis this past year and it has helped. However, the side effect has been increased cholesterol. My last count was 346, up 100 points from before.” Since then, we have heard from others that their cholesterol rises when taking glucosamine.

Researchers have attempted to study this phenomenon; they have not identified a problem.

We can only speculate that certain people may be especially sensitive to glucosamine. Studies might not pick up such individual reactions.

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. PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”