Reader has solution for those with nasal spray dependence
Q: I had a full-blown addiction to nasal spray before most people knew that could happen.
To recover, I sprayed one nostril only until the other cleared, and then stopped. Having one nostril free for breathing is tolerable. It took about a week for this to clear.
A:
Decongestant nasal sprays can lead to rebound congestion upon discontinuation. That is why labels often caution against using such products for more than three days.
Weaning one nostril at a time can be helpful in overcoming the dependence. Corticosteroid sprays can also make this process easier.
Q: My migraines started in perimenopause and then ramped up until I was suffering more than half the month. I have tried so, so many things, among them hormone replacement therapy, supplements, rescue medications, exercise, acupuncture, massage, Botox and major dietary changes.
What has helped me the most is Ajovy, but not right away. It took a full four months before I really learned how to self-inject properly and that has made a difference.
A:
Ajovy (fremanezumab) belongs to a category of migraine prevention medicines called CGRP antagonists. Other drugs in this class include Aimovig (erenumab) and Emgality (galcanezumab).
We’re glad you have gotten relief. The clinical trial for Ajovy demonstrated that people using this monthly injection had about two fewer migraines a month compared to placebo. These volunteers averaged about 13 “moderate severity” migraines a month prior to treatment. If insurance does not cover these monthly injections, the cost could be nearly $800 a month.
Q: I had a bad reaction to my blood pressure medicines, amlodipine and chlorthalidone. I saw my primary care physician at the end of 2022 for a routine checkup and bloodwork. At that time, I asked about my potassium level, as I know certain blood pressure medications can deplete it. She said it was “low normal” and told me to eat an extra banana.
Jump forward to February 2023. I started feeling ill; my heart was racing, and I had numbness in my hands and felt like I might pass out. I thought I was having a heart attack, so my husband took me to urgent care.
They did not find anything but sent me to the emergency department. After more EKGs and lab tests, a doctor finally told me that my potassium level had dropped dangerously low. They gave me two intravenous potassium drips.
After a night in the hospital for observation, they let me go home with instructions to quit taking the chlorthalidone. I’m glad I survived, but doctors should be more aware of the side effects of medications they prescribe.
A:
Low potassium levels can trigger life-threatening heart rhythm changes. Other symptoms include confusion and weakness as well as numbness or tingling and muscle spasms or cramps. Constipation, frequent urination and thirst may also occur.
Diuretics like chlorthalidone or hydrochlorothiazide can deplete the body of potassium, magnesium and sodium. It seems your doctor may not have been paying close enough attention to this possibility. The advice to eat an extra banana might not counteract a potentially dangerous potassium imbalance.