OTC eye drops safe to use with AMD meds
Q: I am a healthy 67-yearold female being treated with Eylea for wet age-related macular degeneration, or AMD. I have just had my second round of Eyelea, and with the pollen starting up, my eyes are beginning to itch. Is it safe to use over-thecounter eye drops? I also take Zyrtec nightly for my interstitial cystitis.
A: Eylea is used to treat several cancersm as well as the “wet” form of AMD. Eylea works by preventing the formation of new blood vessels and blocking a compound called the vascular endothelial growth factor, or VEGF.
In the eye, AMD causes damage by creating new blood vessels, which tend to leak. This causes blood and proteins to develop under the retina, leading to distortions in vision and affecting sight. VEGF inhibitors like Eylea can be directly injected into the vitreous humor of the eye, providing high levels of the medicine around the blood vessels and stopping new blood vessels from forming.
Because Eylea is injected directly into the vitreous humor, regular eye drops that go in the front of the eye should not interfere with its action. I did look up interactions between Eylea, Zyrtec, and several over-thecounter eye drops, and I couldn’t find any evidence of harmful interactions.
Your pharmacist also has access to the data I have and lots of experience with looking up drug interactions.
Q: I am a 78-year-old male who had a sudden severe onset of ulcerative colitis at 66, which was confirmed by a colonoscopy. (Prior routine colonoscopies were normal.) Colonoscopies done afterward showed only minimal inflammatory changes, and I was put on mesalamine. But my symptoms remained severe, with unpredictable onsets until I was put on intravenous Entyvio every two months instead.
For a full year, there was no change. Then, quite suddenly, everything became normal. I am still on Entyvio over a year later.
My question is: Is it advisable, or even possible, to wean off this immunosuppressant? I cannot find any study that specifically addresses this issue. But I was told that if I discontinued Entyvio and my symptoms recurred, it might no longer be effective for me.
A: Entyvio works by blocking a compound called integrin, which helps white blood cells move into the gut. Since ulcerative colitis is an inflammatory disease of the gut, mediated in large part by white blood cells, keeping them out can cause a remission of the disease.
It has much less of an effect on other infections than treatments that are designed to suppress the immune system, as it only works in the gut. It’s not really an immunosuppressant. It has few serious side effects.
I did find a study that specifically looked at what happened to people who were in remission and voluntarily stopped Entyvio. Withing six months, 20% relapsed; 40% (cumulatively) relapsed at six months; and almost twothirds of these subjects had
relapsed at the end of 18 months. Retreatment with Entyvio was effective in about two-thirds of those who had relapsed.
If you aren’t having significant side effects with this drug, it is inadvisable to discontinue it, as most people will relapse, and not all of them can be effectively treated again with the same drug.
Q: I am a 58-year-old female in reasonably good health. When I was young, I donated blood several times and would have continued to do so had I not become ineligible due to living in England during the mad cow disease outbreak. I happened upon something recently stating that this particular disqualifier has been lifted — so much to my delight that I made a
blood donation.
The American Red Cross was delighted, too. My blood type is AB negative, and I learned that it is the universal donor type for platelets. The Red Cross reached out to me by phone, text and email to encourage me to make a platelet donation, which I did.
After my donation, I was able to track where my platelets and plasma went. I also received a card in the mail telling me that I was a “super platelet donor” because I had a high platelet count (no specifics mentioned). At first, I thought that must be a good thing, but researching “a high platelet count” made me think: “Oh, no!”
My last two complete blood count tests had my platelet
count at 265,000 and 278,000 (the oldest was done in 2023), which was middle-of-theroad, according to the normal range given. I have two concerns: Should I see my doctor right away about this? Are there any health risks to donating platelets? The Red Cross wants me to do it quite frequently. I love that my donations help others, but I don’t want to harm myself by donating too often.
A:
People with any blood type are encouraged to donate blood or blood products, such as platelets and plasma. But you are right that you, like only 3% of the population, are the ideal platelet and plasma donor.
Most people know that O negative is the universal blood donor. They don’t have the A, B or D (formerly called Rh) antigens in their red blood cells, so their cells can be given to anyone. In the case of platelets and plasma, what the blood bank is trying to avoid are antibodies. People with an AB blood type (both AB positive and AB negative) have no A or B antibodies, so their plasma and platelets are the safest. AB positive is the best of the best, but as you saw, they are very happy to have an ABnegative donor like you.
I think there was a miscommunication about what a “super platelet donor” means. It means you are doing a great job donating platelets, not that there is anything abnormal about your platelet count. There’s no rush to see your doctor. I confirmed with the Red Cross that if your platelet count were abnormally high, they would let you know. The normal platelet count in adults is 150,000 to 350,000. (That’s thousands of platelets in a microliter of blood.) A single platelet donation is then about 3.5 billion platelets.
Many repeated platelet donations can cause a small and temporary decrease in blood platelet counts. For this reason, the Food and Drug Administration limits platelet donations to no more than 24 times in any 12 months. In a study of 471 repeat donors followed over 2 ½ years, nobody developed an abnormally low platelet count while following the FDA’s regulations.
You are quite right that the restrictions against donating by those who lived in the U.K., Ireland and France were lifted in 2023.
Thank you for donating, and you can safely donate as often as you are comfortable.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.