WebMD Ask the Pharmacist

Women's Health: Ask the Pharmacist

Macary Marciniak, PharmD, BCPS, answers questions about women's health issues.

Question:

My gynecologist once suggested I take phentermine to assist with post-pregnancy weight gain, although he couldn't prescribe the pills. What is the concern with this type of diet pill?

Answer:

Phentermine is a prescription medication for weight loss. It is an amphetamine-like medication that works in the brain to reduce appetite. It is a medication that should only be used for a short period of time in persons who are obese and who are actively working to lower their weight through diet and lifestyle changes. This medication should also be avoided in individuals who have heart disease and, generally, it would not be recommended for use by  a woman who is breastfeeding.

Question:

My mom has breast cancer. She is getting chemo. The drugs are Adriamycin and Cytoxan. She also takes lisinopril for high blood pressure. She has been having problems with swelling in her legs and some lethargy. Could this be caused by the medications?

Answer:

Cancer chemotherapy is very potent and, of itself, could cause lethargy. It is possible that lisinopril could be contributing as well. Swelling in the legs is not a common side effect of any of these medications.

I encourage patients being treated for cancer to keep in regular contact with their oncologist and report any troublesome problems immediately. That way, the medical team is fully aware of any problems, or potential problems, and can act immediately to resolve those concerns without hindering the cancer treatment.

Question:

My grandmother has been prescribed 3 mL of acetylcysteine three times daily. She has macular degeneration and can't measure out the liquid. Does acetylcysteine come in a tablet form?

Answer:

Acetylcysteine is not available in a tablet (or other solid) dosage form; it is only available as a solution for inhalation.

Question:

My wife is pregnant and has an upset stomach. She is wondering if she can take Pepto-Bismol for her upset stomach.

Answer:

Pepto-Bismol contains bismuth subsalicylate as the active ingredient. Use of this product (or other salicylates like aspirin) is not recommended during pregnancy, particularly in the third trimester. The best recommendation for upset stomach while pregnant is an antacid like calcium carbonate (example brand name: Tums). In this way, she will help treat her upset stomach and also get some needed calcium!

Question:

My daughter has been prescribed omeprazole capsules. She has noticed that she is bruising more than normal. Could these two things be related?

Answer:

Bruising is not a side effect of omeprazole. If the bruising is a concern, you may want to have your child’s pediatrician evaluate your daughter, as the bruising could be related to something else.

Question:

My sister forgot her high blood pressure med, Diovan, while visiting me for three days. Should she begin again by taking half a pill or a whole one?

Answer:

It would be fine to start back on the regular dose of her Diovan. It is very important that she goes back to taking this medication as prescribed. Not taking Diovan for a couple days could increase her blood pressure and place her at risk for a heart attack or stroke.

Question:

Can Paxil or Zocor cause female hair loss?

Answer:

Hair loss can be a rare side effect of Zocor therapy. To fully investigate this, it would be helpful to know the timing of the hair loss and when the medication was started. There could also be other things contributing to the hair loss. If you are concerned about this, please contact your primary care doctor to investigate this further.

Question:

My wife has been given cefdinir 300 mg capsules for an infection. Her throat is bothering her the most. What over-the-counter drug can I get her that she can take with this medicine?

Answer:

An option for dealing with a sore throat while sick could be a topical anesthetic, for example a product like Chloraseptic. A pain reliever like acetaminophen (example brand name: Tylenol) or ibuprofen (example brand name: Motrin, Advil) might also be options. It would also be important to know the other medical conditions your wife has, and the other prescription medications, nonprescription medications, herbal products, or dietary supplements that your wife uses to ensure that there are no interactions with the throat product you choose.

It is also important for her to drink lots of water. This will help to keep her throat moist. Sucking on a sugar-free candy or lozenges can also help to increase throat secretions and keep her throat from being dry. Salt water gargles are often used to relieve sore throat pain, too.

Question:

My wife has giant cell arteritis, which is being treated with prednisone. She started with 60 milligrams and is down to 6 milligrams at present. Short-term memory problems and severe confusion started coincident with her first doses of prednisone and continues at present. How common is this?

Answer:

Short-term memory problems and confusion are not side effects of prednisone therapy. I don’t believe that these symptoms are related to the giant cell arteritis, either. I would encourage you to talk about these symptoms with the doctor managing her care, as they sound concerning, and are bothersome to both of you.

Question:

Is there an over-the-counter vaginal yeast infection medication that can be used when a woman is allergic to sulfa drugs and penicillin?

Answer:

If someone is allergic to sulfa drugs and penicillin, many of the nonprescription vaginal yeast infection medications like clotrimazole, miconazole, terconazole, or tioconazole, are safe to use. Of course, any vaginal yeast infection medications you choose might also create a problem with other existing medical conditions or interact with other medications, so it is important to check those before using.

Question:

My doctor wants me to start taking calcium pills. She said she wants me to take 600 mg a day, but only 300 mg in the morning then 300 mg in the evening. She said the body does not absorb more than 300 mg at a time. My mom takes 1,200 mg all at once. Is this harmful to my mother to take so much at once?

Answer:

This is a wonderful question, as it is so important that women take the right amount of calcium and take the products correctly. It is true that your body can only absorb so much calcium at one time -- that amount is about 500 to 600 mg of elemental calcium. Most women need 1,000 mg to 1,500 mg of calcium daily. There are two main types of calcium products that are available over-the-counter: calcium carbonate and calcium citrate.

For calcium carbonate products, you should take one tablet three times daily with food. For calcium citrate products, you will probably need to take two tablets three times daily, but you won’t need to take them with food.

Taking 1,200 mg daily all at once is not harmful to your body, just your pocketbook. Your body won’t absorb all of the calcium, so you will be wasting your product. Splitting the dose up throughout the day ensures that your body will absorb all the calcium.

Question:

Will grapefruit juice interfere with my birth control pills?

Answer:

There are a number of medications that may interact with grapefruit juice; however, birth control pills are not one of the medications that should be a problem.

Question:

I am having night sweats. I had a complete hysterectomy in 1990 and I have never had any problems before. Recently, I was taken off Wellbutrin 450 mg. Could that be causing them?

Answer:

Wellbutrin is a prescription medication that is often used to treat depression. Flushing or hot flashes are a possible, but generally a less common side effect of the medication. However, stopping this medication would not cause these types of symptoms.

It might be helpful to know other medications you are be taking, or if you started any other medications instead of Wellbutrin. It is possible that another medication may be contributing to this issue. If you find the symptoms bothersome, please contact your primary care doctor so this issue can be further investigated.

Question:

Can certain vitamins give you a strong urine smell?

Answer:

Vitamin B6 may cause urine to have a strong odor. With B vitamins, if you consume too much, your body will excrete the excess in your urine. However, a number of other things can create a funny or strong smell to urine, including urinary infections, type 2 diabetes or even eating asparagus. If you or someone you know is concerned about the smell of their urine, it is best to have a doctor evaluate this so that all potential medical conditions and medications can be considered.

Question:

Can a pregnant woman use Orajel?

Answer:

Orajel is a topical anesthetic that is often used to relieve mouth pain, toothaches, or cold sores. Typically, Orajel contains benzocaine as the active ingredient. Orajel is a pregnancy category C drug, which means that we don’t have any data on its potential problems in humans. Practitioners would typically use these medications, if necessary, for the expectant mother. In general, you should not treat problems like mouth pain, toothaches, or cold sores for more than 7 days with nonprescription products. If you find that your problem is not resolved, then you should consult your primary care doctor.

There have been rare reports of serious problems with individuals who apply benzocaine topically in large amounts or have left these products on for long periods of time. As with any nonprescription product, please follow the directions on the label and do not deviate from the instructions on how much or how often the product should be applied. It should generally be safe for a pregnant woman to use a product like Orajel, if used as directed, topically, for a short period of time.

Question:

I'm looking for information on a drug that was given to my mother back in 1959 because she was pregnant with me and hemorrhaging. It's called DES, which is all I know. Can you help me?

Answer:

DES likely stands for diethylstilbestrol. It is a prescription medication that was once available in the United States. You can find out more about this product by visiting this web site from the Centers for Disease Control and Prevention (CDC): http://www.cdc.gov/des/consumers/about/index.html.

Question:

What pregnancy category does the medication Lipitor fall under, and why?

Answer:

Lipitor is a category X drug. This means that the medication should definitely NOT be used in pregnancy. Lipitor is a prescription medication that reduces the amount of cholesterol a person makes. Cholesterol is very important to fetal development, so a woman should not take a medication like Lipitor while pregnant.

Question:

My sister has a cold. I need to buy her an over-the-counter cold and flu medication. She is 55 years old and takes enalapril maleate (Vasotec) and levothyroxine. What can I buy for her?

Answer:

There are a number of nonprescription products marketed for cold and flu. When choosing a product, it is important to match up a person’s symptoms with the active ingredients that can treat those symptoms. While I don’t have your sister’s specific symptoms, I can tell you some general tips on using cold and flu medications if you are taking enalapril and levothyroxine.

Enalapril is a prescription medication for high blood pressure and levothyroxine is a prescription medication for thyroid disorders. For both high blood pressure and thyroid disorders, it is best to avoid the use of decongestants, like pseudoephedrine (example brand name: Sudafed). Decongestants may be OK to take for a short period of time, but they can increase blood pressure, increase heart rate, and put too much strain on the heart, which is not good for people with high blood pressure or thyroid disease.

It may be OK for your sister to use these medications for a short period of time; however, she should check with her doctor first to ensure that her doctor is OK with her taking the product.

Question:

I take Premarin daily. Is there a generic version of Premarin that is much more affordable?

Answer:

There is no generic version of Premarin; however, there are other types of estrogen products that do have generic versions available. If the cost of Premarin is a concern for you, talk with your doctor. Together, you may be able to find a product that will help treat your symptoms and will be less expensive for you.

Question:

My daughter’s husband took prescription prenatal vitamins on accident. He thought they were something else and took three in a day. Is this dangerous?

Answer:

Prenatal vitamins are very similar to multivitamins. The three elements that are most important for a prenatal vitamin are the amounts of folic acid, iron, and calcium. Typically, a prescription prenatal vitamin has more folic acid and/or iron than a nonprescription prenatal vitamin or a traditional multivitamin.

It would not be dangerous for your daughter’s husband to take her prenatal vitamins by accident. Depending on the product, he may have consumed more of some daily vitamins and minerals than is necessary, but as a one-time error, this should not be harmful.

Question:

My daughter's hair is breaking very badly. Her hairstylist told me to get her prenatal vitamins. Would these harm her? She is 18 years old.

Answer:

Prenatal vitamins are very similar to multivitamins. The three elements that are most important for a prenatal vitamin are the amounts of folic acid, iron, and calcium. Typically, a prescription prenatal vitamin has more folic acid and/or iron than a nonprescription prenatal vitamin or a traditional multivitamin. So taking prenatal vitamins would not harm her at all.

Biotin is a B-vitamin found over-the-counter, and there is some evidence that it may help with hair growth. Your daughter can talk to her doctor about trying this product.

Question:

My wife has the flu. The doctor prescribed an albuterol inhaler. She is allergic to sulfa. Is this OK for her to use?

Answer:

It is a great idea for persons with allergies to check if there are any concerns with new medications they are starting, whether it is a prescription medication, a nonprescription medication, an herbal product, or a dietary supplement. Albuterol is not one of the medications to avoid if you have an allergy to sulfa medications.

Question:

I'm on Boniva. Can I take Osteo Bi-Flex, too?

Answer:

Osteo Bi-Flex is a dietary supplement that contains glucosamine and chondroitin and is often used to improve joint health. You should take about 1,500 mg of glucosamine and 1,200 mg of chondroitin. Depending on the version of Osteo Bi-Flex you choose, you will need to take multiple pills to achieve this total amount of glucosamine and chondroitin. The Osteo Bi-Flex pills can be taken all at once or separated throughout the day. Osteo Bi-Flex will not interact with your Boniva.

However, Boniva should be taken on an empty stomach, an hour before any other food, medications, or supplements. If you will be taking Osteo Bi-Flex, be sure to take the Boniva first, with a full glass of water, and stay upright for the full hour. Then, you can take the Osteo Bi-Flex, either all at once, or spread out through the rest of the day.

Question:

Is there a generic available for Cymbalta or Lyrica? I am trying to figure out if my new insurance covers them.

Answer:

Currently, both Cymbalta and Lyrica are only available as brand-name products.

Question:

Can antibiotics interfere with the Depo-Provera birth control shot the way they do with oral contraceptives?

Answer:

Antibiotics would not interfere with Depo-Provera, an injectable form of contraception that only contains progesterone.

Question:

My physician prescribed levothyroxine for an underactive thyroid. On the prescription label, it states, "Do not take products with iron or calcium within 4 hours of taking medication." Does this mean that I cannot eat breakfast containing these minerals and that I have to wait 4 hours before eating? Most everything contains iron or calcium.

Answer:

Levothyroxine should be taken on an empty stomach 30 minutes before breakfast. It will be OK to eat after then, even if your food contains some iron or calcium. You should space taking levothyroxine from taking antacids or iron products by 4 hours. The best thing is to take your levothyroxine consistently.

Question:

I have been diagnosed with ADHD and my doctor wants to start me on Methylin 10 mg. I am currently taking Effexor XR 37.5 mg twice a day and Depakote ER 250 mg twice a day. I just want to make sure these are OK to take together. I am 29 years old and have kids at home. I just want to make sure there won't be any interactions.

Answer:

It is a great idea to check for interactions before taking any prescription medication, nonprescription medication, herbal product, or dietary supplement. There are no interactions with Methylin, Effexor XR, or Depakote ER.

Question:

I am currently taking 100 mg Topamax daily, and it says it can alter the effectiveness of your birth control. I also am currently using the NuvaRing. I am careful, but can you just clarify how it can alter effectiveness of birth control?

Answer:

Topamax may decrease the effectiveness of contraceptives like NuvaRing. The risk is greater with higher doses of Topamax (200 mg/day or greater). You should talk with your doctor(s) and be sure they know that you are on both of these medications.

If you are concerned about becoming pregnant, a non-hormonal form of contraception could be used, like a condom or diaphragm. You can talk with your doctor(s) about the best choice for you, considering all of the medical conditions you have or medications you may be taking.

Question:

My sister is on Seroquel for bipolar disorder. I heard that it contains some form of methamphetamine. Is that true?

Answer:

Seroquel is an antipsychotic, a prescription medication used for bipolar disorder and some other mental health issues. It is not a form of methamphetamine. In fact, one of the biggest side effects is that it may be sedating, the opposite of an amphetamine-like medication.

Question:

I was prescribed the antibiotic Cefzil. Are there any vitamins or minerals I should avoid that will affect the antibiotic's effectiveness?

Answer:

There are not any vitamins or minerals that you should avoid while taking Cefzil.

Thank you for joining us for WebMD Ask the Pharmacist.  Be sure to check in on Tuesday, May 10 at 1 p.m. ET when we cover moms and newborn babies. Sign up if you'd like an email reminder the day before the premier event.