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Video: Is your medication making you sick?

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    >>> this morning on "today's health," is your medication making you sick? if your pain reliever is not relieving the pain or your eye drops are drying out your eyes, you're not alone. nbc's chief medical editor dr. nancy snyderman is here along with liz vaccariello, editor in chief of "prevention" magazine. good to see you ladies.

    >> hi, al.

    >> good to be here.

    >> liz , when we talk about medication, if it's making you feel worse, you're talking about a rebound effect .

    >> right.

    >> what is that?

    >> so, you have a headache and you take medication and the headache gets worse. researchers call this the rebound effect . it can often be a function of the medication itself or an incorrect self-diagnosis, or it's just a quirk of the remedy itself, but it's this vicious cycle. you're taking more medication and the pain's getting worse and you're taking more and more and more and what's going on?

    >> what happens there, nancy? how's this happen?

    >> well, there's a couple things that could happen. one thing is the blood flow to the brain can change and sometimes it lowers your pain threshold , but it really depends on what medications you're using for what organ system , but absolutely, it is -- this is not some concocted in your head thing.

    >> this is real?

    >> this is a well-known medical problem.

    >> let's go through some of them. first of all, perpetual stuffy nose .

    >> right.

    >> i've heard of this one, that the nasal spray actually really is the culprit.

    >> yeah. i'm an ear, nose and throat surgeon, and this is one of the big, big problems. people come in and say i've been on this nasal spray for two weeks. how come my nose is still so stuffy? and here's the problem -- when you use a nasal spray , it constricts the blood vessels , allows you to breathe easily, but the problem is, when those blood vessels have to sort of come back to normal, they spring back almost like a garden hose you've had kinked off and that blood flow really rushes forward, and when it does so, it makes the nose a little bit more congested. so, two days max, max, for any over-the-counter nasal spray , and you'll be fine. you even go towards that third day and you run the risk of having a more congested nose.

    >> what can you do to kind of prevent that? there are saline sprays, or --

    >> saline will help, but you can't fool yourself, it would still happen.

    >> i prevention" readers sway by the netty pod --

    >> i've seen that, which seems disgusting.

    >> but it's very soothing, and particularly during allergy season, it can clear out the nasal passages.

    >> like pouring water through your nose --

    >> mild saltwater. a little dab will do you. mild saltwater. it's the irrigation more than what's in it.

    >> constant headaches, liz . you hear about people taking pain medication , and then suddenly, they get a worse headache or a migraine. what causes that?

    >> this is definitely a function of the pain medication itself. researchers aren't exactly sure what's causing it, but they think that something in the medication might be turning off your body's ability to kill pain naturally or lower your pain threshold . it can happen with acetaminophen, ibuprofen, but also the medications that contain caffeine are the worst culprits. we tell readers to keep a pain medication diary, and if you're using meds for a headache more than 15 times a month, it might be the medication.

    >> so, what do you do to relieve that?

    >> one thing i suggest that people do is take aspirin and then a little while later, acetaminophen, and then a little while later, aspirin, because they work somewhat differently. but if you have ongoing pain, this is when you have to see a physician, because it may be medication-induced, or there might be a bigger problem and you're treating the wrong issue.

    >> all right. skin problems, skin flare-ups. people use cortisone or different creams and it makes the situation worse. what's that?

    >> well, the cortisone is good because it takes away the inflammation, and again, shrinks the blood vessels . here's the problem with cortiso cortisone. the stuff you get over the counter isn't particularly strong. so, people use it like it's lanolin or any other moisturizer, and over a long period of time, it not only interferes with the local immune system of your skin, but it shrinks those blood vessels again, so when you stop using it, what happens? the blood vessels die late and the problem's all over again, and it's particularly a problem on your face.

    >> what should they do instead?

    >> you should stop using it -- use it five to seven days maximum, particularly on the face. and you should wean yourself off of it. and if you're continuing to have symptoms, use a cooling moisturizer, cold showers . do not rub the face, though, aggressively. so, pat it dry.

    >> dry eyes . i always thought eye drops were the cure-all for that, but in fact, they can exacerbate the problem.

    >> there is something that takes the redness out of your eyes, but the other problem is it can make your eyes drier. and as you get older, your eyes get drier anyway. so you're better off sticking with the moisturizing drops, but now ophthalmologists are saying even those can tell your body not to produce the natural tears. the red eye drops, i'm not a big fan of them. the moisturizer drops, a little bit.

    >> we tell readers to avoid them entirely, antired drops in particular.

    >> and i know it's not really a medication, but teeth whiteners can have a rebound effect . what kind of rebound effect do you get?

    >> the bleaches and strips are wonderful at temporarily brightening your teeth, but what happens is once they get past the enamel, they can start to affect the underlying dent --

    >> they take off the enamel.

    >> yeah, and it produces a translunacy in the teeth. use it once or once in a lifetime .

    >> and the fda says a lot of the over-the-counter stuff has compounds in it that the average person doesn't know about.

    >> and another good thing to try to counteract any of these problems is to keep gummy bears in your lap like dr. nancy does.

    >> can i have the red one?

    >> sure.

    >> okay, thank you.

    >> what kind would you like?

    >> oh, i'll go with orange.

    >> okay.

    >> thank you so much.

    >> and you know what? they're good, stale ones. this is how the doctors --

    >> and they're warm!

    >> liz vaccariello, dr. nancy snyderman ,

By
updated 11/23/2009 1:53:26 PM ET 2009-11-23T18:53:26

You take pain medication for a headache... and it gets worse. Is this possible? The answer is yes. It's called the rebound effect, and researchers say this happens startlingly often. In some cases, a user takes too much of a drug or makes an incorrect self-diagnosis; in others, it's a quirk of the remedy itself. Whatever the reason, a vicious cycle develops, as patients go on using the offending medicine, hoping they'll soon see improvement if they take just a little more.

Some of the most widely used prescriptions and OTC drugs and products can cause the rebound effect. At any given time, 3 million Americans suffer headaches brought on by taking pain relievers, according to Stephen D. Silberstein, MD, a professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University. Other common remedies that may worsen the condition they're meant to help include decongestant sprays, sleeping pills, and teeth whiteners.

If you think you're experiencing rebound, bring this up with your physician. "Some doctors may not be aware that drugs they recommend are causing a problem, not solving it," says Silberstein. They may even tell patients to increase the dosage when the real solution is quitting the medication altogether, he says.

Here's a checklist of symptoms that may mean you're experiencing medication rebound effect and the best methods for getting rid of the problem, once and for all.

Perpetually stuffy nose

The culprit: OTC nasal sprays

The cause: These products, which contain the vasoconstrictor oxymetazoline, tighten tiny nasal blood vessels to clear out stuffiness. "Unfortunately, they can also exacerbate swelling and congestion," says Richard F. Lockey, MD, an allergy expert at the University of South Florida. After several days of use, your blood vessels can lose the ability to constrict on their own. Then, when you stop the spray, the nasal passages swell. In a study of 500 patients at an allergy clinic, 9 percent suffered from this problem.

What to do: Use a spray containing oxymetazoline no more than 5 days in a row, and never exceed the recommended dosage. If you think you're suffering from rebound congestion, see your doctor. "For some patients, switching to a prescription nasal steroid drug can help restore blood vessel function and reduce congestion," says Lockey. If your congestion stems from allergies, you may need the steroid spray through allergy season. If you have mild congestion, however, relieve it with a saline spray or a neti pot.

Video: Doctor shares insider’s tips

Skin flare-ups

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The culprit: OTC and prescription corticosteroid (cortisone) creams

The cause: Although they offer powerful temporary relief from the itching and flaking of rashes, these preparations can also cause severe flare-ups of redness. With prescription creams, if your skin gets worse while using it or when you stop — and especially if the itching turns into burning — that could indicate rebound, according to UCLA dermatologist Marvin J. Rapaport, MD, who has treated 2,000 patients with steroid-rebound flare-ups over the past 20 years.

The steroids work by constricting the skin's blood vessels, thereby clearing up any redness and the accompanying irritation, explains Rapaport. But when you discontinue the steroids, the blood vessels can react by overdilating and getting stuck in the "open" position, causing a skin flare-up. If you medicate with yet more cream, you perpetuate the symptoms and the "rash," he says.

What to do: Use an OTC cream for no more than 7 days, especially on the face and groin. If you've been using a steroid-based cream for longer and suffer persistent rashes, see your doctor. "The only solution is to stop the steroids completely," says Rapaport. That will allow blood vessels to function normally again. The downside: It can take a year or more for complete recovery. During that time, ease symptoms with nonsteroidal moisturizers and cool showers.

Constant headaches

The culprits: OTC and prescription pain and migraine medications

The cause: This rampant rebound problem emerges when headache sufferers overuse pain meds. Researchers don't know why this leads to chronic headaches, but they suspect the drugs may turn off the production of natural painkillers or lower your pain threshold.

Potentially problematic OTC drugs include aspirin, Tylenol, and Advil. However, those containing caffeine, including Excedrin Migraine, are most likely to cause overuse headaches, says Robert Kunkel, MD, a consulting specialist at the Cleveland Clinic Center for Headache and Pain. Among prescription remedies, the worst offenders are drugs that contain butalbital (a barbiturate), such as Fioricet and Fiorinal.

Track just how many days a month you take headache medicine. If it adds up to 15 or more days, chances are the drugs are at fault.

What to do: Until recently, the only solution was to stop all painkillers completely. However, researchers at Thomas Jefferson University have successfully used the migraine-prevention drug Topamax to wean medication overuse headache sufferers off pain meds without discomfort. Once your system is clean, work with your doctor to find and eliminate the cause of your problem.

Dingy teeth

The culprit: Teeth whiteners

The cause: Used in moderation, bleaches and strips remove stains from the outer layer, or enamel. "But if used too often, the bleach can penetrate to the underlying dentin, causing the teeth to look translucent," says New York City dentist Irwin Smigel, DDS, president of the American Society for Dental Aesthetics. The damage is irreversible.

What to do: Make sure your home whitening product carries the American Dental Association's seal of approval, which guarantees it has been reviewed for safety and effectiveness. Whether you bleach on your own or at the dentist's office, stop when your cuspids--the pointed (and typically darkest) teeth on either side of your four front teeth — match the ones in front. "When they are the same color, you won't get any more benefit and may begin to do damage," Smigel says. A single course of whitening is enough for some people; for others, treatment every 1 to 3 years is sufficient.

Skip This Entirely: OTC Eyedrops
Drugstore drops with tetrahydrozoline make your eyes look less red because they reduce blood flow, says Mark Sibley, MD, past president of the Florida Society of Ophthalmology: "But that cuts nutrients and oxygen to your eyes, which can cause dryness and irritation, leaving you more bloodshot than before." Try artificial tears or prescription Restasis (which increases tearing) for dryness. If you suffer persistent redness and itching, see your doctor--you may have an eye infection.

Copyright© 2012 Rodale Inc.All rights reserved. No reproduction, transmission or display is permitted without the written permissions of Rodale Inc.

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