People’s Pharmacy: Check kidney function before taking Paxlovid
Q. My wife and I, both in our 60s, took Paxlovid when we caught COVID-19 on vacation in New Mexico last fall. She tested positive first, and the doctor who helped us over the phone asked all the right questions about medication. He told her to discontinue her rosuvastatin while taking Paxlovid to avoid complications.
He also asked about her GFR, a measure of how effectively kidneys filter the blood. We were able to look up her recent test results and give him her 90ish number. Because one of the components of Paxlovid inhibits the kidneys from filtering out some substances – in order to keep the other antiviral agent working in the bloodstream – there are two dosage levels of Paxlovid offered. One is for people like my wife whose kidneys are efficient. The other has half the dose of antiviral for people like me whose kidneys don’t work so well. Doctors need to ask about kidney function as well as drug interactions when prescribing Paxlovid.
A. Thank you for this important reminder. Paxlovid reduces the risk of serious complications from COVID-19. That said, physicians and pharmacists must check carefully for dangerous drug interactions. Kidney function should also be assessed, as you so thoughtfully explained.
Q. I took Prilosec and then generic omeprazole for over 15 years. Every time I tried to stop, my heartburn got worse.
Last year, I got extremely tired and out of breath if I climbed a short stairway in my house. When I saw my doctor, I described these symptoms. To find out what was wrong, he had me take several blood tests, including one for iron level.
He called me that evening at 9 and told me to take a cab to the local emergency room. It turns out that I had almost no iron in my body, so they did a blood transfusion. Apparently, taking PPIs long term stops acid production, as it should. But that, in turn, makes it harder to absorb minerals, including iron.
At the hospital, they ran a bunch of tests: colonoscopy, endoscopy and even a mammogram. No blood loss was found. I almost died from anemia as a drug side effect.
Never quit PPIs cold turkey. The rebound heartburn is horrible. It’s better to ease off over several months, taking one every other day, then every third day, and so on.
A. Stomach acid is essential for the absorption of many nutrients including iron. We suspect that few people are warned about this possible complication when taking proton pump inhibitors for indigestion.
Stopping PPIs such as esomeprazole, lansoprazole or omeprazole suddenly can trigger severe heartburn symptoms, as you discovered. That’s why gradual discontinuation is important. In our “eGuide to Overcoming Digestive Disorders,” we list other adverse consequences from PPIs and describe several strategies for getting off such drugs. This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com.
Q. Many decades ago, Dad used a styptic pencil to stop the bleeding when he’d cut his face shaving. Later on, he used an electric razor and didn’t need the pencil.
As I have now developed wrinkles and furrows on my face, I more frequently nick myself when I shave. Should I look for a styptic pencil? Does it really work? And also, is it safe for occasional use?
A. A styptic pencil or stick usually contains potassium aluminum sulfate, also known as alum. The same compound is also found in so-called natural crystal deodorants.
It causes blood to clot, so yes, it really does work. Some people prefer to avoid aluminum, but occasional use should not pose a serious hazard.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”