People’s Pharmacy: Athlete’s foot spray calmed under-breast rash

Q. You have written about treating under-breast rash. I use Lotrimin with miconazole for this. When I first experienced the rash, my doctor prescribed a powder with miconazole. The prescription was a very small amount of powder, and the copay was not cheap.

One day, while in the drugstore, I walked past the section where the athlete’s foot items were. I noticed that Lotrimin AF Athlete’s Foot Powder Spray contains miconazole. All I can say is, it works for me.

A. Many under-breast rashes are caused by yeast infections that respond well to an antifungal drug such as miconazole. These are the same agents that are effective against athlete’s foot.

There are several Lotrimin products. Some contain other antifungal ingredients, including butenafine, clotrimazole or tolnaftate. Keeping the area dry with powder or zinc oxide cream can help discourage yeast from growing. Avoiding friction with an anti-chafing product may also prevent irritation.

Q. Voltaren gel helped my sore knee. But it also raised my blood pressure to 209/91 and caused AFib. I never experienced anything so scary in my life. Hopefully, I’ll have a full recovery. Now, I need a better way to control my arthritis pain.

A. You are not the only person to report blood pressure elevation after applying a diclofenac gel such as Voltaren. Most people do not experience such a dramatic reaction, but it is worth recognizing that even topical NSAIDs (nonsteroidal anti-inflammatory drugs) can be absorbed and cause systemic side effects.

Oral pain relievers such as ibuprofen or naproxen are notorious for causing stomach upset. Creams or gels are less likely to do this, but some people are especially sensitive and suffer digestive distress.

You can learn more about a wide range of other options in our “eGuide to Alternatives for Arthritis.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. Why isn’t Singulair (montelukast) available over the counter? It has a better safety profile than antihistamines and is safe in children. How does one advocate for a generic drug to change its classification to OTC?

A. The Food and Drug Administration has approved montelukast to treat asthma, exercise-induced bronchoconstriction (trouble breathing) and allergic rhinitis. It is not approved for use during an acute asthma attack.

We wish that this oral medicine were as safe as you suggest. Drug companies are required to warn prescribers that it may trigger serious neuropsychiatric events, including aggression, agitation, depression, suicidal thoughts and even suicide. These reactions may not be common, but as a result, the FDA notes, “the benefits of montelukast sodium may not outweigh the risks in some patients.” Other side effects include severe allergic reactions to the drug itself and seizures.

It makes sense for such a medicine to be available, as the FDA recommends, “for patients with allergic rhinitis who have an inadequate response or intolerance to alternative therapies.”

Readers have described undesirable reactions to this medicine. One mother wrote: “My 10-year-old happy child was put on montelukast and became very sad and depressed. As soon as we took him off montelukast, his happy disposition returned.”

A wife reported: “My husband took this drug for asthma and allergies and experienced severe, debilitating episodes of depression. It got so bad that he became suicidal. This drug should be taken off the market, as it is extremely dangerous.”

Such reactions make a medicine inappropriate for OTC use.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”