By O. Einar. Loyola College, Baltimore. 2018.
In our laboratory order 90 mg dapoxetine free shipping, reaction phenotyping is carried out with a bank of human liver microsomal samples (e dapoxetine 60 mg line. Banks of human liver microsomes intended for correlation analysis are commercially available as kits (e. The latter determination also provides a measure of the statistical significance of any correlations. Correlation analysis provides valuable information on the extent to which the metabolism of a drug candidate will potentially vary from one subject to the next (i. However, when two or more enzymes contribute to metabolite formation, corre- lation analysis may lack the statistical power to establish the identity of each enzyme. Statistically significant correlations should always be confirmed with a visual inspection of the graph because there are two situations that can produce a misleadingly high correlation coefficient: (1) the regression line does not pass through or near the origin and (2) there is an outlying data point that skews the correlation analysis, as illustrated in Figure 25. Correlation analysis works particularly well when a single enzyme dominates the formation of a particular metabolite. This approach success- fully identifies the enzymes involved when each enzyme contributes 25% or more to metabolite formation, but it will likely not identify an enzyme that contributes only approximately 10%. A graphical representation of the application of multivariate analysis to the results of a reaction phenotyping experiment is shown in Figure 26, on the basis of an examination of the sample-to-sample variation in the 1-hydroxylation of bufuralol (12 mM) by a panel of human liver microsomes. The sample-to-sample variation in bufuralol 1-hydroxylation correlates reasonably well with In Vitro Study of Drug-Metabolizing Enzymes 327 Figure 25 Common pitfalls in correlation analysis. Correlation analysis is suspected when the regression line is unduly affected by a single outlying data point, or when the regression line does not pass near the origin. When two enzymes contribute significantly to metabolite formation, their identity and relative con- tribution can be established by performing correlation analysis in the presence and absence of an inhibitor of one of the participating enzymes (preferably the major contributor). This approach works even when one of the enzymes contributes substantially less than 25% to metabolite formation, as was demonstrated by 328 Ogilvie et al. Chemical and Antibody Inhibition Chemical and antibody inhibition represent the second and third approaches to reaction phenotyping. As in the case of correlation analysis, chemical and antibody inhibition experiments must be conducted with pharmacologically relevant concentrations of the drug candidate in order to obtain clinically relevant results. Therefore, appropriate solvent and preincubation controls should be included in all chemical inhibition experiments. The lack of specificity can complicate the interpretation of chemical inhibition experiments. If a drug candidate is metabolized by a high-affinity enzyme, the con- centration of a competitive chemical inhibitor must be increased with increasing concentration of the drug candidate in order to achieve a high degree of inhi- bition. A good rule of thumb is to use multiples (generally up to 10-fold) of the lowest inhibitor concentration, which is calculated from the following equation: ½DrugÁKiðinhibitorÞ Lowest½Inhibitor¼ ð10Þ KmðDrugÞ where [Drug] is the intended final concentration of the drug candidate added to the microsomal incubation, Ki is the inhibition constant of the inhibitor for a given enzyme, and Km is the Michaelis constant of the drug candidate (as determined in Step 3). This method of calculating of the lowest concentration of inhibitor is applicable to competitive inhibitors but not to noncompetitive or metabolism-dependent inhibitors. A range of inhibitor concentrations is rec- ommended to demonstrate concentration dependence. For example, if the lowest concentration of the chemical inhibitor were calculated to be 1 mM (from the above equation), then the range of inhibitor concentration should span at least 10-fold (e. If both enzymes contribute to metabolite formation, the inhibitory effect of the chemical on one enzyme may be offset by its activating effect on the other enzyme. When chemical inhibition experiments are conducted with a relatively metabolically stable drug candidate (one that must be incubated with relatively high concentrations of human liver microsomes for a relatively long time in order to generate quantifiable levels of metabolite), it is important to take into account the metabolic stability of the inhibitors themselves. Lack of metabolic stability makes some compounds poor choices as chemical inhibitors despite their selectivity. Finally, appropriate controls should be included in each chemical inhibi- tion experiment to evaluate whether any of the chemical inhibitors interfere with the chromatographic analysis of the metabolites of interest and whether metabolite formation is inhibited by any of the organic solvents used to dissolve the chemical inhibitors. Unfortu- nately, the utility of this method is limited by the availability of specific inhibitory antibodies and by nonspecific effects associated with the addition of antiserum and ascites fluid to the microsomal incubation. The use of antiserum (for polyclonal antibodies) and ascites fluid (for monoclonal antibodies) rather than purified antibodies often necessitates adding a large amount of albumin and other proteins to the micro- somal incubation. For this reason, control (preimmune) serum and ascites fluid should be included as negative controls in antibody inhibition experiments. These issues are lessened when purified antibodies are used instead of antisera and ascites fluid. As in the case of chemical inhibition, a lack of specificity can complicate the interpretation of antibody inhibition experiments. A lack of specificity and the nonspecific effects outlined above likely account for the majority of cases where the sum of the inhibitory effects of a panel of inhibitory antibodies adds up to greater than 100%. If an antibody inhibits the metabolism of a marker substrate by 80%, and if the same antibody inhibits the metabolism of drug candidate by 80%, there is uncertainty as to whether the inhibited enzyme contributes 80% or 100% to the metabolism of the drug candidate. Genetic or drug- mediated loss of an enzyme that accounts for 80% of a drug’s clearance will cause a fivefold increase in systemic exposure, whereas loss of an enzyme that accounts for 99% of a drug’s clearance will cause a 100-fold increase in exposure. In both cases, cytochrome b5 increases Vmax/Km, which is a measure of in vitro intrinsic clearance. The kinetic constants are only determined for those enzymes that were shown in preliminary experiments to be capable of metabolizing the drug candidate.
I discovered that my particular case of scoliosis was caused by lifestyle factors cheap dapoxetine 60mg otc, not the major medical conditions often associated with the condition 60 mg dapoxetine mastercard. If you’ve seen a medical doctor and have determined your scoliosis is not caused by a major medical issue, then the following action plan can help you, as it addresses scoliosis caused by lifestyle factors. This action plan covers two areas: 1) short-term, temporary pain relief and 2) long-term solutions. I always encourage people to work toward the goal of total pain relief—in other words, no more back pain, period. But if you’re too uncomfortable to get through the steps needed for the long-lasting solution, you may want to start with the temporary pain-relief options (listed below). For each category of pain relief (temporary versus long term), I’ve arranged the solutions in order, with the step likely to help you the most listed first. Start with the solution at the top of the list, and then work your way down only if the pain improves but doesn’t completely disappear. Inversion therapy caused by lifestyle factors, not the major medical conditions 4. Dietary adjustments scoliosis is not caused by a major medical issue, then the following action plan can help you, as it addresses scoliosis caused by lifestyle factors. This action plan covers two areas: 1) short-term, temporary pain relief and 2) long-term solutions. I always encourage people to work toward the goal of total pain relief—in other words, no more back pain, period. But if you’re too uncomfortable to get through the steps needed for the long-lasting solution, you may want to start with the temporary pain-relief options (listed below). For each category of pain relief (temporary versus long term), I’ve arranged the solutions in order, with the step likely to help you the most listed first. Start with the solution at the top of the list, and then work your way down only if the pain improves but doesn’t completely disappear. If a nerve is touched or squeezed by the spinal canal, pain can occur in the back, legs, neck, arms, and hands, all depending on the location of the narrowing. Numbness or tingling in the legs and feet are also possible, as well as cramps in the legs. These symptoms can occur intermittently, depending on if and when the nerves are affected. Considered an aging disease, spinal stenosis usually occurs in people over 40 years old. While age is a factor, there are two other factors that often are overlooked: the calcification of the spinal canal, which is primarily caused by a nutrient imbalance; and a build-up of fibrin (scar tissue) brought on 185 The 7-Day Back Pain Cure by a reduction in proteolytic enzymes in the body as we age. The following action plan covers two areas: 1) short-term, temporary pain relief and 2) long-term solutions. I always encourage people to work toward the goal of total pain relief—in other words, no more back pain, period. But if you’re too uncomfortable to get through the steps needed for the long-lasting solution, you may want to start with the temporary pain-relief options (listed below). For each category of pain relief (temporary versus long term), I’ve arranged the solutions in order, with the step likely to help you the most listed first. Start with the solution at the top of the list, and then work your way down only if the pain improves but doesn’t completely disappear. Inversion therapy 185 The 7-Day Back Pain Cure Spinal Stenosis 186 by a reduction in proteolytic enzymes in the body as we age. Emotional troubleshooting The good news is that both of these things can be addressed 6. The following action plan covers two areas: 1) short-term, temporary pain relief and 2) long-term solutions. I always Nutrient Supplementation encourage people to work toward the goal of total pain relief—in other words, no more back pain, period. But if For this condition, it’s imperative you begin nutrient you’re too uncomfortable to get through the steps needed for supplementation immediately. First, if you haven’t already, the long-lasting solution, you may want to start with the start with an enzyme supplement. Without these critical enzymes to “eat term), I’ve arranged the solutions in order, with the step likely up” and help wash away scar tissue, it builds up around the to help you the most listed first. Start with the solution at the top of the list, and then work Supplementing your diet with additional enzymes will help your way down only if the pain improves but doesn’t your body to clear away the scar tissue and give your spine completely disappear. These enzymes also act as the body’s natural anti-inflammatories, Temporary Pain Relief – Action Plan which help prevent fibrin from forming in the first place. Far infrared heat therapy often contributes to the calcification of the spinal canal— namely, an imbalance in calcium, magnesium, and vitamin D. If you aren’t getting enough of these, your calcium most likely will continue on its merry way through your body. You may absorb 30 percent of Long-Term Relief – Action Plan it, but for healthy bones, that isn’t enough.
This type of drug promotes impulsive actions—not a good consequence if a user is angry and afraid dapoxetine 90mg overnight delivery. Overindulgence can leave a person tired buy dapoxetine 30 mg online, peevish, confused, and depressed when the drug session ends. Over time some abusers feel a need to increase dosages in order to get the Drug Types 15 same effects that lower doses once provided. That suggests an abuser has developed “tolerance” to the drug, a classic component of addiction. In con- trast to abusers of other drugs, amphetamine abusers commonly ﬁght toler- ance not by gradually increasing their dose but by alternating between periods of little use and binges of massive use, a practice promoting inconsistent be- havior that can bewilder acquaintances. Despite all of this, into the 1980s am- phetamines were described as not addictive. Although amphetamines have a long history and widespread usage, their potential for causing cancer is unknown; necessary animal experiments had not been conducted as the twentieth century closed. Abnormal fetal devel- opment has occurred in mice receiving over 40 times the maximum safe hu- man dose, but normal development of offspring has occurred despite administration of 12. Standard medical advice cautions pregnant women against using the drug without ﬁrst discussing the issue with a physician. Some stud- ies claim to ﬁnd that children born of women who abused amphetamines during pregnancy will have long-term problems with personality and intelli- gence—but these same women abused other drugs as well; some were dis- pleased about their pregnancies; and about 80% of children in one study had been taken away from the mothers and put into foster homes. Babies from women who abused amphetamines during pregnancy can exhibit anxiety and physical dis- comfort suggesting dependence and withdrawal. We know that excessive use by a pregnant woman can promote premature birth and reduce a newborn’s weight. Genetic predisposition appears to inﬂuence how much this type of drug will affect fetal development. Amphetamines enter human milk and can reach levels three to seven times higher than shown in maternal blood, so nursing mothers can be dosing their infants. Because this kind of drug can act as an appetite suppressant, causing a person to take in inadequate nutrition, that effect is still another concern if infants receive amphetamines through a mother’s milk. For information about speciﬁc amphetamine class stimulants, see alphabet- ical listings for: dextroamphetamine, ephedrine, khat, ma huang, metham- phetamine, methcathinone, and methylphenidate. That self-perception may be more prevalent than obesity itself, but even so, by medical standards a good 33% to 50% of Americans are overweight. Persons seeking slimness and who are dissatisﬁed with results from changes in diet and exercise may seek pharmacological help. Its use for this purpose began in the 1890s on the theory that it would boost a person’s metabolism and thereby promote faster use of calories. Al- though it boosted metabolic rate, it also boosted rates of cataracts and of harm to the peripheral nervous system (which involves the functioning of various organs and muscles). In the 1930s amphetamines became available and quickly became a popular diet aid de- spite their potential for abuse. Many stimulants suppress appetite, and some are used as medicines to help people lose weight. Such drugs are casually described as appetite suppressants, but not all pro- mote weight loss in that way. For instance, some may affect the way food is absorbed in the body; some increase a person’s rate of metabolism so the person burns more calories; some make a person more physically energetic. Question has even been raised about whether a stimulant’s anorectic action simply comes from elevating the mood of depressed people and thereby re- ducing their need to gain comfort from eating. Compared to placebos, most studies show additional weight loss among persons taking anorectics to be measurable but barely noticeable; some studies show anorectics to be no more effective than placebos. In experiments where anorectics work well, skeptics wonder if results come from factors other than the drug, such as rapport between physician and patient, belief that the substance would work, or even from basics such as controls on food intake during the experiment. Scientists directing one study of anorectics concluded that sensations of appetite sup- pression were so subtle that a user could miss them unless the person was trying to be aware of them. A telling exception to development of tolerance is methylcellulose, an unscheduled substance used to increase bulk of consumed food and thereby increase the physical feeling of fullness. Abusers of stimulant anorectics exhibit symptoms similar to those found among abusers of amphetamines, from skin rash to psychosis. Some persons using anorectics properly under medical supervision experience muscle pain and cramps, weariness, peevishness, depression, difﬁculty in thinking. That group of symptoms is the same as those undergone by persons trying to cope with lack of food regardless of drug use, a coincidence raising question about whether some undesired effects attributed to anorectics are simply undesired effects of being hungry. A harsh fact about anorectics is that weight lost while using them tends to return if a person stops taking the drugs (and generally they are intended for short-term use only). Behavioral therapy teaches people how to change their Drug Types 17 eating and exercise habits. A comparison study10 not only found behavioral therapy superior to anorectic therapy in preventing regain of lost pounds but also found behavioral therapy to be more effective alone than when using anorectics along with it—a troubling result for advocates of anorectics. Skep- tics ask whether drugs that produce only mild temporary improvement in a chronic condition are worth anything.
The full moon also with some persons and the new moon with other generic dapoxetine 90 mg with mastercard, has an unfavorable erect buy dapoxetine 90mg without prescription. Or should we regard such a chronic disease as not being psoric, because the patient cannot remember, that he at sometime, all the way back to his birth, has had several or more (intolerably voluptuously) itching pustules of itch on his skin, or (since the itch-disease is considered as something disgraceful) is not willing to acknowledge it? Since at all times, all the innumerable chronic diseases resulting from an acknowledged preceding itch (when this has not been cured) are ineradicable through the vital force, and advance in their equable course as psoric ailments, and are continually aggravated: so long as the doubters of the psora doctrine cannot show me any other source which is at least as probable for a (non-veneric) ailment, which, despite of favorable external conditions, correct diet, good morality and vigorous bodily constitution, nevertheless increases every year, without any preceding infection from itch so far as memory goes: so long I have on my side an overpowering analogous probability, i. To prove the psoric nature of these chronic diseases without acknowledged infection, we do not even need the fact that the anti-psoric remedies prove effectual therein; this serves only like the proof to a correctly solved mathematical problem. Now since, in addition, the other remedies, although also selected according to the similarity of their symptoms, do not by far yield so durable and thorough a cure in such chronic diseases, as those which are recognized as anti-psoric, and which are selected in as Homoeopathic a manner, because these more than the others are adequate to the whole extent of the endless number of symptoms of the great psora malady: I do not see why men will deny to the latter the title of the especially anti-psoric remedies, unless this springs from dogmatism. And just as little is there any good reason for contradicting me, when I (Organon, ¤73,) explain the acute diseases which return from time to time; e. These, nevertheless, have their source in a latent psora, because their customary return cannot be prevented by anything but a final cure with anti-psoric remedies. We now proceed to the medical Homoeopathic treatment of the illimitably large number of chronic diseases, which, after the above gained knowledge of their threefold nature, has not, indeed, become easy, but - what without this knowledge was before impossible - has at last become Possible, since the homoeopathically specific remedies for each one of these three different miasmata have in great part been discovered. The first two miasmata, which cause by far the smaller part of the chronic diseases, the venereal chancre-disease (syphilis) and the figwart-disease (sycosis), with their sequelae, we will treat first, in order that we may have a free path to the therapeutics of the immeasurably greater number of the various chronic diseases which spring from Psora. First, then, concerning sycosis, as being that miasma which has produced by far the fewest chronic diseases, and has only been dominant from time to time. This figwart-disease, which in later times, especially during the French war, in the years 1809-1814, was so widely spread, but which has since showed itself more and more rarely, was treated almost always, in an inefficient and injurious manner, internally with mercury, because it was considered homogeneous with the venereal chancre-disease; but the excrescences on the genitals were treated by Allopathic physicians always in the most violent external way by cauterizing, burning and cutting, or by ligatures. These excrescences usually first manifest themselves on the genitals, and appear usually, but not always, attended with a sort of gonorrhoea* from the urethra, several days or several weeks, even many weeks after infection through coition; more rarely they appear dry and like warts, more frequently soft, spongy, emitting a specifically fetid fluid (sweetish and almost like herring- brine), bleeding easily, and in the form of a coxcomb or a cauliflower (brassica botrytes). These, with males, sprout forth on the glans and on, or below, the prepuce, but with women, on the parts surrounding the pudenda; and the pudenda themselves, which are then swollen, are covered often by a great number of them. When these are violently removed, the natural, proximate effect is, that they will usually come forth again, usually to be subjected again, in vain, to a similar, painful, cruel treatment. But even if they could be rooted out in this way, it would merely have the consequence, that the figwart-disease, after having been deprived of the, local symptom which acts vicariously for the internal ailment, would appear in other and much worse ways, in secondary ailments; for the figwart-miasm, which in the whole organism, has been in no way diminished, either by the external destruction of the above-mentioned excrescences, or by the mercury which has been used internally, and which is in no way appropriate to sycosis. Besides the undermining of the general health by mercury, which in this disease can only do injury, and which is given mostly in very large doses and in the most active preparations, similar excrescent then break out in other parts of the body, either whitish, spongy, sensitive, flat elevations, in the cavity of the mouth on the tongue, the palate and the lips, or as large, raised, brown and dry tubercles in the axillae, on the neck, on the scalp, etc. They yield either to a dose of one drop of fresh parsley-juice, when this is indicated by a frequent urgency to urinate, or a small dose of cannabis, of cantharides, or of the copaiva balm, according to their different constitution and the other ailments attending it. These should, however, be always used in the higher and dynamizations (potencies), unless a psora, slumbering in the body of the patient, has been developed by means of a strongly affecting, irritating or weakening treatment by Allopathic physicians. In such a case frequently secondary gonorrhoeas remain, which can only be cured by an anti- psoric treatment. It is not necessary to use any external application, except in the most inveterate and difficult cases, when the larger figwarts may be moistened. But if the patient was at the same time affected with another chronic ailment, as is usual after the violent treatment of figwarts by Allopathic physicians, then we often find developed psora** complicated with sycosis, when the psora, as is often the case, was latent before in the patient. At times, when a badly treated case of venereal chancre disease had preceded, both these miasmata are conjoined in a threefold complication with syphilis. Then it is necessary first to come to the assistance of the most afflicted part, the psora, with the specific anti-psoric remedies given below, and then to make use of the remedies for sycosis, before the proper dose of the best preparation of mercury, as will be described below, is given against the syphilis; the same alternating treatment may be continued, until a complete cure is effected. Only, each one of these three kinds of medicine must be given the proper time to complete its action. The second chronic miasma, which is more widely spread than the figwart-disease, and which for three and a half [now four] centuries has been the source of many other chronic ailments, is the miasm of the venereal disease proper, the chancre-disease (syphilis). This disease only causes difficulties in its cure, if it is entangled (complicated) with a psora that has been already far developed - with sycosis it is complicated but rarely, but then usually at the same time with psora. When syphilis is still alone and attended with its associated local symptom, the chancre, or at least if this has been removed by external applications, it is still associated with the other local symptom, which in a similar manner acts vicariously for the internal disorder, the bubo. The chancre appears, after an impure coition, usually between the seventh and fourteenth days, rarely sooner or later, mostly on the member infected with the miasma, first as a little pustule, which changes into an impure ulcer with raised borders and stinging pains, which if not cured remains standing on the same place during manÕs lifetime, only increasing with the years, while the secondary symptoms of the venereal disease, syphilis, cannot break out as long as it exists. In order to help in such a case, the Allopathic physician destroys this chancre, by means of corroding, cauterizing and desiccating substances, wrongly conceiving it to be a sore arising merely from without through a local infection, thus holding it to be a merely local ulcer, such also it is declared to be in their writings. They falsely suppose, that when it appears, no internal venereal disease is as yet to be thought of, so that when locally exterminating the chancre, they suppose that they remove all the venereal disease from the patient at once, if only he will not permit this ulcer to remain too long in its place, so that the absorbent vessels do not get time to transfer the poison into the internal organism, and so cause by delay a general infection of the system with syphilis. They evidently do not know, that the venereal infection of the whole body commenced with the very moment of the impure coition, and was already completed before the appearance of the chancre. The Allopathic doctor destroys in his blindness, through local applications, the vicarious external symptom (the chancre ulcer), which kind nature intended for the alleviation of the internal extensive venereal general disease; and so he inexorably compels the organism to replace the destroyed first substitute of the internal venereal malady (the chancre) by a far more painful substitute, the bubo, which hastens onward to suppuration; and when the Allopath, as is usually the case, also drives out this bubo through his injurious treatment, then nature finds itself compelled to develop the internal malady through far more troublesome secondary ailments, through the outbreak of the whole chronic syphilis, and nature accomplishes this, though slowly, (frequently not before several months have elapsed), but with unfailing certainty. He relates that Petit cut off a part of the labia of a woman, who had thereon for a few days a venereal chancre; the wound healed, but syphilis, nevertheless, broke out. The disease is not cured except when through the effect of the internal remedy alone, the chancre is cured; but it is fully extinguished, as soon as through the action of the internally operating medicine alone (without the addition of any external remedy) the chancre is completely cured, without leaving any trace of its former presence. But whenever anyone is so imprudent, as to destroy this vicarious local symptom, the organism is ready to cause the internal syphilis to break out into the venereal disease, since the general venereal disease dwells in the body from the first moment of infection. For in the spot, into which at the impure coition the syphilitic miasma had been first rubbed in and had been caught, it is, in the same moment, no more local: the whole living body has already received (perceived) its presence, the miasma has already become the property of the whole organism.
A double dose of ephedrine can be poisonous order dapoxetine 30 mg amex, in comparison to other drugs with the same therapeutic effects but that require 10 or 20 times the regular dose to become severely toxic purchase 90 mg dapoxetine otc. Ephedrine can cause skin rash, nausea, diarrhea, constipation, hepatitis, rise in body temperature, jitteriness, insomnia, hyperactivity, irregular heartbeat, high blood pressure, heart attack, stroke, seizures, kidney stones, visual and auditory hallucinations, and paranoid psychosis. Ephedrine can worsen mus- cle tics; animal experimentation shows the drug causing brain damage that can lead to the tics seen in Parkinson’s disease. During strong physical exer- tion, such as bodybuilding, ephedrine may increase danger of heart attack. Suspicion exists that persons who stop taking ephedrine may be more sensi- tive to it if they start using the drug again. Many reports of adverse events come from cases in which a person was using ephedrine diet supplements commonly found in health food stores. Per- haps people regard such products as inherently “healthy” and fail to realize that an ephedrine food supplement can produce a drug overdose or be haz- ardous if used moderately but for too long. Alcohol is an ingredient in some ephedrine inhalers and can inﬂuence read- ings in breathalyzer tests for drunk driving. That problem can be avoided by a 15-minute wait between using the inhaler and administering a test. Historically ephedrine has seldom been abused, but in the 1990s it was cited as growing in popularity among youths, as a recreational stimulant with euphoric and aphrodisiac effects. Some cocaine users ﬁnd ephedrine less satisfying but still a satisfactory substitute. Caffeine boosts ephedrine’s power and can transform a normal dose into a dangerous one. Less serious adverse effects may occur if ephedrine is taken with the antiasthma medicine theophylline. The drug is known to raise fetal heart rate, and fetal blood levels can reach about 70% of the pregnant woman’s blood level of ephedrine. The drug is transferred to breast milk in sufﬁcient quantity to affect nursing infants, making them grouchy and interfering with their sleep. Chicken experiments with ephedrine produce defects in embryos, but such testing is considered inconclusive re- garding human impact. Rabbit experiments ﬁnd a mix of ephedrine, theoph- ylline, and phenobarbital to cause birth defects similar to those observed in the child of a woman who took that drug combination while pregnant. Although a study of 373 human pregnancies found no malformations attributable to ephedrine even when used in the ﬁrst trimester, the drug is associated with a small increase in likelihood of birth defects and is not recommended for use during pregnancy. Depending on actions being measured, pseudoephedrine may have from 25% to 50% of ephedrine’s strength. Pseudoephedrine is believed to promote a dangerous bowel disease called ischemic colitis, particularly in women around the time they go into meno- pause. A case report indicates that taking pseudoephedrine with serotonin reuptake inhibitor antidepressants may create a medical emergency called “se- rotonin syndrome. Caution is advised about using pseudoephedrine shortly after receiving vaccinations, which tem- porarily increase body temperature. Nonetheless, in the 1980s research on more than 100,000 individuals using prescription pseudoephedrine found no hospitalizations caused by the drug. Inﬂuence on fetal development is uncertain, although pseudoephedrine is suspected of causing birth defects when used in the ﬁrst trimester. The drug is known to accelerate fetal heartbeat but has no particular effect on fetal blood ﬂow, nor does the substance seem to hinder passing nutrients and gases be- tween woman and fetus. Although excreted into human milk, the amount of excretion is so slight as to be considered safe for infants of nursing mothers. Additional scientiﬁc information may be found in: “Adverse Events Associated with Ephedrine-Containing Products—Texas, December 1993–September 1995. Ergot comes from a rather ﬁshy- smelling fungus growing on improperly stored grain (typically rye). In cool and damp conditions ergot is also found on various grains and grasses in the ﬁeld. This happens around the world; in the 1990s Iowa’s barley crop suffered infection. Although ergot is typically an unwanted contamination in grain, sometimes the fungus is deliberately cultivated to be harvested for pharmaceutical purposes. Ergot is a traditional treatment to reduce menstrual blood ﬂow and bleeding after childbirth. The substance promotes contractions of the uterus, and the raw product has been used for centuries as an aid to birthing. Chemicals from ergot can induce abortions in cows and sheep, but reports conﬂict on whether ergot has this effect on hu- mans.
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