July 9, 2013

July 9, 2013
10 Types of Meds That Can Cause Insomnia
Part 2


Welcome to another day in my life. Today is Tuesday and I hope you are having a beary safe and great week so far. It is another busy week for Dab the AIDS Bear and me as we finish our trip to Washington DC and meeting with our elected officials about the Ryan White Care Act.

Having trouble getting a good night's sleep? One of these drugs might be the problem. Yesterday I started blogging about the medications that can cause insomnia that I will conclude today.

6. Angiotensin II-receptor blockers (ARBs)

Why they're prescribed: ARBs are often used to treat coronary artery disease or heart failure in patients who can't tolerate ACE inhibitors or who have type 2 diabetes or kidney disease from diabetes. Instead of blocking the body's production of angiotensin II, ARBs prevent it from exerting its blood vessel-constricting effects.

Examples of ARBs include: candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan).

How they can cause insomnia: Like ACE inhibitors, ARBs frequently lead to potassium overload in the body, causing diarrhea as well as leg cramps and achy joints, bones and muscles all of which can disturb normal sleep.

Alternatives: As with ACE inhibitors, I'd recommend you consult with your health care provider about the advisability of switching to a benzothiazepine calcium channel blocker, which is often better tolerated by older adults. This is especially important for African Americans and Asian Americans, who because of differences in their renin-angiotensin systems, have much higher incidences of adverse side effects.

A low dose of a long-acting loop diuretic such as torsemide may also be desirable.

7. . Cholinesterase inhibitors

Why they're prescribed: Cholinesterase inhibitors are commonly used to treat memory loss and mental changes in individuals with Alzheimer's disease and other types of dementia.

Examples: donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea and sleep disturbances.

How they can cause insomnia: These drugs are thought to work by inhibiting the enzyme in the body that breaks down acetylcholine (a neurotransmitter that's important for alertness, memory, thought and judgment) and thus boosting the amount available to brain cells. This, in theory, slows the patient's loss of memory and helps him or her perform daily activities with fewer problems. But blocking the breakdown of acetylcholine which is everywhere in the body, not just in the brain can interfere with all kinds of involuntary body processes and movements, including those related to sleep.

In addition to insomnia and abnormal dreams, the identified side effects of cholinesterase inhibitors include serious changes in heart rhythm, diarrhea, nausea and vomiting as well as leg cramps and muscle spasms all of which can interfere with normal sleep patterns.

Alternatives: It's important to remember that cholinesterase inhibitors cannot reverse Alzheimer's disease or slow the underlying destruction of nerve cells. And because the Alzheimer's-afflicted brain produces less acetycholine as the disease progresses, all medications in this class eventually lose whatever effectiveness they may be presumed to have.

For these reasons, it may be worthwhile to talk with your doctor (or the doctor treating your loved one) about whether the adverse effects of the drug prescribed outweigh its possible benefits. In my experience, that's nearly always the case.

8. Second-generation (nonsedating) H1 antagonists

Why they're prescribed: H1 antagonists, which are in a class of drugs commonly known as antihistamines, inhibit the body's production of histamine the chemical that's released when you have an allergic reaction. Elevated histamine levels cause such common allergic reaction symptoms as itching, sneezing, runny nose, watery eyes, nasal congestion and hives.

Second-generation H1 antagonists, also known as nonsedating antihistamines, do not have the same side effects as first-generation antihistamines, such as diphenhydramine (Benadryl), which suppress the central nervous system, causing severe drowsiness.

Examples of second-generation H1 antagonists include: azelastine (Astelin) nasal spray, cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), levocetirizine (Xyzal) and loratadine (Claritin).

How they can cause insomnia: In varying degrees, all H1 antagonists block acetylcholine, a nervous system neurotransmitter, and thus can cause anxiety and insomnia.

Alternatives: Since these second-generation antihistamines are typically active in the body for around eight hours, you may find that taking your daily dose in the morning may be all that's needed to resolve any sleep-related problems it may be causing.

9. Glucosamine and chondroitin

Why they're used: Glucosamine and chondroitin are dietary supplements that are used to relieve joint pain, improve joint function and lessen inflammation. (Both are found naturally in the human body.) Many arthritis supplements contain glucosamine and chondroitin, both of which are regulated by the Food and Drug Administration as a food rather than a drug.

How they can cause insomnia: Researchers aren't sure exactly how glucosamine and chondroitin work, but studies identify a range of gastrointestinal side effects, including nausea and diarrhea, as well as headaches and insomnia.

Alternatives: While many people take glucosamine and chondroitin, alone or together, for osteoarthritis, they may not help at all. A recent analysis of many studies of these supplements failed to find evidence that they slow joint destruction or relieve pain.

A 2010 survey of Consumer Reports subscribers found that among those who identified osteoarthritis as one of their most bothersome conditions, yoga and massage were rated twice as helpful as glucosamine and chondroitin.

If you choose to use one or both of these supplements, you should be aware that glucosamine has a longer half-life (the time it's active in the body) than chondroitin. So if glucosamine is part of your medication regimen, taking your daily dose in the morning should prevent problems with insomnia.

You may also wish to consider asking your doctor for a prescription of tramadol 50mg tablets and taking one with an acetaminophen 325mg tablet two to three times a day. This should work well to relieve pain. Ask the Pharmacist

Information contained in the Ask the Pharmacist column by Dr. Armon B. Neel Jr. is intended to help individuals and their families become more informed about medication usage and interactions, and be better health care consumers. Any advice or information provided should not be followed in lieu of a personal consultation with a trained medical professional.

10. Statins

Why they're prescribed: Statins are used to treat high cholesterol.

The top-selling statins are atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor) and simvastatin (Zocor).

How they can cause insomnia: The most common side effect of all types of statins is muscle pain, which can keep people who take them awake at night and unable to rest. In the worst cases, the pain caused by statins can be immobilizing.

Studies show that statins can interfere with muscle growth by inhibiting the production of satellite cells in the muscle. Muscle weakness and aches throughout the body can be symptoms of statin-induced rhabdomyolysis, a breakdown of skeletal muscle that causes muscle fibers to be released into the bloodstream, sometimes harming the kidneys.

Researchers have found that fat-soluble statins which include Lipitor, Mevacor, Vytorin and Zocor are more likely to cause insomnia or nightmares because they can more easily penetrate cell membranes and make their way across the blood-brain barrier, which protects the brain from chemicals in the blood.

Alternatives: If you're among the millions of older Americans who haven't been diagnosed with heart disease but are taking these drugs to lower your slightly elevated cholesterol, ask your doctor or other health care provider about making changes to your diet and getting regular exercise instead of using statins. You also might try lowering your blood levels of homocysteine which is linked to high cholesterol by taking a combination of sublingual (under-the-tongue) vitamin B12 (1,000 mcg daily), folic acid (800 mcg daily) and vitamin B6 (200 mg daily).

Hope these tips help you get the sleep you need and that you have a beary safe and great Tuesday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,



Daddy Dab