Q. I was dependent on OTC vasoconstrictor nasal sprays and had almost unbearable rebound congestion when I tried to stop. My doctor prescribed fluticasone (generic Flonase) spray. It took a couple of days to go to work, and then I dropped the Afrin. The rebound was much more bearable for those few days. There is always some discomfort; the piper has to be paid.
When I’d been off the Afrin a week, I stopped the steroid spray. I keep some fluticasone around for severe nasal congestion, so I can use that rather than reaching for something like Afrin.
A. Thank you for sharing your experience. Nasal-spray dependence is common after allergy season, and others may benefit from your strategy.
Q. If a spermicidal lubricant is used during sexual relations, can it cause the man genital irritation or discomfort? A friend of mine told me that after using this type of lubricant several times, he experienced irritation and pain.
A. The most common ingredient in spermicides is nonoxynol-9. This compound acts a bit like detergent to break down surface tension. That’s why it also is used in some shaving creams as a wetting agent or in poison ivy creams to help dissolve away poison ivy resin.
Side effects include irritation of the skin, such as itching, stinging or burning. Spermicides do not provide protection against sexually transmitted diseases and may even increase the risk of transmission by irritating delicate tissues and disrupting their normal barrier function.
Q. My uncle lives alone and is about to turn 86. He is part of a generation that goes to the doctor regularly and takes whatever is prescribed without question.
He has been dizzy lately and has had a few fender benders with poles in parking lots. I think he is on too much medicine or perhaps the wrong combination.
I want him to ask his doctor about this, but he did not want to question the doctor. He is taking glimepiride, lisinopril, finasteride, doxazosin, fenofibrate, metoprolol, levothyroxine and metformin.
I love my uncle and want him to have as much independence as possible. If there is a safety issue with his drugs, I will step in for his sake.
A. Doctors may perceive dizziness as a minor side effect, but if it leads to a fall, it can be life-threatening. Your uncle is taking a number of different medicines that could contribute to his dizziness.
Blood pressure pills such as doxazosin, lisinopril and metoprolol frequently cause this side effect. So can the diabetes drug glimepiride. His other diabetes medication, metformin, can deplete the body of vitamin B-12. When levels get low, people may develop numbness in the feet and have trouble walking. Judgment can be affected, which might contribute to his fender benders.
We are sending you our Guide to Drugs and Older People, with a list of medicines such as doxazosin that older people should usually avoid. We hope this will help you in your discussion with his doctor. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. O-85, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”