Caffeine

Caffeine is a bitter substance found in coffee, tea, soft drinks, chocolate, kola nuts, and certain medicines. It has many effects on the body’s metabolism, including stimulating the central nervous system. This can make you more alert and give you a boost of energy.

For most people, the amount of caffeine in two to four cups of coffee a day is not harmful. However, too much caffeine can cause problems. It can

  • Make you jittery and shaky
  • Make it hard to fall asleep or stay asleep
  • Cause headaches or dizziness
  • Make your heart beat faster or cause abnormal heart rhythms
  • Cause dehydration
  • Make you dependent on it so you need to take more of it. If you stop using caffeine, you could get withdrawal symptoms.

Some people are more sensitive to the effects of caffeine than others. They should limit their use of caffeine. So should pregnant and nursing women. Certain drugs and supplements may interact with caffeine. If you have questions about whether caffeine is safe for you, talk with your health care provider.

Calcium

You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium Photograph of calcium-rich foodsin the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system.

It is important to get plenty of calcium in the foods you eat. Foods rich in calcium include

  • Dairy products such as milk, cheese, and yogurt
  • Leafy, green vegetables
  • Fish with soft bones that you eat, such as canned sardines and salmon
  • Calcium-enriched foods such as breakfast cereals, fruit juices, soy and rice drinks, and tofu. Check the product labels.

The exact amount of calcium you need depends on your age and other factors. Growing children and teenagers need more calcium than young adults. Older women need plenty of calcium to preventosteoporosis. People who do not eat enough high-calcium foods should take a calcium supplement.

Carbohydrates

Photograph of two loaves of breadCarbohydrates are one of the main types of nutrients. They are the most important source of energy for your body. Your digestive system changes carbohydrates into glucose (blood sugar). Your body uses this sugar for energy for your cells, tissues and organs. It stores any extra sugar in your liver and muscles for when it is needed.

Carbohydrates are called simple or complex, depending on their chemical structure. Simple carbohydrates include sugars found naturally in foods such as fruits, vegetables, milk, and milk products. They also include sugars added during food processing and refining. Complex carbohydrates include whole grain breads and cereals, starchy vegetables and legumes. Many of the complex carbohydrates are good sources of fiber.

For a healthy diet, limit the amount of added sugar that you eat and choose whole grains over refined grains.

Carpal Tunnel Syndrome

You’re working at your desk, trying to ignore the tingling or numbness you’ve had for some time in your hand and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm. Just a passing cramp? It could be carpal tunnel syndrome.

The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed. Symptoms usually start gradually. As they worsen, grasping objects can become difficult.

Often, the cause is having a smaller carpal tunnel than other people do. Other causes include performing assembly line work, wrist injury, or swelling due to certain diseases, such as rheumatoid arthritis. Women are three times more likely to have carpal tunnel syndrome than men.

Early diagnosis and treatment are important to prevent permanent nerve damage. Your doctor diagnoses carpal tunnel syndrome with a physical exam and special nerve tests. Treatment includes resting your hand, splints, pain and anti-inflammatory medicines, and sometimes surgery.

Cartilage Disorders

Cartilage is the tough but flexible tissue that covers the ends of your bones at a joint. It also gives shape and support to other parts of your body, such as your ears, nose and windpipe. Healthy cartilage helps you move by allowing your bones to glide over each other. It also protects bones by preventing them from rubbing against each other.

Injured, inflamed, or damaged cartilage can cause symptoms such as pain and limited movement. It can also lead to joint damage and deformity. Causes of cartilage problems include

Tears and injuries, such as sports injuries
Genetic factors
Other disorders, such as some types of arthritis
Osteoarthritis results from breakdown of cartilage.

Chest Injuries and Disorders

The chest is the part of the body between your neck and your abdomen. It includes the ribs and breastbone. Inside your chest are several organs, including the heart, lungs, and esophagus. The pleura, a large thin sheet of tissue, lines the inside of the chest cavity.

Chest injuries and disorders includeIllustration of the thorax

  • Heart diseases
  • Lung diseases and collapsed lung
  • Pleural disorders
  • Esophagus disorders
  • Broken ribs
  • Thoracic aortic aneurysms
  • Disorders of the mediastinum, the space between the lungs, breastbone, and spine

Chest Pain

Having a pain in your chest can be scary. It does not always mean that you are having a heart attack. There can be many other causes, including

  • Other heart problems, such as anginaA photograph of a man clutching his chest
  • Panic attacks
  • Digestive problems, such as heartburn or esophagus disorders
  • Sore muscles
  • Lung diseases, such as pneumonia, pleurisy, or pulmonary embolism
  • Costochondritis – an inflammation of joints in your chest

Some of these problems can be serious. Get immediate medical care if you have chest pain that does not go away, crushing pain or pressure in the chest, or chest pain along with nausea, sweating, dizziness or shortness of breath. Treatment depends on the cause of the pain.

Cholesterol

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Your body needs some cholesterol to work properly. But if you have too much in your blood, it can combine with other substances in the blood and stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them.

High levels of cholesterol in the blood can increase your risk of heart disease. Your cholesterol levels tend to rise as you get older. There are usually no signs or symptoms that you have high blood cholesterol, but it can be detected with a blood test. You are likely to have high cholesterol if members of your family have it, if you are overweight or if you eat a lot of fatty foods.

You can lower your cholesterol by exercising more and eating more fruits and vegetables. You also may need to take medicine to lower your cholesterol.

Chronic Pain

Pain is a feeling set off in the nervous system. Acute pain lets you know that you may be injured or have a problem you need to take care of. Chronic pain is different. The pain signals go on for weeks, months, or even years. The original cause may have been an injury or infection

There may be an ongoing cause of pain, such as arthritis or cancer. But in some cases there is no clear cause.

Problems that cause chronic pain include

  • Headache
  • Low back strain
  • Cancer
  • Arthritis
  • Pain from nerve damage

Chronic pain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, relaxation and meditation therapy, biofeedback, and behavior modification.

Club Drugs

Club drugs are group of psychoactive drugs. They act on the central nervous system and can cause changes in mood, awareness, and how you act. These drugs are often abused by young adults at all-night dance parties, dance clubs, and bars. They include

  • Methylenedioxymethamphetamine (MDMA), also known as Ecstasy XTC, X, E, Adam, Molly, Hug Beans, and Love Drug
  • Gamma-hydroxybutyrate (GHB), also known as G, Liquid Ecstasy, and Soap
  • Ketamine, also known as Special K, K, Vitamin K, and Jet
  • Rohypnol, also known as Roofies
  • Methamphetamine, also known as Speed, Ice, Chalk, Meth, Crystal, Crank, and Glass
  • Lysergic Acid Diethylamide (LSD), also known as Acid, Blotter, and Dots

Some of these drugs are approved for certain medical uses. Other uses of these drugs are abuse.

Club drugs are also sometimes used as “date rape” drugs, to make someone unable to say no to or fight back against sexual assault. Abusing these drugs can cause serious health problems and sometimes death. They are even more dangerous if you use them with alcohol.

Codeine

Codeine, also known as 3-methylmorphine, is an opiate used to treat pain, as a cough medicine, and for diarrhea. It is typically used to treat mild to moderate degrees of pain. Greater benefit may occur when combined with paracetamol (acetaminophen) or aspirin. Evidence does not support its use for cough suppression. 

In Europe it is not recommended as a cough medicine in those under twelve years of age. It is taken by mouth. It typically starts working after half an hour with maximum effect at two hours. Effects last for about four to six hours.

Codeine is used to relieve mild to moderate pain. It is also used, usually in combination with other medications, to reduce coughing. Combination products that contain codeine and promethazine should not be used in children younger than 16 years of age. Codeine will help relieve symptoms but will not treat the cause of symptoms or speed recovery. Codeine belongs to a class of medications called opiate (narcotic) analgesics and to a class of medications called antitussives. When codeine is used to treat pain, it works by changing the way the brain and nervous system respond to pain. When codeine is used to reduce coughing, it works by decreasing the activity in the part of the brain that causes coughing.

Codeine is also available in combination with acetaminophen (Capital and Codeine, Tylenol with Codeine); aspirin; and carisoprodol; and as an ingredient in many cough and cold medications. This monograph only includes information about the use of codeine. If you are taking a codeine combination product, be sure to read information about all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.

DRUG CLASS AND MECHANISM: Codeine is a narcotic pain-reliever and cough suppressant similar to morphine and hydrocodone. Moreover, a small amount of codeine is converted to morphine in the body. The precise mechanism of action of codeine is not known; however, like morphine, codeine binds to receptors in the brain (opioid receptors) that are important for transmitting the sensation of pain throughout the body and brain. Codeine increases tolerance to pain, decreasing discomfort, but the pain still is apparent to the patient. In addition to reducing pain, codeine also causes sedation drowsiness and depresses breathing. Codeine frequently is combined with acetaminophen (Tylenol) or aspirin for more effective pain relief. The FDA approved codeine in 1950.

Codeine is habit forming. Mental and physical dependence can occur but are unlikely when used for short-term pain relief. If codeine is suddenly withdrawn after prolonged use, symptoms of withdrawal may develop. The dose of codeine should be reduced gradually in order to avoid withdrawal symptoms.

How should this medicine be used?

Codeine (alone or in combination with other medications) comes as a tablet, a capsule, and a solution (liquid) to take by mouth. It is usually taken every 4 to 6 hours as needed. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take codeine exactly as directed.

Codeine can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Do not stop taking codeine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop taking codeine, you may experience withdrawal symptoms such as restlessness, widened pupils (black circles in the center of the eyes), teary eyes, irritability, anxiety, runny nose, difficulty falling asleep or staying asleep, yawning, sweating, fast breathing, fast heartbeat, chills, hair on your arms standing on end, nausea, loss of appetite, vomiting, diarrhea, stomach cramps, muscle aches, or backache.

If you are giving codeine to a child, give the medication only as needed. Do not give codeine on a regular (around-the-clock) schedule and do not give more than six doses in 24 hours.

Shake the solution well before each use to mix the medication evenly. Do not use a household spoon to measure your dose. Use the measuring cup or spoon that came with the medication or use a spoon that is made especially for measuring medication.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking codeine,

  • tell your doctor and pharmacist if you are allergic to codeine, any other medications, or any of the ingredients in the codeine product you plan to take. Ask your doctor or pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; medications for cough, cold, or allergies; medications for anxiety, mental illness, nausea, or seizures; monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have slowed breathing, or have or have ever had asthma or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take codeine.
  • tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have had recent abdominal or urinary tract surgery. Also tell your doctor if you have or have ever had a head injury; a brain tumor; any condition causing increased pressure in your brain; seizures; mental illness; lung disease such as asthma, chronic obstructive pulmonary disease (COPD, a group of diseases that cause gradual loss of lung function),obstructive sleep apnea, or other breathing problems; prostatic hypertrophy (enlargement of a male reproductive gland); urinary problems; low blood pressure; Addison’s disease (condition in which the body does not make enough of certain natural substances); allergies; or thyroid, pancreatic, intestinal, gallbladder, liver, or kidney disease.
  • tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking codeine, call your doctor.
  • tell your doctor if you are breast-feeding. Some women who take codeine may have increased amounts of the medication in their breast milk, which can cause serious or life-threatening side effects in their breast-fed babies. Call your doctor immediately or get emergency medical help if you become very sleepy and have difficulty caring for your baby. You should also call your baby’s doctor or get emergency help if your baby is sleepier than usual, has trouble breast-feeding or breathing, or becomes limp. If you breast-feed during your treatment and stop breast-feeding or stop taking codeine, your baby might experience withdrawal symptoms including irritability, being more active than usual, vomiting, problems sleeping, weight loss, high-pitched cry, fever, shaking, or diarrhea or more stools than usual. Call your baby’s doctor if your baby has any of these symptoms.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking codeine.
  • you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. If you are giving codeine to a child, watch the child to be sure he or she does not get hurt while riding a bike or participating in other activities that could be dangerous.
  • you should know that drinking alcohol during your treatment may increase the risk that you will experience serious or life-threatening side effects. Talk to your doctor about the risks of drinking alcohol during your treatment.
  • you should know that codeine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking codeine. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
  • you should know that codeine may cause constipation. Talk to your doctor about changing your diet and using other medications to treat or prevent constipation.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Codeine is usually taken as needed. If your doctor has told you to take codeine regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Codeine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • dizziness
  • lightheadedness
  • headache
  • drowsiness
  • mood changes
  • nausea
  • vomiting
  • constipation
  • stomach pain
  • difficulty urinating

Some side effects can be serious. If you experience any of the following symptoms, stop taking codeine and call your doctor immediately or get emergency medical attention:

  • sleepiness
  • confusion
  • noisy or shallow breathing
  • difficulty breathing or swallowing
  • fast, pounding, or irregular heartbeat
  • rash
  • itching
  • hives
  • changes in vision
  • seizures

Codeine may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed. at room temperature and away from excess heat and moisture (not in the bathroom). Keep it in a safe place where no one else can take it accidentally or on purpose. Be especially careful to keep codeine out of reach of children. If a child accidentally takes codeine, get emergency medical help right away. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include the following:

  • difficulty breathing
  • excessive drowsiness
  • loss of consciousness
  • loss of muscle tone
  • cold and clammy skin
  • fainting
  • dizziness
  • slow heartbeat

What other information should I know?

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking codeine.

Do not let anyone else take your medication. Selling or giving away this medication may cause death or harm to others and is illegal. Your prescription might not be refillable. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

  • Tuzistra XR® (as a combination product containing Chlorpheniramine, Codeine)

Brand names of combination products

  • Airacof® (containing Codeine, Diphenhydramine, Phenylephrine)
  • Ala-Hist AC® (containing Codeine, Phenylephrine)
  • Allfen CD® (containing Codeine, Guaifenesin)
  • Ambenyl® (containing Bromodiphenhydramine, Codeine)
  • Ambophen® (containing Bromodiphenhydramine, Codeine)
  • Antituss AC® (containing Codeine, Guaifenesin)
  • Bitex® (containing Codeine, Guaifenesin)
  • Bromanyl® (containing Bromodiphenhydramine, Codeine)
  • Bromotuss® with Codeine (containing Bromodiphenhydramine, Codeine)
  • Brontex® (containing Codeine, Guaifenesin)
  • Bron-Tuss® (containing Codeine, Guaifenesin)
  • Brovex CB® (containing Brompheniramine, Codeine)
  • Brovex PBC® (containing Brompheniramine, Codeine, Phenylephrine)
  • Calcidrine® (containing Anhydrous Calcium Iodide, Codeine)
  • Cheracol® with Codeine (containing Codeine, Guaifenesin)
  • Cheratussin® (containing Codeine, Guaifenesin)
  • Codafen® (containing Codeine, Guaifenesin)
  • Codimal PH® (containing Codeine, Phenylephrine, Pyrilamine)
  • Cotab A® (containing Chlorpheniramine, Codeine)
  • Demi-Cof® (containing Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide)
  • Dex-Tuss® (containing Codeine, Guaifenesin)
  • Diabetic Tussin C® (containing Codeine, Guaifenesin)
  • Dicomal-PH® (containing Codeine, Phenylephrine, Pyrilamine)
  • Duraganidin NR® (containing Codeine, Guaifenesin)
  • EndaCof AC® (containing Brompheniramine, Codeine)
  • Endal CD® (containing Codeine, Diphenhydramine, Phenylephrine)
  • ExeClear-C® (containing Codeine, Guaifenesin)
  • Gani-Tuss NR® (containing Codeine, Guaifenesin)
  • Giltuss Ped-C® (containing Codeine, Guaifenesin, Phenylephrine)
  • Glydeine® (containing Codeine, Guaifenesin)
  • Guaifen AC® (containing Codeine, Guaifenesin)
  • Guiatuss AC® (containing Codeine, Guaifenesin)
  • Guiatussin® with Codeine (containing Codeine, Guaifenesin)
  • Halotussin AC® (containing Codeine, Guaifenesin)
  • Iophen® (containing Codeine, Guaifenesin)
  • Mar-cof CG® (containing Codeine, Guaifenesin)
  • Maxiphen CD® (containing Codeine, Guaifenesin, Phenylephrine)
  • M-Clear WC® (containing Codeine, Guaifenesin)
  • M-End PE® (containing Brompheniramine, Codeine, Phenylephrine)
  • Mytussin AC® (containing Codeine, Guaifenesin)
  • Nalex® AC (containing Brompheniramine, Codeine)
  • Notuss AC® (containing Chlorpheniramine, Codeine)
  • Notuss PE® (containing Codeine, Phenylephrine)
  • Pediacof® (containing Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide)
  • Pedituss® (containing Chlorpheniramine, Codeine, Phenylephrine, Potassium Iodide)
  • Pentazine VC® (containing Codeine, Phenylephrine, Promethazine)
  • Pentazine® with Codeine (containing Codeine, Promethazine)
  • Phenergan® VC with Codeine (containing Codeine, Phenylephrine, Promethazine)
  • Phenergan® with Codeine (containing Codeine, Promethazine)
  • Poly-Tussin AC® (containing Brompheniramine, Codeine, Phenylephrine)
  • Prometh® with Codeine (containing Codeine, Guaifenesin, Promethazine)
  • Robafen AC® (containing Codeine, Guaifenesin)
  • Robichem AC® (containing Codeine, Guaifenesin)
  • Robitussin® AC (containing Codeine, Guaifenesin)
  • Rolatuss® (containing Ammonium Chloride, Chlorpheniramine, Codeine, Phenylephrine)
  • Romilar AC® (containing Codeine, Guaifenesin)
  • Tusnel C® (containing Brompheniramine, Codeine, Guaifenesin)
  • Tussi Organidin® (containing Codeine, Guaifenesin)
  • Tussiden C® (containing Codeine, Guaifenesin)
  • Tussirex® (containing Caffeine, Codeine, Pheniramine, Phenylephrine, Salicylic Acid)
  • Tusso-C® (containing Codeine, Guaifenesin)
  • Vanacof® (containing Codeine, Dexchlorpheniramine, Phenylephrine)
  • Z Tuss AC® (containing Chlorpheniramine, Codeine)
  • Zodryl AC® (containing Chlorpheniramine, Codeine)
  • Zotex C® (containing Codeine, Phenylephrine, Pyrilamine)

This branded product is no longer on the market. Generic alternatives may be available.

Cold and Cough Medicines

Sneezing, sore throat, a stuffy nose, coughing — everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

What can you do for your cold or cough symptoms? Besides drinking plenty of fluids and getting plenty of rest, you may want to take medicines. There are lots of different cold and cough medicines, and they do different things.

  • Nasal decongestants – unclog a stuffy nose
  • Cough suppressants – quiet a cough
  • Expectorants – loosen mucus so you can cough it up
  • Antihistamines – stop runny noses and sneezing
  • Pain relievers – ease fever, headaches, and minor aches and pains

Here are some other things to keep in mind about cold and cough medicines. Read labels, because many cold and cough medicines contain the same active ingredients. Taking too much of certain pain relievers can lead to serious injury. Do not give cough medicines to children under four, and don’t give aspirin to children. Finally, antibiotics won’t help a cold.

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