Dear Mr. President

Dear Mr. President (Feb 2018)

A short list of thoughts from someone who didn’t vote for you—or your opponent—in 2016. (used “write in”)

Caveat: an apology, as “letters to the President” are hardly original.

1. Thanks for the positive financial bubble. Our lower middle class family has benefited, but the long term costs of these benefits are not clearly defined. We are in hopes that your conviction that the economy will grow enough to make up the difference plays out, even if history has not been all that kind to this approach. However, I would be remiss in not admitting that right now, we’re better off than we were a year ago.

2. Is there any chance you might consider going cold turkey to your Twitter addiction? Yes, going cold turkey is very hard. But, as you have professed significant intelligence, I am confident that you could drop your Twitter use for at least 30 days. This would give the results of your executive orders a chance to develop as they will without distraction from you or your advisers. In order for your constituents to get a clear bead on what you are doing in the following: Economy, Environment, Law Enforcement, National Security, Immigration and Statesmanship, I suggest that NOT firing off a running stream of consciousness commentary may better serve you and what you are attempting to achieve. The old adage, “actions speak louder than words” really holds true, as I expect it did for your parents and grandparents.

3. Stand by those individuals who seek the Truth. Seeking the truth in all things is a challenging thing. Truth is a consensus; there is ample proof that 25 witnesses to an event will give you 25 different appraisals of that event. However, there are many in Federal agencies who simply want the Truth. They are not out “to get anyone”. They simply want the truth. At this junction in history, we face an unprecedented amount of technological advantages, but also vulnerabilities. Do we, as Americans, wish to be naive about this? I suggest that all the investigations going on will lead to something salient. It may not be of your personal taste and that is too bad.

If you have nothing to fear, proceed fearlessly.

This latter position doesn’t require comment, only your support of Our Democracy and Our Constitution. If you belief in those two icons of our Nation, than logically, you can’t come to any other conclusion other than to ride it all out with dignity and statesmanship that the Office of President demands. I know you can do this, if you wish to.

4. Spend less time in Florida. Though I know you probably realize it will be under water in your children’s lifetime, spreading your presence in other parts of the Nation you lead might be worthy of your consideration. And, if you spend time in other parts of the Nation, please be open to other’s opinions and be patient with differing views of thought. Here in New England, we have “Town Meeting” the last bare knuckle form of democracy practiced in the United States of American. In the annual Town Meeting, there is much disagreement, some of it quite heated. However, for the most part, at the end of the meeting, or during it, most towns break for lunch, and come together in a very civil, community, fashion. The reason is simple… we are COMMUNITIES, which means that though we may disagree with each other, this disagreement doesn’t have to be uncivilized or unkind. I have many close friends with whom I vehemently disagree with their positions on many things. However, our common cause is in complete agreement. Plus, I know that even with the disagreement, these friends “have my back” as I have theirs.

5. Let Mrs. Trump loose to pursue more visible, positive programs of her desire. First Lady is a great platform to get a great deal of GOOD THINGS done. Don’t hold anyone back in this capacity, least of all the First Lady

6. Consider a refresher course in American History. This will give you perspective on what has worked in the past, and why. Another old adage your parents and grandparents likely knew if not lived by, is from Philosopher George Santayana…”Progress, far from consisting in change, depends on retentiveness. When change is absolute there remains no being to improve and no direction is set for possible improvement: and when experience is not retained, as among savages, infancy is perpetual. Those who cannot remember the past are condemned to repeat it.”

There is a proper balance between all things Federally managed… a balance between environment and material extraction from it, a balance between security and privacy, a balance between dignified, fair immigration policy and national security, a balance between taxation levels and infrastructure spending needs, a balance between budget and deficit concerns and military spending. Surely, you are familiar with a balance sheet and the basic principals of human dignity. Balance is hard to manage, ask ANY of your living predecessors. However, if you find it, you will be rewarded by more of our citizens recognizing you are trying to fulfill the demands of your position as US President.

In closing, thank you (if you actually read this in person), no matter how unlikely this result would be. The great thing about the United States is that, with a few qualifications, anyone can be voted in as President. You represent the 45th person that has been elected to this solemn position. I would ask you, pursuant to item #6 above, how many of those 45 individuals have made a really positive difference during their tenure? I would follow up that being remembered for making a positive difference would be a good thing. And, quite possibly, something that others could Tweet about.

Respectfully submitted,

Peter Bruce Wilder
Vermonter

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Rules to Live By

The challenge for so many of those committed to religious fundamentalism is that they have a difficult time recognizing that they have knowingly locked themselves into what is really a closed room of intellectual fascism.

I observe that this plays out in the simple manner that,  if they don’t understand another, different position, they don’t respect it.  They have no empathy. Without empathy, they cannot understand a different social position. This plays out in knee jerk, typically hyper-religious judgments that have no factual bearing in the teachings of major Earth-followed prophets.

These fundamentalists are not alone, by a long shot.  It is difficult in a violent world to not have immediate judgement without considering the path that brought individuals to that violence.

It’s a timeless adage, one known in every language on the Planet: “without walking a mile in another person’s shoes, you cannot possibly have the benefit of that fellow human being’s experiences.” This results in a conscious, self-imposed (if not celebrated) ignorance which then develops into a crude justification for extremely harsh views (or worse) of others.

Ignorance remains the root cause for reactions to the many frightening aspects of change… like those who still oppose the practical aspects of Darwin’s findings, for example.

The saddest thing inflicted by self limitation and lack of empathy is that one’s life does not become enriched by the experience of the living (and sharing) of life itself. This leads inevitably toward an unhappy death, a death that is feared because it follows a life unrewarded by the conscious filtering of the simple consideration that there might be another experience (experiences) different than our own…and that that experience has equal validity simply because it is.

The Ongoing Relationship between Ignorance and Despair

The title of this blog is what creates everything from gang violence to economic upheaval.  The solution is more complicated than extracting a higher percentage of wealth from the rich.  The only solution is education, but there is a hurdle in that many parents seem to not want their children to be smarter, or educated outside of religious or idealistic barriers, or that they don’t want offspring wiser and more experienced than they are or don’t feel their children need to be.

Further, many parents see educated children as “terrifyingly enlightened” and therefore their children are able to make individually informed decisions that are likely to be more informed than the values promoted by their parents and peers.

The “education” in my own candid opinion is best served by teaching within some traditional basic structures (wrote memorization is NOT a bad thing, for example) enhanced by the expansion (or return to) creatives (music and art as mandatory) and physical education (during the school day) as mandatory.  A strong focus on history, but with as many possible viewpoints on history as possible.  The so called STEM (Science Technology Engineering and Math) curriculum is desperately needed in K-12, as well as college for the simple reason that “… those who do not understand technology and science are doomed to be controlled by those who do. ”

Education on this scale is hardly an easy path, but it is the ONLY path.  A second and major hurdle comes from when the “baby boom” generation dies out, which it surely will do, what then?  A world wide population drop?  Not likely, but there will be a profound population drop in “first world” zones, as statistics are already reporting in many Eurozone countries.  This will likely be the most massive shift in world wealth seen in some time, with fewer recipients of that wealth creating even greater concentration.  And, whether or not those individuals will have any greater sense of civic duty than their parents, grandparents and so forth have shown is debatable.

Interesting fact:  Canada is the one country in the world with the highest percentage of college graduates.  How is this possible?  It’s a short list… secondary education is comparatively inexpensive (by a long shot) and Universal Healthcare has been in place for nearly four decades.  Visit Canada.  See how it feels.  Lots more arts and creative, lots more everything.  Vitality in motion.  Is consensus nearly impossible?  Indeed, but no more so than any New England town meeting.

Alexander De Tocqueville (a classical liberal skeptical of the extremes of democracy) famously said about a young United States in his seminal book, Democracy in America: “…The Americans, on the contrary, are fond of explaining almost all the actions of their lives by the principle of interest rightly understood; they show with complacency how an enlightened regard for themselves constantly prompts them to assist each other, and inclines them willingly to sacrifice a portion of their time and property to the welfare of the state.”

And there it is and so it goes.  Only as a “civilization, social and progressive” can we eradicate the social illnesses of the past and create an imperfect but nearly level playing field.  We need to identify and support exceptional individuals and ideas, but not do so at the expense of crushing the majority.

It seems to me that the Scandinavian countries, no matter how flawed, understand this better than any other nations, with the possible exception of Canada.

Live in the Now

A preposterously silly film, “Wayne’s World” created years ago by comedians Mike Meyers and Dana Carvey (SNL alums and more) still has many moments of pithy salience, perhaps my favorite being “Live in the now!”

This is hardly a new concept, having several thousand years of Guru based insight underscoring the same advice.  In popular culture, the “living in the moment” idea is distributed from Star Wars (Yoda, naturally) to Psychology Today.

It is a difficult thing, this living in the now.  Perhaps because we are the sum of our memories and those memories cause each of us to have expectations (or designs) upon the future.  The challenge in future planning is to extrapolate a practical balance between hopes/expectations and actual likelihood.

This past week, I listened to an NPR “On Being” rebroadcast of an April interview with New York State Poet Laureate Marie Howe.  

I admit to being fully taken in by Ms. Howe’s practicality, world weary observations, and her choice to seek out the meaning of each moment revealed.  Perhaps this last point is the item to practice fully.  To seek out the meaning and the positive as much as possible.  To turn around the negative into something positive.  Though it is a couched attempt at generating more business, I cannot help but be moved by Insurer Liberty Mutual’s ad campaign, “Responsibility, what’s Your Policy?”.

Seriously, all these things that for many of us used to be a part of public education, weekly religious doctrine, and more seem to have fallen to the sidelines in popular culture.

Good news doesn’t sell.

Ironically, I don’t think it has to.  I do believe, however; that good news should be promoted.

Somewhere in this blog, I have written many things about my own perspective of “wealth”.  Frankly, my family doesn’t see ourselves as wealthy as we struggle against rising expenses across the board, with less income.  However, I have no platform on which to whine or wallow in my own just-beneath-the-surface selfishness.  We are clothed, fed and housed.  We have the tremendous good fortune to have trusted and loving friends, family and neighbors.  We live within a spectacular part of the planet, the State of Vermont.   In fact, I implore you to check out the World Wealth Calculator for your own reality check.

As an unrelated (but perhaps related) aside: some thoughts about “living in the now” and creativity.  Being immersed in creative play and development for my entire life (thank you Mom and Dad) — it is a large part of what I know.

From music to graphical arts to poetry, prose, architectural design and sculpture, I have enjoyed many avenues to express my own muse.  In addition, all of these creative disciplines combined have greatly influenced my contributions to product development, corporate planning, marketing, municipal planning and much more.  To be completely candid, creativity is part of everything I do, every decision I make, from domestic challenges (lawn tractor, bicycle and auto repair and maintenance, to pluming, carpentry and electrical) to personal relationships (how much empathy can you find in relating to another individual’s situation?) .

I have observed in the past 25 years that most humans possess an amazing amount of creativity that they simply don’t choose to exercise.  This is a shame.  Not because of the personal loss of this type of very healthy expression, but because it leads to a society that doesn’t value creativity.  Without creativity, you don’t have creative solutions to challenges.  Where do you think “out-of-the-box” thinking comes from?  Hint: it does not come from memorization of textbooks.  Witness the complete lack of music and art in public schools… where to cut expenses?  Cut the budget for the VERY THING that makes us human… creativity!   It seems outrageous.  You have entire world industries…manufacturers of musical instruments, art supplies and universities, big city symphonies and more wondering why no one is either interested — or prepared — in any of these valuable artistic disciplines!   Look no further than your local school board, folks.  As in the classic POGO cartoon for Earth Day in 1971, “We have met the enemy and he is us.”

A further aside:  in my work as a subcontractor to Research and Design groups of very large corporations, I have had the privilege of working with some of the most intelligent, scintillating men and women I may ever meet in this lifetime.  ALL are highly artistic and ridiculously creative.  To say that music, art and creative training from K-Ph.D has no value is complete and utter nonsense.  Humanity’s history isn’t remembered by budget cutting.  It is remembered through its art and architecture.  As my friend Suzanne Roberts often recounts, “Ars longa, vita brevis (Art is long, life is short.)  Taxpayers, please take note.  You can’t have a future without investing in creativity.  Without it, you get Groundhog Day.

Returning to the original premise of this meandering diatribe, ritual and discipline can have a significant, positive effect toward “living in the now”.  Making time for a daily “quiet time”, which you might also call “meditation”, “prayer”,  semantics not withstanding, is a critical order.  Do you have drive time in your work?  Shut off the car audio, mute your cell phone.  Use the time to “be”.   Some of my best ideas have occurred to me during long drives from Vermont to points afar.

For me, mornings are the best.  Mostly because I have to be up with our two aging female dogs.  There’s something about the stillness at dawn I still find remarkable, if not downright miraculous.  My dear friend Linda Stoler advocates dancing, among other many other creative, simple things.  I believe she is absolutely correct.  All of the practices she suggests can add up to reinforcement of being in the moment.

I believe we will be remembered for our individual contributions to each of those who know us.  I believe this is best served when we make a supreme effort to train ourselves to appreciate each and every moment, to “live in the now” in order to value this gift of life—or at the very least to overcome its challenges with as much compassion as we can muster.  It’s a tall order, but one absolutely worth the effort.

On a recent rebroadcast of Christopher Plummer’s performance “Barrymore” one of the lines (paraphrased) is that “…you know you are old when dreams are replaced by regrets.”

May each of us forever be dreamers.

The Awesome Power (and disregard for) the Disclaimer

This is an article based solely on disclaimers, which I personally find akin to bald-ass  lying—but legally.  With a disclaimer, you can CLAIM anything, and then refute the claims, or at the very least, adjust them downward to the point of ridiculousness.   I am making liberal use of the “highlighter” function, changing the text color to point out some of my favorite items.

As a primer to this long article, here’s an example of a short disclaimer, mine:

Use of this article is not recommended.  Use will increase blood pressure resulting in almost certain headache, stress related.  Author’s opinion of the absolutely factual material presented below is to be treated solely as opinion, if not extreme sarcasm.  The following disclaimers are true, pulled word for word from each corporation’s website.

Now, with that over and done with, here are some of my favorites:

First, CYMBALTA® (Duloxetine/Oral route), an anti depressant, from Lilly Pharmaceuticals (just approved for generic manufacture in 2013)
(source)

Drugs and Foods to Avoid

• Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using cimetidine (Tagamet®), thioridazine (Mellaril®), tryptophan, or medicine to treat an infection (such as ciprofloxacin, enoxacin Ciloxan®, Cipro®, or Penetrex®).
• Make sure your doctor knows if you are using St. John’s wort, lithium (Eskalith®, Lithane®, Lithobid®), tramadol (Ultram®), other medicines to treat depression (such as amitriptyline, desipramine, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, Celexa®, Effexor®,
• Lexapro™, Luvox®, Norpramin®, Paxil®, or Zoloft®), medicine to treat headaches (such as eletriptan, sumatriptan, zolmitriptan, Imitrex®, Relpax®, or Zomig®), medicine to treat an infection (such as linezolid, Levaquin®, Tequin®, or Zyvox®), or a phenothiazine medicine (such as prochlorperazine, Compazine®, Phenergan®, Thorazine®, or Trilafon®).
• Tell your doctor if you are using a blood pressure medicine (such as atenolol, lisinopril, metoprolol, Cozaar®, Diovan®, Lotrel®, Norvasc®, or Toprol®), diuretic or “water pill” (such as hydrochlorothiazide [HCTZ], furosemide, or Lasix®), medicine for heart rhythm problems (such as flecainide, propafenone, quinidine, Rythmol®, or Tambocor®), pain or arthritis medicine, also called “NSAIDs” (such as aspirin, ibuprofen, Advil®, Aleve®, Celebrex®, or Motrin®), or a blood thinner (such as warfarin, Coumadin®).
• Tell your doctor if you drink alcohol or if you are using any medicine that makes you sleepy, such as allergy medicine or narcotic pain medicine.
• Do not drink alcohol while you are using this medicine. Drinking alcohol while using this medicine may increase your risk of liver damage. If you regularly drink 3 or more alcoholic drinks every day, tell your doctor.

When Not To Use

• You should not use this medicine if you have had an allergic reaction to duloxetine, or if you are using or have used an MAO inhibitor
• (MAOI) such as isocarboxazid, phenelzine, selegiline, tranylcypromine, Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days.
• Do not start taking an MAO inhibitor within 5 days of stopping duloxetine. You should not use this medicine if you have severe kidney disease or uncontrolled narrow-angle glaucoma.

Warnings

• It is important to tell your doctor if you are pregnant or trying to become pregnant. Your doctor may want you to join a pregnancy registry for patients taking this medicine.
• Make sure your doctor knows if you are breastfeeding, or if you have kidney disease, liver disease (including cirrhosis), bleeding problems, diabetes, narrow-angle glaucoma, problems with urination, digestion problems (slow bowels), or a history of seizures or mania. Tell your doctor if you have heart disease, high or low blood pressure, or low sodium in the blood. Also tell your doctor if you have been addicted to drugs or alcohol.
• For some teenagers and young adults, this medicine can increase thoughts of suicide. Tell your doctor right away if you start to feel more depressed and have thoughts about hurting yourself. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.
• Stop using this medicine and check with your doctor right away if you have pain or tenderness in the upper stomach; pale stools; dark urine; loss of appetite; nausea; unusual tiredness or weakness; or yellow eyes or skin. These could be symptoms of a serious liver problem.
• Serious skin reactions can occur during treatment with this medicine, including erythema multiforme and Stevens-Johnson Syndrome (SJS). Stop using this medicine and check with your doctor right away if you have blistering, peeling, or loosening of the skin; red skin lesions; severe acne or skin rash; sores or ulcers on the skin; or fever or chills while you are using this medicine.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert. You may also feel lightheaded when getting up suddenly from a lying or sitting position, so get up slowly. If these symptoms are bothering you or keeping you from doing your daily activities, tell your doctor right away.
• This medicine may cause serious conditions called serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions when it is taken with certain medicines. Check with your doctor first before taking any other medicines.
• You will need to have your blood pressure measured before starting this medicine and while you are using it. If you notice any change to your recommended blood pressure, call your doctor right away. If you have questions about this, talk to your doctor.
• Do not suddenly stop taking this medicine without checking first with your doctor. If you have been instructed to stop taking duloxetine, ask your doctor how to slowly decrease the dose. This will decrease your chance of having withdrawal symptoms such as dizziness, nausea, headaches, vomiting, increased sweating, irritability, nightmares, or prickling or tingling feelings.
• This medicine may increase your risk for bleeding problems when it is taken with certain medicines. Check with your doctor first before taking any other medicines.
• After you stop using the medicine, call your doctor if you have mood or behavior changes, confusion, headaches, nausea, vomiting, seizures, tingling pain, or ringing in your ears.
• Hyponatremia (low sodium in the blood) may occur with this medicine. Stop using the medicine and check with your doctor right away if you have confusion, difficulty concentrating, headaches, memory problems, weakness, and unsteadiness.
• This medicine may affect blood sugar levels. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments. Blood tests may be needed to check for unwanted effects.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

•     Abdominal or stomach pain
•     area rash
•     blindness
•     blistering, peeling, or loosening of the skin
•     blurred vision
•     change in consciousness
•     chills
•     clay-colored stools
•     cold sweats
•     confusion
•     convulsions
•     dark urine
•     decreased urine output
•     decreased vision
•     difficulty swallowing
•     dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
•     eye pain
•     fainting
•     fast or irregular heartbeat
•     general tiredness or weakness
•     hives or welts
•     hives, itching, puffiness, or swelling of the eyelids or around the eyes, face, lips, or tongue
•     increased thirst
•     itching
•     joint or muscle pain
•     large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
•     light-colored stools
•     loss of consciousness
•     red skin lesions, often with a purple center
•     red, irritated eyes
•     redness of the skin
•     shortness of breath
•     skin rash
•     sores, ulcers, or white spots in the mouth or on the lips
•     swelling of the face, ankles, or hands
•     tearing
•     tightness in the chest
•     unpleasant breath odor
•     upper right stomach pain
•     vomiting of blood
•     wheezing
•     yellow eyes and skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

•     Agitation
•     diarrhea
•     fever
•     loss of bladder control
•     muscle spasm or jerking of all extremities
•     overactive reflexes
•     poor coordination
•     restlessness
•     shivering
•     sleepiness or unusual drowsiness
•     sudden loss of consciousness
•     sweating
•     talking or acting with excitement you cannot control
•     trembling or shaking
•     twitching
•     unusual tiredness or weakness
•     vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side
effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

•     Body aches or pain
•     cough
•     difficulty having a bowel movement (stool)
•     difficulty with breathing
•     dry mouth
•     ear congestion
•     frequent urination
•     headache
•     lack or loss of strength
•     loss of appetite
•     loss of voice
•     muscle aches
•     nausea
•     sleepiness or unusual drowsiness
•     sleeplessness
•     sneezing
•     sore throat
•     stuffy or runny nose
•     sweating increased
•     trouble sleeping
•     unable to sleep
•     weight loss

Less common

•     Abnormal orgasm
•     acid or sour stomach
•     belching
•     burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
•     change in taste
•     change or problem with discharge of semen
•     decreased interest in sexual intercourse
•     difficulty with moving
•     fear
•     feeling of warmth or redness of the face, neck, arms, and occasionally, upper chest
•     heartburn
•     inability to have or keep an erection
•     indigestion
•     joint pain
•     longer than usual time to ejaculation of semen
•     loose stools
•     loss in sexual ability, desire, drive, or performance
•     loss of taste
•     muscle aching or cramping
•     muscle pains or stiffness
•     nervousness
•     shakiness in the legs, arms, hands, or feet
•     stomach discomfort, upset, or pain
•     sudden sweating
•     swollen joints
•     trembling or shaking of the hands or feet

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

———————

Holy cow, isn’t there someone else I could simply talk to?!? Sigmund, we hardly knew ye.

Next up, another favorite from Pfizer Pharmaceuticals, LIPITOR® (Atorvastatin/Oral route)
(source)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products,
read the label or package ingredients carefully.

Children

• Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of atorvastatin in children 10 to 17 years of age. However, safety and efficacy have not been established in children younger than 10 years of age.
• Teenage girls taking atorvastatin should be counseled on appropriate birth control methods to prevent pregnancy.

Older Adults

• Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of atorvastatin in the elderly. However, elderly patients are more likely to have age-related muscle problems, which may require caution in patients receiving atorvastatin.

Pregnancy

• All Trimesters – Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit.

Breast Feeding

• There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are
taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.  The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

•     Posaconazole

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•     Atazanavir
•     Bezafibrate
•     Ciprofibrate
•     Clarithromycin
•     Clofibrate
•     Cobicistat
•     Colchicine
•     Conivaptan
•     Crizotinib
•     Cyclosporine
•     Dabrafenib
•     Dalfopristin
•     Danazol
•     Daptomycin
•     Darunavir
•     Diltiazem
•     Domperidone
•     Erlotinib
•     Erythromycin
•     Eslicarbazepine Acetate
•     Fenofibrate
•     Fenofibric Acid
•     Fentanyl
•     Fluconazole
•     Fosamprenavir
•     Fusidic Acid
•     Gemfibrozil
•     Indinavir
•     Itraconazole
•     Ketoconazole
•     Lopinavir
•     Mibefradil
•     Nefazodone
•     Nelfinavir
•     Niacin
•     Piperaquine
•     Primidone
•     Quinupristin
•     Saquinavir
•     Telaprevir
•     Telithromycin
•     Tipranavir
•     Troleandomycin
•     Verapamil

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•     Amiodarone
•     Amprenavir
•     Azithromycin
•     Bexarotene
•     Black Cohosh
•     Boceprevir
•     Bosentan
•     Clopidogrel
•     Digoxin
•     Efavirenz
•     Eltrombopag
•     Etravirine
•     Fosphenytoin
•     Interferon Beta
•     Oat Bran
•     Pectin
•     Phenytoin
•     Pioglitazone
•     Quinine
•     Rifampin
•     St John’s Wort
•     Voriconazole

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on
the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

•     Alcohol abuse, or history of or
•     Diabetes or
•     Hypothyroidism (an underactive thyroid) or
•     Liver disease, history—Use with caution. May cause side effects to become worse.
•     Convulsions (seizures), not well-controlled or
•     Electrolyte disorders, severe or
•     Endocrine disorders, severe or
•     Hypotension (low blood pressure) or
•     Kidney disease, severe or
•     Metabolic disorders, severe or
•     Sepsis (severe infection)—Patients with these conditions may be at risk of developing muscle and kidney problems.
•     Liver disease, active or
•     Liver enzymes, elevated—Should not be used in patients with these conditions.
•     Stroke, recent or
•     Transient ischemic attack (TIA), recent—Atorvastatin may increase the risk of stroke in patients with these conditions.

Proper Use of This Medicine

• Take this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it or for a longer time than your doctor ordered.
• In addition to this medicine, your doctor may change your diet to one that is low in fat, sugar, and cholesterol. Carefully follow your doctor’s orders about any special diet.
• Take this medicine at the same time each day.
• Swallow the tablet whole. Do not break, crush, or chew it. Take this medicine with or without food.
• Do not drink large amounts of alcohol with atorvastatin. This could cause unwanted effects on the liver.
• Tell your doctor if you regularly drink grapefruit juice. Drinking large amounts of grapefruit juice (more than 1.2 liters each day) while you take this medicine may increase your risk of muscle injury and could result in kidney problems.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.  The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):
For high cholesterol:
Adults—At first, 10 or 20 milligrams (mg) once a day. Some patients may need to start at 40 mg per day. Your doctor may increase your dose as needed. However, the dose is usually not more than 80 mg per day.
Children 10 to 17 years of age—At first, 10 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 20 mg per day.
Children younger than 10 years of age)—Use and dose must be determined by your doctor.

Missed Dose

• If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double dose and do not take 2 doses of this medicine within 12 hours.

 

Storage

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
• Keep out of the reach of children.
• Do not keep outdated medicine or medicine no longer needed.
• Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine

• It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly to lower your cholesterol and triglyceride levels and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.
• Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant.
• If you think you have become pregnant while using the medicine, tell your doctor right away.
• Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness. These could be symptoms of serious muscle problems, such as myopathy or immune-mediated necrotizing myopathy (IMNM).
• Call your doctor right away if you have dark-colored urine, fever, muscle cramps or spasms, muscle pain or stiffness, or unusual tiredness or weakness. These could be symptoms of a serious muscle problem called rhabdomyolysis, which can cause kidney problems.
• Call your doctor right away if you get a headache, stomach pain, vomiting, dark-colored urine, loss of appetite, weight loss, general feeling of tiredness or weakness, light-colored stools, upper right stomach pain, or yellow eyes or skin. These could be symptoms of liver damage.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine if you have a major surgery, major injury, or you develop other serious health problems.
• Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common or rare

•     Cough
•     difficulty with swallowing
•     dizziness
•     fast heartbeat
•     fever
•     hives
•     itching
•     muscle cramps, pain, stiffness, swelling, or weakness
•     puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
•     skin rash
•     tightness in the chest
•     unusual tiredness or weakness
•     wheezing

Incidence not known

•     Blistering, peeling, or loosening of the skin
•     chills
•     dark-colored urine
•     diarrhea
•     joint pain
•     large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
•     red skin lesions, often with a purple center sore
•     red, irritated eyes
•     sore throat
•     sores, ulcers, or white spots in the mouth or on the lips

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side  effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

•     Headache
•     hoarseness
•     lower back or side pain
•     pain or tenderness around the eyes and cheekbones
•     painful or difficult urination
•     stuffy or runny nose

Less common

•     Abdominal or stomach pain
•     back pain
•     belching or excessive gas
•     constipation
•     general feeling of discomfort or illness
•     heartburn, indigestion, or stomach discomfort
•     lack or loss of strength
•     loss of appetite
•     nausea
•     shivering
•     sweating
•     trouble sleeping
•     vomiting

Incidence not known

•     Appetite increased
•     black, tarry stools
•     bloody nose
•     bloody or cloudy urine
•     blurred vision
•     continuing ringing or buzzing or other unexplained noise in the ears
•     difficult, burning, or painful urination
•     difficulty seeing at night
•     excessive muscle tone or tension
•     fruit-like breath odor
•     groin or scrotum pain
•     inability to have or keep an erection
•     increased body movements
•     increased sensitivity of the eyes to light
•     increased sensitivity to touch or pain
•     increased thirst
•     increased urination
•     loss of bladder control
•     loss of sexual ability, drive, or desire
•     menstrual bleeding occurring earlier or lasting longer than usual
•     mental depression
•     nervousness
•     nightmares
•     pale skin
•     paranoia
•     pinpoint red spots on the skin
•     slurred speech
•     swollen or tender lymph glands in the neck, armpit, or groin
•     unable to move or feel face
•     unusual bleeding or bruising
•     weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

————————————————–

Wowza, just pass the red meat and allow me to expire!

Next up, LUNESTA® (Eszopiclone/Oral route) from Dainippon Sumitomo Pharma Co. Ltd. (sleep aid… the glowing butterfly ads)
(source)

Uses of This Medicine

Eszopiclone is used to treat insomnia (trouble in sleeping). It belongs to the group of medicines called central nervous system (CNS) depressants, which are medicines that slow down the nervous system. Eszopiclone helps you get to sleep faster and sleep through the
night. In general, when sleep medicines are used every night for a long time, they may lose their effectiveness. In most cases, sleep medicines should be used only for short periods of time, usually 7 to 10 days, and generally for no longer than 2 weeks.

This medicine is available only with your doctor’s prescription.

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products,
read the label or package ingredients carefully.

Children

Appropriate studies have not been performed on the relationship of age to the effects of eszopiclone in the pediatric population. Safety and efficacy have not been established.

Older Adults

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of eszopiclone in the elderly. However, dizziness, confusion, clumsiness, or unsteadiness are more likely to occur in the elderly, who may require a lower dose to help reduce unwanted effects.

Pregnancy/All Trimesters 

Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential  benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are
taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below.

The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.  Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•     Carbinoxamine
•     Fentanyl
•     Fospropofol
•     Hydrocodone
•     Hydromorphone
•     Meclizine
•     Oxycodone
•     Tapentadol
•     Zolpidem

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•     Ketoconazole
•     Perampanel

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.

Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

•     Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

•     Alcohol or drug abuse, history of—Dependence on eszopiclone may develop.
•     Breathing problems or lung disease or

•   Depression, history of
• Mental illness, history of—Use with caution. May make these conditions worse.
• Diseases affecting metabolism or disease involving blood circulation—Caution should be used in patients with these medical problems.
• Liver disease, severe—Use with caution. Higher blood levels of eszopiclone may result, increasing the chance of side effects.

Proper Use of This Medicine

• Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If too much is taken, it may become habit-forming (causing mental or physical dependence). Take eszopiclone just before going to bed, when you are ready to go to sleep. This medicine works very quickly to put you to sleep. This medicine should come with a medication guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.
• Do not take this medicine when your schedule does not permit you to get a full night’s sleep (8 hours). If you must wake up before this, you may continue to feel drowsy and may experience memory problems, because the effects of the medicine have not had time to wear off.  Swallow the tablet whole. Do not break, crush, or chew it.
• You should not take eszopiclone with or immediately after a high-fat meal or a heavy meal.

 

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the  medicine.

For oral dosage form (tablets):
For insomnia (trouble in sleeping):
Adults—At first, 2 milligrams (mg) at bedtime. Your doctor may increase your dose as needed.
Older adults—At first, 1 milligram (mg) at bedtime. Your doctor may increase your dose as needed.
Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double dose.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

• Keep out of the reach of children.
• Do not keep outdated medicine or medicine no longer needed.
• Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine

• It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for any unwanted effects. This medicine may cause sleep-related behaviors such as driving a car (sleep-driving), walking (sleep-walking), having sex, making phone calls, or preparing and eating food while asleep or not fully awake. If these reactions occur, tell your doctor right away.
• If you think you need to take eszopiclone for more than 2 weeks, be sure to discuss it with your doctor. Insomnia that lasts longer than this may be a sign of another medical problem.
• This medicine will add to the effects of alcohol and other CNS depressants (medicines that makes you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping
• medicine; prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.
• This medicine may cause some people, especially older persons, to become drowsy, dizzy, lightheaded, clumsy or unsteady, or less alert than they are normally. Even though eszopiclone is taken at bedtime, it may cause some people to feel drowsy or less alert on arising.
• Make sure you know how you react to eszopiclone before you drive, use machines, or do anything else that could be dangerous if you are dizzy, or are not alert or able to see well.
• If you develop any unusual and strange thoughts or behavior while you are taking eszopiclone, be sure to discuss it with your doctor. Some changes that have occurred in people taking this medicine are like those seen in people who drink alcohol and then act in a manner that is not normal. Other changes may be more unusual and extreme, such as confusion, worsening of depression, hallucinations (seeing, hearing, or feeling things that are not there), suicidal thoughts, and unusual excitement, nervousness, or irritability.
• Eszopiclone may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Stop taking this medicine and call your doctor right away if you have itching, hives, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.
• If you will be taking eszopiclone for a long time, do not stop taking it without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping completely. Stopping this medicine suddenly may cause withdrawal side effects.
• After taking eszopiclone for insomnia, you may have difficulty sleeping (rebound insomnia) for the first few nights after you stop taking it.
• Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:

More common

•     Cough or hoarseness
•     fever or chills
•     lower back or side pain
•     painful or difficult urination
•     sleepiness or unusual drowsiness

Less common

•     Bladder pain
•     bloody or cloudy urine
•     cold flu-like symptoms
•     confusion
•     difficult, burning, or painful urination
•     discouragement
•     fear or nervousness
•     feeling sad or empty
•     frequent urge to urinate
•     irritability
•     lack of appetite
•     loss of interest or pleasure
•     nerve pain
•     nervousness
•     seeing, hearing, or feeling things that are not there
•     tiredness
•     trouble with concentrating
•     trouble with sleeping

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

•     Change in consciousness
•     loss of consciousness
•     very drowsy or sleepy

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side
effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

•     Acid or sour stomach
•     bad, unusual, or unpleasant (after) taste
•     belching
•     change in taste
•     dizziness
•     dry mouth
•     headache
•     heartburn
•     indigestion
•     nausea
•     pain
•     stomach discomfort, upset, or pain

Less common

•     Abnormal dreams
•     accidental injury
•     decreased interest in sexual intercourse
•     diarrhea
•     inability to have or keep an erection
•     pain, cramps, or heavy bleeding (females)
•     rash
•     swelling of the breasts or breast soreness (in both males and females)
•     vomiting

Incidence not known

•     Loss of memory
•     problems with memory

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

————————————————–

Why not try warm milk before bed time?

Next up, the perennial favorite, VIAGRA (Sildenafil/By mouth) from Pfizer Pharmaceuticals

Brand Name(s) in the US: Revatio, Viagra

Therapeutic: Antihypertensive, Peripheral Vasodilator; Pharmacologic: Phosphodiesterase Type 5 Inhibitor

Uses of This Medicine

Sildenafil is used to treat men who have erectile dysfunction (also called sexual impotence). Sildenafil belongs to a group of medicines called phosphodiesterase 5 (PDE5) inhibitors. These medicines prevent an enzyme called phosphodiesterase type-5 from working too quickly. The penis is one of the areas in the body where the phosphodiesterase enzyme works. By controlling the enzyme, sildenafil helps to maintain an erection after the penis is stroked. Without physical action to the penis, such as that occurring during sexual intercourse, sildenafil will not work to cause an erection.

Sildenafil is also used in both men and women to treat the symptoms of pulmonary arterial hypertension. This is a type of high blood pressure that occurs between the heart and the lungs. When hypertension occurs in the lungs, the heart must work harder to pump enough blood through the lungs. Sildenafil works on the PDE5 enzyme in the lungs to relax the blood vessels. This will increase the supply of blood to the lungs and reduce the workload of the heart.

This medicine is available only with your doctor’s prescription.

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

• Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

 

Children

• Sildenafil should never be used in children for erectile dysfunction. In general, sildenafil should not be used for pulmonary arterial hypertension in children, especially for chronic use.

Older Adults

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of sildenafil in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment in the dose for patients receiving sildenafil.

Pregnancy – All Trimesters

Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

•     Amprenavir
•     Amyl Nitrite
•     Atazanavir
•     Boceprevir
•     Cobicistat
•     Darunavir
•     Erythrityl Tetranitrate
•     Fosamprenavir
•     Indinavir
•     Isosorbide Dinitrate
•     Isosorbide Mononitrate
•     Lopinavir
•     Molsidomine
•     Nelfinavir
•     Nitroglycerin
•     Nitroprusside
•     Pentaerythritol Tetranitrate
•     Riociguat
•     Ritonavir
•     Saquinavir
•     Telaprevir
•     Tipranavir

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•     Cannabis
•     Dabrafenib
•     Dihydrocodeine
•     Eslicarbazepine Acetate
•     Nefazodone
•     Piperaquine
•     Primidone
•     Telithromycin
•     Voriconazole

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

•     Alfuzosin
•     Bosentan
•     Bunazosin
•     Ciprofloxacin
•     Delavirdine
•     Doxazosin
•     Erythromycin
•     Etravirine
•     Itraconazole
•     Ketoconazole
•     Moxisylyte
•     Nebivolol
•     Prazosin
•     Rifapentine
•     Silodosin
•     Tamsulosin
•     Terazosin
•     Trimazosin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

•     Abnormal penis, including a curved penis or birth defects or
•     Angina (chest pain) or
•     Arrhythmia (irregular heartbeat) or
•     Bleeding problem, history of or
•     Coronary artery disease or
•     Heart attack (within the last 6 months) or
•     Heart disease or
•     Hypertension (high blood pressure) or
•     Hypotension (low blood pressure) or
•     Leukemia (type of blood cancer) or
•     Multiple myeloma (bone marrow cancer) or
•     Priapism, history of or
•     Retinitis pigmentosa (an inherited eye disorder) or
•     Sickle-cell anemia (blood disorder) or
•     Stomach ulcer, history of or
•     Stroke (within the last 6 months)—Use with caution. May cause side effects to become worse.
•     Age greater than 50 years or
•     Coronary artery disease or
•     Crowded disc or low cup to disc ratio in the eye (an eye disorder) or
•     Diabetes or
•     Heart disease or
•     Hyperlipidemia (high fats in the blood) or
•     Hypertension (high blood pressure) or
•     Non-arteritic anterior ischemic optic neuropathy or NAION (serious eye condition), history of or
•     Smoking—May increase the chance for a serious side effect in the eye called NAION.
•     Kidney disease, severe or
•     Liver disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
•     Pulmonary veno-occlusive disease or PVOD (a type of lung disease)—Use with caution. May make this condition worse.

Proper Use of This Medicine

• This medicine comes with patient instructions. Read and follow these instructions carefully each time you get a refill of your medicine. Ask your doctor if you have any questions.
• Use sildenafil exactly as directed by your doctor. Do not use more of it and do not use it more often than your doctor ordered. If too much is used, the chance of side effects is increased.
• When using this medicine for pulmonary arterial hypertension, you may take it with or without food.
• If you are using the oral liquid, shake the bottle well for at least 10 seconds before measuring each dose. Use the oral syringe provided in the package to measure each dose. Wash the oral syringe after each use.
• This medicine usually begins to work for erectile dysfunction within 30 minutes after taking it. It continues to work for up to 4 hours, although its action is usually less after 2 hours.
• Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For treatment of erectile dysfunction:
For oral dosage form (tablets):
Adults up to 65 years of age—50 milligrams (mg) as a single dose no more than once a day, 1 hour before sexual intercourse. Alternatively, the medicine may be taken 30 minutes to 4 hours before sexual intercourse. Your doctor may adjust your dose if needed.
Adults 65 years of age and older—25 mg as a single dose no more than once a day, 1 hour before sexual intercourse. Alternatively, the medicine may be taken 30 minutes to 4 hours before sexual intercourse. Your doctor may adjust your dose if needed.
Children—Not recommended for this age group.
For treatment of pulmonary arterial hypertension:
For oral dosage forms (suspension or tablets):
Adults—20 milligrams (mg) three times a day. Each dose should be taken about 4 to 6 hours apart.
Children—Use and dose must be determined by your doctor.

Storage

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
• Keep out of the reach of children.
• Do not keep outdated medicine or medicine no longer needed.
• Ask your healthcare professional how you should dispose of any medicine you do not use.
• Throw away any unused mixed Revatio® oral liquid after 30 days.
• Precautions While Using This Medicine
• It is important that you tell all of your doctors that you take sildenafil. If you need emergency medical care for a heart problem, it is important that your doctor knows when you last took sildenafil.
• If you will be taking this medicine for pulmonary arterial hypertension, your doctor will want to check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.
• If you take sildenafil for pulmonary arterial hypertension, do not take Viagra® or other PDE5 inhibitors, such as tadalafil (Cialis®) or vardenafil (Levitra®). Viagra® also contains sildenafil. If you take too much sildenafil or take it together with these medicines, the chance for side effects will be higher.
• Sildenafil should not be used with any other medicine or device that causes erections.
• If you experience a prolonged or painful erection for 4 hours or more, contact your doctor immediately. This condition may require prompt medical treatment to prevent tissue damage to the penis and possibly permanent impotence.
• This medicine does not protect you against sexually transmitted diseases. Use protective measures and ask your doctor if you have any questions about this.
• Do not use this medicine if you are also using a nitrate medicine for chest pain (angina). Some examples of nitrate medicines are: isosorbide, nitroglycerin, Imdur®, Nitro-Bid®, Nitro-Dur®, Nitrol® ointment, Nitrolingual® spray, Nitrostat®, and Transderm Nitro®. Some illegal (“street”) drugs or “poppers” also contain nitrates, such as amyl nitrate, butyl nitrate, or nitrite.
• It is important to tell your doctor about any heart problems you have now or may have had in the past. This medicine can cause serious side effects in patients with heart problems.
• If you experience a sudden loss of vision in one or both eyes, stop using sildenafil and contact your doctor right away. This could be a symptom of a very serious eye condition called non-arteritic anterior ischemic optic neuropathy (NAION).
• Stop using this medicine and check with your doctor right away if you have a sudden decrease in hearing or loss of hearing. You might also have dizziness and ringing in the ears.
• If you already use medicine for high blood pressure (hypertension), sildenafil could make your blood pressure go too low. Call your doctor right away if you have more than one of these symptoms: blurred vision, confusion, dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly, sweating, or unusual tiredness or weakness.
• Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

•     Bladder pain
•     burning feeling in the chest or stomach
•     burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
•     cloudy or bloody urine
•     dizziness
•     increased frequency of urination
•     indigestion
•     pain on urination
•     stomach upset
•     tenderness in the stomach area

Rare

•     Abnormal vision
•     anxiety
•     behavior change similar to drunkenness
•     bleeding of the eye
•     blurred vision
•     bone pain
•     breast enlargement
•     chest pain
•     chills
•     cold sweats
•     confusion
•     convulsions (seizures)
•     cool and pale skin
•     deafness or hearing loss
•     decrease in amount of urine or the frequency of urination
•     decreased vision
•     difficulty in concentrating
•     dizziness or lightheadedness, especially when getting up from a lying or sitting position suddenly
•     double vision
•     drowsiness
•     dry eyes
•     dry mouth
•     dryness, redness, scaling, or peeling of the skin
•     excessive hunger
•     eye pain
•     fainting or faintness
•     fast, irregular, or pounding heartbeat
•     feeling of something in the eye
•     fever or chills
•     headache (severe or continuing)
•     heart failure
•     hives
•     increase in the size of the pupil
•     increased sweating
•     increased thirst
•     itching of the skin
•     lower back or side pain
•     migraine headache
•     nausea (severe or continuing)
•     nervousness
•     nightmares
•     numbness of the hands
•     painful, swollen joints
•     prolonged, painful erection of penis
•     redness, burning, or swelling of the eyes
•     redness, itching, or tearing of the eyes
•     restless sleep
•     seeing shades of colors differently than before
•     sensitivity to light
•     shakiness
•     skin lesions with swelling
•     skin paleness
•     skin rash
•     skin ulcers
•     slurred speech
•     sore throat
•     sudden weakness
•     swelling of the face, hands, feet, or lower legs
•     trouble with breathing
•     twitching of the muscles
•     unusual feeling of burning or stinging of the skin
•     unusual tiredness or weakness
•     vision changes
•     vision loss, temporary

Incidence not known

•     Blindness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

•     Aches or pains in the muscles
•     bloody nose
•     diarrhea
•     difficult or labored breathing
•     flushing
•     headache
•     pain or tenderness around the eyes and cheekbones
•     redness of the skin
•     sneezing
•     stomach discomfort following meals
•     stuffy or runny nose
•     trouble sleeping
•     unusually warm skin

Rare

•     Abdominal or stomach pain
•     abnormal dreams
•     anxiety
•     clumsiness or unsteadiness
•     cough
•     diarrhea or stomach cramps (severe or continuing)
•     difficulty in swallowing
•     ear pain
•     increased amount of saliva
•     increased skin sensitivity
•     lack of coordination
•     loss of bladder control
•     mental depression
•     nausea
•     numbness or tingling of the hands, legs, or feet
•     rectal bleeding
•     redness or irritation of the tongue
•     redness, soreness, swelling, or bleeding of the gums
•     ringing or buzzing in the ears
•     sensation of motion, usually whirling, either of one’s self or of one’s surroundings
•     sexual problems in men (continuing), including failure to experience a sexual orgasm
•     sleepiness
•     sores in the mouth and on the lips
•     tense muscles
•     trembling and shaking
•     vomiting
•     waking to urinate at night
•     worsening of asthma

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

————————————————–

Geez Louise.  My little “disclaimer” article has highlighted only FOUR “popular” drugs on the market.  For the final chapter of this article, the 3rd Quarter 2013 top 10 drugs in the United States, by sales volume:

1  Abilify / Otsuka Pharmaceutical Co.         $1,567,331,000 ($1.56Billion)
2  Nexium / AstraZeneca Pharmaceuticals     $1,525,103,000 ($1.53Billion)
3  Humira / AbbVie, Inc.             $1,407,506,000 ($1.4Billion)
4  Cymbalta / Eli Lilly and Company         $1,383,170,000 ($1.38Billion)
5  Crestor / AstraZeneca Pharmaceuticals     $1,275,755,000  ($1.28Billion)
6  Advair Diskus / GlaxoSmithKline         $1,215,177,000  ($1.22Billion)
7  Enbrel / Amgen Inc.             $1,172,679,000  ($1.17Billion)
8  Remicade / Centocor Ortho Biotech, Inc     $1,021,678,000  ($1.02Billion)
9  Neulasta / Amgen Inc.             $   898,539,000  ($0.90Billion)
10  Copaxone / Teva Pharmaceuticals         $   893,267,000  ($0.90Billion)

By comparison, Nike Inc. (NKE), the world’s largest sporting-goods company announced (Aug 31, 2013) domestic sales of $780,000,000.

Abilify (aripiprazole), the number one “seller”, is typed as an “Atypical antipsychotic” whose peer drugs in same class include: Quetiapine, Risperidone, Olanzapine, Ziprasidone, Clozapine, Paliperidone, Lurasidone, Asenapine, Iloperidone, Quetiapine Fumarate, Olanzapine/fluoxetine, Paliperidone palmitate, Asenapine maleate, Ziprasidone hydrochloride, Ziprasidone mesylate

“Aripiprazole is an antipsychotic medication. It works by changing the actions of chemicals in the brain. Aripiprazole is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression). It is also used together with other medications to treat major depressive disorder in adults. Aripiprazole is also used to treat irritability and symptoms of aggression, mood swings, temper tantrums, and self-injury related to autistic disorder in children who are at least 6 years old.”

The Abilify® DISCLAIMER is an epic tale.

In author Aldous Huxley’s infamous novel “A Brave New World”, a drug, SOMA was part of that dystopian culture. “All the advantages of Christianity and alcohol; none of their defects.”

We are far beyond Huxley’s wildest nightmares with our use of drugs.   In 2012, the world consumption of pharmaceuticals approached $1Trillion. 

Just for comparison, a trillion miles is 320 light years, or traveling at the speed of light for 320 continuous years.  A trillion is large, and in charge.

We live, unfortunately, within the Disclaimer Era.  It doesn’t have to be this way, we could make products and offer services that are good enough to not require them.  But that takes time and shaves profits.  So, what’s your disclaimer?

The Insincere Shield

This is a simple musing, and I am certainly not the first person nor the last to voice an observation that simmers just below the surface of my interpretation of human behavior now, then and seemingly way too far in the predicted future:

“In the name of God” is the biggest fake since the invention of cinema.

The constant use of “God” to justify violence and in most cases, pure evil has become quite intolerable to me.  Even in seemingly lesser circumstances such as graft, greed, insecurity based judgements, lack of tolerance for no harm differences, the common self divined human capacity for “interpretation” of what God wants has also become intolerable to me.

The God I contemplate is completely unknowable, is above the fray of humanity, and in fact, may be above it by a significant distance.  The God I know could be embodied more simply in my personal observation of Life Itself.  By this, I mean that LIFE, i.e., a pile of chemistry that somehow can organize and reproduce itself, is God.  God is LIFE.  And, when you remove the “astonishment of mortality” that clouds all human thinking… from our societal need for order and ethics, morality, etc. (all laudable), LIFE exists only for Its own sake.  Period.  And, LIFE understands clearly that sometimes one is the windshield, sometimes one is the bug (thank you Mark Knopfler).

LIFE seeks to reproduce Itself, in any capacity and in any form.  It doesn’t understand good and evil, It doesn’t understand or recognize organized religion, It doesn’t concern Itself with any judgements, assessment of history, media shenanigans, racial unfairness, or the current CAFE standards for automobiles.  In fact, if we as a species are clever enough to completely waste everything that LIFE has provided for us here on this planet, LIFE doesn’t care, doesn’t give a hoot, won’t even notice.  If we evaporated tomorrow as a species in entirety, LIFE would allow processes to take place that would likely yield the “next” hierarchy on this planet, and it would likely be unrecognizable to puny humanity.

Ironically, my personal contribution to LIFE is simple.  I have existed, I have reproduced (two sons) I have been involved.  Ultimately, if this matters even in the short term of the next 1000 generations, it will be due to the random realities my sons experience, not me… at least as far as I can see from my 52 year old vantage point.

In the name of God.  I hope at some time in the future this obtuse rationalization for antisocial behavior dies a permanent death.  May the reality that “God” as “LIFE” isn’t really interested in human events (our entire history is but a fleeting gasp in the infinite annals of regarded history) be our mantra.

Maybe then we can get on with the more urgent matter of treating the rest of LIFE with a bit of kindness.

 

Unfaith Based Faith and the Idea Mill

 

 

 

 

 

 

This past weekend I was privileged to catch a National Public Radio interview in Krista Tippet’s OnBeing program. The interview was with Poetry Foundation director (and poet) Chris Wiman, a wayward fellow who was brought up within the southern Christian religious tradition, fell away, fell farther away and then with some worldly living, spiraled back toward Christianity.  It was a whopper of an interview. I follow it up with a quick search and uncovered a NYT article on Wiman.

My take away from both the NYT article and the OnBeing interview is from the NYT article:

 “Get off your mystified ass and do something.”

These both are considerably long interviews (see the links), but in my candid opinion, are highly worth it.

I will make an attempt to expand this idea (do something) outside of religion for a moment:  The challenge for creative types, idea people, conceptioneers, is to actually achieve one (or more) of those ideas. In earlier blog entries I have relayed the story of my pal Henry Huston who for years has told me of the ancient Vedic concepts of the formation of all human ideas… that all ideas exist in a virtual ether — free for any member of humanity enlightened enough to see and grab them.

Henry’s long standing truth is that success only comes to the person that not only recognized the idea, but has the fortitude to see it through to success, through almost certain heartbreak, setbacks, poverty and sorry.

In my experience, Henry is completely correct.

In western society it seems like Necessity is no longer the Mother of Invention because of our ridiculously high standard of living (compared to just about anywhere else on earth). “Necessity” has now become in many ways an equivalent to “appetite.”  (Hence the continued bloating of the population. Perhaps we all need to physically work a bit harder to grow and nurture our food.)   So, if you buy this idea for a moment… that necessity is no longer the driving impetus behind ideas, what is? Greed? Self Love? Insecurity?

For me, creativity has visited me often and almost always spontaneously. Mostly while I am otherwise incapacitated with something: like driving somewhere, on a plane or stuck in some sort of “have to wait here” situation. I keep a memo recorder near me at all times. It’s getting pretty full of files. At the time of each idea, I think I am experiencing the Second Coming, or a similar otherworldly miracle.  Over time, I play back the ideas and chuck out the clunkers. There are many clunkers. But, even with the ideas I feel are pretty good and have some real merit, I am still having trouble “getting of my mystified ass…” and moving forward.

Of course, Wiman was referring to religion in general, Christianity specifically and having been brought up Presbyterian and protestant, I get it. Having never been too much a fan of organized religion, but deeply loving the work done by my family pastors (Maternal Grandfather, Maternal Uncle, younger Brother),  pairing an unfair sense of creativity with moral and ethical duty becomes even more of a challenge.  There’s guilt!

But, I digress, again.

My point in this textual exercise is to explore the nature of ideas that fly vs ideas that fall—or more to expose the reality of the treacherous, obstacle strewn pathways that define ideas that fly vs fall.  Furthermore, I don’t think anyone can doubt the reality of raw luck in the aspect of any type of success, the simple random reality of being in the right place at the right time. Consider the recent “PowerBall” lottery winner in Florida. $590,000,000.  We bought a couple of tickets here in Vermont, along with 180 million others.  But this individual won in Florida, on a number chosen at random by the lottery’s computer. Go figure.

But luck favors the prepared.

Dans les champs de l’observation le hasard ne favorise que les esprits préparés.

“In the fields of observation chance favors only the prepared mind.” – Louis Pasteur

I have written before in this blog about Edison vs. Tesla and others. Behind every legendary idea, every renown individual, lies a container ship full of extremely hard work and toil.

And sacrifice. I remember a conversation lead by Billy Joel’s long time drummer, Liberty DeVito at a KoSA workshop not to many years back. He said that his dedication to being “the drummer” cost a lot. Marriages, relationships with children, more. He stated his commitment always being to “the gig” was not without extreme collateral damage. It was a eye opening, open soul characterization of the darker reality aspects of celebrity.

Personally speaking, I have long realized I am not worthy of many of the ideas I come up with, simply because I won’t make the commitment to making them happen. I won’t sacrifice my relationships with my family and children, and I won’t risk losing the income (primary provider) that making the time to pursue these ideas would take.

And here lies one of my own identified ironies:  those with the means (inherited wealth) to actually pursue great ideas 1.) rarely seem to come up with their own and 2.) rarely seem to get behind another’s idea unless there is some stellar guarantee of a terrific payout.

(Research the true story of John Sylvan, the inventor of the Keurig instant coffee maker and you’ll see not only sacrifice, but full-on fiscal evisceration.)

In the creative fields,  being honest to the muse and to completely submit to an idea until it succeeds leaves most individuals far away from perfect.

I have to wonder if the next wave of epic sized, great ideas will come because of a collective and desperate need to survive on this planet due to the excesses of our own hand.  Perhaps Disney animator and children’s author Bill Peet is onto something… maybe Necessity is the True Mother of Invention.