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Originally published Sunday, June 8, 2014 at 6:22 AM

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Desperate for effective lice treatments

People’s Pharmacy on treating lice, bioidentical vs. synthetic hormones, and generic Toprol-XL formulations.


Syndicated columnists

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Q: My grandchildren started scratching their heads several weeks ago. Upon careful examination, we discovered they had lice.

Their parents have been diligent in using lice shampoo, combing out nits and washing the bedding, to no avail. Are there any more effective strategies besides over-the-counter lice shampoos? My daughter is desperate.

A: Lice in the U.S. have developed some degree of resistance to insecticides such as permethrin and pyrethrin found in many OTC lice shampoos. Relatively new prescription treatments are effective but pricey. They include Ulesfia (benzyl alcohol), Sklice (ivermectin) and Natroba (spinosad). A treatment can run from $250 to $300.

Many visitors to our website report success with alternative approaches. Some drench the hair in old-fashioned amber Listerine for half an hour or so (wrapping the hair in a towel). The dead lice and nits are combed out.

Another option is Cetaphil Gentle Skin Cleanser. One reader shared her technique: “We put Cetaphil in dry hair, comb the excess out and then blow-dry the hair. We leave it in for at least 24 hours and then shampoo it out. We also comb to check for nits, and do a follow-up treatment seven days later to catch any bugs that hatched from eggs.”

Q: My daughter insists that bioidentical hormones are superior to horse-derived hormones, and that they are safe to use over the long term. Every doctor I’ve asked says this is not so. Apparently bioidentical hormones are made in compounding pharmacies that are not Food and Drug Administration regulated. Dosages may be inconsistent. Do you have more information?

A: Bioidentical hormones have been promoted as safer than synthetic or equine-derived compounds, but this topic is extremely controversial. The FDA doesn’t always monitor the compounding pharmacies that make them.

Dr. Susan Love has suggested that taking any type of hormone for a long time is more problematic than the specific type of hormone (natural or synthetic) used.

Q: I was taking Toprol-XL for an irregular heartbeat. When I was switched to generic metoprolol, I thought nothing of it. Then the irregular heartbeats started again.

I had no idea why the drug wasn’t working until I read about metoprolol problems. I was able to get more brand-name Toprol-XL and now am back to normal. I never dreamed generic drugs could cause such trouble!

A: In the past several years, a number of problems have been uncovered with generic Toprol-XL formulations (metoprolol succinate). In the latest, an Indian manufacturer called Wockhardt recalled almost 110,000 bottles because of a quality problem.

The 50-mg tablets were from Lots LN-10686, 10687, 10688, 10707 and 10708, all expiring in 02/15. Pharmacies rarely put lot numbers on prescription bottles, so it may be hard to tell whether your metoprolol was included in the recall. Nevertheless, you should contact your pharmacist to ask.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 300 W. 57th St., 15th floor, New York, NY 10019, or via their website: www.peoplespharmacy.org



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