Instructions : Cabergoline

Cabergoline Side Effects: What Patients Should Know

Cabergoline is a prescription medication used to treat health problems caused by high prolactin levels (also known as hyperprolactinemia). It helps lower prolactin levels in the blood, which can improve symptoms such as irregular menstrual cycles, unwanted breast milk production, or fertility problems.

Like all medicines, Cabergoline can cause side effects. Most are mild and go away with time, but some may be serious. Knowing what to expect and when to contact your doctor is important for your safety.

🚗 Safety Tips While Taking Cabergoline

• Avoid driving or operating heavy machinery until you know how this medication affects you.
  
  

• To prevent dizziness or fainting, stand up slowly after sitting or lying down.
  
  

• Be cautious on stairs or when moving quickly.
  
  

• Your doctor may ask you to have regular blood tests to monitor how your body is responding.
  
  

• Check your blood pressure and heart rate regularly as advised.
  
  

• If you are pregnant, planning to get pregnant, or breastfeeding, speak to your doctor. You’ll need to discuss the benefits and potential risks of using Cabergoline.
  
  

⚠️ Serious Cabergoline Side Effects — Call Your Doctor Immediately

These serious side effects are rare, but if they occur, seek medical help right away:

• Allergic reaction symptoms: rash, hives, itching, redness, swelling, blistering, peeling skin (with or without fever), wheezing, chest tightness, or swelling of the mouth, lips, tongue, or throat.
  
  

• Stroke-like symptoms: weakness or numbness on one side of the body, trouble speaking, confusion, loss of balance, or blurred vision.
  
  

• Chest pain or shortness of breath.
  
  

• Severe dizziness, fainting, or feeling like you might pass out.
  
  

• Unusual behavior changes, such as anxiety, agitation, or mood swings.
  
  

• Strong urges that are difficult to control (for example, gambling, sex, or shopping).
  
  

• Burning, tingling, or numbness sensations that feel abnormal.
  
  

• Back pain that is persistent or severe.
  
  

If any of these occur, stop taking the medicine and contact your doctor immediately.

💬 Common Questions About Cabergoline

1. What are the common side effects of Cabergoline?

Most people tolerate Cabergoline well. Some may experience mild nausea, dizziness, fatigue, or headaches, especially when first starting the medication. These symptoms often improve as your body adjusts.

2. How can I reduce dizziness while taking Cabergoline?

Take your dose with food and get up slowly from sitting or lying positions. Staying hydrated and avoiding alcohol can also help.

3. Can I take Cabergoline during pregnancy or breastfeeding?

Always talk to your doctor first. Cabergoline may not be recommended in some cases during pregnancy or breastfeeding due to potential effects on hormones and milk production.

🩺 When to Follow Up with Your Doctor

Your doctor may schedule follow-up visits and blood tests to:

• Monitor prolactin levels
  
  

• Check heart function and blood pressure
  
  

• Adjust your dose if needed
  
  

Never change your dose or stop Cabergoline without consulting your healthcare provider.

🧠 Key Takeaway

Cabergoline is an effective treatment for high prolactin levels, but it’s important to use it safely. Always take it as prescribed, report any unusual symptoms promptly, and attend your regular check-ups.

If you experience serious side effects such as chest pain, severe dizziness, changes in behavior, or signs of an allergic reaction, seek immediate medical help.

Instructions : Cialis 2.5 daily

💊 Cialis (Tadalafil) for Erectile Dysfunction: Uses, Dosage, and Safety Tips

The recommended dose for daily use is 2.5 mg, taken once a day at the same time, with or without food.
Unlike other ED medications, Cialis does not need to be timed around sexual activity. It works continuously when taken daily.

⚠️ Important: Do not take more than one dose in 24 hours unless directed by your doctor.

⚠️ Important Safety Information About Cialis

Cialis can cause a sudden and dangerous drop in blood pressure if taken with certain other medicines—especially nitrates used for chest pain (angina).
This can lead to dizziness, fainting, heart attack, or stroke.

❌ Do NOT take Cialis if you use:

• Nitrate medications for heart disease (e.g., nitroglycerin tablets, sprays, patches, or ointments).
  
  

• Isosorbide dinitrate or isosorbide mononitrate.
  
  

• Recreational drugs known as “poppers” (e.g., amyl nitrite, butyl nitrite).
  
  

If you’re unsure whether your medicines contain nitrates, ask your doctor or pharmacist.

🩺 Tell all healthcare providers that you take Cialis — especially in an emergency. The drug can stay in your body for over 48 hours, longer if you have kidney or liver problems.

Stop sexual activity and get medical help immediately if you experience:

• Chest pain
  
  

• Dizziness
  
  

• Nausea during sex
  
  

Sexual activity can stress the heart, particularly if you already have heart disease.

🧠 What Is Cialis Used For?

Cialis is prescribed for:
✅ Erectile dysfunction (ED) — difficulty getting or keeping an erection.
✅ Benign prostatic hyperplasia (BPH) — symptoms like difficulty urinating or needing to urinate often.
✅ Men with both ED and BPH.

Cialis works by increasing blood flow to the penis during sexual stimulation. It helps you achieve and maintain an erection suitable for sexual activity. After sexual activity, the erection naturally goes away.

Note: Sexual stimulation is required for Cialis to work.

🚫 What Cialis Does NOT Do

Cialis does not:

• Cure erectile dysfunction
  
  

• Increase sexual desire or libido
  
  

• Prevent sexually transmitted diseases (STDs), including HIV
  
  

• Work as birth control
  
  

Cialis is only for adult men aged 18 and older, including men with diabetes or who have had prostate surgery.

❌ Who Should Not Take Cialis

Do not take Cialis if you:

• Take any nitrate medications or recreational nitrates (“poppers”)
  
  

• Are allergic to Cialis, Adcirca (another form of tadalafil), or any of its ingredients
  
  

Signs of an allergic reaction include:

• Rash or hives
  
  

• Swelling of the lips, tongue, or throat
  
  

• Difficulty breathing or swallowing
  
  

👉 If you have any of these symptoms, seek medical attention immediately.

💬 Before You Take Cialis, Tell Your Doctor If You:

• Have heart problems (angina, irregular heartbeat, heart failure, or history of heart attack)
  
  

• Have low or uncontrolled high blood pressure
  
  

• Have had a stroke
  
  

• Have liver or kidney problems (especially if you need dialysis)
  
  

• Have retinitis pigmentosa (a rare inherited eye disease)
  
  

• Have ever had vision loss, including NAION (non-arteritic anterior ischemic optic neuropathy)
  
  

• Have stomach ulcers or bleeding problems
  
  

• Have a deformed penis shape (Peyronie’s disease)
  
  

• Have ever had an erection lasting more than 4 hours (priapism)
  
  

• Have blood cell disorders such as sickle cell anemia, multiple myeloma, or leukemia
  
  

Only your doctor can determine if Cialis is safe for you. Never start or stop taking it without medical guidance.

💡 Key Takeaway

Cialis is an effective and proven treatment for erectile dysfunction and prostate symptoms, but it must be used safely.
Always follow your doctor’s instructions, avoid nitrate medications, and seek immediate medical help if you experience chest pain or dizziness during sex.

✅ Take it daily.
✅ Avoid mixing with nitrates.
✅ Talk to your doctor about your heart and medications.

Instructions : DHEA not useful

⚠️ DHEA (Dehydroepiandrosterone): Why Its Use Is Not Recommended

Dehydroepiandrosterone (DHEA) is a hormone naturally produced by your adrenal glands. It helps make other hormones, such as testosterone and estrogen.

While DHEA has been promoted as a supplement for anti-aging, energy, weight loss, and athletic performance, medical experts caution that its benefits are unproven, and safety concerns remain.

🧪 What DHEA Is Claimed to Do

DHEA has been advertised to have a wide range of effects, including:

• Anti-aging and energy-boosting properties
  
  

• Anti-inflammatory and antidepressant effects
  
  

• Improved muscle strength and athletic performance
  
  

• Better mood and cognitive function
  
  

• Reduced belly fat and improved insulin sensitivity
  
  

However, scientific studies do not support these claims in healthy adults or older individuals.

🚫 Why DHEA Use Is Not Indicated

Despite being widely available over-the-counter in the United States, DHEA is prescription-only in most other countries due to uncertain safety and poor quality control.

Studies show that many DHEA supplements sold in health food stores and online may have inaccurate labels, with inconsistent purity and potency.

Medical experts do not recommend using DHEA for:

• Enhancing athletic performance
  
  

• Treating systemic lupus erythematosus (SLE) or Sjögren’s syndrome
  
  

• Managing depression
  
  

• Acting as androgen replacement in healthy postmenopausal women or elderly men
  
  

📉 What Research Shows About DHEA

Clinical studies on DHEA have shown mixed and often disappointing results:

1. Mental Health & Well-being

• Some small trials found mild improvement in mood or psychological well-being,
  
  

• But most studies show no meaningful benefit in mood, energy, or overall quality of life.
  
  

2. Muscle Strength & Performance

• Trials involving trained athletes and older adults have shown no consistent improvement in muscle mass or strength.
  
  

• The supposed “performance boost” remains unproven.
  
  

3. Body Composition

• Animal studies suggested that DHEA might reduce body fat, but human studies have been inconsistent.
  
  

• A few small trials showed a minor decrease in abdominal fat, while larger, long-term studies found no effect on weight or fat distribution.
  
  

4. Insulin Sensitivity

• One short-term study found that DHEA improved insulin sensitivity, but larger trials failed to confirm this benefit.
  
  

⚕️ DHEA and Aging: The Myths vs. Reality

Because DHEA levels naturally decline with age, some claim that taking supplements can “reverse aging” or restore youth.
However, research shows that while DHEA can raise hormone levels to those seen in younger adults, it does not consistently improve energy, cognition, or body composition.

In fact, long-term safety data are limited, and potential side effects may outweigh any small or temporary benefit.

⚠️ Potential Risks and Side Effects of DHEA

Even though DHEA is sold as a “natural supplement,” it acts like a hormone, and misuse can cause side effects such as:

• Acne or oily skin
  
  

• Hair loss
  
  

• Mood changes or irritability
  
  

• Menstrual irregularities in women
  
  

• Breast tenderness
  
  

• Deepening of the voice (in women)
  
  

• Lower HDL (“good”) cholesterol levels
  
  

• Worsening of hormone-sensitive conditions (like certain cancers)
  
  

🩺 Medical Guidance

Because DHEA acts on hormone pathways, it should not be used without medical supervision.
If you are considering DHEA for fatigue, depression, menopause symptoms, or aging concerns, talk to your healthcare provider first.

They can discuss safer, evidence-based alternatives for your condition.

🧠 Key Takeaway

• ✅ DHEA supplements are not proven to be effective for athletic performance, mood, weight loss, or anti-aging.
  
  

• ⚠️ Use is not recommended in healthy adults, postmenopausal women, or elderly individuals.
  
  

• ❌ Over-the-counter DHEA products are poorly regulated and may be unsafe or mislabeled.
  
  

• 🩺 Always consult your doctor before using any hormone-related supplement.

Instructions : Fortesta

💪 Fortesta (Testosterone Gel): Instructions, Uses, and Safety Information

Fortesta® Gel is a prescription testosterone replacement therapy (TRT) used to treat adult men with low or no natural testosterone production (a condition called hypogonadism).
This guide explains how to use Fortesta safely, who should not use it, and important precautions to protect you and your family.

📋 What Fortesta Is Used For

Fortesta (testosterone gel) is indicated for testosterone replacement therapy in adult men with conditions linked to testosterone deficiency or absence, such as:

• Primary hypogonadism (congenital or acquired): due to testicular failure from causes like:
  
  

  • Cryptorchidism (undescended testicles)
    
    

  • Bilateral torsion or orchitis
    
    

  • Klinefelter’s syndrome
    
    

  • Orchiectomy (removal of testes)
    
    

  • Damage from chemotherapy, toxins, or alcohol
    
    

• Hypogonadotropic hypogonadism (congenital or acquired): caused by problems with the pituitary gland or hypothalamus, tumors, trauma, or radiation.
  
  

⚠️ Note: The safety and effectiveness of Fortesta in males under 18 years old have not been established.

⚠️ Important Safety Warning: Secondary Exposure to Testosterone

Testosterone gel can transfer from your skin to others if they touch the application area before it’s washed or covered. This can cause virilization (masculine side effects) in children or women.

To prevent accidental exposure:

• Apply Fortesta exactly as directed by your doctor.
  
  

• Wash your hands thoroughly with soap and water after applying.
  
  

• Allow the gel to dry completely, then cover the application site with clothing.
  
  

• Wash the area before skin-to-skin contact with anyone (especially women or children).
  
  

• If someone touches the area before washing, clean their skin immediately with soap and water.
  
  

🚫 Who Should NOT Use Fortesta

Do not use Fortesta or other testosterone gels if you:

• Have or suspect prostate cancer or male breast cancer.
  
  

• Are a woman who is pregnant, planning pregnancy, or breastfeeding — exposure can cause serious harm to the baby.
  
  

• Are allergic to any ingredient in Fortesta.
  
  

🩸 Warnings and Precautions

🔹 Prostate Health

• Testosterone therapy may worsen benign prostatic hyperplasia (BPH).
  
  

• It may increase prostate cancer risk, so regular PSA (prostate-specific antigen) checks are important.
  
  

🔹 Blood Clots

• Cases of deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported.
  
  

  • Seek emergency help if you notice leg pain, swelling, chest pain, or shortness of breath.
    
    

🔹 Red Blood Cell Increase

• Fortesta can raise hematocrit levels (red blood cell count), which increases the risk of blood clots or stroke.
  
  

  • Your doctor will check your blood counts regularly and adjust the dose if needed.
    
    

🔹 Heart, Liver, and Kidney Health

• Fluid retention (edema) may occur — particularly dangerous if you have heart failure, liver disease, or kidney problems.
  
  

• Use with caution if you take steroids (like prednisone) or ACTH, as they can worsen swelling.
  
  

🔹 Sleep Apnea

• Testosterone therapy can worsen sleep apnea, especially in men who are obese or have chronic lung disease.
  
  

🔹 Fertility Effects

• Testosterone therapy can reduce sperm production (azoospermia) and may affect fertility.
  
  

🔹 Other Possible Effects

• Gynecomastia (breast enlargement)
  
  

• Acne or oily skin
  
  

• Changes in blood sugar levels
  
  

• Mood changes or irritability
  
  

• Decreased thyroid-binding proteins
  
  

🔬 Monitoring During Treatment

Your doctor may periodically check:

• Testosterone levels (to ensure the dose is right)
  
  

• PSA (prostate) and digital rectal exams
  
  

• Hemoglobin and hematocrit
  
  

• Liver function tests
  
  

• Blood lipids (cholesterol and triglycerides)
  
  

• Blood calcium (especially if you have cancer)
  
  

• INR or prothrombin time if you’re on blood thinners
  
  

🔥 Additional Safety Tips

• Fortesta Gel is flammable until dry — avoid smoking or open flames right after applying.
  
  

• Do not apply the gel to your genitals.
  
  

• There’s limited long-term safety data in older men, including potential risks for heart disease and prostate cancer.
  
  

🧴 Common Side Effects

The most common side effect (occurring in about 16% of users) is skin irritation at the application site.
Other possible side effects include:

• Headache
  
  

• Increased red blood cell count
  
  

• Acne or oily skin
  
  

• Breast tenderness or swelling
  
  

• Mood changes
  
  

If side effects persist or worsen, contact your healthcare provider.

💡 Key Takeaway

Fortesta Gel is an effective testosterone replacement treatment when used exactly as prescribed.
To stay safe:
✅ Follow your doctor’s instructions carefully.
✅ Wash hands and cover the application area every time.
✅ Keep women and children away from the site of application.
✅ Attend regular follow-up appointments and lab tests.

Your healthcare provider is your best resource for adjusting your dose, managing side effects, and ensuring safe long-term use.

Instructions : generic testosterone gel

💪 Testosterone Gel Safety Guide (AndroGel, Testim, Fortesta, Vogelxo): Warnings, Precautions & Instructions

Testosterone gel (brands include AndroGel®, Testim®, Fortesta®, and Vogelxo®) is a prescription medication used to treat low testosterone (hypogonadism) in adult men.
While it can help improve energy, libido, and mood, it must be used safely and exactly as prescribed to prevent serious side effects and unintentional exposure to others.

This guide reviews the warnings, precautions, and proper use of testosterone gel preparations.

⚠️ Contraindications — Who Should NOT Use Testosterone Gel

Do not use testosterone gel if you:

1. Have or are suspected to have prostate cancer or male breast cancer.
   
   

2. Are a woman who is pregnant, planning pregnancy, or breastfeeding — exposure can cause fetal harm or serious side effects in nursing infants.
   
   

🧴 Important: Testosterone gels are for adult men only and should never be used by women or children.

🧠 Warnings and Precautions

🔹 1. Prostate Health and BPH

• Testosterone therapy may worsen benign prostatic hyperplasia (BPH), causing increased urinary symptoms.
  
  

• Men receiving testosterone should be monitored for prostate enlargement and prostate cancer risk with PSA blood tests and regular exams.
  
  

🔹 2. Correct Application Areas

Apply testosterone gel only to the upper arms and shoulders — areas covered by a short-sleeved shirt.
Do not apply to the penis, scrotum, or abdomen.
Let the gel dry completely before dressing.

🔹 3. Avoiding Secondary Exposure

Accidental transfer of testosterone to others can occur through direct skin contact.
This may cause virilization (masculine side effects) in women and children such as:

• Early puberty
  
  

• Acne or oily skin
  
  

• Deepening of the voice
  
  

• Hair growth in unusual areas
  
  

To prevent this:

✅ Wash hands thoroughly with soap and water after applying the gel.
✅ Allow the gel to dry completely before dressing.
✅ Cover the application site with clothing.
✅ Wash the area before any skin-to-skin contact with others.
✅ If someone touches the unwashed area, they should wash the area immediately with soap and water.

⚠️ If signs of virilization occur in a child or adult exposed to testosterone gel, contact a doctor immediately and stop using the medication until the cause is identified.

🔹 4. Increased Red Blood Cell Count (Polycythemia)

Testosterone can raise hematocrit (the percentage of red blood cells in your blood).
High hematocrit can increase the risk of blood clots, stroke, or heart attack.

Your doctor will:

• Check your hematocrit before starting treatment,
  
  

• Recheck at 3–6 months, and then annually thereafter.
  If hematocrit becomes too high, your doctor may pause or adjust treatment.
  
  

🔹 5. Blood Clot Risk (Venous Thromboembolism)

There have been reports of deep vein thrombosis (DVT) and pulmonary embolism (PE) in men taking testosterone.

Seek emergency care if you experience:

• Leg pain, redness, swelling, or warmth (possible DVT)
  
  

• Sudden shortness of breath or chest pain (possible PE)
  
  

🔹 6. Effects on Fertility (Spermatogenesis)

High doses of testosterone (including Vogelxo and other gels) can reduce sperm production, potentially affecting fertility.

🔹 7. Liver Health

Although testosterone gels are not linked to the same liver risks as oral anabolic steroids, patients should report symptoms of liver problems such as:

• Yellowing of the skin or eyes
  
  

• Dark urine
  
  

• Persistent nausea or abdominal pain
  
  

If these occur, stop the medication and contact your doctor immediately.

🔹 8. Fluid Retention (Edema)

Testosterone may cause swelling (with or without heart failure) in men with heart, kidney, or liver disease.
If swelling occurs, your doctor may stop treatment and prescribe a diuretic (water pill).

🔹 9. Gynecomastia (Breast Enlargement)

Some men develop breast tenderness or enlargement while using testosterone therapy.
Report any changes to your provider.

🔹 10. Sleep Apnea

Testosterone may worsen sleep apnea, especially in men who are overweight or have lung disease.

🔹 11. Cholesterol and Lipids

Testosterone can affect cholesterol levels.
Doctors typically check your lipid profile before and during treatment.

🔹 12. Hypercalcemia in Cancer Patients

Men with certain cancers may have high calcium levels (hypercalcemia). Testosterone can worsen this, so regular calcium monitoring is recommended.

🔹 13. Thyroid Effects

Testosterone may slightly lower thyroxine-binding globulin (TBG) levels, leading to changes in total thyroid hormone readings — but this does not cause thyroid disease or symptoms.

🔹 14. Flammability Warning

Testosterone gels are alcohol-based and flammable until dry.
Avoid smoking, flames, or open heat sources until the gel has fully dried.

💊 Drug Interactions

Be sure to tell your doctor about all medications and supplements you take.
Testosterone gel may interact with:

• Insulin: may lower blood sugar and reduce insulin needs.
  
  

• Blood thinners (Warfarin, Coumadin): testosterone can alter anticoagulant effects — frequent INR monitoring is needed.
  
  

• Corticosteroids (Prednisone, Dexamethasone): may increase fluid retention, especially in men with heart, liver, or kidney disease.
  
  

👴 Use in Older Adults

There is limited long-term data on the use of testosterone gel in older men.
It’s unclear whether therapy increases the risk of heart disease or prostate cancer.
Regular check-ups and lab monitoring are essential.

🔍 Common Side Effects

Most side effects are mild and may include:

• Skin irritation or redness at the application site
  
  

• Increased red blood cell count
  
  

• Acne or oily skin
  
  

• Mood changes or irritability
  
  

• Increased appetite or weight gain
  
  

Contact your healthcare provider if symptoms are bothersome or persistent.

🩺 Key Takeaways for Safe Use

✅ Apply only to upper arms and shoulders — not to genitals or abdomen.
✅ Wash hands and cover the area after applying.
✅ Keep women and children away from unwashed or uncovered skin.
✅ Follow your lab schedule (testosterone, hematocrit, PSA, liver tests, cholesterol).
✅ Avoid open flames until the gel has dried.
✅ Report chest pain, shortness of breath, leg swelling, or mood changes immediately.

Instructions : glipizide trial (5 mg tabs)

💊 Starting Glipizide: Instructions for Safe Use and Blood Sugar Monitoring

Glipizide is an oral medication used to help lower blood sugar levels in people with type 2 diabetes. It works by helping your pancreas release more insulin, which lowers blood sugar after meals.

To get the best results and avoid low blood sugar, it’s important to take Glipizide exactly as directed and to monitor your blood sugars at home.

📅 How to Start Glipizide

• Starting dose: Take Glipizide 5 mg once daily in the morning, usually before breakfast.
  
  

• Swallow the tablet with water — do not skip meals after taking it.
  
  

⚠️ Never change your dose more often than every 4–5 days.
This allows time for your body and blood sugar levels to adjust safely.

🩸 How to Adjust Your Glipizide Dose

You’ll need to check your blood sugar regularly using a glucometer at home — especially before meals.

🔼 If blood sugar is too high:

• If your pre-meal blood sugar readings are above 200 mg/dL for three consecutive checks,
  ➜ Increase your dose to 10 mg once daily (take two 5 mg tablets together in the morning).
  
  

🔽 If blood sugar is too low:

• If you have any reading below 60 mg/dL, your dose is too strong.
  ➜ Cut the dose in half.
  
  

  • If you are on 5 mg daily, take 5 mg every other day instead of cutting the tablet.
    
    

  • Always carry a source of quick sugar (like glucose tablets or juice) in case of low blood sugar symptoms.
    
    

⚠️ Signs of Low Blood Sugar (Hypoglycemia)

Call your doctor or treat immediately if you experience:

• Shakiness or sweating
  
  

• Dizziness or confusion
  
  

• Headache or weakness
  
  

• Sudden hunger or irritability
  
  

If symptoms occur, take 15 grams of fast-acting carbohydrates (such as 4 oz of juice or 3 glucose tablets), then recheck your blood sugar after 15 minutes.

🍽️ Important Tips for Taking Glipizide

✅ Always take Glipizide before a meal, not on an empty stomach.
✅ Eat regular, balanced meals to prevent blood sugar drops.
✅ Avoid skipping meals while on this medication.
✅ Check your blood sugar as instructed by your healthcare provider.
✅ Keep a log of your readings and doses to share at follow-up visits.
✅ Let your provider know if your blood sugars remain consistently high or low.

🩺 When to Call Your Doctor

Contact your healthcare provider if:

• You experience frequent low blood sugars (<70 mg/dL)
  
  

• You develop severe dizziness, confusion, or fainting
  
  

• You have persistent blood sugar readings above 250 mg/dL
  
  

• You notice unusual fatigue, nausea, or weight changes
  
  

🧠 Key Takeaway

• Start Glipizide 5 mg once daily before breakfast.
  
  

• Adjust slowly — no more often than every 4–5 days.
  
  

• Increase only if three consecutive pre-meal readings are >200 mg/dL.
  
  

• Reduce your dose if any blood sugar is <60 mg/dL.
  
  

• Always monitor your sugars carefully and stay in touch with your healthcare team.

Instructions : HCTZ side effects

💊 Hydrochlorothiazide (HCTZ): Uses, Side Effects, and Safety Information

Hydrochlorothiazide (HCTZ) is a common water pill (diuretic) used to treat:

• High blood pressure (hypertension)
  
  

• Fluid retention (edema) due to heart failure, liver disease, or kidney problems
  
  

Lowering blood pressure helps prevent strokes, heart attacks, and kidney damage.

⚕️ How HCTZ Works

HCTZ helps your body remove excess salt and water through urine. This reduces swelling and lowers blood pressure.

You may notice you urinate more often — especially after starting treatment. This is normal.

💡 Before Taking HCTZ

Tell your doctor if you have any of the following:

• Allergy to HCTZ, sulfa drugs, or any medication ingredients
  
  

• Trouble urinating or kidney failure
  
  

• Liver disease
  
  

• Gout or high uric acid
  
  

• Diabetes (HCTZ can raise blood sugar)
  
  

• Lupus, which may worsen while taking this drug
  
  

• If you are pregnant or breastfeeding
  
  

Also tell your doctor about all medicines and supplements you take, including:

• Lithium
  
  

• Dofetilide (Tikosyn)
  
  

• Blood thinners
  
  

• Diabetes medications
  
  

• Steroids or anti-inflammatory pain medicines (NSAIDs)
  
  

• Cholestyramine or colestipol
  
  

⚠️ Never start, stop, or change your medication dose without consulting your healthcare provider.

🩺 Important Safety Tips While Taking HCTZ

✅ Tell every healthcare provider (doctor, pharmacist, dentist) that you take HCTZ.
✅ Rise slowly from sitting or lying down to avoid dizziness.
✅ Check your blood pressure regularly.
✅ If you have diabetes, monitor your blood sugar closely.
✅ Avoid alcohol, marijuana, or sedatives until you know how HCTZ affects you.
✅ Be cautious in hot weather — sweating or dehydration can lower your blood pressure too much.
✅ Use sunscreen — HCTZ can make your skin more sensitive to sunlight.

⚠️ Serious Side Effects — Call Your Doctor Immediately

Although rare, HCTZ can cause serious side effects. Seek medical attention right away if you experience:

🚨 Allergic Reactions

• Rash, itching, hives
  
  

• Swelling of the face, lips, tongue, or throat
  
  

• Trouble breathing or swallowing
  
  

💧 Low Fluid or Electrolyte Levels

• Confusion or mood changes
  
  

• Muscle cramps, weakness, or irregular heartbeat
  
  

• Extreme thirst or dry mouth
  
  

• Dizziness or fainting
  
  

⚡ Other Serious Reactions

• Severe stomach or back pain (possible pancreatitis)
  
  

• Dark urine or yellowing of skin/eyes (liver problems)
  
  

• Fever, chills, sore throat, or unusual bruising (infection or low blood counts)
  
  

• Sudden vision changes or eye pain (possible acute glaucoma)
  
  

• Shortness of breath or swelling (possible kidney or heart issue)
  
  

🩸 Increased Risk of Skin Cancer

Long-term HCTZ use may slightly raise the risk of certain skin cancers.
Protect your skin by:

• Wearing sunscreen and protective clothing
  
  

• Avoiding tanning beds and intense sunlight
  
  

• Having your skin checked regularly by your doctor
  
  

😊 Common (Mild) Side Effects

These are usually temporary and improve as your body adjusts:

• Upset stomach, diarrhea, or loss of appetite
  
  

• Headache or mild dizziness
  
  

• Fatigue or weakness
  
  

• Constipation or mild cramps
  
  

If these persist or bother you, talk with your doctor.

💊 How to Take HCTZ

• Take exactly as prescribed — usually once daily in the morning.
  
  

• Avoid taking it close to bedtime to prevent waking up to urinate.
  
  

• Keep taking HCTZ even if you feel well — high blood pressure often has no symptoms.
  
  

⏰ Missed Dose

• Take it as soon as you remember.
  
  

• If it’s close to your next dose, skip the missed dose — do not double up.
  
  

🧴 Storage Tips

• Store at room temperature, away from light and moisture.
  
  

• Keep the bottle tightly closed and out of reach of children.
  
  

• Don’t flush leftover pills — use a local drug take-back program if available.
  
  

🧠 Key Takeaway

Hydrochlorothiazide is an effective treatment for high blood pressure and fluid retention, but it must be used safely.
Monitor your blood pressure, watch for dizziness or dehydration, and report any unusual symptoms to your doctor right away.

Instructions : Osteoporosis treatments

🦴 Osteoporosis Treatment and Prevention: What You Need to Know

Osteoporosis is a condition where bones become thin, weak, and more likely to break. It affects both men and women but is most common in postmenopausal women and older adults.
The good news: osteoporosis can be treated and prevented with a healthy lifestyle, proper nutrition, and medications when needed.

🥛 Lifestyle Changes to Strengthen Your Bones

1. Calcium and Vitamin D

Both are essential for building and maintaining strong bones.

• Calcium helps form bone structure.
  
  

• Vitamin D helps your body absorb calcium effectively.
  
  

💡 Dietary Sources of Calcium

• Milk, yogurt, and cheese
  
  

• Leafy greens (like kale and broccoli)
  
  

• Fortified foods such as orange juice or cereals
  
  

💊 Supplements

If you don’t get enough calcium from food, your doctor may recommend supplements.

Group

Recommended Calcium (diet + supplement)

Vitamin D (IU/day)

Premenopausal women & men under 70

1000 mg

600 IU

Postmenopausal women & men over 70

1200 mg

800 IU

2. Exercise

Regular physical activity can help build bone density and reduce the risk of falls.

• Aim for at least 30 minutes of exercise, 3 times per week.
  
  

• Focus on weight-bearing activities like walking, dancing, or light strength training.
  
  

3. Avoid Smoking

Smoking weakens bones and interferes with calcium absorption. Quitting smoking is one of the best steps you can take for bone health.

4. Prevent Falls

Falls are a major cause of fractures in older adults.
To reduce your risk:

• Use non-slip mats and good lighting at home.
  
  

• Have your vision checked regularly.
  
  

• Wear supportive shoes and maintain balance exercises.
  
  

5. Review Your Medications

Certain medications can cause bone loss over time.
Examples include:

• Steroids (e.g., prednisone)
  
  

• Heparin
  
  

• Certain anti-seizure drugs (e.g., phenytoin, carbamazepine, primidone, phenobarbital)
  
  

Talk to your healthcare provider about whether these can be adjusted or replaced.

💊 Medications for Osteoporosis

When lifestyle changes aren’t enough, medications can help slow bone loss or build new bone.

1. Bisphosphonates

Examples: Fosamax® (alendronate), Boniva® (ibandronate), Actonel®, Reclast®

These are first-line medications for osteoporosis. They work by slowing bone breakdown and improving bone density.

💉 How They’re Taken

• Most are oral tablets taken weekly or monthly.
  
  

• Reclast is given as a yearly IV infusion (15 minutes).
  
  

⚠️ Important Instructions

• Take the pill first thing in the morning with a full glass of water.
  
  

• Stay upright (no lying down) and don’t eat or drink for at least 30–60 minutes after.
  This helps prevent stomach irritation.
  
  

💬 Possible Side Effects

• Mild stomach upset or reflux
  
  

• Temporary aches and fever after infusion
  
  

• Rare: osteonecrosis of the jaw (especially in cancer patients receiving high-dose IV forms)
  
  

Most people do not need to stop bisphosphonates before routine dental work, but discuss with your doctor if you’re undergoing major oral surgery.
Bisphosphonates are typically used for 5–10 years, after which your doctor may recommend a “drug holiday.”

📊 Effectiveness (NNT Data)

In postmenopausal women with low bone density or prior fractures:

• 1 in 20 were helped — vertebral fracture prevented
  
  

• 1 in 100 were helped — hip fracture prevented
  
  

• Only a small number experienced side effects
  
  

2. Prolia® (Denosumab)

Prolia is an injection given every 6 months that works by blocking a protein (RANKL) involved in bone breakdown.

💪 Benefits

• Increases bone density
  
  

• Reduces the risk of fractures in postmenopausal women
  
  

⚠️ Possible Side Effects

• Skin infections (cellulitis)
  
  

• Mild rash or eczema
  
  

• Temporary drop in calcium levels (especially in patients with kidney disease)
  
  

Prolia is often used if oral bisphosphonates aren’t tolerated or effective.
It should not be started until calcium and vitamin D levels are normal.

3. Forteo® (Teriparatide)

Forteo is a form of parathyroid hormone (PTH) — the only drug that stimulates new bone formation rather than slowing bone loss.

💉 How It’s Taken

• Daily injection under the skin for up to 2 years.
  
  

✅ Who Benefits Most

• Patients with severe osteoporosis (T-score < –2.5 and prior fracture).
  
  

• Works particularly well for spine fractures.
  
  

⚠️ Considerations

• Expensive and requires daily injections.
  
  

• Not recommended for premenopausal women.
  
  

4. Raloxifene (Evista®)

Raloxifene is a selective estrogen receptor modulator (SERM) — it acts like estrogen in bones to prevent bone loss and reduce fracture risk in postmenopausal women.

💊 Benefits

• Helps maintain bone density
  
  

• Reduces risk of breast cancer in high-risk women
  
  

⚠️ Risks & Side Effects

• Increased risk of blood clots (DVT, pulmonary embolism)
  
  

• May cause hot flashes
  
  

• Not for premenopausal women
  
  

🩺 Summary: Osteoporosis Treatment at a Glance

Treatment

How It Works

Frequency

Best For

Key Notes

Bisphosphonates

Slow bone loss

Weekly–yearly

First-line therapy

May cause stomach upset; avoid lying down after dose

Prolia (Denosumab)

Blocks bone breakdown

Every 6 months (injection)

For those who can’t take bisphosphonates

Ensure normal calcium/vitamin D

Forteo (Teriparatide)

Builds new bone

Daily injection (up to 2 years)

Severe osteoporosis

Expensive; daily injection

Raloxifene (Evista)

Estrogen-like bone protection

Daily tablet

Postmenopausal women

Slight clot risk; may cause hot flashes

🧠 Key Takeaway

Osteoporosis is manageable and preventable.
Combining healthy habits, adequate calcium and vitamin D, exercise, and the right medication can significantly reduce your risk of fractures and improve bone strength.

Always discuss treatment options with your healthcare provider to find the safest and most effective plan for your needs.

Instructions : Prolia

🩺 What to Know Before and During Treatment

✅ Before Starting Prolia

• Tell your doctor, dentist, and surgeon that you are receiving Prolia.
  
  

• Have a dental exam before starting treatment and maintain good oral hygiene.
  
  

• Take calcium and vitamin D daily as directed by your doctor.
  
  

• You may need blood tests and bone density scans to monitor progress.
  
  

• Let your doctor know if you smoke, have kidney problems, or have low calcium levels.
  
  

• Women should avoid pregnancy while on Prolia and use reliable birth control.
  
  

• If you become pregnant or are breastfeeding, notify your doctor immediately.
  
  

⚠️ Do not give Prolia to children.

💬 While Taking Prolia

• Keep taking your calcium and vitamin D supplements.
  
  

• Wash your hands often and stay away from people who are sick — Prolia can increase your risk of infection.
  
  

• Call your doctor right away if you develop any signs of infection (fever, sore throat, cough, or wound that won’t heal).
  
  

• Prolia may slightly increase the risk of unusual leg fractures — report new or unexplained hip, groin, or thigh pain.
  
  

⚠️ When to Call Your Doctor Immediately

Seek medical attention right away if you experience any of the following serious side effects:

🚨 Allergic Reactions

• Rash, hives, itching
  
  

• Swelling of the face, lips, tongue, or throat
  
  

• Difficulty breathing or swallowing
  
  

⚡ Low Calcium Symptoms

• Muscle cramps or spasms
  
  

• Tingling or numbness (especially around lips or fingers)
  
  

• Seizures
  
  

🦷 Jawbone Problems (Osteonecrosis of the Jaw)

• Jaw pain or swelling
  
  

• Mouth sores or poor healing after dental work
  
  

Risk is higher if you have cancer, wear dentures, or are receiving chemotherapy or steroids.

🦵 Bone or Muscle Problems

• Severe bone, joint, or muscle pain
  
  

• New or unusual pain in your groin, thigh, or hip
  
  

🦠 Infection Signs

• Fever, chills, sore throat, or sinus pain
  
  

• Painful urination or increased frequency
  
  

• Red, swollen, or painful skin area
  
  

• Wound that doesn’t heal
  
  

💔 Other Serious Symptoms

• Chest pain or irregular heartbeat
  
  

• Severe stomach or back pain (possible pancreatitis)
  
  

• Very bad skin irritation
  
  

😊 Common (Mild) Side Effects

These are usually mild and temporary:

• Back, arm, or leg pain
  
  

• Muscle or joint aches
  
  

• Sore throat or runny nose
  If symptoms persist or worsen, contact your healthcare provider.
  
  

💉 How Prolia Is Given

• Prolia is given as an injection under the skin (usually in the upper arm, thigh, or abdomen).
  
  

• It is given once every 6 months.
  
  

• Do not miss a dose — call your doctor or infusion center if you need to reschedule.
  
  

🏡 Storage and Disposal

• Prolia is typically administered at your doctor’s office or infusion center.
  
  

• If you are storing it at home, follow your doctor or pharmacist’s instructions carefully.
  
  

• Keep all medications out of reach of children and pets.
  
  

• Ask your pharmacist about the safest way to dispose of unused medication.
  
  

📋 Important Reminders

• Continue taking calcium and vitamin D daily.
  
  

• Have regular blood work and bone density tests as recommended.
  
  

• Keep a current list of your medications and share it with your healthcare providers.
  
  

• Do not share this medication with others.
  
  

• If you suspect an overdose, contact your doctor or poison control center immediately.
  
  

🧠 Key Takeaway

Prolia (Denosumab) is an effective treatment to strengthen bones and reduce fracture risk in people with osteoporosis.
To stay safe:

• Keep up with scheduled injections every 6 months.
  
  

• Take calcium and vitamin D supplements daily.
  
  

• Maintain good oral hygiene and regular dental checkups.
  
  

• Report any jaw pain, unusual bone pain, or signs of infection immediately.

Instructions- Email results

💻 Patient Portal Messaging Instructions

At Houston Thyroid and Endocrine Specialists, we use a secure online patient portal to communicate important health information, including lab results and physician messages.

📬 Receiving Your Lab Results

• If your physician has indicated that results should be sent electronically, you will receive an email notification about your lab results approximately 7–10 days after your blood draw.
  
  

• The email will come from:
  reminders@eclinicalmail.com
  Sender name: “Houston Thyroid and Endocrine Specialists”
  
  
  ⚠️ Please check your junk or spam folder to ensure you don’t miss this message.
  
  
  

• Once you receive the email, you’ll be prompted to log in to your secure patient portal to view your results and any messages from your provider.
  
  

🩺 How to Access the Patient Portal

You can access your patient portal in three convenient ways:

1️⃣ From Our Website

Visit: www.houstonendocrine.com/patientportal

2️⃣ From the Healow® Mobile App

Access your health information anytime, anywhere using the Healow app for your smartphone.

• Download the app from:
  www.healow.com
  or from your Apple App Store or Google Play Store.
  
  

• Once installed, search for Houston Thyroid and Endocrine Specialists to connect your account.
  
  

3️⃣ From Your Email

If a secure message or lab result is sent to you, you’ll automatically receive an email with a link to your patient portal.
Follow the link to log in and view your message.

🔑 Tips for Easy Access

• Keep your username and password in a secure location.
  
  

• If you forget your login details, follow the “Forgot Password” link on the portal or app login page to reset your access.
  
  

• If you have trouble logging in, our staff can help you during your next appointment.
  
  

Instructions: Saxenda

💉 Saxenda® (Liraglutide) for Weight Loss: Information and Safety Guide

Saxenda® (liraglutide) is a prescription medication used for chronic weight management in adults who are overweight or obese.
It is most effective when combined with a reduced-calorie diet and increased physical activity.

⚖️ Who Can Use Saxenda

Saxenda is approved for adults with:

• A BMI of 30 or higher (obesity), or
  
  

• A BMI of 27 or higher (overweight) with at least one weight-related health condition, such as:
  
  

  • High blood pressure (hypertension)
    
    

  • Type 2 diabetes
    
    

  • High cholesterol (dyslipidemia)
    
    

🔸 Saxenda is not approved for treating diabetes.
🔸 It should not be used together with Victoza® or other GLP-1 receptor agonists.

🕒 How to Take Saxenda

Saxenda is given as a once-daily injection under the skin (subcutaneous), using a prefilled pen.
It can be injected into the abdomen, thigh, or upper arm — the site and time of day may be changed without adjusting the dose.

Do not inject Saxenda into a vein or muscle.

💊 Dosing Schedule

To minimize stomach side effects, the dose is increased gradually each week:

Week

Daily Dose

Week 1

0.6 mg

Week 2

1.2 mg

Week 3

1.8 mg

Week 4

2.4 mg

Week 5 and onward

3.0 mg (maintenance dose)

If you experience side effects during dose increases, your provider may advise staying at a lower dose for an extra week.
However, Saxenda should be discontinued if you cannot tolerate the full 3 mg daily dose — lower doses have not been proven effective for weight loss.

⚠️ Important Safety Warning: Thyroid Tumor Risk

Saxenda carries a boxed warning for a potential risk of thyroid C-cell tumors based on animal studies.
It is not known if Saxenda causes this in humans.

🚫 Do not use Saxenda if you:

• Have a personal or family history of medullary thyroid carcinoma (MTC)
  
  

• Have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  
  

Call your doctor right away if you notice:

• A lump or swelling in your neck
  
  

• Difficulty swallowing or breathing
  
  

• Persistent hoarseness
  
  

Routine calcitonin testing or thyroid ultrasounds are not routinely recommended unless directed by your doctor.

⚠️ Other Warnings and Precautions

🩺 1. Pancreatitis (Inflammation of the Pancreas)

Serious cases, including rare fatalities, have been reported.
Call your doctor immediately if you experience:

• Severe or persistent abdominal pain (may spread to your back)
  
  

• Pain accompanied by nausea or vomiting
  
  

Stop Saxenda immediately if pancreatitis is suspected.

🫶 2. Gallbladder Problems

Weight loss and Saxenda use can increase the risk of gallstones or gallbladder inflammation.
If you experience upper abdominal pain, fever, or yellowing of the skin/eyes, seek medical care.

🩸 3. Low Blood Sugar (Hypoglycemia)

When used with diabetes medications (like sulfonylureas), Saxenda can cause low blood sugar.
Your doctor may adjust your diabetes medication dose.
Watch for:

• Sweating
  
  

• Dizziness
  
  

• Shakiness
  
  

• Confusion
  
  

❤️ 4. Increased Heart Rate

Saxenda may slightly increase your resting heart rate (by 2–3 bpm).
Tell your doctor if you feel palpitations or a racing heartbeat while at rest.
Regular heart rate monitoring is recommended.

💧 5. Kidney Problems

In rare cases, Saxenda has been associated with worsening kidney function, usually due to dehydration from nausea or vomiting.
Stay hydrated and report any changes in urination.

🧠 6. Mental Health Concerns

A few patients in clinical trials reported depression or suicidal thoughts.
Notify your provider immediately if you experience:

• Mood changes
  
  

• Suicidal thoughts
  
  

• Unusual behavior
  
  

Avoid Saxenda if you have a history of suicidal ideation or attempts.

🤧 7. Allergic Reactions

Serious allergic reactions are rare but possible.
Get emergency help for:

• Rash, itching, or hives
  
  

• Swelling of the face, lips, or throat
  
  

• Difficulty breathing
  
  

🚫 Do Not Use Saxenda If You:

• Have or have a family history of medullary thyroid cancer or MEN 2
  
  

• Have had a serious allergic reaction to liraglutide or any ingredients in Saxenda
  
  

• Are pregnant or breastfeeding
  
  

💊 Possible Side Effects

Most Common (≥5%)

• Nausea or vomiting
  
  

• Diarrhea or constipation
  
  

• Headache or dizziness
  
  

• Fatigue
  
  

• Abdominal discomfort or pain
  
  

• Decreased appetite
  
  

These symptoms are typically mild and improve with time as your body adjusts.

⚗️ Drug Interactions

• Saxenda can slow stomach emptying, which may delay absorption of other oral medications.
  
  

• Use caution and monitor when taking medications that require consistent absorption (e.g., birth control pills, thyroid medication).
  
  

• Do not combine Saxenda with insulin, Victoza, or other GLP-1 receptor agonists.
  
  

👩‍🍼 Use in Specific Populations

• Pregnancy: Saxenda should be discontinued immediately if pregnancy occurs.
  
  

• Breastfeeding: Not recommended — safety in nursing infants is unknown.
  
  

• Children: Not approved for use in pediatric patients.
  
  

• Kidney or liver disease: Use with caution under close medical supervision.
  
  

💡 Key Takeaway

Saxenda® is an effective injectable option for long-term weight management in adults when combined with healthy lifestyle changes.
To stay safe and achieve the best results:

• Follow the dose escalation plan carefully
  
  

• Continue diet and exercise routines
  
  

• Report any new symptoms, especially abdominal pain, mood changes, or neck swelling
  
  

• Attend all follow-up visits for lab monitoring and dose review
  
  

Always take Saxenda exactly as prescribed by your healthcare provider.

Instructions: Victoza

💉 Victoza® (Liraglutide) Pen Instructions for Patients

Victoza® is an injectable medication used to help lower blood sugar levels in adults with type 2 diabetes. It also supports healthy weight control when combined with diet and exercise.

If you are just starting Victoza, please read these instructions carefully before your first injection.

🩺 Starting Victoza: Sample Pen Instructions

You have been provided with a sample Victoza pen to ensure you tolerate the medication before continuing long-term.

• The sample pen lasts up to 1 month at room temperature after first use.
  
  

• Use a new pen needle for each injection (pen needles are prescribed separately).
  ➜ This helps prevent infection and ensures accurate dosing.
  
  

📆 Dosing Schedule

Time Period

Daily Dose

When to Inject

Weeks 1–2

0.6 mg once daily

Inject on an empty stomach or before a meal

Weeks 3–4

1.2 mg once daily

Continue if tolerated

After Week 4

1.8 mg once daily (only if instructed by your doctor)

Maintain this dose long-term if well tolerated

💡 Tip: Inject your dose at the same time every day for consistency.
You can inject into your abdomen, thigh, or upper arm. Rotate injection sites daily.

⚠️ Important Safety Information

🚫 Do NOT Use Victoza If You:

• Have a personal or family history of medullary thyroid cancer (MTC)
  
  

• Have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  
  

• Are pregnant or planning pregnancy
  
  

⚠️ Possible Side Effects

The most common side effects (seen in ≥5% of users) include:

• Nausea
  
  

• Diarrhea
  
  

• Headache
  
  

These effects are usually mild and improve as your body adjusts to the medication.

🚨 Serious Side Effects — Call Your Doctor Immediately If You Experience:

1. Pancreatitis (Inflammation of the Pancreas)

Watch for:

• Severe or persistent abdominal pain (may radiate to the back)
  
  

• Nausea or vomiting
  
  

❗ If these occur, stop Victoza immediately and contact your doctor or go to the emergency room.

2. Kidney Problems

Tell your doctor if you notice:

• Swelling in your legs or ankles
  
  

• Sudden weight gain
  
  

• Changes in urination
  
  

3. Thyroid Tumor Risk

In animal studies, very high doses of liraglutide caused thyroid C-cell tumors.
While this has not been proven in humans, you should notify your doctor if you experience:

• A lump or swelling in your neck
  
  

• Hoarseness, difficulty swallowing, or shortness of breath
  
  

💉 How to Inject Victoza

1. Wash your hands and prepare your Victoza pen.
   
   

2. Attach a new needle to the pen for each use.
   
   

3. Set the dose (0.6 mg, 1.2 mg, or 1.8 mg as directed).
   
   

4. Inject subcutaneously (under the skin) into your abdomen, thigh, or upper arm.
   
   

5. Dispose of the needle safely in a sharps container.
   
   

🧾 Note: Do not inject Victoza into a vein or muscle.

📹 Injection Demonstration Video

For step-by-step instructions, watch this official Victoza injection video:
🔗 Victoza Dosing and Injection Guide

🧠 Key Takeaway

Victoza can help improve blood sugar control and may support weight loss when used properly.
To ensure your safety and best results:

• Follow the dose escalation schedule provided.
  
  

• Use a new pen needle for every injection.
  
  

• Monitor for any side effects and report new symptoms to your doctor.
  
  

• Do not share your pen with anyone else.

Instructions: 2 hour OGTT

🧃 2-Hour Glucose Tolerance Test (GTT) Instructions

The 2-hour glucose tolerance test (GTT) measures how your body processes sugar (glucose) and helps diagnose prediabetes or diabetes.

Your results are interpreted as follows:

• 2-hour glucose level ≤139 mg/dL: Normal
  
  

• 140–199 mg/dL: Prediabetes
  
  

• ≥200 mg/dL: Diabetes
  
  

🩺 Preparing for the Test

To ensure accurate results, please follow these preparation steps carefully:

✅ 1. Maintain a Normal Diet

Continue eating your regular diet (including carbohydrates) for at least 3 days before the test.
Avoid any extreme dieting or fasting before your appointment.

🚫 2. Fasting Before the Test

• Do not eat or drink anything (except water) for at least 8 hours before your test.
  
  

• You may drink plain water only — no coffee, tea, juice, soda, or any beverage with caffeine, sugar, or artificial sweeteners.
  
  

• Avoid smoking or chewing gum before and during the test.
  
  

💡 Example: If your test is at 8:00 AM, finish eating by midnight the night before.

💊 3. Medications

Unless told otherwise by your provider, continue taking your regular medications with small sips of water.
If you take medication for diabetes, ask your doctor if it should be adjusted for this test.

🧍 4. What to Bring

• A book, phone, or quiet activity — you’ll need to wait in the office for 2 hours.
  
  

• You may also want to bring a light snack to eat after the test is complete.
  
  

🧪 During the Test

1. Initial Blood Draw:
   When you arrive, a small blood sample will be taken to measure your fasting glucose level.
   
   

2. Glucose Drink:
   You’ll be given a sweet glucose solution to drink within 5 minutes.
   The drink contains a specific amount of sugar that helps measure how your body responds.
   
   

3. Waiting Period:
   After finishing the drink, you will wait in the office for 2 hours.
   ➜ Please remain seated and avoid walking around or running errands during this time, as activity can affect your results.
   
   

4. Second Blood Draw:
   Exactly 2 hours after finishing the drink, your blood will be drawn again to check how much glucose remains in your blood.
   
   

⚠️ Important Notes

• Arrive on time, as the timing of each step is critical.
  
  

• If you feel dizzy, nauseated, or unwell during the test, inform the staff immediately.
  
  

• Your provider will contact you with results and next steps once the test is complete.
  
  

🧠 Key Takeaway

The 2-hour glucose tolerance test helps your healthcare provider understand how well your body handles sugar.
By following the fasting and preparation instructions carefully, you ensure your test results are accurate and reliable.

Instructions: 24 h Urine 5-HIAA

🧪 24-Hour Urine 5-HIAA Collection Instructions

🩺 Purpose of the Test

The 24-hour urine 5-HIAA test measures the amount of 5-hydroxyindoleacetic acid (5-HIAA)—a substance made when your body breaks down serotonin.
This test helps your doctor assess hormone levels and kidney function, and it can aid in diagnosing conditions such as carcinoid syndrome and other disorders affecting serotonin metabolism.

📦 Preparation Before the Test

🧴 1. Pick Up Supplies

• You will need to pick up your urine collection jugs from the laboratory in advance.
  
  

• Women: It’s recommended to buy a “urine collection hat” from your local pharmacy to make collection easier and more accurate.
  
  

🍽️ 2. Avoid Certain Foods and Medications

To prevent inaccurate results, stop the following foods and medicines 3 days before starting the urine collection:

🚫 Avoid These Foods (high in serotonin):

• Avocado
  
  

• Bananas
  
  

• Butternuts
  
  

• Dates
  
  

• Grapefruit
  
  

• Kiwi
  
  

• Melons
  
  

• Nuts
  
  

• Pineapple
  
  

• Plums
  
  

• Tomatoes
  
  

💊 Avoid These Medications (if approved by your doctor):

• Robitussin® (guaifenesin)
  
  

• Methocarbamol (Robaxin®)
  
  

• Phenothiazines (antipsychotic medications)
  
  

⚠️ Always check with your physician before stopping any prescribed medications.

🧍‍♀️ How to Collect Your 24-Hour Urine Sample

1. Start with an empty bladder:
   
   

   • Choose a time to begin (for example, 9:00 AM).
     
     

   • Urinate and flush away this first sample.
     
     

   • Write down this start time — your 24-hour collection begins now.
     
     

2. Collect all urine for the next 24 hours:
   
   

   • Each time you urinate, collect all urine in the container provided.
     
     

   • Store the urine on ice or in the refrigerator during the collection period.
     
     

3. Finish with one final sample:
   
   

   • Exactly 24 hours after your start time, urinate one last time and add this to your collection.
     
     

   • Example: If you started at 9:00 AM, end your collection at 9:00 AM the next day.
     
     

4. Label the container clearly:
   
   

   • Write your name, medical record number, and the start and end dates/times on the label.
     
     

   • Secure the lid tightly to avoid leakage.
     
     

5. Deliver the sample promptly:
   
   

   • Take the entire collection directly to the laboratory as soon as possible.
     
     

   • Do not let the sample sit overnight.
     
     

💧 Stay hydrated: Drink at least eight 8-ounce glasses of water (or equivalent fluids) during the 24-hour collection period.

📝 Record Your Start and End Times

Step

Date

Time

Start (after emptying bladder):

___________

___________

End (last urine collection):

___________

___________

⚠️ Important Reminders

• Keep urine refrigerated or on ice throughout the 24-hour period.
  
  

• Do not skip any samples—a missed collection can make the test invalid.
  
  

• Take the collection jug with you if you need to leave home during the test.
  
  

• Return the sample immediately after completion for accurate results.
  
  

💡 Key Takeaway

The 24-hour urine 5-HIAA test is an important tool for measuring hormone levels and kidney function.
Following these instructions carefully helps ensure that your results are accurate and reliable.

Instructions: 24 h Urine Calcium

🧪 24-Hour Urine Calcium Collection Instructions

🩺 Purpose of the Test

A 24-hour urine calcium test measures the amount of calcium excreted in your urine over a 24-hour period.
The results help your doctor evaluate:

• How well your kidneys are functioning
  
  

• Possible causes of kidney stones, bone disorders, or abnormal calcium levels in the blood
  
  

🧴 Preparation Before the Test

🧾 1. Pick Up Supplies

• Pick up the urine collection jugs from your laboratory before the day of your test.
  
  

• Women: For easier collection, purchase a “urine collection hat” from your local pharmacy. This device fits over the toilet to collect urine, which you can then pour into the lab jug.
  
  

⚗️ 2. Preservative in the Collection Jug

The lab jug provided already contains a small amount of liquid acid preservative.

⚠️ Do not pour out or rinse the container before starting your test.
Handle the jug carefully and keep it out of reach of children and pets.

💧 3. Hydration

Drink at least eight 8-ounce glasses of fluid (water or other non-caffeinated beverages) during the 24-hour collection unless your doctor gives you different instructions.

⏰ How to Collect the 24-Hour Urine Sample

1. Choose a Start Time
   You may start the test at any time of day that is convenient for you.
   Begin the test with an empty bladder.
   
   

2. Empty and Flush the First Urine
   
   

   • When you’re ready to begin, urinate and flush away this first sample.
     
     

   • Write down the start time and date on the form below.
     
     

   • Start counting your 24-hour collection period from this time.
     
     

3. Collect All Urine for the Next 24 Hours
   
   

   • Each time you urinate, collect all urine in the provided jug.
     
     

   • Store the jug on ice or in the refrigerator during the collection period.
     
     

   • Be careful not to spill any urine or the preservative.
     
     

4. Finish the Collection
   
   

   • Exactly 24 hours after your start time, collect one final urine sample.
     
     

   • Example: If you started at 9:00 AM, finish at 9:00 AM the next day.
     
     

   • Record your end time and date below.
     
     

5. Label and Deliver the Sample
   
   

   • Write your name, medical record number, and the start/end times on the bottle label.
     
     

   • Ensure the lid is tightly sealed.
     
     

   • Take the collection directly to the laboratory as soon as possible after completion.
     
     

   • Do not let the sample sit overnight.
     
     

⚠️ Important Reminders

• Keep the jug refrigerated or on ice for the full 24-hour period.
  
  

• Do not miss any samples — missing even one urination may invalidate your results.
  
  

• If you leave home during the test, bring the collection jug with you.
  
  

• Handle the jug carefully — the acid preservative can be irritating to skin or eyes.
  
  

• Wash hands thoroughly after each transfer of urine.
  
  

📝 Record Your Collection Times

Step

Date

Time

Start (after emptying bladder):

___________

___________

End (last urine collection):

___________

___________

💡 Key Takeaway

Following these instructions carefully will ensure that your 24-hour urine calcium test results are accurate and reliable.
If you have any questions before or during your collection, contact your healthcare provider or the laboratory.

Instructions: 24 h Urine Cortisol

🧪 24-Hour Urine Free Cortisol Collection Instructions

🩺 Purpose of the Test

The 24-hour urine free cortisol test measures the amount of cortisol, a stress hormone produced by the adrenal glands, released into your urine over a full day.
This test helps your doctor evaluate adrenal gland function and can help diagnose conditions such as Cushing’s syndrome or adrenal insufficiency.

During the 24-hour collection period, your urine must be kept cold — stored on ice or in the refrigerator — to ensure accurate results.

🧴 Preparation Before the Test

1. Pick Up Supplies

• Pick up your urine collection container(s) from the laboratory before starting the test.
  
  

• The container may contain a preservative — do not empty or rinse it before use.
  
  

• Women: For convenience, purchase a “urine collection hat” from your local pharmacy to collect urine before transferring it to the lab jug.
  
  

2. Hydration

Drink at least eight 8-ounce glasses of liquid (such as water) throughout the 24-hour collection period, unless instructed otherwise by your doctor.

⏰ How to Complete the 24-Hour Urine Collection

1. Choose a Start Time
   
   

   • You may begin the test at any time of day.
     
     

   • Begin with an empty bladder.
     
     

2. Discard the First Urine
   
   

   • When you’re ready to start, urinate and flush this first sample away.
     
     

   • Record the start date and time below.
     
     

   • This marks the beginning of your 24-hour collection period.
     
     

3. Collect All Urine for the Next 24 Hours
   
   

   • Collect every drop of urine for the next 24 hours in the provided container.
     
     

   • Keep the container on ice or refrigerated at all times.
     
     

   • If you leave your home, take the container with you in a small cooler.
     
     

4. End the Collection
   
   

   • Exactly 24 hours after your start time, urinate one last time and add this to the container.
     
     

   • Example: If you started at 8:00 AM, finish at 8:00 AM the next day.
     
     

   • Record your end date and time below.
     
     

5. Label and Return the Sample
   
   

   • Clearly write your name, medical record number, and start/end times on the container label.
     
     

   • Ensure the lid is tightly closed.
     
     

   • Deliver the completed collection directly to the laboratory as soon as possible after finishing.
     
     

   • Do not let the container sit overnight before turning it in.
     
     

⚠️ Important Reminders

• Keep the urine cold at all times (store on ice or in the refrigerator).
  
  

• Do not miss any urine samples — every urination during the 24 hours must be collected.
  
  

• Handle the container carefully — if it contains preservative, avoid skin contact.
  
  

• Wash your hands thoroughly after handling the sample.
  
  

📝 Record Your Start and End Times

Step

Date

Time

Start (after emptying bladder):

___________

___________

End (last urine collection):

___________

___________

💡 Key Takeaway

Accurate collection is essential for reliable results.
By carefully following these instructions — collecting all urine for 24 hours and keeping it cold — you’ll help your doctor get the most accurate measurement of your body’s cortisol levels.

Instructions: 24 h Urine Metanephrines

🧪 24-Hour Urine Metanephrines Collection Instructions

🩺 Purpose of the Test

The 24-hour urine metanephrines test measures levels of metanephrine and normetanephrine, substances produced when your body breaks down adrenaline and noradrenaline.
This test helps your doctor detect pheochromocytoma, paraganglioma, and other disorders related to the adrenal glands.

Accurate collection of all urine over 24 hours is essential for reliable results.

🧴 Preparation Before the Test

🧾 1. Pick Up Supplies

• Obtain your collection jug(s) from the laboratory before the day of your test.
  
  

• Women: For easier collection, purchase a “urine collection hat” from your local pharmacy.
  
  

☕ 2. Foods, Drinks, and Medications to Avoid (3 Days Before Starting)

To ensure accurate test results, avoid the following for at least 3 days prior to and during the urine collection:

🚫 Avoid:

• Tobacco products (including nicotine or vaping)
  
  

• Coffee, tea, and caffeinated beverages
  
  

• Certain medications, including:
  
  

  • Alpha agonists (e.g., Aldomet / methyldopa)
    
    

  • Alpha blockers (e.g., Dibenzyline / phenoxybenzamine)
    
    

Common blood pressure medications such as diuretics, ACE inhibitors, calcium channel blockers, and beta blockers typically do not interfere and can be continued unless otherwise instructed by your doctor.

Always check with your healthcare provider before stopping any prescribed medication.

⏰ How to Collect Your 24-Hour Urine Sample

1. Choose a Start Time
   
   

   • Begin the test in the morning after you wake up, after emptying your bladder for the first time.
     
     

   • Do not save this first urine — flush it away.
     
     

   • Note the exact time (e.g., 6:15 AM) — this marks the start of your collection period.
     
     

2. Collect Every Drop for 24 Hours
   
   

   • After your first morning void, collect every drop of urine for the next 24 hours in the provided jug(s).
     
     

   • Include urine passed during both day and night.
     
     

   • If you have a bowel movement, collect any urine passed at that time.
     
     

   • If feces accidentally enters the jug, do not try to remove it — contact the lab for instructions.
     
     

3. End the Collection
   
   

   • The next morning, collect your first urine of the day within 10 minutes before or after your original start time.
     
     

   • Example: If you started at 6:15 AM, finish between 6:05 and 6:25 AM the next day.
     
     

   • If you need to urinate early, drink a full glass of water so you can void again at the correct time.
     
     

   • Record your end time carefully, even if it differs slightly from the start time.
     
     

4. Label and Deliver Your Sample
   
   

   • Write your name, medical record number, start and end times, and dates clearly on the jug label.
     
     

   • Secure the lid tightly to prevent leaks.
     
     

❄️ Storage and Transport Instructions

• If your jug does not contain acid preservative, keep it refrigerated or on ice during collection.
  
  

  • After finishing, bring the sample to the lab within 6 hours of completion.
    
    

• If your jug already contains acid, it can be stored at room temperature or refrigerated.
  
  

  • In this case, the sample may be delivered within 5 days of completion.
    
    

⚠️ Always check the label on your container — if unsure whether it contains acid, keep it refrigerated and deliver it to the lab as soon as possible.

💧 Hydration

Drink at least eight 8-ounce glasses of water during the 24-hour period unless your doctor gives you different instructions.

📝 Record Your Collection Times

Step

Date

Time

Start (after emptying bladder):

___________

___________

End (final urine collection):

___________

___________

💡 Key Takeaway

To ensure accurate results:

• Collect all urine for the full 24 hours.
  
  

• Avoid caffeine, tobacco, and certain medications before and during the test.
  
  

• Keep urine cold unless instructed otherwise.
  
  

• Return your sample to the lab promptly after completion.
  
  

These steps will help your doctor accurately evaluate your adrenal function and diagnose any potential hormone-related conditions.

Instructions: Acarbose 25 mg starting

💊 Acarbose 25 mg Tablet Instructions

🩺 Purpose of This Medication

Acarbose (brand name Precose) is a medication used to help control blood sugar levels in people with type 2 diabetes.
It works by slowing the absorption of carbohydrates in your stomach and intestines, helping to prevent high blood sugar after meals.

⏱️ How to Take Acarbose

Acarbose should always be taken with the first bite of your meal, not before or after.
Your body needs time to adjust to the medication, so your dose will be increased gradually over several weeks.

Step-by-Step Dosing Schedule

1. Weeks 1–2:
   ➤ Take one 25 mg tablet with the first bite of your largest meal of the day.
   
   

2. Weeks 3–4:
   ➤ Take one 25 mg tablet with the first bite of your largest meal and with your second largest meal of the day.
   
   

3. After Week 4:
   ➤ Take one 25 mg tablet with the first bite of each of your three main meals (breakfast, lunch, and dinner).
   
   

🕒 Always take Acarbose as you begin eating, not after your meal.

⚙️ Finding the Right Dose

• The best dose is the highest amount you can tolerate without side effects, up to a maximum of 100 mg three times daily (with each meal).
  
  

• Your healthcare provider may adjust your dose over time to help balance blood sugar control and tolerability.
  
  

⚠️ Possible Side Effects

The most common side effects occur as your body adjusts to the medication and include:

• Gas (flatulence)
  
  

• Bloating
  
  

• Diarrhea
  
  

If these side effects become severe or difficult to tolerate, reduce your dose to the previous level that was comfortable for you and contact your healthcare provider for guidance.

💡 Helpful Tips

• Always take Acarbose with food — it won’t work if taken on an empty stomach or after eating.
  
  

• Continue following your diabetes meal plan and exercise routine as advised by your doctor.
  
  

• Monitor your blood sugar regularly and report any low readings or unusual symptoms.
  
  

• If you miss a dose, skip it and take your next dose with your next meal — do not double up.
  
  

📞 When to Call Your Doctor

Contact your healthcare provider if you experience:

• Persistent or severe bloating, gas, or diarrhea
  
  

• Signs of low blood sugar (shakiness, sweating, dizziness)
  
  

• Unexplained fatigue or weakness
  
  

• Any new or concerning symptoms
  
  

Instructions: ACE inhibitor ARB

💊 ACE Inhibitors and ARB Medications for Diabetes

(Protecting Your Kidneys and Heart Health)

🩺 What Are ACE Inhibitors and ARBs?

ACE inhibitors (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) are medications that are primarily used to treat high blood pressure (hypertension).

For people with diabetes, these medications offer an important protective benefit beyond blood pressure control — they help protect your kidneys and slow the progression of diabetic kidney disease (also called diabetic nephropathy).

💪 Benefits for People with Diabetes

Research has shown that ACE inhibitors and ARBs can:

• Slow down kidney damage caused by diabetes.
  
  

• Reduce protein loss in urine (a marker of kidney injury).
  
  

• Protect the kidneys even in people who have normal blood pressure.
  
  

• Lower the risk of heart disease and other complications related to diabetes.
  
  

These benefits appear to go beyond blood pressure control, meaning these medications help protect the kidneys through other mechanisms as well.

💊 Common ACE Inhibitors

Generic Name

Brand Name

Benazepril

Lotensin

Captopril

Capoten

Enalapril

Vasotec, Epaned

Fosinopril

Monopril

Lisinopril

Prinivil, Zestril

Moexipril

Univasc

Perindopril

Aceon

Quinapril

Accupril

💊 Common ARBs (Angiotensin Receptor Blockers)

Generic Name

Brand Name

Losartan

Cozaar, Cozaar Comp

Olmesartan

Olmetec, Olmetec Plus

Telmisartan

Micardis, Micardis Plus

Valsartan

Diovan, Co-Diovan, Exforge

⚠️ Possible Side Effects

While most people tolerate these medications well, a few side effects can occur:

1. Low Blood Pressure (Hypotension)
   
   

   • You may feel weak, dizzy, or faint, especially when standing up quickly.
     
     

   • Rise slowly from sitting or lying positions.
     
     

2. Reduced Kidney Function (GFR Decrease)
   
   

   • A mild reduction in kidney filtration rate is common and expected, but your doctor will monitor this.
     
     

   • In rare cases (such as with renal artery narrowing or heart failure), kidney function may worsen significantly.
     
     

3. High Potassium (Hyperkalemia)
   
   

   • These medications can raise potassium levels in the blood.
     
     

   • Routine blood tests are necessary to monitor kidney function and potassium levels.
     
     

4. Cough (ACE Inhibitors Only)
   
   

   • A dry, persistent cough may develop in 5–20% of people taking an ACE inhibitor.
     
     

   • Characteristics of ACE inhibitor–related cough:
     
     

     • Usually starts within 1–2 weeks of beginning treatment (but can be delayed up to 6 months).
       
       

     • More common in women and Chinese populations.
       
       

     • Resolves within 1–4 days of stopping the medication (may take up to 4 weeks).
       
       

     • Usually returns if the same or a similar ACE inhibitor is restarted.
       
       

   • ARBs do not typically cause cough, so your doctor may switch you to an ARB if this happens.
     
     

🩸 Monitoring

Regular follow-up and blood work are essential when taking these medications:

• Kidney function tests (creatinine, GFR)
  
  

• Potassium level monitoring
  
  

• Blood pressure checks
  
  

Your healthcare provider will adjust your medication as needed to ensure safety and effectiveness.

💡 Key Takeaway

ACE inhibitors and ARBs are cornerstone medications for people with diabetes — not only to manage blood pressure but also to protect kidney function and heart health.
They are often continued long-term, even if your blood pressure is normal, due to their proven kidney-protective benefits.

Instructions: Acromegaly Growth Hormone Suppression testing 2 hour glucose challenge

🧪 Confirmatory Testing for Acromegaly

Growth Hormone (GH) Suppression Test

🩺 Purpose of the Test

This test helps confirm a diagnosis of acromegaly, a condition caused by excessive production of growth hormone (GH) by the pituitary gland.

The growth hormone suppression test checks whether your GH levels decrease (are “suppressed”) in response to high blood sugar after drinking a glucose solution.
Normally, high glucose levels cause GH to drop. If GH does not decrease, it may suggest acromegaly.

🧍 How the Test Is Performed

(Provide this section to your phlebotomist or laboratory staff)

1. Three blood samples are collected.
   
   

   • The first sample is drawn between 6:00 a.m. and 8:00 a.m. (fasting).
     
     

2. After the first blood draw, you will be asked to drink a glucose solution containing 75 grams of glucose.
   
   

   • Drink the entire solution within 5 minutes (slowly, if needed, to avoid nausea).
     
     

3. The second and third blood samples are collected exactly 1 hour and 2 hours after finishing the glucose drink.
   
   

4. The lab will measure both glucose and growth hormone (GH) levels in each sample.
   
   

⚠️ Timing is critical. Each sample must be collected precisely at 1 and 2 hours after completing the glucose drink.

🍽️ How to Prepare for the Test

To ensure accurate results:

• Do not eat or drink anything (except water) for 10–12 hours before your test.
  
  

  • Overnight fasting is recommended.
    
    

• Avoid exercise and strenuous activity for at least 12 hours before and during the test.
  
  

• Remain relaxed and seated for at least 60 minutes before and during the test.
  
  

  • Stress, anxiety, or physical activity can raise GH levels and alter results.
    
    

• Do not smoke or chew gum the morning of the test.
  
  

• Inform your provider if you are taking any medications, as some can affect GH or glucose levels.
  
  

💉 What to Expect

• The test takes about 2 to 2.5 hours to complete.
  
  

• You may experience mild nausea from the glucose drink.
  
  

• The phlebotomist will collect blood samples at the scheduled times.
  
  

• You can eat normally after the final blood draw.
  
  

📄 Important Notes

• Bring a light snack for after the test.
  
  

• If you are ill, please reschedule, as illness can affect results.
  
  

• Your provider will review your results with you once all laboratory data are available.
  
  

🧠 Key Takeaway

The growth hormone suppression test is the gold standard confirmatory test for acromegaly.
Accurate preparation and precise sample timing are essential for reliable results.

Instructions: ACTH stim testing all patients

🧪 Cosyntropin (ACTH) Stimulation Test Instructions

📍 Test Location

Your medical assistant will coordinate with an infusion center based on your insurance coverage and location.
Once the order is sent, you will receive a message through your patient portal with location details.

If you do not hear from the infusion center within 3–5 business days, please call them directly to schedule your appointment.

• St. Luke’s Infusion Center
  📞 832-957-6525
  
  

• Alternate Infusion Scheduling Line
  📞 832-355-7119
  
  

🍽️ How to Prepare for the Test

• You must be fasting the morning of your test.
  ➜ No food or drink (except water) for 8–10 hours before your appointment.
  
  

• Hold hydrocortisone (Cortef):
  ➜ Skip your evening dose the night before and morning dose on the day of the test, so that you are off the medication for at least 24 hours prior to testing.
  
  

• Avoid all steroid-containing medications or creams (oral, injectable, topical, or nasal) for at least 2 months before your test unless otherwise directed by your provider.
  ➜ If you have recently used any steroid creams, injections, or medications, please inform your doctor. These can affect the results.
  
  

• You may resume your usual medications after the test is complete unless told otherwise.
  
  

🧠 Reason for the Test

The ACTH (Cosyntropin) Stimulation Test measures how well your adrenal glands respond to ACTH, a hormone produced by the pituitary gland that stimulates cortisol release.

This test helps your doctor determine whether your adrenal glands and pituitary gland are functioning normally and is most commonly used to evaluate for:

• Adrenal insufficiency (Addison’s disease)
  
  

• Secondary adrenal insufficiency (pituitary-related causes)
  
  

💉 How the Test Is Performed

1. You will have an initial blood draw to measure your baseline cortisol level.
   
   

2. The nurse will then inject a small amount of cosyntropin (synthetic ACTH) into your arm.
   
   

3. Follow-up blood samples will be taken — typically at 30 minutes and 60 minutes after the injection — to measure your cortisol response.
   
   

4. Sometimes, additional samples may be collected depending on your provider’s protocol.
   
   

⏱️ The entire test usually takes about 1–1.5 hours.

🧾 After the Test

• You can eat and drink normally once the test is complete.
  
  

• Resume any held medications unless your provider instructs otherwise.
  
  

• Your test results will be reviewed by your endocrinologist during your next visit or through your patient portal.
  
  

⚠️ Important Reminders

• Be on time for your appointment — sample timing is critical for accurate results.
  
  

• Bring a light snack to eat after the test.
  
  

• Inform your healthcare provider if you feel unwell or faint during the procedure.
  
  

🧠 Key Takeaway

The Cosyntropin (ACTH) Stimulation Test is a safe, standard test used to evaluate how well your adrenal glands make cortisol.
Proper fasting and avoidance of steroid medications before the test help ensure accurate results.

Instructions: Actonel for osteoporosis

💊 Acontel (Risedronate) Monthly Dosing Instructions

Risedronate (brand name Acontel) is a bisphosphonate medication used to treat and prevent osteoporosis by slowing bone loss and improving bone strength.
Because food and certain behaviors can interfere with absorption or cause side effects, it’s important to take this medication exactly as directed.

⏰ How to Take Acontel (Risedronate)

Take your medication first thing in the morning on an empty stomach before eating, drinking, or taking any other medications.

Step-by-Step Instructions:

1. Take the tablet immediately after waking up, before you eat or drink anything other than water.
   
   

2. Swallow one tablet with a full glass (6–8 oz) of plain water.
   
   

   • Do not take with coffee, juice, mineral water, or any beverage other than plain tap or bottled water.
     
     

3. Stay upright (sitting or standing) for at least 60 minutes after taking the tablet.
   
   

   • You may walk around or perform light activity but do not lie down.
     
     

4. Wait at least 60 minutes before eating, drinking (other than water), or taking other medications.
   
   

   • This ensures full absorption of the medication and minimizes irritation to your esophagus.
     
     

⚠️ Taking Acontel with food or beverages other than water will reduce its effectiveness.

📅 Monthly Dosing Schedule

• Choose a specific day each month to take your dose — for example, the 1st of each month or your birthday date.
  
  

• Mark your calendar with “BONE MEDICATION” as a reminder.
  
  

• Take the medication at the same time each month for best results.
  
  

⏳ If You Miss a Dose

If your next scheduled dose is more than 7 days away:

• Take the missed tablet as soon as you remember in the morning.
  
  

• Then, take your next dose on your regular monthly schedule.
  
  

If your next scheduled dose is less than 7 days away:

• Take the missed tablet as soon as possible, then
  
  

• Wait at least 1 week before taking your next tablet.
  
  

• Resume your regular monthly schedule after that.
  
  

Never take two tablets on the same day.

⚠️ Important Safety Tips

• Do not chew or crush the tablet. Swallow it whole with water.
  
  

• Remain upright for at least one full hour after taking your dose.
  
  

• Tell your doctor if you experience chest pain, trouble swallowing, or severe heartburn.
  
  

• Take adequate calcium and vitamin D as prescribed to support bone health.
  
  

🦷 Dental Procedures and Jaw Health (Osteonecrosis of the Jaw – ONJ)

Osteonecrosis of the jaw (ONJ) is a rare complication associated with bisphosphonate use.
It is most often reported in patients receiving high-dose IV bisphosphonates for cancer, but rarely, it can occur in patients taking oral bisphosphonates for osteoporosis.

🩺 Estimated Risk

• For patients on oral bisphosphonates for osteoporosis, the risk is very low — estimated between 1 in 10,000 to 1 in 100,000 patient-years.
  
  

⚠️ Risk Factors

• High-dose or IV bisphosphonate therapy
  
  

• Cancer or chemotherapy
  
  

• Dental extractions or implants
  
  

• Ill-fitting dentures
  
  

• Glucocorticoid (steroid) use
  
  

• Diabetes
  
  

• Smoking or poor dental hygiene
  
  

• Prolonged use (more than 4 years)
  
  

🦷 Dental Surgery Guidelines

If you are already taking Acontel (Risedronate) and need dental surgery (such as extractions or implants):

• If treated for less than 4 years and you have no other risk factors, continue therapy — surgery can proceed as usual.
  
  

• If treated for more than 4 years or if you use steroids or have other risk factors:
  
  

  • Your provider may recommend pausing Acontel for 2 months before dental surgery and restarting after healing is complete.
    
    

  • This approach follows the American Association of Oral and Maxillofacial Surgeons and International Task Force on ONJ recommendations.
    
    

Always inform your dentist or oral surgeon that you are taking Acontel or any other bisphosphonate.

🧠 Key Takeaway

• Take Acontel (Risedronate) on an empty stomach, with plain water, and stay upright for at least 60 minutes.
  
  

• Maintain monthly consistency for best bone protection.
  
  

• Inform your doctor and dentist before any new medications or dental work.
  
  

• Report any jaw pain, swelling, or difficulty healing after dental procedures.

Instructions: Actos

💊 Pioglitazone (Actos) Information and Safety Guide

🩺 What Is Pioglitazone?

Pioglitazone (brand name Actos) is a medication used to help control blood sugar (glucose) levels in adults with type 2 diabetes.
It belongs to a class of medications called thiazolidinediones (TZDs), which work by improving your body’s sensitivity to insulin — helping it use sugar more effectively.

Pioglitazone is often used along with diet, exercise, and other diabetes medications to achieve better glucose control.

⏱️ How to Take Pioglitazone

• Take one dose once daily, at the same time each day.
  
  

• You can take it with or without food.
  
  

• If you miss a dose, do not double up the next day — simply take your next dose as scheduled.
  
  

Consistent daily use helps maintain stable blood sugar levels.

⚙️ How It Works

Pioglitazone helps lower blood sugar by:

• Making your body’s cells more responsive to insulin
  
  

• Decreasing sugar production in the liver
  
  

• Helping your muscles and fat tissue absorb sugar more efficiently
  
  

It is not an insulin replacement and does not cause low blood sugar on its own.

⚠️ Possible Side Effects

Common Side Effects

• Mild leg or ankle swelling (edema) — not usually serious
  
  

• Weight gain due to mild fluid retention
  
  

These effects are common and often manageable, but let your provider know if they become bothersome.

Serious Side Effects (Contact Us Immediately)

• Shortness of breath, especially when lying down or during activity
  
  

• Sudden swelling in the legs or feet
  
  

• Rapid weight gain
  
  

These may be signs of congestive heart failure (fluid buildup in the lungs).
This condition requires urgent medical attention — contact our office or go to the emergency room immediately.

⚠️ FDA Safety Warning: Bladder Cancer Risk

In December 2016, the U.S. Food and Drug Administration (FDA) updated its review on pioglitazone and the possible link to bladder cancer.

FDA Recommendations

• Pioglitazone should not be used in patients with active bladder cancer.
  
  

• In patients with a history of bladder cancer, your doctor will carefully weigh the risks and benefits before prescribing.
  
  

Contact your healthcare provider immediately if you experience:

• Blood or red color in your urine
  
  

• Pain or burning when urinating
  
  

• New or worsening urge to urinate
  
  

These symptoms could indicate bladder irritation or, rarely, bladder cancer and should be evaluated promptly.

🦴 Bone Health and Fracture Risk

Some studies have shown that pioglitazone may slightly increase the risk of bone fractures, particularly in women.
If you experience a fracture or develop new bone pain while on this medication, please notify our office.
Your provider may recommend bone density monitoring or calcium and vitamin D supplementation.

💬 Key Takeaways

• Take once daily — do not skip or double doses.
  
  

• Report shortness of breath, leg swelling, or blood in urine immediately.
  
  

• Inform your doctor if you have a history of heart failure or bladder cancer.
  
  

• Maintain regular blood sugar checks and follow-up visits.
  
  

Instructions: adrenal insufficiency dx

⚠️ Adrenal Insufficiency: Patient Instructions and Emergency Guide

You have been diagnosed with Adrenal Insufficiency, a condition in which your adrenal glands (or, in some cases, your pituitary gland) do not produce enough cortisol — a hormone essential for life.
This is a serious but manageable chronic condition that requires lifelong treatment and careful self-management.

🩺 Why Cortisol Is Important

Cortisol helps your body:

• Respond to stress (such as illness, injury, or surgery)
  
  

• Regulate blood pressure and blood sugar
  
  

• Maintain energy and immune function
  
  

Because your body cannot increase cortisol levels during stress, you must adjust your medication in certain situations to stay safe.

🆘 Emergency Identification

Always wear a Medical Alert bracelet or necklace that says:

“Adrenal Insufficiency – Requires Steroid Treatment”

Also, carry a wallet card or emergency identification card with:

• Your diagnosis
  
  

• Your daily steroid dose
  
  

• Your doctor’s contact information
  
  

You can obtain an official MedicAlert ID through MedicAlert Foundation or by calling 888-633-4298.

💊 Daily Maintenance Therapy

Most patients require a daily glucocorticoid such as:

• Hydrocortisone (Cortef)
  
  

• Prednisone
  
  

• Dexamethasone (Decadron)
  
  

Some individuals may also need fludrocortisone (Florinef) for additional salt and water balance.

👉 Take your medication exactly as prescribed, every day, and never stop abruptly without medical advice.

🤒 What to Do During Illness or Stress

People with adrenal insufficiency cannot naturally increase cortisol during illness or stress.
Therefore, you must increase your steroid dose (“stress dose”) during times of physical stress.

Increase your glucocorticoid dose if you have:

• Fever > 100°F (37.8°C)
  
  

• Vomiting or moderate-to-severe diarrhea
  
  

• Infection (such as flu, pneumonia, urinary tract infection)
  
  

• Any illness requiring antibiotics
  
  

• Injury or hospitalization
  
  

Temporary “Sick Day” Dosing

• Prednisone: 10 mg daily
  
  

• Hydrocortisone (Cortef): 20 mg twice daily (every 12 hours)
  
  

• Dexamethasone: 1 mg daily
  
  

Continue the increased dose until your fever and symptoms improve, then return to your normal daily dose.
If you are not improving within a week, contact your doctor.

💉 If You Vomit or Can’t Keep Medication Down

If you vomit within 2 hours of taking your steroid:

• Take your dose again.
  
  

If you vomit a second time within 2 hours:

• Go to the nearest Emergency Room for an emergency steroid injection (hydrocortisone or Solu-Cortef).
  
  

• Contact your endocrinologist immediately.
  
  

🧳 Travel and Emergency Preparedness