People’s Pharmacy: Did heartburn drug cause itchy bottom?

Q. I had a recent bout with anal itching. It was extremely frustrating, to say the least. I hadn’t really figured out what was causing it until this week. I traveled out of town and forgot to take my meds with me. After a few days without meds, the anal itching went away.

I’m on three medications and, after being off all meds for four days, I realized that my anal itching began the same time I began taking omeprazole for heartburn.

A. Anal itching (pruritus ani) is not a recognized side effect of the acid-suppressing drug omeprazole (Prilosec). Many years ago, though, a reader wrote that a different heartburn drug, lansoprazole (Prevacid) caused his anal itching. He stated that “within two days of eliminating Prevacid, the itching stopped.”

The only proton pump inhibitor (PPI) that lists pruritus ani as an adverse reaction is esomeprazole (Nexium). It is a close relative of omeprazole. Although there is nothing in the medical literature about pruritus ani and acid suppressing drugs, it’s an association that might be hard to discover in a clinical drug trial. Anal itching is not something most people want to discuss.

Q. I recently read a comment by a physician who insisted that you gave readers bad advice. He recommended using a blow dryer after swimming to prevent swimmer’s ear instead of alcohol and/or vinegar drops.

As a pharmacist manager for 45 years, I can say the use of alcohol and vinegar in swim ear drops is valid. The most important thing is to restore the acidity to the ear canal after prolonged swimming. Vinegar does this. A warm hair dryer does not. The alcohol easily mixes with trapped water in the ear and allows it to drain more easily.

The doctor was concerned about the potential for ear drops to penetrate a perforated eardrum. A child with a perforated eardrum should NOT be in the pool without ear plugs, period.

A. Thank you for your thoughtful defense. We think anyone with a perforated eardrum should not swim unless they have been seen by an otolaryngologist. That expert may be able to offer a treatment plan or recommend a secure ear plug that would keep water out.

Q. My doctor says my blood tests indicate I have hypothyroidism. I’m skeptical because I have none of the symptoms on her list. I’d rather not take medicine I don’t need.

Is there another way to determine for sure if I have it or not?

A. Laboratory tests may sometimes give misleading data. In addition, some medicines and dietary supplements may alter some results on a thyroid panel. Ask your doctor if you could be tested again before starting treatment.

It is possible that you have “subclinical hypothyroidism.” In this condition, people don’t have bothersome symptoms even though their thyroid glands are not functioning properly. Sometimes, thyroid hormone levels normalize over time. Some people, however, later develop symptoms such as weight gain, fatigue, brain fog, dry skin, brittle fingernails, constipation, puffy eyes and sensitivity to cold.

Treatment of subclinical hypothyroidism is controversial. An endocrinologist will enable you to review your test results and assess the need for hormone supplementation.

To help with that conversation, we have created an “eGuide to Thyroid Hormones.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com. It provides insights on interpreting test results and analyzing various treatment options if necessary.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”