A Brief Overview of Tips for Using Antibiotic

Article written by Weston Malek, MPH

As the winter weather is finally upon us, we’ve been seeing a steady uptick in the number of antibiotic and cold medicine prescriptions. Each year, there are more than 250 million antibiotics prescribed in the United States, and winter tends to be time when antibiotics are most frequently prescribed.1,2 This means that there are roughly 4 antibiotic prescriptions for every 5 people in the U.S.

Although most people have taken antibiotics at some point and are comfortable with taking them when they are prescribed, those who are taking other medications or are particularly sensitive to medication side effects might have more concerns about adding on an antibiotic. At Four Corners Pharmacy, we do our best to make sure to always counsel patients on new antibiotics. To help with this further, below is a chart to be used as a quick reference outlining the main points and major drug interactions to be aware of for the most common outpatient antibiotics we see.

First, a few things that are common to most oral antibiotics (unless otherwise noted in the chart):

  • Nausea, vomiting, and stomach upset can be common side effects. Taking doses with food may help reduce stomach upset.
  • Diarrhea may also occur later as normal bacteria in the gut are killed off as well. Stay hydrated and let your doctor know if this is severe or lasts longer than a few days after finishing the antibiotic.
  • Some medications are affected by the normal bacteria in the gastrointestinal tract that get killed off by antibiotics. This may cause fluctuations in the way these medications work. Some such are warfarin (Coumadin) and oral contraceptives.
  • For birth control specifically, it is recommended that patients use an additional contraception method while taking an antibiotic due to the potential for reduced effectiveness of oral contraception while taking an antibiotic
  • For liquid suspensions: shake well before each use and refrigerate if necessary

Antibiotic Class

  • Drug (Brand)

Unique Notes

Drug Interactions

Red/Bold = Avoid


  • Amoxicillin (Amoxil)
  • Amoxicillin/Clavulanate (Augmentin)
  • Penicillin V Potassium (Veetids)
  • Clavulanate tends to increase stomach upset over amoxicillin alone
  • Augmentin better absorbed if given with food
  • Methotrexate


  • Cefdinir (Omnicef)
  • Cefixime (Suprax)
  • Cephalexin (Keflex)
  • Only about 10% of people with penicillin allergies will also have cephalosporin allergies
  • Cefdinir only: Wait 2 hours before or after taking food/medications containing aluminum or magnesium (such as some antacids) or iron supplements
  • None significant


  • Azithromycin (Zithromax)
  • Clarithromycin (Biaxin)
  • Wait 2 hours before or after taking food/medications containing aluminum or magnesium (such as some antacids)
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc.
  • Statins, such as Simvastatin and Lovastatin
  • Warfarin


  • Ciprofloxacin (Cipro)
  • Levofloxacin (Levaquin)
  • Moxifloxacin (Avelox)
  • Wait 2 hours before or after taking food/medications with calcium
  • Tell your doctor if you experience tendon pain
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Tizanidine
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc.
  • Simvastatin
  • Theophylline

Clindamycin (Cleocin)

  • Take with a full glass of water
  • Erythromycin

Doxycycline (Oracea)

  • Wait 2 hours before or after taking food/medications with calcium, iron, or zinc
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Take with a full glass of water
  • Methotrexate
  • Penicillins

Metronidazole (Flagyl)

  • Avoid alcohol  during and for 72 hours after stopping – reaction with alcohol can cause significant nausea, vomiting, and hangover symptoms
  • Alcohol
  • Dronabinol
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc

Trimethoprim (Bactrim)

  • Contains sulfa – warning for those with sulfa allergy
  • Stay hydrated to avoid kidney stones
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Amiodarone
  • Warfarin
  • Drugs that increase potassium, such as Lisinopril, Losartan, Valsartan, Spironolactone, potassium supplements, etc.

While the actual choice of antibiotic and dosing will vary based on the patient and what’s being treated, a few recommendations are generally always true:

  • Take your antibiotics according to the instructions on the prescription, and never take an antibiotic unless your doctor determines it is necessary. Many colds are caused by viruses, which will not be affected by an antibiotic. Sometimes “watchful waiting” to see if symptoms improve is better than starting a potentially unnecessary antibiotic immediately.
  • Take the full amount of your antibiotic prescription even if you start to feel better sooner (unless otherwise directed by your doctor). The full course is necessary to kill off bacteria, and taking a shorter course can encourage the development of antibiotic resistance.
  • Medications such as cough syrup, decongestants, and pain relievers, on the other hand, only need to be taken when needed to control symptoms.
  • Other techniques may also be used to help you feel better faster, including drinking extra water/fluids, using a humidifier, using lozenges/honey for sore throat and cough, and, of course, getting more rest.

Keep in mind, this is only a general guide, and some people may have additional concerns that require more individual consideration. As always, feel free to ask us at the pharmacy if you have any questions.


  1. Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2014 [Internet]. 2017 [cited 2017 Dec 17] Available from: https://www.cdc.gov/antibiotic-use/community/pdfs/annual-reportsummary_2014.pdf.
  2. Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Taylor TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother. 2014 May;58(5):2763-6.

New guidelines released to manage hypertension treatment

Article written by Weston Malek, MPH

Last year, the American Heart Association (AHA) and American College of Cardiology (ACC) released a joint guideline changing the criteria used to diagnose and treat high blood pressure. As doctors will soon begin to use these new guidelines to manage hypertension treatment, it’s important to consider what this will mean for patients.

High blood pressure, or hypertension, had previously been defined by guidelines as blood pressure ≥ 140/90 mmHg. As such, about 72 million American adults were considered to have hypertension and it is one of the most commonly diagnosed chronic conditions. Under the new guideline criteria, anyone with systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg will now be diagnosed as hypertension. This results in an additional 29 million hypertensive Americans. However, the AHA/ACC statement suggests that only a small percentage – about 4.2 million people – of newly-diagnosed adults will be recommended to use blood pressure-lowering medications that are already suggested to those diagnosed according to the previous guidelines.

The reason only a fraction of those now considered hypotensive will receive medication treatment is because the guidelines distinguish those with blood pressures ranging from 130-139 mmHg systolic blood pressure or 80-89 mmHg diastolic blood pressure as having stage 1 hypertension, and those with higher blood pressures (≥ 140 mmHg systolic blood pressure or ≥ 90 mmHg diastolic blood pressure) to have stage 2 hypertension. In stage 1, the primary recommendation is to address high blood pressure with lifestyle changes, such as following the DASH diet with an emphasis on fruits and vegetables, reducing sodium intake, increasing potassium intake, exercising 90 to 150 minutes per week, and maintaining a healthy body weight. Only those diagnosed with stage 1 hypertension at a heightened risk of developing heart disease or stroke within 10 years are recommended to start on blood pressure-lowering medication in addition to lifestyle changes. Those at higher risk include patients with cardiovascular disease, diabetes, or chronic kidney disease, or those who have a > 10% risk using the AHA’s atherosclerotic cardiovascular disease (ASCVD) risk calculator (available online at: http://static.heart.org/riskcalc/app/index.html#!/baseline-risk).

So, while the change in the number of people diagnosed with high blood pressure according to new guidelines seems alarming, the majority of individuals will not see a significant change in their doctor’s recommendations. Overall, the criteria change represents a need to shift perception about the risk associated with high blood pressure and begin to make dedicated efforts to lower blood pressure earlier.


1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/
AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017 Nov 13. doi: 10.1016/j.jacc.2017.11.006.

CDC announces Shingrix as preferred vaccine to prevent shingles

Article written by Weston Malek

In our last post, we gave a brief overview of shingles and how Zostavax has been the primary prevention method for the past decade. Now, we’ll discuss the latest development in shingles prevention: the herpes zoster subunit vaccine, Shingrix®.

On October 25, 2017, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) announced endorsement of a new shingles vaccine, Shingrix, as the preferred vaccine to prevent shingles and shingles-related complications in adults 50 years and older. This marks a shift in current shingles vaccination policy in that Zostavax is no longer recommended as the standard prevention method. Additionally, adults age 50-59 years old who previously were at risk of developing shingles but not eligible for vaccination may now be protected.

Shingrix is a recombinant subunit vaccine given as a 2-dose series. It contains a combination of glycoprotein E, a herpes zoster virus (HZV) surface protein, and AS01B, an adjuvant suspension comprised of a purified soap bark tree extract (referred to as QS-21) and a Salmonella minnesota endotoxin fragment (monophosphoryl lipid A or MPL). This adjuvant mixture augments the immune system’s response to glycoprotein E, improving its ability to recognize and challenge to HZV reactivation before it can cause shingles. As a result, Shingrix was more than 90% effective in preventing shingles occurrence in clinical trials. The most common side effects to Shingrix were typically mild and common to receiving any vaccination: pain/inflammation at the injection site, muscle pain, tiredness, headaches, fever, and upset stomach.

The reason Shingrix has so quickly been adopted as the preferred shingles vaccine is because of how substantially it outperforms Zostavax. While Shingrix is more than 90% effective in preventing shingles rash, Zostavax is only 51% effective. Adequate protection lasts more than 4 years with Shingrix. By comparison, protection rapidly wanes after Zostavax immunization, with only about 20% of people still protected after 4 years. Likewise, Zostavax efficacy rates decrease with age – at the same time as the risk of shingles increases. Shingrix, however, appears to be effective in any age group. Perhaps the most important difference besides improved efficacy is the fact that Shingrix is a non-live, recombinant subunit vaccine while Zostavax is a live attenuated vaccine. While ACIP has not yet made an official statement recommending Shingrix for those who are immunocompromised, a non-live vaccine significantly reduces the concern for complications that prevents those with weakened immune systems from getting Zostavax.

In fact, the advantages of Shingrix are so impressive that ACIP has gone so far as to recommend that adults previous vaccinated with Zostavax should also receive Shringrix. Including these people and adults 50-59 years old who will now be eligible for shingles vaccination, a total of about 62 million Americans are recommended to receive Shingrix. But, for now, those individuals will have to wait: Shingrix is not expected to be available to the public until early 2018. Even then, it may take longer for insurance to begin covering Shringrix – though ACIP anticipates that it will be covered, just as Zostavax is currently.



  1. GlaxoSmithKline. CDC’s Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up [press release] (2017 Oct 25) [cited 2017 Nov 29]. Available from: https://www.gsk.com/en-gb/media/press-releases/cdc-s-advisory-committee-on-immunization-practices-recommends-shingrix-as-the-preferred-vaccine-for-the-prevention-of-shingles-for-adults-aged-50-and-up/
  2. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015.
  3. Shingrix [package insert]. Research Triangle Park (NC): GlaxoSmithKline LLC; 2017.

New vaccine could help protect against shingles

Article written by Weston Malek

Almost 1 in 3 Americans will suffer from a severely painful condition as a result of a vaccine-preventable disease at some point in their lifetime. About 1 million cases occur in the United States each year, the majority in people over 60 years old. The disease with these alarming rates: shingles.

Shingles (also referred to as herpes zoster) is a painful, itchy, blistering rash that often develops in a stripe on one side of the body or face. Even though this rash typically clears up within a few weeks, the burning or stabbing pain can last for weeks to months after. This is called post-herpetic neuralgia (PHN) and the risk of developing PHN increases with age, especially in people over 60 years old. PHN alone can be debilitating, but shingles can also have other complications leading to vision problems or blindness.

The virus that causes shingles, varicella zoster virus (VZV), is the same virus that causes chickenpox. Most adults – and almost everyone born in the U.S. before 1980 – have been exposed to the virus, even if they do not remember ever having chickenpox. Shingles results from a reactivation of the virus later in life due to a weakening of the immune system with age, due to medical conditions that compromise the immune system (such as leukemia or HIV), or due to medications that suppress the immune system (such as steroids and other drugs used in rheumatologic disorders or after organ transplantation). People who had chickenpox younger than 18 months of age or who were exposed before birth are also at a higher risk of developing shingles.

Even though those at risk of shingles have already been infected with the virus, the best method of reducing shingles and PHN in adults is through vaccination. Since 2006, Zostavax® has been recommended for adults 60 years and older as a single-dose, live virus vaccine for shingles prevention. Zostavax reduces the risk of developing shingles by 51% and PHN by 67%. Unfortunately, people with weakened immune systems from medical conditions who are at the highest risk of developing shingles should not receive Zostavax because of the potential risk for complications from receiving a live virus vaccine. Additionally, shingles protection from Zostavax typically only lasts about 5 years, meaning that older adults will be at high risk again when immunity wanes.

On October 25, 2017, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) endorsed use of a new vaccine, Shingrix®, as the preferred vaccine to prevent shingles. Our next blog will discuss the advantages of Shingrix and why everyone over 50 years old should consider getting vaccinated.


1. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015.

2. GlaxoSmithKline. CDC’s Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up [press release] (2017 Oct 25) [cited 2017 Nov 29]. Available from: https://www.gsk.com/en-gb/media/press-releases/cdc-s-advisory-committee-on-immunization-practices-recommends-shingrix-as-the-preferred-vaccine-for-the-prevention-of-shingles-for-adults-aged-50-and-up/


Why should I get a flu shot?

The flu, or influenza, is an infectious disease caused by a virus and it can lead to hospitalization and even death. ‘Flu season’ is a time period when the flu virus circulates at higher levels than normal; in the U.S., flu season can last from October to as late as May.

The best way to prevent getting the flu and spreading it to others is to get the annual flu shot.

Flu vaccination can reduce your risk of flu-associated hospitalization. It can also help prevent hospitalizations for those with chronic conditions such as heart disease, diabetes, and lung disease.

The question becomes who should get the flu vaccine? Flu vaccination is recommended for everyone 6 months of age and older. The flu shot causes your body to develop antibodies to the virus about two weeks after receiving the vaccine. You need to get a new flu shot every year because the flu viruses are always changing and the vaccine has to be updated in order to be effective every year.

The vaccine is made to protect against the three (trivalent) or four (quadrivalent) strains of the flu virus that researchers predict to be most common during that flu season. The immune response that the flu shot gives you also decreases over time, so you must re-vaccinate every year. The vaccine effectiveness can vary from year to year.

There is a possibility that you could get the flu despite getting vaccinated, and this depends on whether the viruses in the vaccine are a good ‘match’ to the ones circulating in your community. However, the flu shot can still provide some protection for similar viruses and make your illness milder if you do get sick.

Getting vaccinated also helps protect the people around you by providing something called ‘herd immunity.’ When a high percentage of people in a community are vaccinated, it makes it difficult for the disease to spread because there’s so few people left that it can infect.

By getting the vaccine yourself, you are protecting others who are more vulnerable to the flu, such as babies too young to be vaccinated, people with immune system problems, and those too ill to receive vaccines (some cancer patients).

It is never too early to get your flu shot and is better to get it before flu season is in full swing. Please don’t wait to call us at Four Corners Pharmacy 518-439-8200 to schedule your appointment.


  1. Key facts about seasonal flu vaccine [Internet]. 2017 [cited 10 Sept 2017]. Available from: https://www.cdc.gov/flu/protect/keyfacts.htm
  2. What is herd immunity? [Internet]. 2017 [cited 10 Sept 2017]. Available from: https://www.vaccinestoday.eu/stories/what-is-herd-immunity/

Signs of a possible concussion

The topic of concussions has often been discussed with football but these type of injuries can occur in any sport, or in everyday life. It is important to be on the lookout for these symptoms if a loved one or even yourself suffers a bump on the head.

A concussion is a type of traumatic brain injury (TBI) that’s caused by a bump, blow, or jolt to the head. It’s important to be able to recognize the signs and symptoms of a concussion and to seek medical attention when necessary.

Symptoms of a concussion may appear right away but some may not become apparent for days or months after the injury. The most common symptoms of concussions include the following:

• Thinking/Remembering: difficulty thinking clearly, concentrating, or remembering new information, feeling slowed down

• Physical: headache, blurry vision, nausea and vomiting, dizziness, sensitivity to noise or light, balance problems, feeling tired

• Emotional/Mood: irritability, sadness, nervousness, feeling more emotional

• Sleep: sleeping more or less than usual, or having trouble falling asleep

The key to concussions is knowing the warning signs for more serious concussions and when to seek medical attention. Concussions can lead to blood clots in the brain and lead to more severe TBI.

TBI can lead to impaired thinking, memory, movement, sensation, or emotional function and can even lead to death. Seek medical attention right away if you or someone else experiences the following after a bump, blow or jolt to the head:

• Headache that gets worse and doesn’t go away

• Weakness, numbness, or decreased coordination

• Repeated vomiting or nausea

• Slurred speech

If someone with a concussion experiences the following symptoms, they should go to the emergency department immediately:

• Looking very drowsy or cannot wake up

• One pupil larger than the other

• Convulsions or seizures

• Cannot recognize people or places

• Becoming more and more confused, restless, or agitated

• Unusual behavior

• Loss of consciousness

• For children, if they will not stop crying or will not nurse or eat


1 What are the signs and symptoms of concussion? [Internet]. 2017 [cited Sep 3 2017]. Available from: https://www.cdc.gov/traumaticbraininjury/symptoms.html

2 TBI: get the facts [Internet]. 2017 [cited Sep 3 2017]. Available from: https://www.cdc.gov/traumaticbraininjury/get_the_facts.html


The different kinds of sports injuries and how to treat them

By: Calla Jacobs

With the start of the school year, it also means the beginning of fall sports for many high schools and middle schools in the area. This also tends to lead to an increase of sports injuries, especially in the beginning.

The most common sports injuries include muscle sprains and strains, tears of the ligaments that hold joints together, tears of the tendons that support joints, dislocated joints, and fractured bones.

While sprains and strains are the most common there is a distinct difference between the two. A sprain is a stretch or tear of a ligament, which is the connective tissue that connects the end of one bone to another. While a strain is a twist, pull or tear or a muscle or tendon, which is a cord of tissue connecting the muscle to the bone.

Some of these injuries can be treated at home, it is important to know when to consult a doctor. You should see a doctor if the injury causes severe pain, swelling or numbness, you can’t bear weight on the area, or the injury is accompanied by increased swelling, joint abnormality, or instability.

Mild injuries can be treated at home using the RICE method:
• Rest: Decrease your amount of physical activity as needed to avoid exacerbating the injury. Don’t try to ‘work through’ the pain as it may cause further harm.
• Ice: Apply an ice pack to the injury for 20 minutes, 4-8 times a day. Do not use heat immediately after an injury; heat will increase internal bleeding and swelling.
• Compression: Compressing the injured area can reduced swelling. You can use elastic wraps, special boots, air casts, and splints.
• Elevation: Elevating the injured area on a pillow above the level of the heart can also help to decrease swelling.

To control the pain, over-the-counter nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are recommended. Acetaminophen (Tylenol) is another medication that may be used to help with pain, however it will not help with inflammation as it is not an NSAID.

If you have any questions about pain medications, you can call us at Four Corners Pharmacy (518-439-8200) or consult with your doctor.

Another common treatment for sports injuries is immobilization. Slings, splints, casts, and leg immobilizers may be used to reduce the movement of the injured site to prevent further injury, reduce pain, swelling and muscle spasm, and enable blood to flow more directly to the site to help begin the healing process.We have a number splints and slings, as well as crutches, in our store and our staff would be happy to help determine which is best.

More severe injuries may require surgery to repair connective tissues or realign bones with compound fractures.

It is best to prevent injuries before they happen by properly warming up and stretching before exercising and not over-doing exercise. We wish everybody luck on their upcoming seasons.

1. Handout on Health: Sports Injuries [Internet]. 2016 [cited 2017 Aug 27]. Available from: https://www.niams.nih.gov/health_info/sports_injuries/default.asp


Medication Take Back Day

17426365_1512412502142114_5712868167775875152_nNational Prescription Drug Take Back Day is on Saturday, April 29, 2017, and is a day on which prescription medications may be taken to local collection sites, including the Bethlehem Town Park, so that they may be properly disposed of. The major purpose of drug take back day is to provide a safe and responsible way of disposing of prescription medications, as well as providing education and awareness about drug abuse and misuse.

National drug take back day began back in 2010, created by the Drug Enforcement Agency (DEA) as a way to allow patients an appropriate and safe opportunity to get rid of their unused medications. In 2016, a record high 893,498 pounds (or 447 tons) of unwanted medications were collected, shattering the old record of 390 tons collected in 2014.1

It is vastly important for everyone to understand the vital role they each play in making their homes and communities safer, especially with the opioid abuse epidemic ravaging the country. It is known that the majority of prescription drug abusers get their drugs from friends and family, and that 8 out of 10 new heroin users began by abusing prescription painkillers.1 This opportunity to clean out drawers, tables, medicine cabinets only helps decrease the chances of someone close misusing and/or abusing those medications!

On Saturday, April 29, 2017 you can stop by the Bethlehem Town Park to dispose of any unwanted or unused medications. Both controlled and non-controlled substances are being accepted, however intravenous solutions, injectables and needles will NOT be! For more information visit the town’s website!

  1. DEA collects record-setting amount of meds at latest national Rx take-back day [internet]. 2016 [cited April 15, 2017]. Available from: https://www.dea.gov/divisions/hq/2016/hq050616.shtml