Monthly Archives: March 2013

Multiple Combination Medicines and Your Child

Know Active Ingredients in Children’s Meds

childrensdrugs

If your child is sneezing up a storm, it must be allergy season once more.

And if your child is taking more than one medication at the same time, there could be dangerous health consequences if those medicines have the same active ingredient, according to Hari Cheryl Sachs, M.D., a pediatrician at the Food and Drug Administration (FDA).

A medicine is made of many components. Some are “inactive” and only help it to taste better or dissolve faster, while others are active. An active ingredient in a medicine is the component that makes it pharmaceutically active—it makes the medicine effective against the illness or condition it is treating.

Active ingredients are listed first on a medicine’s Drug Facts label for over-the-counter (OTC) products. For prescription medicines, they are listed in a patient package insert or consumer information sheet provided by the pharmacist.

Many medicines have just one active ingredient. But combination medicines, such as those for allergy, cough, or fever and congestion, may have more than one.

Take antihistamines taken for allergies. “Too much antihistamine can cause sedation and—paradoxically—agitation. In rare cases, it can cause breathing problems, including decreased oxygen or increased carbon dioxide in the blood, Sachs says.

“We’re just starting allergy season,” says Sachs. “Many parents may be giving their children at least one product with an antihistamine in it.” Over-the-counter (OTC) antihistamines (with brand name examples) include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), fexofenadine (Allegra), loratadine (Claritin, Alavert), and cetirizine (Zyrtec).

multiple_combination_medicinesBut parents may also be treating their children for a separate ailment, such as a cough or cold. What they need to realize is that more than one combination medicine may be one too many.

“It’s important not to inadvertently give your child a double dose,” Sachs says.

Other Health Complications

The same goes for other active ingredients, often found in combination products for allergies but also used to treat other symptoms, such as fever, headache or nasal congestion:

  • Acetaminophen (in Tylenol and many other products), a pain reliever often used to treat fevers, mild pain or headache. Taking too much can cause liver damage.
  • Ibuprofen (for example, Advil or Motrin), another common medicine for relieving mild to moderate pain from headaches, sinus pressure, muscle aches and flu, as well as to reduce fever. Too much ibuprofen can cause nausea, vomiting, diarrhea, severe stomach pain, even kidney failure.
  • Decongestants such as pseudoephedrine or phenylephrine (found in brand name drugs such as Actifed and Sudafed) taken in large amounts can cause excessive drowsiness in children. They can also cause heart rhythm disturbances, especially if combined with products and foods containing caffeine. In the form of nasal sprays and nose drops, these products, as well as oxymetazoline (the active ingredients in products such as Afrin), can cause “rebound” congestion, in which the nose remains stuffy or gets even worse.

Never give a child aspirin or aspirin containing products, as you risk triggering Reye’s Syndrome, a deadly disease!

Any of the above symptoms may indicate a need for immediate medical attention. “The bottom line is that neither you, nor your children, should take multiple combination medicines at the same time without checking the active ingredients and consulting your health care professional first,” recommends Sachs.

Furthermore, two different active ingredients may serve the same purpose, Sachs says. For example, both acetaminophen and ibuprofen help reduce pain and fever. So there’s generally no need to give your child both medicines for the same symptoms.

Write It All Down

Whether you’re treating your child’s condition with OTC medicines from the drug store or ones prescribed by your doctor, it’s essential that you keep track of every medicine and the active ingredients each contains, Sachs says.

“It’s easy to forget which medicines you’re giving your child,” Sachs says. “And if you have more than one child, it can get even more complicated.” She recommends making it a habit to write down the name of any medicine you give your child, whether it’s OTC or prescription (download a daily medicine records template).

“It’s really a good idea to carry that list with you when you go to see your pediatrician or even when you go to the pharmacy,” she adds. You should also note whatever vitamins or supplements your child is taking, as these can interact unfavorably with certain medicines, too.

Most importantly, Sachs says parents should always read the Drug Facts label on OTC products, and the patient package insert or consumer information sheet that comes with prescription medicines, every time they’re considering a medication for their child, even if they think they already know the ingredients. They should know that the ingredients can change without an obvious change in the packaging. And they should contact their health care professional with any questions.

A list of ingredients to avoid, (other names for aspirin) can be downloaded here, or you can email the NRSF for a wallet size card(s) you can carry with you when shopping for medications.

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Breastfeeding and Drugs: Drugs Deemed Safe

Information about what drugs are safe to use during breastfeeding.breastfeeding

A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her physician to stop nursing.  Of course, if you don’t have to take drugs, whether they are over the counter, or prescription, it is always for the best.

This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacological treatment of breastfeeding mothers.

Below is a list of drugs deemed safe to take by the American Academy of Pediatrics.

Maternal Medication Usually Compatible With Breastfeeding and any effects on the baby :

Acetaminophen
Acetazolamide
Acitretin
Acyclovir — Drug is concentrated in human milk
Alcohol (ethanol) — With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain; maternal ingestion of 1 g/kg daily decreases milk ejection reflex
Allopurinol
Amoxicillin
Antimony
Atropine
Azapropazone (apazone)
Aztreonam
B1 (thiamin)
B6  (pyridoxine)
B12
Baclofen
Barbiturate
Bendroflumethiazide  — Suppresses lactation
Bishydroxycoumarin (dicumarol)
Bromide  — Rash, weakness, absence of cry with maternal intake of 5.4 g/d
Butorphanol
Caffeine — Irritability, poor sleeping pattern, excreted slowly; no effect with moderate intake of caffeinated beverages (2–3 cups per day)
Captopril
Carbamazepine
Carbetocin
Carbimazole — Goiter
Cascara
Cefadroxil
Cefazolin
Cefotaxime
Cefoxitin
Cefprozil
Ceftazidime
Ceftriaxone
Chloral hydrate —  Sleepiness
Chloroform
Chloroquine
Chlorothiazide
Chlorthalidone — Excreted slowly
Cimetidine — Drug is concentrated in human milk
Ciprofloxacin
Cisapride
Cisplatin — Not found in milk
Clindamycin
Clogestone
Codeine
Colchicine
Contraceptive pill with estrogen/progesterone — Rare breast enlargement; decrease in milk production  and protein content (not confirmed in several studies)
Cycloserine
D (vitamin) —  follow up infant’s serum calcium level if mother receives pharmacological doses
Danthron — Increased bowel activity
Dapsone —  sulfonamide detected in infant’s urine 191, 219
Dexbrompheniramine maleate with d-isoephedrine — Crying, poor sleeping patterns, irritability
Diatrizoate
Digoxin
Diltiazem
Dipyrone
Disopyramide
Domperidone
Dyphylline — Drug is concentrated in human milk
Enalapril
Erythromycin — Drug is concentrated in human milk
Estradiol — Withdrawal, vaginal bleeding
Ethambutol
Ethanol (cf. alcohol)
Ethosuximide — drug appears in infant serum
Fentanyl
Fexofenadine
Flecainide
Fleroxacin — One 400-mg dose given to nursing mothers; infants not given breast milk for 48 hours
Fluconazole
Flufenamic acid
Fluorescein
Folic acid
Gadopentetic (Gadolinium)
Gentamicin
Gold salts
Halothane
Hydralazine
Hydrochlorothiazide
Hydroxychloroquine — Drug is concentrated in human milk
Ibuprofen
Indomethacin — Seizure (1 case)
Iodides — May affect thyroid activity; see iodine
Iodine — Goiter
Iodine (povidone-iodine, eg, in a vaginal douche) — Elevated iodine levels in breast milk, odor of iodine on infant’s skin
Iohexol
Iopanoic acid
Isoniazid– acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity reported in infants
Interferon-a
Ivermectin
K1 (vitamin)
Kanamycin
Ketoconazole
Ketorolac
Labetalol
Levonorgestrel
Levothyroxine
Lidocaine
Loperamide
Loratadine
Magnesium sulfate
Medroxyprogesterone
Mefenamic acid
Meperidine
Methadone
Methimazole (active metabolite of carbimazole)
Methohexital
Methyldopa
Methyprylon — Drowsiness
Metoprolol — Drug is concentrated in human milk
Metrizamide
Metrizoate
Mexiletine
Minoxidil
Morphine — infant may have measurable blood concentration
Moxalactam
Nadolol — Drug is concentrated in human milk
Nalidixic acid — Hemolysis in infant with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
Naproxen
Nefopam
Nifedipine
Nitrofurantoin — Hemolysis in infant with G-6-PD deficiency 305
Norethynodrel
Norsteroids
Noscapine
Ofloxacin
Oxprenolol
Phenylbutazone
Phenytoin — Methemoglobinemia (1 case)
Piroxicam
Prednisolone
Prednisone
Procainamide
Progesterone
Propoxyphene
Propranolol
Propylthiouracil
Pseudoephedrine — Drug is concentrated in human milk
Pyridostigmine
Pyrimethamine
Quinidine
Quinine
Riboflavin
Rifampin
Scopolamine
Secobarbital
Senna
Sotalol
Spironolactone
Streptomycin
Sulbactam
Sulfapyridine — Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant’s milk
Sulfisoxazole — Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant’s milk
Sumatriptan
Suprofen
Terbutaline
Terfenadine
Tetracycline — negligible absorption by infant
Theophylline — Irritability
Thiopental
Thiouracil — drug not used in United States
Ticarcillin
Timolol
Tolbutamide — Possible jaundice
Tolmetin
Trimethoprim/sulfamethoxazole
Triprolidine
Valproic acid
Verapamil
Warfarin
Zolpidem

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Breastfeeding and Drugs: Drugs Deemed Not Safe

Information about what drugs are NOT safe to use during breastfeeding.

A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her breastfeedingphysician to stop nursing.  Of course, if you don’t have to take drugs, whether they are over the counter, or prescription, it is always for the best.

This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacological treatment of breastfeeding mothers.

Below is a list of drugs deemed NOT safe to take by the American Academy of Pediatrics.

Cytotoxic Drugs That May Interfere With Cellular Metabolism of the Nursing Infant:

Cyclophosphamide  — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
Cyclosporine —  Possible immune suppression; unknown effect on growth or association with carcinogenesis
Doxorubicin* — Possible immune suppression; unknown effect on growth or association with carcinogenesis
Methotrexate — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
* Drug is concentrated in human milk.

Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported*

Amphetamine† — Irritability, poor sleeping pattern
Cocaine — Cocaine intoxication: — irritability, vomiting, diarrhea, tremulousness, seizures
Heroin — Tremors, restlessness, vomiting, poor feeding
Marijuana — Only 1 report in literature; no effect mentioned; very long –half-life for some components
Phencyclidine — Potent hallucinogen
* The Committee on Drugs strongly believes that nursing mothers should not ingest drugs of abuse, because they are hazardous to the nursing infant and to the health of the mother.
† Drug is concentrated in human milk.

Radioactive Compounds That Require Temporary Cessation of Breastfeeding*

Copper 64 (64Cu) — Radioactivity in milk present at 50 h
Gallium 67 (67Ga) — Radioactivity in milk present for 2 wk
Indium 111 (111In) — Very small amount present at 20 h
Iodine 123 (123I) — Radioactivity in milk present up to 36 h
Iodine 125 (125I) — Radioactivity in milk present for 12 d 42
Iodine 131 (131I) —  Radioactivity in milk present 2–14 d, depending on study
Iodine131 — If used for treatment of thyroid cancer, high radioactivity may prolong exposure to infant
Radioactive sodium — Radioactivity in milk present 96 h
Technetium 99m (99mTc), 99mTc
macroaggregates, 99mTc O4 — Radioactivity in milk present 15 h to 3 d
* Consult nuclear medicine physician before performing diagnostic study so that radionuclide that has the shortest excretion time in breast milk can be used. Before study, the mother should pump her breast and store enough milk in the freezer for feeding the infant; after study, the mother should pump her breast to maintain milk production but discard all milk pumped for the required time that radioactivity is present in milk. Milk samples can be screened by radiology departments for radioactivity before resumption of nursing.

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*

Anti-anxiety:
Alprazolam
Diazepam
Lorazepam
Midazolam
Perphenazine
Prazepam†
Quazepam
Temazepam
Antidepressants:
Amitriptyline
Amoxapine
Bupropion
Clomipramine
Desipramine
Dothiepin
Doxepin
Fluoxetine — Colic, irritability, feeding and sleep disorders, slow weight gain
Fluvoxamine
Imipramine
Nortriptyline
Paroxetine
Sertraline†
Trazodone
Antipsychotic:
Chlorpromazine — Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores
Chlorprothixene
Clozapine†
Haloperidol — Decline in developmental scores
Mesoridazine
Trifluoperazine
OTHERS:
Amiodarone — Possible hypothyroidism
Chloramphenicol — Possible idiosyncratic bone marrow suppression
Clofazimine — Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation
Lamotrigine —  Potential therapeutic serum concentrations in infant
Metoclopramide† — dopaminergic blocking agent
Metronidazole — In vitro mutagen; may discontinue breastfeeding for 12–24 h to allow excretion of dose when single-dose therapy given to mother
Tinidazole  — See metronidazole
* Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.
† Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.

Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers With Caution*

Acebutolol — Hypotension; bradycardia; tachypnea
5-Aminosalicylic acid — Diarrhea (1 case) ,  Aspirin; Reye’s Syndrome
Atenolol — Cyanosis; bradycardia
Bromocriptine — Suppresses lactation; may be hazardous to the mother
Aspirin — (salicylates) Metabolic acidosis (1 case),  Reye’s Syndrome
Clemastine — Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness (1 case)
Ergotamine — Vomiting, diarrhea, convulsions (doses used in migraine medications)
Lithium — One-third to one-half therapeutic blood concentration in infants
Phenindione — Anticoagulant: increased prothrombin and partial thromboplastin time in 1 infant; not used in United States
Phenobarbital — Sedation; infantile spasms after weaning from milk containing phenobarbital, methemoglobinemia (1 case)
Primidone — Sedation, feeding problems
Sulfasalazine (salicylazosulfapyridine) — Bloody diarrhea (1 case), Reye’s Syndrome
* Blood concentration in the infant may be of clinical importance

 

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Grapefruit, Drug Interactions

Don’t take this with that! Seriesgrapefruit

Grapefruit causes problems when taken with certain medications

Sometimes the juice just isn’t worth the squeeze…especially when combining grapefruit with medicines.

While it can be part of a balanced and nutritious diet, grapefruit can have serious consequences when taken with certain medications. Currently, there are more than fifty prescription and over-the-counter drugs known to the U.S. Food and Drug Administration that can have negative interactions with grapefruit.

As little as one cup of juice or two grapefruit wedges can alter the way your medicines work. When taken with medicine, grapefruit can delay, decrease, or enhance absorption of certain drugs; as a result, the patient does not receive the prescribed dosage of the medication. If the label on your medicine reads “DO NOT TAKE WITH GRAPEFRUIT” or has similar words, heed the warning. It can save you a bushel of problems.

How it does or doesn’t work

pills

Depending on the active ingredient, grapefruit can reduce the effectiveness of a drug or worse, create potentially dangerous drug levels in the body. Grapefruit can interfere with transporters in the intestine that help absorb drugs. When this happens, less of the drug reaches the bloodstream and the patient receives no benefit.

Grapefruit can also interfere with enzymes that break down drugs in your digestive system. This can result in the body absorbing too much of the drug, which can potentially cause serious problems.

Help may be on the way

Scientists are currently working on breeding hybrid grapefruits that will be safe to mix with medications. In the near future you may be able to enjoy these tasty mounds without compromising your safety. But until the new fruit containers start to arrive, follow these tips:

  • Ask your pharmacist or other health care professional if you can have fresh grapefruit or grapefruit juice while using your medication. If you can’t, you may want to ask if you can have other juices with the medicine.
  • Read the Medication Guide or patient information sheet that comes with your prescription medicine to see if it interacts with grapefruit juice. Some information may advise not to take the drug with grapefruit juice. If it’s OK to have grapefruit juice, there will be no mention of it in the guide or information sheet.
  • Read the Drug Facts label on your non-prescription medicine, which will let you know if you can have grapefruit or other fruit juices with it.
  • If you can’t have grapefruit juice with your medicine, check the label of bottles of fruit juice or drinks flavored with fruit juice to make sure they don’t contain grapefruit juice.
  • Seville oranges (often used to make orange marmalade) and tangelos (a cross between tangerines and grapefruit) affect the same enzyme as grapefruit juice, so avoid these fruits as well if your medicine interacts with grapefruit juice.

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Triclosan And Your Child’s Well-being

A hand sanitizer, or antiseptic,  is often used as an alternative to hand washing when soap and water is not readily available. But not all hand sanitizers are created equal, and some may even cause health issues in children and adults.

Practicing good hand hygiene is especially important:wash_hands

After using the bathroom
Before eating or drinking anything
Before and after handling raw foods, fish, poultry, or eggs
After using a public phone
After riding public transportation
In schools and day care centers
After changing diapers
When one is sick
After shaking hands
After sneezing or coughing
After touching an ATM, elevator buttons or escalator handrails

Manufactures claim that sanitizers kill 99.9 percent of germs. But some studies suggest that keeping environments too clean and the persistent use of antibacterial soaps and hand sanitizers may inhibit proper immune system development in children. This is because inflammatory systems require the exposure to common germs to properly develop.

Although the FDA recommends, that when possible, it is better to use soap and water and scrub for at least 20 seconds, that is not always possible in the real world.

So what about hand sanitizers, and can they be dangerous?

There are new studies just out that are claiming that one ingredient used by some manufactures can indeed cause health issues. The ingredient is Triclosan.

Triclosan was first registered as a pesticide in 1969.

Triclosan is an antimicrobial active ingredient contained in a variety of products where it acts to slow or stop the growth of bacteria, fungi, and mildew. It is used in items such as conveyor belts, fire hoses, dye bath vats, or ice-making equipment as an antimicrobial pesticide.

brushteeth2Triclosan is also used in products such as, fabrics, vinyl, plastics (toys, toothbrushes), adhesives, polyethylene, polyurethane, polypropylene, floor wax emulsions, textiles (footwear, clothing), caulking compounds, sealants, rubber, carpeting, and a wide variety of other products.

Triclosan has been used since 1972, and it is present in soaps (0.10-1.00%), deodorants, toothpastes, mouth washes, and cleaning supplies, and is infused in an increasing number of consumer products such as kitchen utensils, toys, bedding, socks, and trash bags.bathing

So your morning routine may start with bathing or showering with soap, brushing your teeth with toothpaste and using mouth wash, perhaps applying some cosmetics, and a dash of deodorant. Then throughout the day, to protect yourself from germs, you use a pocket hand sanitizer, or spray.

Have you checked those items for Triclosan? If the product contains Triclosan, it must be labled.

ingredient_tricolsanSeveral scientific studies have come out since the last time the FDA reviewed Triclosan that warrant further review. According to one recent study, Triclosan may impact respiratory health, by promoting the development of allergies and causing inflammation in the mucous lining of the nose, also known as rhinitis.

Researchers from NIEHS, Norway, and the CDC found the link after measuring levels of Triclosan in urine samples from Norwegian children. The authors published their paper online Nov. 12 in the journal Allergy, and state their findings replicate those of another study that used American children participating in the National Health and Nutrition Examination Survey. Since these reports found an association between Triclosan and the occurrence of allergic sensitization in two different populations, the researchers feel confident the relationship is genuine.

The 623 Norwegian children used in the study have been followed since birth. At age 10, the youngsters received two days of extensive clinical evaluation at Oslo University Hospital, undergoing allergy skin prick tests and lung function assessments on a treadmill, and provided urine and blood samples. The research team sent the urine samples to the Centers for Disease Control and Prevention to measure the amounts of Triclosan.

The results showed that children with allergy sensitivity and rhinitis had the highest levels of Triclosan in their urine. Since Triclosan doesn’t stay in the body very long, 1-2 days according to the study, they think the elevated levels come from continued use of certain products.

Animal studies have shown that Triclosan alters hormone regulation. Other studies in bacteria have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics.

The authors of the study plan to continue examining the Triclosan-allergy connection. They say other research groups have measured Triclosan in breast milk from Swedish mothers and, since Norwegian mothers tend to breastfeed their babies during the first 4-6 months of life, the study plans to follow up the Swedish findings with a study of Triclosan andbreastfeeding allergy development in Norwegian infants. The research team has already collected urine from the newborns and will follow up as they age.

The FDA has partnered with other Federal Agencies to study the effects of Triclosan on animal and environmental health.

So what to do?

Check the labels for Triclosan on the items you and your children use.

Many hand sanitizers, like the PURELL® brand, do not contain Triclosan. Using alcohol based instant hand sanitizers, when soap and water are not available, is one of the Centers for Disease Control and Prevention’s recommendations.

The Centers for Disease Control and Prevention have recommended the use of alcohol-based hand sanitizers when soap and water are not available and hands are not visibly dirty. The CDC recommends that children in school may use alcohol-based hand rubs as an alternative to handwashing.

The main active ingredient in Purell hand sanitizers is ethyl alcohol, the primary germ-killing agent in most hand-sanitizing agents.

According to the Purell company, one of the major benefits of using ethyl alcohol over other germ killing agents is that bacteria have been unable to create a resistance to ethyl alcohol. That means that regardless of how often you use the handsanitizer_purellproduct, the bacteria continue to die.

Other Ingredients Include:

Isopropyl alcohol is also a germ-killing agent. Although the percentage of isopropyl alcohol is much less than ethyl alcohol, both work together to keep your hands free of the bacteria and viruses that cause infection and disease.

Carbomer is a common ingredient used to make gel-like solutions. The carbomer is added to water in Purell by sifting it in. As the carbomer combines with the water, it creates a non-foaming gel.

Tocopheryl acetate is a form of the fat-soluble vitamin E. It is commonly used in skin products as an antioxidant and moisturizer. Its moisturizing properties can help offset the drying effect that ethyl alcohol can cause to the skin.

Glycerin is another common ingredient in skin products. It works in two ways–as a skin moisturizer that absorbs moisture from the air, and to make Purell easier to spread on the skin.

Propylene glycol is a moisturizer that works similar to glycerin. This ingredient pulls moisture from the air and deposits it into the upper layers of the skin, helping to keep skin from drying out.

Isopropyl myrisate works to thicken the consistency of the Purell gel. It also acts as an emollient to prevent the product from feeling oily.

Purell states that aboratory testing has never shown alcohol-based hand sanitizers like PURELL® to lead to bacterial resistance. “There is no evidence that organisms adapt and become immune to the active ingredient in PURELL® products. Once your hands are rubbed dry after application of PURELL®, the alcohol has evaporated completely. PURELL® leaves no harmful residue. A small bit of emollient (skin conditioning agent) is left on the hands after use to leave your hands feeling soft and refreshed.”

Non-alcohol, or some labeled ‘natural’ sanitizers are not as good. Alcohol-based sanitizers work because alcohol breaks up bacterial proteins and kills them.

In the end, know your ingredients, read labels, and choose wisely.

For those interested in trying Purell, here is a link to a coupon: http://www.purell.com/about-us/purell-coupons-promotions.aspx

Citations:
http://www.epa.gov/oppsrrd1/REDs/factsheets/triclosan_fs.htm;

http://www.epa.gov/endo/

Bertelsen RJ, Longnecker MP, Lovik M, Calafat AM, Carlsen KH, London SJ, Lodrup Carlsen KC. 2012. Triclosan exposure and allergic sensitization in Norwegian children. Allergy; doi:10.1111/all.12058 [Online 12 November 2012]

http://www.niehs.nih.gov/news/newsletter/2012/12/science-allergies/

http://www.livestrong.com/article/68666-purell-hand-sanitizer-ingredients/#ixzz2Ms7zvFfg

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