Interview with Dr. John Dobbs of PharmiCare

Part of your treatment for mold illness may include the use of cholestyramine and/or BEG spray. Cholestyramine is used to eliminate the mold toxins from your body while BEG spray is used to eliminate multiple antibiotic-resistant coagulase-negative staph if you have a positive nasal culture. Dr. John Dobbs at PharmiCare has provided some helpful information and tips for using these medications appropriately while limiting their side effects to help you successfully treat your mold illness. PharmiCare provides pure cholestyramine without the additives and fillers found in the commonly available form which may help reduce your chance of gastrointestinal side effects. While these medications are only available by prescription from your doctor, you can obtain these medications including the pure form of cholestyramine even if you don’t live in the local area as PharmiCare will ship them to you. You can visit their website or call them at 239-690-7700.

1. Can you tell us a little about your pharmacy and the products and services you provide including shipping medications to those outside of the local area?

PharmiCare is an independent pharmacy that offers concierge services. That means we cater to your health needs, each and every day you need us, always at no extra cost to you. We are a full service pharmacy – meaning we fill prescriptions just like any other pharmacy and we take almost all insurance plans as well. In addition to prescriptions, we offer compounding, home medical equipment, delivery or shipping, after hours emergency services, and lines of non-gmo (non-genetically modified) vitamins and supplements.

PharmiCare can ship your medications if you are outside of the Fort Myers area. We usually ship via UPS and can send via ground or expedited based on urgency. We do not charge any additional fees for shipping. We simply add our shipment cost to your bill. For payment, we can keep a credit card on file or you can call each time with credit card info. If you live in the Fort Myers area we will deliver your medications at no cost to you.

2. What exactly are compounded prescriptions?

Compounding is the creation of a customized pharmaceutical preparation – a drug – by a licensed pharmacist to meet the unique needs of an individual patient when commercially available drugs are not effective or available.

In medicine, some patients do not respond to traditional treatment options, and some need medication strengths that are not available or require different dosage forms. Pharmaceutical compounding meets these needs. Compounding is the only situation where physicians and pharmacists can customize an individual product for the specific needs of the patient. Some examples of compounding include flavoring suspensions; making suppositories; making creams, gels or lotions; preparing sugar free, dye free, additive free medications; altering doses to meet patients specific requirements.

3. How long does it usually take to get a compounded prescription filled?

It depends on the ingredients actually. Compounding should use the pure powder or liquid form of a drug and these pure forms need to be ordered from special wholesalers. This ordering process can take a day or two. After the pharmacy has the products, most orders can be ready within 24-48 hours.

4. What are the benefits of using the pure cholestyramine your pharmacy provides rather than the commonly available form?

Pure cholestyramine contains no additives, sugars, dyes, binders, fillers, etc…nothing but pure cholestyramine. The benefits should include less side effects. Some people have allergic reactions or unwanted side effects from the fillers and additives in the commercially available cholestyramine. Also, you are taking cholestyramine to rid your body of any impurities so why take a product that is full of impurities?

5. Why can’t cholestyramine be put in a capsule to make it easier to take?

Well the pure form could be placed into capsule form, however 1 dose of 4 grams would require many capsules. In addition, this process would require a lot of time to place into capsules, therefore causing the cholestyramine capsules to be expensive and cost prohibitive for a lot of patients.

6. Can you discuss the common side effects of cholestyramine and BEG spray?

A common side effect of cholestyramine is constipation. Other side effects are commonly related to the GI tract and include some bloating and gas. More side effects include weight loss and a skin rash. In addition, the pure form of cholestyramine is more challenging to ingest simply because it contains no sugars or binders to help it stay dissolved in liquid. The best advice we have seen is dissolving each dose in a strong juice such as cranberry juice or mixing a dose in applesauce or a fruit smoothie. Although you are not supposed to eat solid foods while taking your dose of cholestyramine, SMALL amounts of apple sauce or a fruit/veggie smoothie can help patients take the doses. In addition, a 4 gram dose of pure cholestyramine is only approximately 1 and 1/2 teaspoons, which is a much less amount of powder simply because all of the additives are not there. One dose of the commercially available cholestyramine equals 9 grams, and contains 4 grams of cholestyramine and 5 grams of the following additives: citric acid, fructose, mono ammonium glycyrrhizinate, pectin, propylene glycol alginate, sorbitol, sucrose, xanthan gum, artificial orange flavor, D&C yellow No. 10 aluminum lake, FD&C yellow No. 6 aluminum lake.

Common side effects of BEG include a burning or stinging of the nasal cavity and severe nasal discharge. It helps to keep BEG under refrigeration (although it is not required) in order to help reduce any burning – many patients states this helps. You can experience a lot of nasal discharge simply because the toxic biofilm is breaking down and the only way it can leave is out your nose or down the back of your throat.

6. Can you offer any helpful tips for avoiding the digestive issues that some people experience while taking cholestyramine?

Well, hopefully using the pure form will reduce some of the GI side effects because some of the additives can cause the bloating and constipation. If you experience a lot of constipation it is a good idea to add fiber to your diet. Taking a natural fiber capsule or powder is a good idea if you can not get all of your fiber from your diet. Look for a blend of soluble fibers such as psyllium, pectin, and guar gum. Other alternatives include an approach such as using chamomile for example, which acts as a natural laxative.

7. Are there any potential drug interactions that patients using cholestyramine and/or BEG spray should be aware of?

Cholestyramine can delay or reduce the absorption of many drugs. Therefore it is recommended that patients take any other medications at least 1 hour before or 4 hours after taking cholestyramine. In addition, taking cholestyramine for long periods of time may prevent the absorption of fat soluble vitamins such as vitamins A, D, E and K. It may be advisable to take supplementation with water-miscible forms of fat-soluble vitamins.

BEG: Since it is a nasal spray, most of its site of action is on the nasal mucosa and the nasal spray has little systemic (body wide) effects. Try not to use any other nasal sprays immediately after using BEG. You should wait 1 to 2 hours.

8. Do medications administered by nasal spray still work if I have a cold or a stuffy nose?

Yes they do. It is important not to blow your nose for at least 30 minutes after spraying BEG or any nasal spray and tip your head back after spraying to avoid the BEG from dripping out of your nose (if it is stuffed from a cold or allergies).

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