More frequent plasma potassium monitoring is indicated in all the previously mentioned populations, starting in the week after initiation of therapy. Thiazide diuretics and related drugs may reduce urinary calcium excretion, resulting in mild, transient hypercalcemia. Significant hypercalcemia may be related to undiagnosed hyperparathyroidism. Therapy must be interrupted before performing parathyroid function test. In diabetics, blood glucose must be monitored, especially in the presence of hypokalemia.

In patients with hyperuricemia, the risk for attacks of gout may be increased. Dosage should be adjusted as a function of uric acid plasma concentrations. Zinc is used for treatment and prevention of zinc deficiency and its consequences, including stunted growth and acute diarrhea in children, and slow wound healing.

It is also used for boosting the immune system, treating the common cold and recurrent ear infections , and preventing lower respiratory infections. It is also used for malaria and other diseases caused by parasites. Some people use zinc for an eye disease called macular degeneration , for night blindness , and for cataracts.

It is also used for asthma; diabetes ; high blood pressure ; acquired immunodeficiency syndrome AIDS ; and skin conditions such as psoriasis , eczema, and acne. Some people use zinc for benign prostatic hyperplasia BPH , male infertility , erectile dysfunction ED , weak bones osteoporosis , rheumatoid arthritis , and muscle cramps associated with liver disease.

Some athletes use zinc for improving athletic performance and strength. Zinc is also applied to the skin for treating acne , aging skin, herpes simplex infections, and to speed wound healing. There is a zinc preparation that can be sprayed in the nostrils for treating the common cold. Zinc sulfate is used in products for eye irritation. Zinc citrate is used in toothpaste and mouthwash to prevent dental plaque formation and gingivitis.

Note that many zinc products also contain another metal called cadmium. This is because zinc and cadmium are chemically similar and often occur together in nature. Exposure to high levels of cadmium over a long time can lead to kidney failure. The concentration of cadmium in zinc-containing supplements can vary as much as fold. Look for zinc-gluconate products. Zinc gluconate consistently contains the lowest cadmium levels. How does it work? Zinc is needed for the proper growth and maintenance of the human body.

It is found in several systems and biological reactions, and it is needed for immune function, wound healing, blood clotting, thyroid function, and much more. Meats, seafood, dairy products, nuts, legumes, and whole grains offer relatively high levels of zinc. Zinc deficiency is not uncommon worldwide, but is rare in the US. Symptoms include slowed growth, low insulin levels, loss of appetite, irritability, generalized hair loss, rough and dry skin, slow wound healing, poor sense of taste and smell, diarrhea, and nausea.

Moderate zinc deficiency is associated with disorders of the intestine which interfere with food absorption malabsorption syndromes , alcoholism, chronic kidney failure, and chronic debilitating diseases. Zinc plays a key role in maintaining vision, and it is present in high concentrations in the eye. Zinc deficiency can alter vision, and severe deficiency can cause changes in the retina the back of the eye where an image is focused.

Zinc might also have effects against viruses. In addition, there is some evidence that zinc has some antiviral activity against the herpes virus. Low zinc levels can be associated with male infertility, sickle cell disease, HIV, major depression, and type 2 diabetes, and can be fought by taking a zinc supplement. Zinc deficiency might occur in people with severe diarrhea, conditions that make it hard for the bowel to absorb food, liver cirrhosis and alcoholism, after major surgery, and during long-term use of tube feeding in the hospital.

Taking zinc by mouth or giving zinc intravenously by IV helps to restore zinc levels in people who are zinc deficient. However, taking zinc supplements regularly is not recommended. Therefore, when Ziac and nonsteroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.

In patients receiving thiazides, sensitivity reactions may occur with or without a history of allergy or bronchial asthma. Photosensitivity reactions and possible exacerbation or activation of systemic lupus erythematosus have been reported in patients receiving thiazides. The antihypertensive effects of thiazides may be enhanced in the post-sympathectomy patient.

Laboratory Test Interactions Based on reports involving thiazides, Ziac bisoprolol fumarate and hydrochlorothiazide may decrease serum levels of protein-bound iodine without signs of thyroid disturbance. Patients should also be advised to consult a physician if any difficulty in breathing occurs, or if they develop other signs or symptoms of congestive heart failure or excessive bradycardia.

Patients subject to spontaneous hypoglycemia, or diabetic patients receiving insulin or oral hypoglycemic agents, should be cautioned that beta-blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia, and bisoprolol fumarate should be used with caution.

Patients should know how they react to this medicine before they operate automobiles and machinery or engage in other tasks requiring alertness. Patients should be advised that photosensitivity reactions have been reported with thiazides. Bisoprolol Fumarate Long-term studies were conducted with oral bisoprolol fumarate administered in the feed of mice 20 and 24 months and rats 26 months.

On a body weight basis, these doses are and times, respectively, the maximum recommended human dose MRHD of 20 mg, or 0. On a body weight basis, these doses are times in mice and times in rats the MRHD of hydrochlorothiazide On a body surface area basis, these doses are times in mice and 82 times in rats the MRHD. These studies uncovered no evidence of carcinogenic potential of hydrochlorothiazide in rats or female mice, but there was equivocal evidence of hepatocarcinogenicity in male mice.

There was no evidence of mutagenic potential in these in vitro and in vivo assays. Bisoprolol Fumarate The mutagenic potential of bisoprolol fumarate was evaluated in the microbial mutagenicity Ames test, the point mutation and chromosome aberration assays in Chinese hamster V79 cells, the unscheduled DNA synthesis test, the micronucleus test in mice, and the cytogenetics assay in rats.

Hydrochlorothiazide Hydrochlorothiazide was not genotoxic in in vitro assays using strains TA 98, TA , TA , TA and TA of Salmonella typhimurium the Ames test ; in the Chinese Hamster Ovary CHO test for chromosomal aberrations; or in in vivo assays using mouse germinal cell chromosomes, Chinese hamster bone marrow chromosomes, and the Drosophila sex-linked recessive lethal trait gene. Positive test results were also obtained in the Aspergillus nidulans non-disjunction assay, using an unspecified concentration of hydrochlorothiazide.

On a body weight basis, these doses are 75 and times, respectively, the MRHD of bisoprolol fumarate and hydrochlorothiazide. On a body surface area basis, these study doses are 15 and 62 times, respectively, MRHD. Corresponding multiples of maximum recommended human doses are mice and 16 rats on the basis of body weight and 38 mice and 3. Bisoprolol fumarate and hydrochlorothiazide doses used in the rat study are, as multiples of the MRHD in the combination, and times greater, respectively, on a body weight basis, and 26 and times greater, respectively, on the basis of body surface area.

The drug combination was maternotoxic decreased body weight and food consumption at B5. There are no adequate and well-controlled studies with Ziac in pregnant women. Ziac bisoprolol fumarate and hydrochlorothiazide should be used during pregnancy only if the potential benefit justifies the risk to the fetus.

In rabbits, bisoprolol fumarate was not teratogenic at doses up to At these doses, which are multiples of the MRHD equal to 12, for mice and for rats, based on body weight, and equal to for mice and for rats, based on body surface area, there was no evidence of harm to the fetus. There are, however, no adequate and well-controlled studies in pregnant women.

Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. While use of these products as directed 0. Such toxicity has been reported in individuals who used 2 or more standard 2. Many denture creams have now been reformulated to eliminate zinc. However, some evidence suggests that zinc intakes among older adults might be marginal.

Zinc Deficiency Zinc deficiency is characterized by growth retardation, loss of appetite, and impaired immune function. In more severe cases, zinc deficiency causes hair loss, diarrhea, delayed sexual maturation, impotence, hypogonadism in males, and eye and skin lesions [ 2 , 8 , 24 , 25 ].

Weight loss, delayed healing of wounds, taste abnormalities, and mental lethargy can also occur [ 5 , 8 , ]. Many of these symptoms are non-specific and often associated with other health conditions; therefore, a medical examination is necessary to ascertain whether a zinc deficiency is present.

Zinc nutritional status is difficult to measure adequately using laboratory tests [ 2 , 31 , 32 ] due to its distribution throughout the body as a component of various proteins and nucleic acids [ 33 ]. Plasma or serum zinc levels are the most commonly used indices for evaluating zinc deficiency, but these levels do not necessarily reflect cellular zinc status due to tight homeostatic control mechanisms [ 8 ].

Clinical effects of zinc deficiency can be present in the absence of abnormal laboratory indices [ 8 ]. Clinicians consider risk factors such as inadequate caloric intake, alcoholism, and digestive diseases and symptoms of zinc deficiency such as impaired growth in infants and children when determining the need for zinc supplementation [ 2 ].

When zinc deficiency does occur, it is usually due to inadequate zinc intake or absorption, increased losses of zinc from the body, or increased requirements for zinc [ 26 , 27 , 34 ]. People at risk of zinc deficiency or inadequacy need to include good sources of zinc in their daily diets. Supplemental zinc might also be appropriate in certain situations. People with gastrointestinal and other diseases Gastrointestinal surgery and digestive disorders such as ulcerative colitis, Crohn's disease, and short bowel syndrome can decrease zinc absorption and increase endogenous zinc losses primarily from the gastrointestinal tract and, to a lesser extent, from the kidney [ 2 , 26 , 35 , 36 ].

Other diseases associated with zinc deficiency include malabsorption syndrome, chronic liver disease, chronic renal disease, sickle cell disease, diabetes, malignancy, and other chronic illnesses [ 37 ]. Chronic diarrhea also leads to excessive loss of zinc [ 24 ]. Vegetarians The bioavailability of zinc from vegetarian diets is lower than from non-vegetarian diets because vegetarians do not eat meat, which is high in bioavailable zinc and may enhance zinc absorption.

In addition, vegetarians typically eat high levels of legumes and whole grains, which contain phytates that bind zinc and inhibit its absorption [ 31 , 38 ]. In addition, they might benefit from using certain food preparation techniques that reduce the binding of zinc by phytates and increase its bioavailability. Techniques to increase zinc bioavailability include soaking beans, grains, and seeds in water for several hours before cooking them and allowing them to sit after soaking until sprouts form [ 38 ].

Vegetarians can also increase their zinc intake by consuming more leavened grain products such as bread than unleavened products such as crackers because leavening partially breaks down the phytate; thus, the body absorbs more zinc from leavened grains than unleavened grains. Pregnant and lactating women Pregnant women, particularly those starting their pregnancy with marginal zinc status, are at increased risk of becoming zinc insufficient due, in part, to high fetal requirements for zinc [ 39 ].

Lactation can also deplete maternal zinc stores [ 40 ].

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