MVOCs & Mycotoxins (for Sharon)

March 6, 2006

Wow ! Thank you for such a well thought out answer. I have some questions, but I am going to save them until I have read a bit more from the other emails and the the links I have been provided.

By the way, you are so lucky to be at AppalachianState in Boone. What an absolutely beautiful part of the country.

Sharon

March 6, 2006

-

Bravo to you! Great post.

Best Regards,

Stacey Champion

MVOCs & Mycotoxins (for Sharon)

Sharon,

MVOCs are Microbial (M) Volatile Organic Compounds (VOCs). There have been

several good explanations of that already but they still assumed a fairly

high level of chemistry background, which from your writings it appears you

may not have, so hopefully I can clarify a bit in less technical terms.

The " V " in means the chemical is volatile. " Volatile " means that at normal

room pressure and temperature, it is a gas with a certain chemical

qualities. One quality is that, when they were liquids, they evaporated

quickly. For example rubbing alcohol, though you buy it at the store as a

liquid, evaporates quickly into the air if you leave the bottle open because

it is a VOC.

The " O " means " Organic. " Unlike what nonchemists think when they hear this

word, being " organic " in this sense has nothing to do with pesticide use!

Here, " organic " means that it contains at least one carbon atom. It's a

chemist's term because carbon is the " building block of life. "

And " C " is for " compound " , simply meaning it contains one or more molecules.

Thus MVOCs are gases emitted from microbes. In our discussion, fungi are

the microbes of interest so I'll confine further comments to MVOCs from

fungi.

You posed several questions and made several statements to which I will

attempt to respond:

1. " It is well documented that molds can elicit these symptoms. (HP -

farmers, ABPA, CFS) " While true that mold can cause hypersensitivity

pneumonitis (HP), exposure needs to be in the millions or more of spores/m3

to cause these illnesses. Considering " contaminated " homes are often only

in the hundreds to low thousands of spores/m3 (not including flooded homes

here), you can see why there is skepticism in scientific circles that so

many people are becoming seriously ill from modestly elevated levels of mold

in their homes.

Allergic Bronchopulmonary Aspergillosis (ABPA), on the other hand, is only a

concern for people with serious immune compromisation or lung impairment

illness. Patients with such disorders, especially cystic fibrosis, do not

have to be exposed to " high " level of aspergillis (e.g. a moldy house) to

develop this problem.

Finally, if by " well documented " you mean oft-repeated, then I would agree

with you about a connection between Chronic Fatigue Syndrome and mold.

However, I'm not aware of any scientific data linking mold exposure to CFS,

though there are certainly hundreds of websites claiming such an association

(most of which seem also to be selling vitamins or lawsuit services to

" cure " the problem). But I tend to be suspicious of any sources of

information that mix scientific jargon with sales pitches.

2. " People become better when treated with antifungals and/or mycotoxin

eliminating measures. " First of all, I assume you mean " mold eliminating

measures " rather than " mycotoxin eliminating measures. " I don't know why

anyone would want to try to get rid of the mycotoxins and not get rid of the

spores, glucans, etc that cause allergic response as well (assuming it were

even possible to do so).

Becoming well when treated with something that a person believes will make

them well is not " proof " that someone was sick from the presumed causative

factor (e.g. mold). If that were true, then bloodletting and leeches would

still be popular medical interventions. For example, people often get

better after taking antibiotics for what they believed was a sinus

infection, when in fact it was a cold that would have gotten better on its

own in about the same number of days. But they get better after the

antibiotics so think that was " proof " they had the sinus infection.

Furthermore, recent studies have proven that the " placebo effect " is not a

temporary effect that is in someone's head -- it can literally heal. So I

by no means am implying that people who have gotten better were imagining

their illness. Just that mold may or may not have had much to do with it.

There is still much we don't know.

That's not to say they aren't becoming ill from something, or that some sort

of hypersensitivity reaction has happened, or that somehow molds living on

modern-day substrates made of glues and polymers are somehow more irritating

than molds grown in the lab and used in most studies (because we do know

that molds emit different MVOCs and mycotoxins depending on their " food " ).

There is still much work to be done.

3. " Antibiotics sometimes actually increase the symptoms of illness -

because when one kills bacteria that keep fungi in check, the fungi love it

and flourish " This has received increasing scientific scrutiny and does

seem to be bearing out. But that doesn't mean that treating a person with

antibiotics and them getting worse means that the person had a fungal

infection; it just means that the person didn't have a bacterial infection

(or that the antibiotics killed the " bad " bacteria but also caused an

imbalance of the " good " bacteria and now the person is suffering from an

imbalance.). Research on " probiotics " is finally lending some credence to

my doctor's advice to eat a daily " active cultures " yogurt whenever I'm

taking antibiotics. Which Mom has been telling me to do for years anyway.

4. " Would antifungals and antitoxins (new word) also kill MVOC's? " No.

MVOCs are gases, not living things that can be " killed. " It's not correct,

as Dr. Wei's posting explained, to use " MVOCs " interchangeably with

" mycotoxins. " In fact, most mycotoxins are toxic only by ingestion or

occasionally from very high exposures to spores.

As far as " anti-toxins " - there may be antidotes to mycotoxins (I'm not an

MD, that's beyond me -- but try looking up a common mycotoxin such as

aflatoxin and see what the treatment for overexposure is) if you've

ingested/inhaled a toxic dose. But I don't think that's what you are

asking. I think you are asking, is there a chemical or process that will

" get rid of " mycotoxins. And the answer there is, probably not; but why

would you want to get rid of the mycotoxins and not get rid of the mold,

anyway? The dead mold is still going to cause allergic symptoms in

susceptible people, it doesn't have to be alive to do that. And allergic

symptoms are by far the most common health issue associated with mold. You

don't have to be immunecompromised to feel awful from allergies (fatigue,

nausea, aches & pains, fever, headache, mucous membrane irritation, asthma,

cough, wheeze, tight chest, itchy, irritable... Can you tell I suffer from

allergies?!).

5. Finally you asked about health effects of mVOCs. Headaches and eye

irritation are the most common health effects. I'm not aware of any serious

health effects, just transient ones (i.e. they disappear as soon as one is

removed from the source). As far as citations, here are a few.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_ui

ds=10501152 & dopt=Abstract (sensory irritation study. Concludes that " the

contribution of MVOCs to [sensory irritation] seems less than previously

supposed. "

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_ui

ds=11975648 & dopt=Abstract (MVOCs from aspergillus. You could then look up

the MVOCs to find out their health effects).

http://www.epa.gov/mold/append_b.html (Go to " mVOCs " . Lists " reported

symptoms " as headaches, nasal irritation, dizziness, fatigue, and nausea (I

can personally attest to nausea, so much that I finally threw out 48 boxes

of work files and books that, while not moldy themselves, had absorbed the

moldy odor from being stored in a moldy basement!))

http://www.acoem.org/guidelines/article.asp?ID=52 (includes interesting

dosage estimates for illness caused by stachybotrys spores & mycotoxin)

6. Finally, you cited http://wordnet.com.au/Products/infectious_diseases.htm

as a main reference for the mycotic diseases you described. This document

lists no author, no sponsor, nor any publishing body (other than " wordnet "

which describes itself as a site that will write & publish any kind of

document a person wants). This makes me rather suspicious that it is one of

the " cut and paste " jobs (from public-source material) done by an internet

" publisher " to create " original material " they can then sell (the

original-source material is usually publicly available for free). If I'm

wrong, please let me know. But if I'm right, everything in it is suspect

because lord knows what's been muddled together. You would be better served

to compile your own information from reliable sources. Once good place to

start is www.doctorfungus.org.

I apologize for the long response, but felt that you were still struggling

with your questions and I had the rare opportunity to compose a reply today.

Hopefully this response has been useful.

Best wishes,

-mmc

CAVEAT - THE ABOVE RESPONSE IS MINE ALONE AND IS NOT INTENDED TO REPRESENT

THE VIEWS OF ANYONE TO WHOM I AM EMPLOYED OR ANY ORGANIZATION TO WHICH I

BELONG. (yada yada yada).

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M. Cavanaugh, CIH

Industrial Hygiene Office

Appalachian State University, Boone NC 28608-2140

" They're funny things, accidents... You never have them, 'til you're having

them. " - Eeyore.

.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I am sorry you are frustrated. I am asking one simple question to which I

have received NO answer.

Can you point me to any information where the ill health effects from

mVOC's

are described?

I have been trying to better understand this aspect. Dr. Tang's writing

was

excellent and I learned much from it. However I have not seen the ill

health effects of mVOC's written anywhere. And I have been looking for that

info.

You say look at the EPA. I did. Where do I look?

And I am not doing a word play. I am of the opinion that mold toxins and

mycotoxins are the same thing. That is correct, isn't it?

What are the known ill health effects from mVOC's? Just tell me where to

find this info and I will quit asking.

Sharon

FAIR USE NOTICE:

This site contains copyrighted material the use of which has not always been

specifically authorized by the copyright owner. We are making such material

available in our efforts to advance understanding of environmental,

political, human rights, economic, democracy, scientific, and social justice

issues, etc. We believe this constitutes a 'fair use' of any such

copyrighted material as provided for in section 107 of the US Copyright Law.

In accordance with Title 17 U.S.C. Section 107, the material on this site is

distributed without profit to those who have expressed a prior interest in

receiving the included information for research and educational purposes.

For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml.

If you wish to use copyrighted material from this site for purposes of your

own that go beyond 'fair use', you must obtain permission from the copyright

owner.

March 6, 2006

:

Very good. Your response on MVOCs should be saved and posted for other

chemistry-challenged folks that may visit this site. Kudos to you.

--

Geyer, PE, CIH, CSP

President

KENTEC Industries, Inc.

Bakersfield, California

www.kerntecindustries.com

> Sharon,

>

> MVOCs are Microbial (M) Volatile Organic Compounds (VOCs). There have been

> several good explanations of that already but they still assumed a fairly

> high level of chemistry background, which from your writings it appears you

> may not have, so hopefully I can clarify a bit in less technical terms.

>

> The " V " in means the chemical is volatile. " Volatile " means that at normal

> room pressure and temperature, it is a gas with a certain chemical

> qualities. One quality is that, when they were liquids, they evaporated

> quickly. For example rubbing alcohol, though you buy it at the store as a

> liquid, evaporates quickly into the air if you leave the bottle open because

> it is a VOC.

>

> The " O " means " Organic. " Unlike what nonchemists think when they hear this

> word, being " organic " in this sense has nothing to do with pesticide use!

> Here, " organic " means that it contains at least one carbon atom. It's a

> chemist's term because carbon is the " building block of life. "

>

> And " C " is for " compound " , simply meaning it contains one or more molecules.

>

> Thus MVOCs are gases emitted from microbes. In our discussion, fungi are

> the microbes of interest so I'll confine further comments to MVOCs from

> fungi.

>

> You posed several questions and made several statements to which I will

> attempt to respond:

>

> 1. " It is well documented that molds can elicit these symptoms. (HP -

> farmers, ABPA, CFS) " While true that mold can cause hypersensitivity

> pneumonitis (HP), exposure needs to be in the millions or more of spores/m3

> to cause these illnesses. Considering " contaminated " homes are often only

> in the hundreds to low thousands of spores/m3 (not including flooded homes

> here), you can see why there is skepticism in scientific circles that so

> many people are becoming seriously ill from modestly elevated levels of mold

> in their homes.

>

> Allergic Bronchopulmonary Aspergillosis (ABPA), on the other hand, is only a

> concern for people with serious immune compromisation or lung impairment

> illness. Patients with such disorders, especially cystic fibrosis, do not

> have to be exposed to " high " level of aspergillis (e.g. a moldy house) to

> develop this problem.

>

> Finally, if by " well documented " you mean oft-repeated, then I would agree

> with you about a connection between Chronic Fatigue Syndrome and mold.

> However, I'm not aware of any scientific data linking mold exposure to CFS,

> though there are certainly hundreds of websites claiming such an association

> (most of which seem also to be selling vitamins or lawsuit services to

> " cure " the problem). But I tend to be suspicious of any sources of

> information that mix scientific jargon with sales pitches.

>

> 2. " People become better when treated with antifungals and/or mycotoxin

> eliminating measures. " First of all, I assume you mean " mold eliminating

> measures " rather than " mycotoxin eliminating measures. " I don't know why

> anyone would want to try to get rid of the mycotoxins and not get rid of the

> spores, glucans, etc that cause allergic response as well (assuming it were

> even possible to do so).

>

> Becoming well when treated with something that a person believes will make

> them well is not " proof " that someone was sick from the presumed causative

> factor (e.g. mold). If that were true, then bloodletting and leeches would

> still be popular medical interventions. For example, people often get

> better after taking antibiotics for what they believed was a sinus

> infection, when in fact it was a cold that would have gotten better on its

> own in about the same number of days. But they get better after the

> antibiotics so think that was " proof " they had the sinus infection.

>

> Furthermore, recent studies have proven that the " placebo effect " is not a

> temporary effect that is in someone's head -- it can literally heal. So I

> by no means am implying that people who have gotten better were imagining

> their illness. Just that mold may or may not have had much to do with it.

> There is still much we don't know.

>

> That's not to say they aren't becoming ill from something, or that some sort

> of hypersensitivity reaction has happened, or that somehow molds living on

> modern-day substrates made of glues and polymers are somehow more irritating

> than molds grown in the lab and used in most studies (because we do know

> that molds emit different MVOCs and mycotoxins depending on their " food " ).

> There is still much work to be done.

>

> 3. " Antibiotics sometimes actually increase the symptoms of illness -

> because when one kills bacteria that keep fungi in check, the fungi love it

> and flourish " This has received increasing scientific scrutiny and does

> seem to be bearing out. But that doesn't mean that treating a person with

> antibiotics and them getting worse means that the person had a fungal

> infection; it just means that the person didn't have a bacterial infection

> (or that the antibiotics killed the " bad " bacteria but also caused an

> imbalance of the " good " bacteria and now the person is suffering from an

> imbalance.). Research on " probiotics " is finally lending some credence to

> my doctor's advice to eat a daily " active cultures " yogurt whenever I'm

> taking antibiotics. Which Mom has been telling me to do for years anyway.

>

> 4. " Would antifungals and antitoxins (new word) also kill MVOC's? " No.

> MVOCs are gases, not living things that can be " killed. " It's not correct,

> as Dr. Wei's posting explained, to use " MVOCs " interchangeably with

> " mycotoxins. " In fact, most mycotoxins are toxic only by ingestion or

> occasionally from very high exposures to spores.

>

> As far as " anti-toxins " - there may be antidotes to mycotoxins (I'm not an

> MD, that's beyond me -- but try looking up a common mycotoxin such as

> aflatoxin and see what the treatment for overexposure is) if you've

> ingested/inhaled a toxic dose. But I don't think that's what you are

> asking. I think you are asking, is there a chemical or process that will

> " get rid of " mycotoxins. And the answer there is, probably not; but why

> would you want to get rid of the mycotoxins and not get rid of the mold,

> anyway? The dead mold is still going to cause allergic symptoms in

> susceptible people, it doesn't have to be alive to do that. And allergic

> symptoms are by far the most common health issue associated with mold. You

> don't have to be immunecompromised to feel awful from allergies (fatigue,

> nausea, aches & pains, fever, headache, mucous membrane irritation, asthma,

> cough, wheeze, tight chest, itchy, irritable... Can you tell I suffer from

> allergies?!).

>

> 5. Finally you asked about health effects of mVOCs. Headaches and eye

> irritation are the most common health effects. I'm not aware of any serious

> health effects, just transient ones (i.e. they disappear as soon as one is

> removed from the source). As far as citations, here are a few.

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_ui

> ds=10501152 & dopt=Abstract (sensory irritation study. Concludes that " the

> contribution of MVOCs to [sensory irritation] seems less than previously

> supposed. "

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_ui

> ds=11975648 & dopt=Abstract (MVOCs from aspergillus. You could then look up

> the MVOCs to find out their health effects).

>

> http://www.epa.gov/mold/append_b.html (Go to " mVOCs " . Lists " reported

> symptoms " as headaches, nasal irritation, dizziness, fatigue, and nausea (I

> can personally attest to nausea, so much that I finally threw out 48 boxes

> of work files and books that, while not moldy themselves, had absorbed the

> moldy odor from being stored in a moldy basement!))

>

> http://www.acoem.org/guidelines/article.asp?ID=52 (includes interesting

> dosage estimates for illness caused by stachybotrys spores & mycotoxin)

>

> 6. Finally, you cited http://wordnet.com.au/Products/infectious_diseases.htm

> as a main reference for the mycotic diseases you described. This document

> lists no author, no sponsor, nor any publishing body (other than " wordnet "

> which describes itself as a site that will write & publish any kind of

> document a person wants). This makes me rather suspicious that it is one of

> the " cut and paste " jobs (from public-source material) done by an internet

> " publisher " to create " original material " they can then sell (the

> original-source material is usually publicly available for free). If I'm

> wrong, please let me know. But if I'm right, everything in it is suspect

> because lord knows what's been muddled together. You would be better served

> to compile your own information from reliable sources. Once good place to

> start is www.doctorfungus.org.

>

> I apologize for the long response, but felt that you were still struggling

> with your questions and I had the rare opportunity to compose a reply today.

> Hopefully this response has been useful.

>

> Best wishes,

> -mmc

>

> CAVEAT - THE ABOVE RESPONSE IS MINE ALONE AND IS NOT INTENDED TO REPRESENT

> THE VIEWS OF ANYONE TO WHOM I AM EMPLOYED OR ANY ORGANIZATION TO WHICH I

> BELONG. (yada yada yada).

>

> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

> M. Cavanaugh, CIH

> Industrial Hygiene Office

> Appalachian State University, Boone NC 28608-2140

>

> " They're funny things, accidents... You never have them, 'til you're having

> them. " - Eeyore.

> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

>

> I am sorry you are frustrated. I am asking one simple question to which I

> have received NO answer.

>

> Can you point me to any information where the ill health effects from

> mVOC's

> are described?

>

> I have been trying to better understand this aspect. Dr. Tang's writing

> was

> excellent and I learned much from it. However I have not seen the ill

> health effects of mVOC's written anywhere. And I have been looking for that

> info.

> You say look at the EPA. I did. Where do I look?

>

> And I am not doing a word play. I am of the opinion that mold toxins and

> mycotoxins are the same thing. That is correct, isn't it?

>

> What are the known ill health effects from mVOC's? Just tell me where to

> find this info and I will quit asking.

>

> Sharon

>

> FAIR USE NOTICE:

>

> This site contains copyrighted material the use of which has not always been

> specifically authorized by the copyright owner. We are making such material

> available in our efforts to advance understanding of environmental, political,

> human rights, economic, democracy, scientific, and social justice issues, etc.

> We believe this constitutes a 'fair use' of any such copyrighted material as

> provided for in section 107 of the US Copyright Law. In accordance with Title

> 17 U.S.C. Section 107, the material on this site is distributed without profit

> to those who have expressed a prior interest in receiving the included

> information for research and educational purposes. For more information go to:

> http://www.law.cornell.edu/uscode/17/107.shtml. If you wish to use copyrighted

> material from this site for purposes of your own that go beyond 'fair use',

> you must obtain permission from the copyright owner.

>

March 6, 2006

Cholestyramine helped me tremendously in my mold situation, however,

it just deals with mycotoxins in enterohepatic circulation, not the

new exposure. So I still get ill, my eyes burn, I get headaches,

swollen joints, burning skin, etc. but the buildup is not happening

(but it comes back as soon - in six or eight hours, if I forget)

unless I stop taking CSM.

Yes, i do need to get out of my moldy apartment, I'm packing...

But cholestyramine has been a godsend..

I trust my own experience..

March 7, 2006

From Jim H. white

ref detailed response by:

M. Cavanaugh, CIHIndustrial Hygiene OfficeAppalachian State University, Boone NC 28608-2140

That was an 'excellent' response, (can't you just hear the next word?) but;

Mycotoxins are often found in ALL of the fungal debris from mold materials, especially disintegrating dead colonies and not just on and in spores. For some molds they may be very concentrated in the fragments of the mycelia that just love to float around (as an aerodynamicist by partial training I am intrigued by the ability of segments of the mycelia to 'fly' around for ages) and we are likely exposed to way more toxin in mold debris than from spores as such. That is why so many sampling methods can seriously underestimate the amount of exposure we get, something that explains the failure of all sampling methods used in the Wallaceburg studies to correlate with real health effects.

There is so much more to do in mold and health, but if we rely on air sampling of viable spores as any sort of measure of exposure we will likely never get good correlations.

March 7, 2006

Livesimply (What is your real name by the way?) -

I'm glad that you brought up Cholestyramine. I've been doing some research

to try and understand how it " works " for people with the mold connection. I

know Dr. Shoemaker is a huge proponent, and I actually have a couple of

clients right now who are taking it, but can't " wrap my head around, " if you

will, how it " works " and what exactly it (may) or may not do...

My best friend is a nutritionist, and she's been delving into researching it

with me, so that she can explain to me in " layman's terms " things that are

out of my grasp.

I understand that it is generally prescribed as a medication to lower

cholesterol. The brand name being " Questran. " From the info which I've

read, many of the possible side effects of this drug mimic those which are

often described and felt in " sick buildings. "

Can you, Carl G., , Sharon, etc. try o help explain to me how this drug

has seemed to help so many mold victims? (I am being genuinely sincere with

this question, without the lack of a " face-to-face. " ) I do understand that

many drugs out there have the ability to help other conditions which they

were not originally made for, so I'm open to the possibility, but would like

to know " why " it works, and " how " it works... I am also concerned (as is my

best friend) that this drug has the ability to decrease certain vitamin

absorption rates, which could be bad for people with already weakened immune

systems, as well as some of the other side effects...

Best,

Stacey Champion

Here is some info on the drug:

Why is this drug prescribed?

Return to top

Questran is used to lower cholesterol levels in the blood of people with

primary hypercholesterolemia (too much LDL cholesterol).

Hypercholesterolemia is a genetic condition characterized by a lack of the

LDL receptors that remove cholesterol from the bloodstream.

This drug can be used to lower cholesterol levels in people who also have

hypertriglyceridemia, a condition in which an excess of fat is stored in the

body.

This drug may also be prescribed to relieve itching associated with

gallbladder obstruction.

It is available in two forms: Questran and Questran Light. The same

instructions apply to both.

----------------------------------------------------------------------------

----

Most important fact about this drug

Return to top

It's important to remember that Questran is a supplement to--not a

substitute for--diet, exercise, and weight loss. To get the full benefit of

the medication, you need to stick to the diet and exercise program

prescribed by your doctor. All these efforts to keep your cholesterol levels

normal are important because together they may lower your risk of heart

disease.

----------------------------------------------------------------------------

----

How should you take this medication?

Return to top

Never take Questran in its dry form. Always mix it with water or other

liquids before taking it. For Questran, use 2 to 6 ounces of liquid per

packet or level scoopful; for Questran Light, use 2 to 3 ounces. Soups or

fruits with a high moisture content, such as applesauce or crushed

pineapple, can be used in place of beverages.

--If you miss a dose...

Take the forgotten dose as soon as you remember. If it is almost time for

the next dose, skip the one you missed and go back to your regular schedule.

Never try to " catch up " by doubling the dose.

--Storage instructions...

Store at room temperature. Protect from moisture and high humidity.

----------------------------------------------------------------------------

----

What side effects may occur?

Return to top

Side effects cannot be anticipated. If any develop or change in intensity,

inform your doctor as soon as possible. Only your doctor can determine if it

is safe for you to continue taking Questran.

The most common side effect of Questran is constipation.

Less common or rare side effects may include:

Abdominal discomfort, anemia, anxiety, arthritis, asthma, backache,

belching, black stools, bleeding around the teeth, blood in the urine,

brittle bones, burnt odor to urine, dental cavities, diarrhea, difficulty

swallowing, dizziness, drowsiness, fainting, fatigue, fluid retention, gas,

headache, heartburn, hiccups, hives, increased sex drive, increased tendency

to bleed due to vitamin K deficiency, inflammation of the eye, inflammation

of the pancreas, irritation around the anal area, irritation of the skin and

tongue, joint pain, lack or loss of appetite, muscle pain, nausea, night

blindness due to vitamin A deficiency, painful or difficult urination, rash,

rectal bleeding and/or pain, ringing in the ears, shortness of breath, sour

taste, swollen glands, tingling sensation, ulcer attack, vertigo, vitamin D

deficiency, vomiting, weight gain or loss, wheezing

----------------------------------------------------------------------------

----

Why should this drug not be prescribed?

Return to top

If you are sensitive to or have ever had an allergic reaction to Questran or

similar drugs such as Colestid, you should not take this medication. Make

sure that your doctor is aware of any drug reactions that you have

experienced.

Unless you are directed to do so by your doctor, do not take this medication

if you are being treated for gallbladder obstruction.

----------------------------------------------------------------------------

----

Special warnings about this medication

Return to top

If you have phenylketonuria, a genetic disorder, check with your doctor

before taking Questran Light because this product contains phenylalanine.

If you are being treated for any disease that contributes to increased blood

cholesterol, such as hypothyroidism (reduced thyroid function), diabetes,

nephrotic syndrome (kidney and blood vessel disorder), dysproteinemia,

obstructive liver disease, or alcoholism, or if you are taking any drugs

that may raise cholesterol levels, consult your doctor before taking this

medication. Caution is also in order if your kidney function is poor.

Questran should begin to reduce cholesterol levels during the first month of

therapy. If adequate reduction of cholesterol is not obtained, your doctor

may increase the dosage or add other cholesterol-lowering drugs. Therefore,

it is important that your doctor check your progress regularly.

Questran does not cure the tendency to have high cholesterol levels; it

merely helps control it. To maintain healthy levels, you therefore must

continue taking the drug as directed.

The use of this medication may produce or worsen constipation and aggravate

hemorrhoids. If this happens, inform your doctor. To prevent constipation,

the doctor may increase your dosage very slowly, and ask you to drink more

fluids, take more fiber, or take a stool softener. If severe constipation

develops anyway, the doctor may switch to a different drug.

The prolonged use of Questran may change acidity in the bloodstream,

especially in younger and smaller individuals in whom the doses are

relatively higher. Again, it is important that you or your child be checked

by your doctor on a regular basis.

Sipping Questran or holding it in your mouth for a long period can lead to

tooth discoloration, enamel erosion, or decay. Be sure to brush and floss

regularly.

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Possible food and drug interactions when taking this medication

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If Questran is taken with certain other drugs, the effects of either could

be increased, decreased, or altered. It is especially important to check

with your doctor before taking Questran with the following:

Digitalis (Lanoxin, Crystodigin)

Estrogens and progestins (hormones)

Oral diabetes drugs such as DiaBeta and Diabinese

Penicillin G (Pentids, others)

Phenobarbital

Phenylbutazone (Butazolidin)

Propranolol (Inderal)

Spironolactone (Aldactazide, Aldactone)

Tetracycline (Achromycin V)

Thiazide-type water pills such as Diuril

Thyroid medication such as Synthroid

Warfarin (Coumadin)

Your doctor may recommend that you take other medications at least 1 hour

before or 4 to 6 hours after you take Questran.

If you are taking a drug such as digitalis (Lanoxin), stopping Questran

could be hazardous, since you might experience exaggerated effects of the

other drug. Consult your doctor before discontinuing Questran.

This drug may interfere with normal digestion and absorption of fats,

including fat-soluble vitamins such as A, D, E, and K. If supplements of

vitamins A, D, E, and K are essential to your health, your doctor may

prescribe an alternative form of these vitamins.

There are no special considerations regarding alcohol use with this

medication.

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Special information if you are pregnant or breastfeeding

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The effects of Questran during pregnancy have not been adequately studied.

If you are pregnant or plan to become pregnant, inform your doctor

immediately. Because this medication can interfere with vitamin absorption,

you may need to increase your vitamin intake before the baby is born and

while nursing an infant.

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Recommended dosage

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ADULTS

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The recommended starting dose is 1 single-dose packet or 1 level scoopful, 1

to 2 times daily. The usual maintenance dosage is a total of 2 to 4 packets

or scoopfuls daily divided into 2 doses preferably at mealtime (usually

before meals). The maximum daily dose is 6 packets or scoopfuls. Although

the recommended dosing schedule is 2 times daily, your doctor may ask you to

take Questran in up to 6 smaller doses per day.

CHILDREN

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Experience with the use of Questran in infants and children is limited. If

this medication is essential to your child's health, follow your doctor's

recommended dosing schedule.

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Overdosage

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No ill effects from an overdose have been reported. The main potential harm

of an overdose would be obstruction of the stomach and intestines. If you

suspect an overdose, seek medical attention immediately.

Re: MVOCs & Mycotoxins (for Sharon)