You have been diagnosed with allergic rhinitis. Your doctor has prescribed a Relevium Synergy product for your condition. Be sure to take your time and read everything below. It is essential for you to understand the potential risks and benefits of treatment. Please do not hesitate to reach out to our medical support team if you have ANY questions. The following represents a plan that details how you can improve your allergies and optimize your allergic response. This medication works for the vast majority of patients and it usually does so without causing side effects—and that’s great. However, if a trusting relationship is to work, then it must be open, meaning that we must share more than how everything can go according to plan. Sometimes, the plan doesn’t work. It is part of the reality that no drug is a magic bullet. And, just as no drug works on everyone, no drug is 100% safe. It is important that you learn as much as you can about your treatment. The more you read, the more questions will be answered and the better the plan can work.
Telemedicine has the advantage of convenience, but it relies on your honesty and involvement in the process. That includes reading everything below carefully (including the package insert, now online, and when it arrives in print with your medication), and communicating with your doctor. If your health should change, should you have a side effect, should the medicine not work or stop working with time, please contact us. Keep EVERY healthcare provider informed. We are here for you. You’ve taken a big step and you are not alone. Read, learn, and ask us questions. We have done the legwork and put together information so you can do it right. First, you read your plan, which is followed by information about allergies. Lastly, read the detailed information about the medication prescribed by your doctor. Read it all, and read the package insert and the official prescribers’ digital reference (PDR). Being fully informed is the only way for you to know if this plan suits your needs and if you want to accept it as presented. You may reject it or you may want to request a modification to the plan. Please, do not hesitate to make your voice heard. Contact us with any questions. We want the best for you and the only way to do that is if you are fully informed and if we work as a team.
The prescription medicine we are giving you to help with your allergy issues is a compounded formula with multiple ingredients called Relevium. There are different versions of Relevium, depending on your need: original Relevium which contains non-drowsy antihistamines, Relevium AM which contains a nasal decongestant that may cause excitatory side effects in some individuals, and Relevium PM which contains older antihistamines that may cause drowsiness. The most effective combination is using the AM formula in the morning combined with the PM formula in the evening. The usual effective dose of Relevium is 2 capsules by mouth daily for regular Relevium or one AM and one PM tablet for the split dose. . When starting Relevium, it may take several days to notice a reduction in your allergies. It is typical to see maximum improvement within a few weeks of initiation. Contact your doctor if deciding to stop medicine and if tapering off the medicine is necessary. We’ve asked you about your medical history and the medicines you take to determine if it’s safe and appropriate to prescribe Relevium to you. Please try to read all the information below as well as the information that comes with the medicine itself. It contains important details about the risks of taking the medicine. Only by knowing the risks and alternatives can you make an informed decision about whether you want to accept our treatment plan. When starting Relevium, common side effects may include mild nausea or loose stools. Usually these symptoms will gradually improve over 2 weeks. These side effects can possibly occur if taking the medicine on a daily basis.
The ingredients of the Relevium formulas are as follows:
Acetylcysteine – a critical component in the formation of the antioxidant glutathione that decreases oxidative stress and reduces inflammation.
Cetirizine (Zyrtec) – a second generation antihistamine that provides relief from allergy symptoms such as sneezing, itching, watery eyes, and runny nose. It is related to hydroxyzine but confers less CNS side-effects. It also has inhibitory effects on infiltrating inflammatory cells, such as eosinophils and neutrophils.
Diphenhydramine (Benadryl) – Found exclusively in the Relevium PM formula, it is a classic antihistamine used to relieve symptoms of allergies and hay fever and provides sedation.
Doxepin – Found exclusively in the Relevium PM formula, low-dose doxepin prevents the activation of both histamine type 1 and type 2 receptors that results in antihistamine and sedative effects.
Fexofenadine (Allegra) – Found in Relevium and Relevium AM, this second generation antihistamine is available OTC and is used for the treatment of allergic rhinitis. It is less sedating than other antihistamines because it doesn’t cross the blood brain barrier as efficiently.
Nettle Leaf Extract – an herbal extract that reduces histamine receptor activity, stabilizes mast-cells by preventing degranulation, and reduces histamine release. The aqueous extract of nettle yields five polysaccharides and a mixture of lectins that show anti-inflammatory and immunostimulating abilities.
Phenylephrine – Found exclusively in the Relevium AM formula, this sympathomimetic decongestant is used to treat stuffy nose and sinus congestion caused by allergies and hay fever by constricting the blood vessels in the nasal passageway via postsynaptic alpha-receptor stimulation with little heart stimulation.
Pyridoxine – Vitamin B6 is a water soluble vitamin that serves as a cofactor in the production of DAO (diamine oxidase), an enzyme produced by our body that is essential in breaking down the histamine that is at the root of allergic reactions. It also serves as a cofactor in multiple metabolic functions affecting protein, carbohydrate, and lipid utilization.
Quercetin – a flavonol antioxidant with anti-inflammatory and immunomodulating properties that scavenges free-radicals, stabilizes mast-cells and reduces histamine release.
Vitamin C – a water-soluble antioxidant that reduces inflammation, prevents the secretion of histamine, and stimulates the immune system.
Vitamin D3 – cholecalciferol is a potent immunomodulatory hormone and a deficiency may contribute to development of allergic diseases, such as asthma and allergic rhinitis. D3 regulates the activity of certain white blood cells via down-regulation of co-stimulatory molecules, thereby leading to immune tolerance.
ADMINISTRATION Take two capsules by mouth daily as directed by your practitioner. Avoid drinking alcohol when taking this medicine and only take the medicine as prescribed. Marked drowsiness may occur; drowsiness may be substantially increased with concurrent use of alcohol, sedatives, and tranquilizers. Do not take medication with grapefruit or grapefruit juice. Be careful when driving a motor vehicle or operating machinery. Feel free to contact us any time by sending a secure message. We typically respond within 24 to 48 hours. Depending on your response to treatment, there may be a time we recommend that you see a doctor or allergist in person rather than using our service. This compound is not to be used for the reversal of bronchospasm in acute asthma attacks.
ADVERSE REACTIONS If any aspect of your health changes, please make sure to review the medicines you take with a professional.
COMMON SIDE EFFECTS
UNCOMMON/RARE SIDE EFFECTS Important warning signs of uncommon or rare side effects are listed below. Pay close attention to any of the side effects in the list below and send us a message if any occur.
- Symptoms don’t improve in 7 days
EMERGENT SIDE EFFECTS Important warning signs of these severe side effects are listed below. If you have any of the dangerous side effects in the list below, please seek immediate medical attention. Stop taking the medicine because these symptoms may be caused by an allergic reaction or they represent an unusual but severe reaction to the medicine. Once you’ve received medical attention, please let us know by sending us a message.
- Very severe headache
- Severe skin rash such as blistered and peeling skin
- Shortness of breath or wheezing
- Swelling in your face, lips, tongue, or throat
CAUTION WITH PREEXISTING MEDICAL CONDITIONS Please contact us if you have any of the following conditions so that we may properly assess your medical needs:
- Renal Disease
- Liver Disease
- Pregnant or Lactating
- High blood pressure
- Heart disease
- Thyroid disease
- Trouble urinating due to an enlarged prostate gland
- Respiratory disease
ALLERGIES Send us a message and don’t take this medicine if you have any of the following allergies: acetylcysteine, cholecalciferol, doxepin, cetirizine, hydroxyzine, diphenhydramine, fexofenadine, nettle, phenylephrine, pyridoxine, quercetin, vitamin C, or gelatin.
MEDICATIONS THAT MAY INTERACT It’s important to tell your doctor and pharmacist that you’ve started taking Relevium. It can affect other medicines you’re taking. You can download the information about all your visits from the app or website for your own records and to share with your doctor. Please discuss this medication with your doctors because, while rare, the following drug interactions may apply to you. Be sure to talk with a doctor before starting any new medicines that might interfere with your current ones. Send us a message and let us know if you’re taking any of the following medicines:
- MAOI (monoamine oxidase inhibitor) within last 2 weeks
Improving Your Overall Health There are things that you must do to improve your health including eating healthier foods, stopping smoking if you smoke, reducing alcohol consumption, and exercising regularly. If you have health problems such as high blood pressure, cholesterol or diabetes, it’s also important to make sure they’re under good control. At a minimum, check your blood pressure once a year. It should be less than 140/90 and ideally under 120/80. Patients aged 40 or older should have a fasting blood sugar test to screen for diabetes. The decongestant in AM Relevium can increase blood pressure and should be avoided in patients with high blood pressure.
ALTERNATIVE TREATMENT OPTIONS There are alternative treatments to the medicine we’ve prescribed, including other prescription medicines and immunotherapy. You always have the option of declining our recommended treatment. If you are a regular allergy sufferer and medication has failed to provide relief, speak with your doctor about allergy shots, which may help you to develop a tolerance of certain allergens. You can take steps to protect yourself during allergy season by reducing your exposure to pollen. The first step is to closely monitor your environment. Check daily pollen counts and sign up for alerts at www.pollen.com and the allergy tracker at www.weather.com. Close your windows to keep out pollen, and turn on the air conditioner to help eliminate it from the indoor air. Also, exercise in the late afternoon or early evening when pollen count is often lower. And when you are stuck outside when the pollen count is high, wear a surgical mask. A humidifier or steam inhalation (as during a hot shower), Keeping well-hydrated (to keep the mucus thinner), Sleep on propped up pillows, to keep the mucus from collecting at the back of your throat, Nasal irrigation (available over-the-counter).
RISK OF MISDIAGNOSIS We rely on symptoms and your answers to our health questions to diagnose you with an allergic disorder. It’s possible that we may diagnose and treat you for an allergic disorder even though you don’t have it, and that another condition is present that the medicine we prescribed won’t treat. It’s also possible that other potential physical causes of allergies would be identified and investigated further if you were to see a doctor in person. As a result, you may end up taking this medicine unnecessarily and take on the risk of side effects from this medicine without any clear benefit. We try to minimize this risk by using the latest medical guidelines and evidence to determine when it’s appropriate to treat you. If you’re having serious side effects, you should see a doctor in person and keep us informed.
RISK THAT THE MEDICINE WON’T WORK Prescription medicines used to help with allergies may not work effectively if there are other prescription medicines you’re taking, or you have medical conditions that interfere with their ability to be effective. It’s very important that you answer our health questions accurately because the questions we asked you helped us identify pertinent health conditions and the appropriate medicine. If your symptoms aren’t improving with the medicine, or seem to be changing or worsening, you should stop taking the medicine we’ve prescribed and send us a message. If you’re having serious side effects, you should see a doctor in person and keep us informed of your progress.
The biggest culprits for spring and summer allergies are tree, grass, and ragweed pollen. When you inhale pollen, your immune system generates antibodies called immunoglobulin E (IgE) that trigger mast cells to release chemicals called mediators, such as histamine, leukotrienes, and prostaglandins. These eventually spread to different tissues like the eyes, nose, throat, and lungs. With high pollen exposure, the immune system can go haywire and flood the body with mediators. The result is often hallmark allergy symptoms, such as runny and itchy nose, nasal congestion, sneezing, watery and itchy eyes, itchy throat, coughing, and wheezing. These symptoms may vary in severity and length, depending on your specific sensitivity to certain pollen and the amount of exposure. “It’s also dictated by how much IgE your body produces and how many tissues are affected,” says Dr. Castells. This is why some people experience allergies only during the spring or summer, and why people may fight symptoms for several days or weeks or the entire season.
Stress and allergies
Feeling stressed for any reason can also affect allergies. One effect is psychological. Stress amplifies our emotional reaction to any symptoms we are having. The other effect of stress on allergies is physical. In other words, if you’re feeling stressed for any reason, you may find yourself dealing with worse allergy symptoms than usual.
Why is stress so physical?
The stress response is the body’s way of keeping us safe. When the brain senses danger, it alerts the adrenal glands to release stress hormones. That causes your heart to pound, blood pressure to rise, and blood vessels to constrict to send more blood to your brain and muscles. Stress makes your breath quicken to get oxygen to your muscles, and sends fat and sugar into the bloodstream to boost your energy. The stress response is helpful in the short term; it enables you to get through a difficult situation. But if you trigger the stress response repeatedly, then over time it can contribute to depression, anxiety, high blood pressure, diabetes, heart disease, heartburn, and many other health problems—including worse allergies. Alcohol Wine elicits a histamine response that increases allergy symptoms.
Stress reduction tips
You can reduce stress with exercise — the kind that gets your heart and lungs pumping — and by eliciting the relaxation response, a well-studied physiological change that can help lower your blood pressure, heart rate, breathing rate, oxygen consumption, adrenaline levels, and levels of the stress hormone cortisol. There are many ways to elicit the relaxation response, such as meditation, guided imagery, yoga, tai chi, and deep breathing exercises.