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Originally published Sunday, January 19, 2014 at 5:31 AM

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Mail-order medicines vulnerable to freezing or high heat

People’s Pharmacy on mail-order medicines and temperature extremes; the connection between Ambien and stomach problems; and germs on coffee-cup lids.

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Q: How safe are mail-order drugs after sitting in a metal mailbox during summer heat or winter cold? I take lisinopril for high blood pressure and pravastatin to lower cholesterol.

A: You have asked a question that is uncomfortable for many mail-order pharmacies. That’s because they have no way to protect medicines from temperature extremes during shipment.

Lisinopril is supposed to be stored “at controlled room temperature (68-77 degrees F)” and protected “from moisture, freezing and excessive heat.” Pravastatin comes with instructions to “store at 77 degrees F; excursions permitted to 59-86 degrees F.”

During the recent cold snap, many medications were doubtless frozen in unheated delivery vehicles and while sitting in mailboxes.

Liquid medicine is especially vulnerable to freezing or high heat. One reader wrote that a delivery of insulin was left on a porch for hours. She checked with the mail-order pharmacy, which told her that the drug was probably fine. Despite the reassurance, she could not get her blood sugar under control for two months. She became lethargic and confused until the doctor gave her an injection of insulin in the office. Her medication seems to have been affected by the exposure.

Q: Doctors believe Ambien is a relatively benign sleeping pill, but it wreaked havoc with my stomach. The bloating was the worst, followed closely by the acid reflux and extreme eructation (burping beyond belief).

It has been three years since I quit Ambien. I felt better almost immediately.

To sleep, I use melatonin, a regular 15-minute cool-down yoga routine and a cup of herbal tea before bedtime. I also have learned to quiet my mind if I start worrying that I will not get to sleep by reassuring myself that I WILL sleep eventually.

A: Thank you for sharing your experience. More than 100 visitors to our website have reported similar problems. Research reveals a connection between the use of zolpidem (Ambien) and reflux-related GI damage (Clinical Gastroenterology and Hepatology, September 2009).

Your nondrug approaches to insomnia sound sensible. A cup of fennel tea might be useful against both sleeplessness and indigestion.

Q: Are others concerned like I am when a barista touches the top of my coffee cup? When this happened recently, I complained and walked away in frustration. I’m not trying to be difficult, but I don’t want anyone else’s cold, flu or whatever.

A: We share your concern. In some cases, the same person who takes your money fills the coffee cup and then seals the lid. One reader offered the following solution: “When a server at any restaurant handles my food and my money, I ask him to please put on gloves and then handle my food — the reordered food, that is.”

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 300 W. 57th St., 15th floor, New York, NY 10019, or via their

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