GRAEDONS | People's Pharmacy Iron or zinc deficiency can cause ice cravings

Q. About five months ago, I started craving ice. I think the condition is called pica, but I don't know what it means. Before this, I would always order my drinks with no ice, and I couldn't stand drinks if they were too cold. I objected to the sound of anyone chewing ice. But now that person is me.
I started taking Centrum Silver in October, thinking I was lacking something in my diet. I've been taking Protonix daily for the past three years. Please help.
A. Pica is the name doctors use when people eat things that are not considered food. Examples include clay, baking soda, laundry starch or ice. Despite this technical definition, we have also heard from readers with abnormal cravings for popcorn, carrots, orange peels or tomatoes.
Although the cause is not well understood, pica is frequently associated with an iron or zinc deficiency. It was perceptive of you to suspect something lacking in your diet. The multivitamin you selected, however, contains no iron.
Your low iron levels might be linked to the acid-suppressing drug you are taking. Stomach acid is essential for the absorption of certain nutrients, including iron and vitamin B-12. Medications such as Prilosec, Protonix, Aciphex, Prevacid or Nexium might make it harder to get adequate amounts from food. Ask your doctor whether an iron supplement might be helpful.
Q. Viagra gives me headaches that interfere with lovemaking. Would Cialis be better?
A. All three drugs for erectile dysfunction (Viagra, Cialis and Levitra) can cause headaches. A lower dose might be less likely to cause problems, but if that doesn't help, ask your doctor about alternative approaches. Caverject (alprostadil) injected into the penis is less likely to cause headaches.
Q. My wife and I both have cholesterol issues. I take Lipitor, and she's on Crestor. In the winter, we always have grapefruit for breakfast.
I work out nearly every day. Soon after starting Lipitor, my arm muscles became sore. I continued to work out and didn't think much of it. I just lightened the weights that I use for the bicep exercises.
A few weeks later, the muscles around my knee began to ache. Now my lower back also hurts. The doctor said that muscle pain from Lipitor is rare, but I wonder whether the grapefruit is part of the problem. If so, why hasn't my wife had trouble?
A. Your symptoms might be related to a higher dose of Lipitor brought on by an interaction with grapefruit. Crestor is not affected.
Grapefruit can raise blood levels of dozens of different medicines and increase the possibility of side effects. The grapefruit effect can last up to 48 hours, so drinking grapefruit juice in the morning and taking medicine at night doesn't solve the problem.
For more details, we are sending you our Guides to Grapefruit Interactions and Cholesterol-Lowering Drugs.
Q. How valid are expiration dates on prescription drugs? I had trouble sleeping the other night and found some Ambien that "expired" in 2005. It worked just fine.
A. Most prescriptions carry an expiration date one year after the date they were dispensed. This has little bearing on whether the pills still work.
XIn their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or e-mail them via their Web site: www.PeoplesPharmacy.com.
& copy; 2006, King Features Syndicate Inc.