Discontinued them as they caused nose bleeds. Nasal steroid spray use may have a small impact on a childs vertical growth. It used to be available by prescription only, but certain strengths of the medication are now also available over the counter (OTC). Some nasal steroids, however, such as budesonide (Rhinocort) and triamcinolone (Nasacort), are absorbed to a more significant extent. (2018). A new study illustrated that early azelastine nasal spray therapy might lower the SARS-CoV-2 load among virus-infected patients. Astelin- azelastine hydrochloride spray, metered. To provide you with the most relevant and helpful information, and understand which Since illness causes the body to release stress hormones that naturally raise blood glucose, the best option is to choose those products that have minimal effect on blood glucose levels. I had a spike from 112 up to 165 after 2 hours (I can imagine it was probably 200 after an hour) after eating a small 250 calorie Lean cuisine meal of chicken and noodles - net carbs about 25. Azelastine nasal spray is available as a generic drug and as brand-name drugs. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription. You may need to monitor your blood glucose more closely if you take one of the medicines listed below. According to the Mayo Clinic, all steroid nasal sprays can cause side effects. You may opt-out of email communications at any time by clicking on Since starting it a few weeks ago, my blood sugars seem to be spiking much higher after rather modest carb meals. Azelastine comes in the form of a nasal spray and eye drops. Azelastine belongs to a class of drugs called antihistamines. You should avoid using alcohol if your diabetes is not well controlled or if you have high triglycerides, neuropathy (nerve damage), or . Connect with thousands of patients and caregivers for support and answers. Azelastine is used for long-term treatment. Its also available as a generic drug. They cant hurt your medication. Epub 2014 Nov 6. Opt for antihistamines with less of a sedative effect. You might be wondering if your symptoms are due to a cold, flu, or allergies. Sniffles (Nasal Congestion and Discharge), An Overview of Afrin Nasal Spray (Oxymetazoline), The Connection Between Nasal Polyps and Sinus Infections, Sinus Surgery: Everything You Need to Know, Functional Endoscopic Sinus Surgery: Everything You Need to Know, What Thyroid Patients Need to Know About Decongestants. High blood sugar may make you feel confused, drowsy, . Regardless, the diabetic patient should always contact their health care provider (physician, diabetes educator, or pharmacist) prior to taking any new nonprescription medication. Disclaimer. Nasal steroids are generally considered safe, with a few caveats. These symptoms can linger for weeks unless theyre treated. Apa style oman s Keep your carb intake in check while enjoying simple and flavorful meals your entire family will love. Prescription cortisones had either made them diabetic or, if they were diabetic but in good control, the cortisones had made their blood sugar control much harder, in some cases forcing them to use insulin. Dr. Sarah Miller is Professor of Clinical Pharmacy at the University of Montana, and is also a consultant at St. Patrick Hospital in Missoula, Montana. Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Using a steroid nasal spray the wrong way can cause side effects, so always follow product instructions. It works by blocking histamine, a substance released by the body during an allergic reaction. Read More Created for people with ongoing healthcare needs but benefits everyone. This is referring to specific inhalers, I dont believe it is referring to all inhalers as there are so many. All possible dosages and drug forms may not be included here. Have you noticed that it spikes your blood sugars? "And if you're not aware of this, you might be surprised and ask, Why are my numbers high?'" RESULTS: A total of 1768 diabetic patients were treated with topical nasal steroid sprays during the study period. Colchicine reduces swelling, bu Studies show that most intranasal steroids don't significant increase blood sugar levels due to low systemic absorption. Hopefully within a few days of treatment not being necessary then things will return to normal. Azelastine nasal spray may cause drowsiness. Nasal spray was deposited in the bin (trash) Sue thx for your response -- did you have an infection, or was this for allergies ? But they do have side effects that tend to increase with long-term use. This comprehensive guide covers everything you need to know to use household cleaning products safely. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California. A severe bout of the common cold (a viral illness) could certainly produce "sick days," elevated blood sugars--without any effects from your nonprescription or other medications. As pretty and welcoming as this is, many of you (about 50 million!) Information from the drugmaker suggests that it's possible but cannot say with certainty if the drug causes a rise in blood pressure. The diabetic patient should always remember that, in general, "sick days" may be associated with fluctuations in blood sugar. Pharmacodynamics. American Diabetes Association Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes, Lower Blood Sugar Naturally to Prevent High Blood Sugar from Leading to Diabetes. If you experience seasonal allergies, these essential. Mine is normally around 5.6 - 6.8 but since I have been using this spray for sinusitis I noticed it was around 9. While Afrin can be very effective, it comes with quite a few side effects. Daniel More, MD, is a board-certified allergist and clinical immunologist. Your doctor will write the number of refills authorized on your prescription. . Join the community I just wondered if anyone had used Otrivine and then got high a blood sugar result. You may need to show airport staff the pharmacy label for your medication. Unauthorized use of these marks is strictly prohibited. Nose Breather, Local and systemic safety of intranasal corticosteroids, Intranasal fungal (Alternaria) infection related to nasal steroid spray, Overcoming barriers to intranasal corticosteroid use in patients with uncontrolled allergic rhinitis, Growth velocity reduced with once-daily fluticasone furoatenasalsprayin prepubescent children with perennial allergic rhinitis, Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate, Inadequate quality of administration of intranasal corticosteroid sprays, Clinical practice guideline: allergic rhinitis. This includes "lternative"remedies purchased at the health food store or elsewhere; "natural" does not mean "safe from interactions!" The researchers note that improper technique when using a nasal spray can raise your risk of nosebleed or a perforated septum. Be sure to avoid doing this when the weather is very hot or very cold. Shake the bottle well before using the spray. However, one of the main side effects is rebound congestion, also commonly referred to as nasal spray addiction. D.D. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Result of high sugar, long-term steroids can cause other damage to the body. According to the team, azelastine, as. You can avoid these side effects by knowing the correct way to use the spray and applicator. Along with its needed effects, a medicine may cause some unwanted effects. It causes uncomfortable symptoms like sneezing and itchy eyes. Call your doctor at once if you have a serious side effect such as: severe or ongoing nosebleeds; noisy breathing, runny nose, or crusting around your nostrils; redness, sores, or white patches in your mouth or throat; fever, chills, weakness, nausea, vomiting, flu symptoms; any wound that will not heal; or blurred vision, eye pain, or seeing halos around lights. This information is not a substitute for medical advice. The nasal spray was tested in 75 individuals (mean age, 33 years) with type 1 diabetes who were recruited from eight different US clinics. Later nasal steroid spray studies in children have not found any such growth rate change. Continue reading >>, I took these back when they were by prescription and before I was diabetic. According to RX List, other symptoms reported in more than three percent of . Learn more. Years ago when I posted about this on the old alt.support.diabetes board, several people sent me emails reporting that the same thing had happened to them. Use a blood glucose meter system to regularly check your blood sugar levels. Amplodipine (10mg 1x), Metformin (1000mg 2x), Atorvastatin (80mg 1x) Moderator T2 insulin resistant Using Basal/Bolus Therapy Most all nasal sprays I have seen caution you to not use if you are diabetic or have one of several medical conditions listed on their packaging. For about 1 in 5 people, warm weather brings not only blooming flowers and trees but also the telltale symptoms of hay fever (seasonal allergies) -- sneezing, coughing, runny or stuffy nose, scratchy throat, and itchy eyes. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. Im weening off prednisone. Continue reading >>, By the dLife Editors Some medicines that are used for treating other medical conditions can cause elevated blood sugar in people with diabetes. What are the possible side effects of fluticasone nasal (Flonase, Veramyst)? Promoting gluconeogenesis (glucose production in the liver). To find out how this drug might interact with something else youre taking, talk to your doctor or pharmacist. Follow the instructions on the label to spray this medication into your nose as directed. These may occur right away or even days after use. How soon can I use Aleve? However, they are not without side effects. The ingredients in a hot toddy have been shown to have cough-suppressing properties. In fact, the bioavailability (i.e. You also may want to gently pump (prime) the bottle before use, making sure that it's ready to spray so that the drug is delivered as you expect. Azelastine may interact with other medications, Important considerations for taking azelastine, dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=46b2ddff-d40a-43ac-b027-4fac9fc2f4b9, dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e979fc0-353c-11dc-8dea-0002a5d5c51b&audience=professional, dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ccb6046c-3c10-42c6-aa22-23192c21a5fa, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Cleaning Product Safety: Everything You Need to Know, Is Drinking a Hot Toddy Beneficial for a Cough?. It seems like a lot of these side effects could be worse than the actual problem the nasal spray is meant to treat. If you need an antihistamine for frequent allergy symptoms, however, the best choice is Claritin because it does not cross into the brain and has . Advertising revenue supports our not-for-profit mission. Their long-term use appears to be safe, provided that the patients are carefully monitored, especially those receiving triamcinolone acetonide. Most adults can use fluticasone nasal spray. Healthline Media does not provide medical advice, diagnosis, or treatment. Levofloxacin (Levaquin) Ofloxacin (Floxin) Moxifloxacin (Avelox) Ciprofloxacin (Cipro, Cipro XR, Proquin XR) Gemifloxacin (Factive) Second Generation Antipsychotics These medicines are used for a variety of mental health conditions. Call your doctor for medical advice about side effects. Moss WJ, Kjos KB, Karnezis TT, Lebovits MJ. It prevents the release of substances in the body that cause inflammation. Simple and topical remedies can be very effective Gargling with salt water or sucking on throat lozenges can provide relief to sore throat. You may report side effects to the FDA at 1-800-FDA-1088. Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART). By Daniel More, MD Long-term use of steroid nasal sprays may impact a child's growth and behavior, so parents and doctors a like should be mindful of these possibilities. Efficacy and safety of triamcinolone acetonide aqueous nasal spray in children aged 2 to 5 years with perennial allergic rhinitis: a randomized, double-blind, placebo-controlled study with an open-label extension. The tested nasal spray does not require any preparation. Side Effects of NasalCrom: Cromolyn is very safe and does not cause drowsiness or rebound nasal congestion the way OTC nasal decongestants can. It was attributed to the medication itself after ruling out all other factors. Is my pancreas finally just giving up? This site needs JavaScript to work properly. All rights reserved. Systemic side effects of steroid nasal sprays include: Nausea or vomiting Upper respiratory tract infections Abnormal menstrual cycles Cataracts (clouding of eye lenses) Glaucoma (nerve damage in the eye that can cause loss of vision) 3 Body-wide infection Systemic side effects due to using nasal steroid sprays are relatively rare. Im in a two month long gout attack. privacy practices. 2005-2023 Healthline Media a Red Ventures Company. Call your doctor if you become pregnant while taking this drug. Its important to note that just because a medicine has the possibility of raising blood sugar, it does not mean the medicine is unsafe for a person with diabetes. Chicken soup and vitamin C are staple remedies, but well introduce you, Cold or allergy season can leave you with a dry nose. Side effects that are body-wide, such as nausea or infection, can occur but do so less often. Results also revealed that 2,099 patients progressed from oral hypoglycemic treatment to insulin, translating to an annual incidence rate of 14.2 per 1,000 patients for diabetes progression. FOIA Overcoming barriers to intranasal corticosteroid use in patients with uncontrolled allergic rhinitis. The steroid in the spray is quite high from what I can gather. are probably bracing yourself for all of the pollen that is soon to follow, and suffering through the misery that it can bring. information and will only use or disclose that information as set forth in our notice of Methods: Ask your doctor or pharmacist about nasal sprays without steroids. It's a nasal steroid but it has better efficacy than afrin and you can use it long term. If you have any condition related to your adrenal glands, such as Addison's disease, it is possible for nasal steroid sprays to make them worse. These can include sneezing or runny nose. Data on hemoglobin A1c (HbA1c) levels both before and during steroid treatment was available for 245 patients, and data on fasting serum glucose levels at both time points was available for 163 patients. Irritation, itching, burning or dryness inside the nose or throat may commonly occur. I am still undecided as to which is causing my elevations Sue thx for your response -- did you have an infection, or was this for allergies ? Examples include: Others are available over the counter (OTC), including: Nasal steroid sprays are mainly used to treat congestion and symptoms caused by allergies and chronic sinusitis. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Though they are less common, some side effects involve your eyes and sinuses. Pharmacodynamics . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Plast Reconstr Surg. Blood sugar went through the roof. All steroid nasal sprays can suppress the functioning of the immune system, increasing the likelihood of developing other infections, according to RX List. However, animal studies dont always predict the way humans would respond. This helps relieve allergic symptoms such as sneezing or runny nose. Intranasal corticosteroids for non-allergic rhinitis. Common Flonase Side Effects May Include: Minor nose bleeding Burning or itching in your nose Sores or white patches inside or around your nose Cough Trouble breathing Headache Back pain Sinus pain Sore throat Fever Nausea Keep it in your carry-on bag. Azelastine nasal spray causes drowsiness. The nasal spray (3 mg) was effective 99 percent of the time The injection (1 mg) was effective 100 percent of the time It took an average of 16 minutes for the nasal spray to raise bloo Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. One study carried out in the Netherlands found that just 6% of participants actually completed all the steps given in their nasal spray instructions, so it's worth reviewing themeven if you think you have them down pat. The decongestant should have info on the patient leaflet. These symptoms can occur right after you use the nasal spray or days afterward. A prescription for this medication is refillable. Some examples are: hydraSense, NeilMed, NasalMist Simple is best for cold medicines Keep it simple. Clozapine (Clozaril) Olanzapine (Zyprexa) Paliperidone (Invega) Quietiapine (Seroquel, Seroquel XR) Risperidone (Risperdal) Aripiprazole (Abilify) Ziprasidone (Geodon) Iloperidone (Fanapt) Lurasidone (Latuda) Pemavanserin (Nuplazid) Asenapine (Saphris) Beta Blockers Beta blockers are used to treat high blood pressure and certain heart conditions. It is a form of glucagon given as a puff in the nose. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. Catalano LW 3rd, Glickel SZ, Barron OA, Harrison R, Marshall A, Purcelli-Lafer M. Orthopedics. Your doctor or pharmacist will show you how to use the nasal spray correctly. It may also cause other side effects. In these and many other cases, the pros will almost always outweigh the cons. Just wondered if there was a correlation. Options include a saline nasal PMC Does prednisone have to be out of the system? Click here to register for this in-person class Location IEHP Community Resource Center (Victorville) 12353 Mariposa Rd Suites C-2 & C-3 Victorville, CA 92395 There has been some concern about hyperactivity, irritability, or behavioral problems in children who regularly use nasal steroid sprays. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. On statistical analysis, there was no change in either measure from baseline to 3 months after starting treatment (p = 0.104 and p = 0.101, respectively). Reddit and its partners use cookies and similar technologies to provide you with a better experience. 2009 Apr;102(4):339-47. doi: 10.1016/S1081-1206(10)60340-7. Fluticasone is a steroid. Inhaled nasal steroids (also referred to as corticosteroids) are often recommended as a 'first-line' therapy for treating both seasonal and perennial alleges (i.e. Complete your request online or contact us by phone. If these symptoms worsen or do not go away, contact your doctor. There is a strong association between these medicines and elevated blood sugar, and frequent monitoring is recommended. The information here may be outdated and links ma On this page: Every day, two more Australian children and as many as six Australians of all ages develop type 1 diabetes Can cooking oil of any type is helpful in control of sugar levels. They received either beclomethasone dipropionate (BDP) spray for their allergy symptoms or a fake treatment (placebo). You may report side effects to FDA at 1-800-FDA-1088. Talk to your doctor if you breastfeed your child. Inhaled steroids arent supposed to cause high BG like oral steroids, but they can. sharing sensitive information, make sure youre on a federal While nasal steroids can be used on an 'as-needed' basis for temporary relief, studies show that consistent use often results in significant improvements in overall symptoms. Astelin (azelastine): A steroid-free antihistamine that reduces nasal allergy symptoms, such as a runny nose, hay fever, or other allergies (also available OTC in the U.S. under the name Astepro for adults and children ages 6 years and older) Nasarel (flunisolide): Relieves allergy symptoms, such as a runny or stuffy nose; sneezing, and itching (now . You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Dry nose is also common in people in drier climates. Glucagon is a hormone that is naturally produced by the pancreas, and when administered to a person with severe hypoglycemia , it triggers an immediate rise in blood sugar levels. Azelastine works by inhibiting the release of a chemical called histamine from the cells in your body. Elevated Hemoglobin A1C Levels Correlate with Blood Glucose Elevation in Diabetic Patients following Local Corticosteroid Injection in the Hand: A Prospective Study. Reducing insulin sensitivity, decreasing glucose uptake into cells. 2015 Apr;125(4):796-800. doi: 10.1002/lary.25000. What is the most important information I should know about fluti As a general rule, nasal steroid sprays are the most effective in treating nasal allergy symptoms, according to the American Academy of Otolaryngic Allergy. Textbooks may list quite a few classes of potentially-problematic medications, though many of these are in reality not very significant. Astepro - azelastine hydrochloride spray, metered. Dealing with a cold or the flu? I am used to being in control and do not care for this, one bit. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Have you by chance gotten to ask your primary care provider or your allergist (depending on who prescribed your nasal sprays and inhalers) about whether they feel there is a connection in your case? I double checked that reading with another meter. For those with type 2 diabetes, spring allergies may require watching out for things that could affect your blood sugar. Headaches, sneezing, runny nose, upset stomach or nosebleeds are also possible. Research in animals has shown negative effects to the fetus when the mother takes the drug. How long does it take to know that it's working? Is Afrin nasal an antihistamine? To unclog a stuffy nose, you might choose an OTC or prescription nasal spray, but you might not know that some contain steroids. Here's something that helps a lot. This is not a complete list of side effects and others may occur. I use Fluticasone regularly and it has not affected my blood sugar but that doesnt mean it wont someone else. Fluticasone nasal may also be used for purposes not listed in this medication guide. Continue reading >>, Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. All Rights Reserved. 1 Buy Singulair online It does not affect the growth rate of children. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Along with the general otherwise healthy population, many diabetic patients use intranasal steroids as well. For instance, many people with type 2 diabetes need to take a diuretic and a statin to lower blood pressure and cholesterol. 2000;105(2):e23-e23. Conclusions Azelastine nasal spray may increase both systolic and diastolic blood pressures. I have taken Astelin before being cured of hepatitis C. Astelin doesn't produce serious side effects like you are claiming. 1 Buy Singulair online It does not affect the growth rate of children. Do these sprays raise one's blood sugar? General Side Effects. Humidifiers can provide allergy relief by introducing more moisture into the air and easing irritation and inflammation of the mucous membranes. and transmitted securely. In fact, most decongestants (drugs that shrink the swollen membranes in the nose) may cause hypertension. 2013;34(6):743-5. doi:10.1016/j.amjoto.2013.07.016, Bridgeman MB. Nasal sprays act directly on the nose's blood vessels and have less impact anywhere else in the body. Also tried prednisone for 5-Days and I couldnt walk on the 5th day. http://dx.doi.org/10.2310/6650.2005.00006.38 (my last hba1c was 7.3 - which prompted me to start being very strict with my diet again Can the nasal spray raise blood sugar levels? Continue reading >>, Aaachoooo! Continue reading >>, Nasal Spray for Diabetes and Low Blood Sugar By Deborah Mitchell G+ Dec 22 2015 - 7:29pm Results of a new clinical trial suggest that a new nasal spray could be easier than the only other current treatment for cases of severe low blood sugar (hypoglycemia) in people who have diabetes. It seems to indicate that Flonase can increase A1c (by about .025%) when used at high doses; that difference is detectable but not clinically relevant (as stated in the study). You can read more about the long-term use of cromolyn at this link. Continue reading >>, As someone who saw her marginal blood sugar control deteriorate dramatically and permanently after a single course of prednisone I know that cortisone can cause permanent damange to blood sugar control. Wish I could be of better help to you. Results: www iowacourts gov. Could it be rebound congestion instead? Talk to your doctor about side effects and better options that minimize the possibility of blood sugar fluctuations. The short answer seems to be yes. On the shelves of local pharmacies, many non-prescription medications that provide symptomatic relief to the common cold list diabetes as a caution to their use. In regard to blood sugar levels specifically, one study that looked at budesonide (Rhinocort) noted no suppression of cortisol and no increase in blood sugars. Azelastine nasal spray is a prescription drug used to treat allergy symptoms in the nose. She has co-authored a National Cancer Institute report and a number of research articles that have appeared in medical journals. doi: 10.1542/peds.105.2.e23, Rollema C, Roon EN van, Vries TW de. Fluticasone nasal is for use in adults and children who are at least 2 years old. Federal government websites often end in .gov or .mil. Intranasal corticosteroids seem to have no adverse effects on HbA1c and serum glucose levels in diabetic patients. Drug should be taken when necessary and should not be repeated in short interval. People who experience an episode of hypoglycemia can simply shoot the spray up the nose or if they are unconscious, someone else can do it for them. It's best to be aware of the potential for this and watch for any changes in a child using nasal steroid spray. Careers. Anyway long story short I take over the counter nasal steroid Fluticasone Propionate (glucocorticoid) and when she saw me taking it she told me I shouldn't take it because it can raise blood sugars levels and in some cases lead to steroid induced diabetes. You have two choices: an OTC decongestant nasal spray or an OTC antihistamine nasal spray. Intranasal corticosteroids may also have serious adverse effects on the eyes, including d I feel that even relating my personal experience could be too dangerous for some one else to try. You can learn more about how we ensure our content is accurate and current by reading our. Often a medication with just one ingredient is all that is needed to treat the symptom. Okay everything I can find <<>> nasal steroids do not jack your blood sugar. Below listed are common side effects of Flonase which are short term or temporary which does not for a longer period of time. The side profile of oral steroids in extensive, especially when taken long term. They are thought to be safe and effective for treating allergy symptoms in both adults and children. It may make your drowsiness worse. Appointments & Access. Dont ever take matters of medication into your own hands. Spring allergies typically cause a runny nose, itching and sneezing. The Global Diabetes Epidemic, Brought to You by Global Development, 2 Things People With Type 1 Diabetes Can Learn From The Cancer & AIDS Community, Interim results of first-ever global survey show people with type 2 diabetes underestimate their cardiovascular risk. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Do you have a choice of using a non-steroidal inhaler instead? Call your doctor for medical advice about side effects. Clinical practice guideline: allergic rhinitis. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. doi:10.2147/IPRP.S129544. It belongs to a group of medications called antihistamines. There are many nasal sprays/drops or nasal rinses available. I am also on Levofloxacin feel lightheaded and still have the infection. These can include sneezing or runny nose. The worst effects have been dizziness, fatigue that lasts for over 48 hours, nightmares, tight muscles, and the bad tastes (which I don't mind so much).