Fishtown Medicine Library
Clinical Guide Library
Precision medicine strategies tuned to your unique biology.
Two ways to quiet a moment, and what each one costs
Propranolol blocks the body's adrenaline response. A benzodiazepine sedates the brain. Side by side on speed, duration, side effects, dependence, and what each one does to a performance.
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Banned in the sports where they work
Beta-blockers are prohibited under WADA class P1 in a defined set of sports. Which ones, when the ban applies, and how a therapeutic use exemption works.
The treatment that outlasts the pill
Every major guideline says to try CBT-I before a sleeping pill. What the five parts are, why sleep restriction is the active ingredient, and who it is wrong for.
3mg and 150mg are not the same medicine
At 3mg to 6mg, doxepin is a selective antihistamine approved for sleep maintenance. At antidepressant doses it is a tricyclic with all that implies. The gap is the whole story.
The one that increases deep sleep, and the one with a tether
Gabapentin does increase slow-wave sleep. It also carries a breathing warning, a withdrawal syndrome, and enough misuse potential to be scheduled in several states.
The antihistamine, and the question nobody asks about it
Hydroxyzine sedates through the same pathway as older allergy medicines. What that costs in anticholinergic burden, why tolerance builds fast, and who should avoid it.
Not addictive, and still not a pill to stop abruptly
Propranolol causes no euphoria and no dependence, and daily use produces a physiological rebound on abrupt stopping. Why those are different things.
The drink and the tablet pull the same direction
Both lower blood pressure and both are often taken before the same events. What the interaction does, how long to leave between them, and what to do if you already have.
The day your zones stop meaning anything
A beta-blocker caps your heart rate for hours, so training zones, wearable data, and VO2 max estimates all read wrong. How to schedule around it.
How much, how early, how long
The three questions people ask together. Dose ranges for situational use, when to take it, how long the effect holds, and why the first dose belongs at home.
Propranolol, from the prescribing side
What propranolol does to adrenaline, the dose and timing people use before an event, the interactions that change the answer, and the conditions that make it unsafe.
What it feels like, and what to do about it
Most side effects follow directly from the mechanism. Which ones to expect at situational doses, which belong to daily use, and the ones that mean stop now.
The most-prescribed sleep drug with the least evidence
Low-dose trazodone is one of the most common sleep prescriptions in America. The sleep guideline recommends against it. Both of those are true.
The answers that make me say no
The conditions, medicines, and situations that rule propranolol out or change the plan, written from the screening side, with the reason each one is on the list.
The sleeping pills that carry a boxed warning
Zolpidem, eszopiclone and zaleplon work, and they carry an FDA boxed warning for complex sleep behaviors. What that means, who should avoid them, and how they are prescribed here.
The Adult Vaccine Schedule, by Age
Which vaccines adults need and when, as of 2026: flu each fall, shingles and pneumonia at 50, RSV, tetanus, hepatitis B, and the catch-ups adults miss.
What to Sort Out Before Your Trip
A trip is booked. What to sort out and when: destination vaccines, malaria pills, the diarrhea plan, the kit. Ideally 4-6 weeks out; 1 week still counts.
Pennsylvania's Medical Marijuana Program, Explained
The qualifying conditions, the 4 steps in order, what it costs, which forms are legal, and what the law does and does not protect you from at work.
Do I Need Antibiotics?
Sinus infection, bronchitis, cold, sore throat, and UTI. What the criteria are for each, which ones need antibiotics, and what helps otherwise.
When a Blood Pressure Medication Stops Working
Why a losartan-to-telmisartan switch is often the next move, where a thiazide-like diuretic fits, and when to look for a cause behind the number.
Metoprolol: Tartrate vs Succinate
Why the short-acting form is right for finding your dose and the long-acting one is right for staying on it, plus the pill-in-the-pocket approach.
Heavy Metal Detox: The Science
Bioaccumulation is real, but most "detox teas" are not. Learn how to safely test for and reduce heavy metals using sauna, binders, and (rarely) chelation.
Integrative Cancer Care
Going beyond the standard of care. Learn how Medicine 3.0 uses metabolic therapies and fasting alongside oncology to support patients through treatment.
Magnesium: The Invisible Deficiency
Why standard magnesium tests miss most deficiencies and how to choose the right form for sleep, brain fog, and anxiety.
Mindfulness as a Biological Tool
It is not "woo-woo." Learn the neuroscience of how mindfulness lowers cortisol, calms the amygdala, and reduces inflammation.