Medications Archive

Two common classes of drugs have been linked to dementia. Fortunately, there are alternatives to both.

If you're worried about developing dementia, you've probably memorized the list of things you should do to minimize your risk—eating a healthy diet, exercising regularly, getting adequate sleep, and keeping your mind and soul engaged. In addition, some of the drugs you may be taking to help you accomplish those things could increase your risk of dementia. In two separate large population studies, both benzodiazepines (a category that includes medications for anxiety and sleeping pills) and anticholinergics (a group that encompasses medications for allergies and colds, depression, high blood pressure, and incontinence) were associated with an increased risk of dementia in people who used them for longer than a few months. In both cases, the effect increased with the dose of the drug and the duration of use.

These findings didn't come entirely as a surprise to doctors who treat older people. The Beer's List published by the American Geriatrics Society has long recognized benzodiazepines, antihistamines, and tricyclic antidepressants as potentially inappropriate for older adults, given their side effects. Such drugs are on the list because they share troubling side effects—confusion, clouded thinking, and memory lapses—that can lead to falls, fractures, and auto accidents.

Research we're watching

There are a number of different approaches to treating a condition called adhesive capsulitis, better known as frozen shoulder. This common condition causes significant shoulder pain and reduced mobility. While it generally goes away on its own over time, it can take up to a year or longer to heal. But there hasn't been consensus on whether any particular therapy leads to more rapid pain relief and full range of motion.

A study published online Dec. 16, 2020, by JAMA Network Open looked at various treatment options for frozen shoulder to determine which was the most effective. Researchers analyzed 65 different studies with more than 4,000 total participants and found that the first line of therapy should be to inject a steroid directly into the joint to reduce inflammation. This treatment helped to reduce pain and led to the fastest recovery. The study authors said the steroid injection should be accompanied by a home exercise program that includes stretches and exercises to improve range of movement in the shoulder.

News briefs

Hold off before you follow new recommendations to treat mild, persistent asthma — or at least consult your doctor first. The updated guidelines from the National Institutes of Health, published online in the December 2020 issue of The Journal of Allergy and Clinical Immunology, say it's okay for people with mild, persistent asthma to stop daily use of inhaled corticosteroids and instead use them only as needed, along with short-acting beta agonists ("rescue" medications). That's considered a major shift in guidance. But that may not be a good idea for some older adults, notes Dr. Anna Wolfson, an allergist and immunologist at Harvard-affiliated Massachusetts General Hospital. "A lot of people have a harder time with the occasional use of medications than a routine practice of daily use," she says. "And you may not want to decrease your asthma regimen during the pandemic. Poorly controlled asthma could lead to a flare or an ER visit, and perhaps an increased risk for complications if you develop COVID-19." Dr. Wolfson says there are some people who might benefit from using inhaled corticosteroids only as needed, but she urges you to speak with your doctor before changing your medication regimen.

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These drugs actually help stop dangerous blood clots from forming. Here's when you may need them.

Nearly everyone has heard of "blood thinners." Maybe you or someone you know takes one. But these drugs don't "thin" blood at all.

"They are actually anti-clotting drugs," says Dr. Gregory Piazza, a cardiologist with Harvard-affiliated Brigham and Women's Hospital. "They prevent potentially dangerous blood clots from developing in people at high risk, like those who have atrial fibrillation or a stent in a blood vessel, or who are immobile after surgery."

It's more accessible than ever before, but is it the right medicine for you?

Medical marijuana — also referred to as medical cannabis — has enjoyed a boom in recent years. More states have legalized it, more products are available, and more people have turned to it for help, especially older adults.

A study in the April 2020 JAMA Internal Medicine found that the number of adults ages 65 and older using medical cannabis increased from 2.4% to 4.2% between 2015 and 2018.

Cardiovascular problems can conspire to put a damper on sexual enjoyment. Talking to your doctor and your partner can help.

A physical connection with your romantic partner is often an important part of a fulfilling relationship. But when it comes to matters of the heart, the health of your heart matters.

"A satisfying sex life depends on physical health, psychological well-being, and the quality of the relationship," says Dr. Jan Shifren, who directs the Massachusetts General Hospital Midlife Women's Health Center. Heart disease and related conditions can influence all three of those factors in both men and women. Here's a look at the range of those effects and some possible solutions.

A novel study suggests that the "nocebo effect" could be why some people believe they cannot tolerate statins.

Are you hesitant to fill your statin prescription because you're worried the drug will cause muscle aches and other side effects? Although you're far from alone (see "A royal pain?"), the reality is that all drugs have side effects, and statins aren't worse than other drugs. And fears about statin side effects may be depriving people of a potentially lifesaving medication.

The nocebo effect — the flip side of the well-known placebo effect — occurs when people experience negative effects from a drug, placebo, or other treatment based on an expectation of harm. Because of the widespread belief that statins cause muscle aches, statins have been suspected of triggering a strong nocebo effect. A recent study confirmed this observation (see "A study to assess statin side effects").

Ask the doctors

Q. I eat a lot of shellfish and recently developed gout in my knee. Did my diet cause the condition?

A. As you probably know, gout is a painful form of arthritis that occurs when high levels of a waste product called uric acid build up in the body. It can settle into joints, where it forms sharp crystals that can trigger inflammation, redness, and pain. Your diet may have aggravated the condition, but didn't cause it.

Observe these caveats if you use over-the-counter drugs or dietary supplements to help you sleep.

 Image: © Spauln/Getty Images

It's 2 a.m. and you can't sleep. Is it okay to take a nonprescription remedy? "They're not meant for the long term, but it may be okay for an occasional night of problems with sleep," says sleep expert Dr. Lawrence Epstein, an instructor in medicine at Harvard Medical School.

But which option should you reach for? Drugstore shelves are lined with a dizzying array of products promising a good night's sleep. They fall into two categories: nonprescription medications and dietary supplements.

A new study raises questions about whether they're truly equivalent to the brand-name versions.

You've no doubt seen them in the grocery store — typically drab-looking packages on the bottom shelf containing lower-priced generic versions of popular brand-name products. Some shoppers look at them with skepticism: Are they really as good? Or does cheaper just mean lower quality?

Many people have the same questions about generic prescription medications, says Dr. Niteesh K. Choudhry, professor of medicine at Harvard Medical School and executive director of the Center for Healthcare Delivery Sciences at Brigham and Women's Hospital. Are generic drugs really the same quality, or is it better to spend more for the name-brand version?