Medications Archive

Research we're watching

People with chronic pain may be more likely to have a heart attack or stroke than those without chronic pain, according to a study published online May 7, 2020, by the journal Pain Medicine.

From 2001 to 2005, researchers identified 17,614 Taiwanese people who had used pain relievers for at least three months. The most common causes of pain were spinal disorders, arthritis, and headaches; the pain relievers included both over-the-counter drugs and prescription opioids. For the comparison group, researchers used 35,228 people without chronic pain who were matched by age and sex to those in the first group.

Research we're watching

If you've ever experienced a bout of bacterial vaginosis, a vaginal infection that affects anywhere from 15% to 50% of reproductive-age women, a study published May 14, 2020, in The New England Journal of Medicine may be of interest. It found that women who inserted a type of probiotic called Lactobacillus crispatus (Lactin-V) in their vagina twice per week were less likely to have a recurrence of bacterial vaginosis than women who did not. Experts don't fully understand what causes bacterial vaginosis, but it is associated with an overgrowth of some microorganisms (such as Gardnerella vaginalis or Prevotella), which outnumber healthier types of vaginal bacteria, including a common one called Lactobacillus. In many cases, the condition will recur after treatment. All of the 228 women in the study were initially treated for bacterial vaginosis with the standard topical antibiotic metronidazole (MetroGel Vaginal). But after that treatment, 152 of the women were assigned to use Lactin-V for an additional 11 weeks. The remainder of the group got a placebo treatment. Researchers found that only 30% of the Lactin-V group had a recurrence of bacterial vaginosis by week 12, compared with 45% of the placebo group.

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Home delivery is just a few clicks away.

Lots of things can keep you from picking up a prescription at your local pharmacy. You may be stuck at home because of disability, illness, social distancing, or a lack of transportation. But the longer you go without your medication, the more your health is at risk. That's why it's important to know how to use home delivery services that bring prescriptions right to your door.

Local pharmacy delivery

Just like in the old days, some local pharmacies still send their own staffers to deliver prescriptions to their customers. The pharmacies are usually small and independently owned. You might expect that kind of service from them.

If you have experienced a heart attack or undergone a heart procedure, don't neglect your mental health during recovery.

Recovery from a heart attack, heart failure, angioplasty, or heart surgery — what doctors call heart events — can be stressful. Depending on your condition, it may also involve cardiac rehabilitation. This medically supervised program focuses on exercise, diet, and lifestyle changes. While the primary focus is to help you physically, you also need to address your mental and emotional health.

"It's normal to have some anxiety and stress after a heart attack or heart surgery," says Dr. Christopher Celano, assistant professor of psychiatry at Harvard-affiliated Massachusetts General Hospital. "But how long these feelings linger, and whether they are also associated with symptoms of depression, can affect your rehab recovery success and potentially increase your risk of future problems."

News briefs

First it was certain blood pressure and heartburn drugs; now some medications used to treat type 2 diabetes are being recalled because of cancer concerns. The FDA warned in late May and early June 2020 that some lots of extended-release metformin may contain unacceptable levels of N-nitrosodimethylamine (NDMA), a possible cancer-causing chemical. At least five manufacturers are now issuing voluntary recalls of the medications. But if you take extended-release metformin, don't just stop on your own. Not all extended-release metformin products are affected by the voluntary recalls, and stopping any medication that controls blood sugar can be very dangerous. The FDA advises that you check in with your doctor or pharmacist. Ask if your medication is affected by the recall; if so, ask if you should switch to another version of the drug.

Image: fizkes/Getty Images

In the journals

If you are ever hospitalized for a hip fracture, using an anti-osteoporosis medication may protect you from another bone fracture. A study in the September 2020 issue of Bone examined data on almost 78,000 people ages 50 and older hospitalized with hip fractures. About 10,000 were given anti-osteoporosis medication — usually alendronate (Fosamax) — within one year.

People who began treatment 15 to 84 days after their fracture were less likely to be hospitalized for another kind of fracture in the future compared with people who began treatment later. Those who first took medication after 252 days had the highest risk. The researchers were not able to measure the participants' bone density, so it's possible some people had especially strong or weak bones, which may have influenced the outcome.

In the journals

Lowering high blood pressure with medication is good for the brain as well as the heart, suggests a study published online May 19, 2020, by JAMA.

Scientists reviewed 14 trials involving more than 96,000 people who had their high blood pressure monitored without medication vs. those who took one or more blood pressure drugs, such as beta blockers, ACE inhibitors, and angiotensin-receptor blockers. Almost 58% were men, and the average age was 69. The people were tested for dementia or cognitive impairment (trouble learning a new task, concentrating, or making decisions) before taking medication. They were tested again an average of four years later.

Researchers are beginning to better understand if, when, and how to address this condition, which is linked to a newly recognized type of stroke.

In the womb, all fetuses have a foramen ovale (Latin for "oval hole") between the heart's right and left upper chambers (atria). This opening allows blood to take a shortcut within the heart rather than following a longer path through the lungs, which cannot work until they are exposed to air. After birth, when a newborn baby takes his or her first breath, the foramen ovale begins to close. Most of the time, it seals completely within a few months.

But in about a quarter of people, that doesn't happen. This anatomical variation is called a patent foramen ovale (patent means open) or PFO. Most people never know they have it, because a PFO doesn't cause any signs or symptoms. For the most part, the condition is harmless.

Ask the doctors

Q. I have a herniated disc in my back. What does this mean, and will this heal on its own?

A. A herniated disc, also called a slipped or ruptured disc, is a common problem that can happen at any age, but becomes more common in middle age and beyond. It occurs when the jelly-like filling in a spinal disc — one of the pads between your vertebrae, or spinal bones — breaks through the disc's outer shell, called the annulus, and bulges through the tear. When this happens, the material may press on nearby nerves, which can cause a host of symptoms including inflammation, pain, and numbness. Where in your body you experience these symptoms depends on the location of the herniated disc. For example, if the disc is in your neck, you may feel pain down your shoulder and into your arm. If the disc is lower in your back, it may irritate your sciatic nerve, which can cause pain that radiates through your buttock and down your leg. The good news is that in most cases — 90% of the time — pain caused by a herniated disc will go away on its own within six months. Initially, your doctor will likely recommend that you take an over-the-counter pain reliever and limit activities that cause pain or discomfort. But in some cases, if you've been using these strategies and haven't noticed an improvement, your doctor may recommend further evaluation and possibly an additional treatment strategy, such as physical therapy. Surgery is typically not recommended unless the problem does not respond to therapy, if you are having an increasingly hard time moving, or if your doctor believes the spinal cord is being compressed.

Studies of drugs, diets, and devices all come with their own unique set of challenges.

The best way to know if a new medical treatment truly works is with a randomized controlled trial — the "gold standard" of research studies, also known simply as a clinical trial. Volunteers are randomly assigned to receive either the new treatment or the comparison, which may be a placebo (an inactive therapy) or a treatment that's already available.

As the nation's top cause of death, cardiovascular disease has been at the leading edge of evidence generation, says Dr. Robert Yeh, director of the Smith Center for Outcomes Research in Cardiology at Harvard-affiliated Beth Israel Deaconess Medical Center. "We probably have more evidence for cardiovascular treatments than for any other field of medicine," he says. Among the studies with the greatest impact were the clinical trials that heralded new therapies to treat heart attacks. These include clot-dissolving drugs in the 1980s, followed in the 1990s by artery-opening angioplasty procedures, which remain the standard of care today. Stents, the tiny mesh tubes used in these procedures, have also been extensively studied in clinical trials (see "Testing devices: Different dilemmas").