Medications Archive

Memory slips are aggravating, frustrating, and sometimes worrisome. When they happen more than they should, they can trigger fears of looming dementia or Alzheimer’s disease. But there are some treatable causes of forgetfulness.

New studies shed light on the role of aspirin for people without a previous heart attack or stroke.

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It costs just pennies per pill, doesn't require a prescription, and may be lifesaving for some people. But daily low-dose aspirin doesn't make sense for everyone. Now, three major studies that examined the benefits and risks of this widely used drug may alter the advice about who should take aspirin.

"Aspirin remains a cornerstone of treatment after a heart attack or stroke. But the question of whether people with a low to moderate risk of heart disease should take aspirin is a really important one," says Dr. Christopher Cannon, a cardiologist at Brigham and Women's Hospital and professor of medicine at Harvard Medical School. Tens of millions of people in the United States fall into that low-to-moderate-risk category. But until now, there weren't many large trials that included those people, he notes.

Dozens of states are cracking down on the amount of opioids doctors can prescribe.

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Overdoses of powerful painkillers called opioids kill more than 115 people per day in the United States. More than 42,000 people died from opioids in 2016, five times more than in 1999. The reason? Since several of these powerful painkillers became available in pill form several decades ago, doctors have been prescribing more than patients need. "It is estimated that a large part of leftover opioids are diverted to the street, either deliberately or through theft," says Dr. Edgar Ross, senior clinician at the Pain Management Center at Harvard-affiliated Brigham and Women's Hospital.

The misuse of opioids is a risk many states are no longer willing to take. The rules limit the amounts that medical professionals can prescribe for temporary (acute) pain from surgery, injury, or illness.

Some drugs that contain ranitidine (best known as Zantac) have been found by the FDA to have unacceptable amounts of N-nitrosodimethylamine (NDMA), a possible cancer-causing chemical (which also triggered recalls of certain lots of the blood pressure drugs called angiotensin-receptor blockers).

On April 1, 2020, the FDA requested that all forms of ranitidine (Zantac, generic versions), including prescription and over-the-counter products, be removed from the market. They may contain unacceptable levels of a potential cancer-causing substance known as NDMA, or N-Nitrosodimethylamine. In some samples tested by the FDA, the impurity appears to increase over time, especially when stored at higher temperatures. So far, tests of other acid blockers do not show this potential increased cancer risk. 

Cannabis use among older adults has been steadily increasing, due to lessening stigma and increased interest in using medical marijuana. But there are specific concerns for older people, so anyone considering this option should have a conversation with their doctor weighing the benefits and risks.

News briefs

Smoking tobacco is a major cause of high blood pressure, heart disease, heart attack, and stroke. But did you know that smoking marijuana may also be associated with the same problems? A Harvard research review published Jan. 28, 2020, in the Journal of the American College of Cardiology found that more than two million U.S. adults with cardiovascular disease are smoking pot despite the risks, although they may not be aware of the potential link to heart problems. Studies on marijuana use have been limited, primarily because the substance has been illegal for decades. Scientists are calling for more research, since medical marijuana use is now legal in more than 30 states, and recreational use is legal in 11 states and the District of Columbia. "Until we have more answers about the connection between using marijuana and heart problems, you should consider avoiding smoking any form of pot if you have known heart disease or a high risk for a heart attack or stroke," suggests Dr. Deepak L. Bhatt, a study author and editor in chief of the Harvard Heart Letter.

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Research we're watching

Doctors have been overprescribing opioids for chronic musculoskeletal pain, according to a December 2019 study in The Journal of Pain. Researchers looking at data from a survey conducted between 2007 and 2015 found that doctors more often prescribed pills, either non-opioid or opioid, rather than physical therapy, counseling, or other nondrug interventions — a practice that is directly at odds with what experts now recommend, including those in the CDC Guideline for Prescribing Opioids for Chronic Pain. At their first visit with the doctor, people were most often prescribed non-opioid painkillers (40.2%) or opioids (21.5%), followed by counseling, nonpharmacological treatments, and physical therapy. Study authors say this shows there is room for improvement through education. However, it's worth noting that the time period studied (2007 through 2015) preceded much of the recent work and advocacy aimed at reducing prescriptions of opioids.

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Research we're watching

A new kind of drug given by injection can lower blood levels of lipoprotein(a), or Lp(a), a fatty particle linked to a heightened risk of heart attack and narrowing of the aortic valve, according to a study published January 1 in the New England Journal of Medicine.

Up to one in five people has a very high level of Lp(a), which is nearly completely determined by a person's genes. Lp(a) particles are similar to the better-known LDL cholesterol particles but with an extra protein coiled around each particle.

Ask the doctor

Q. I'm in my 70s, and I get breathless when I climb stairs. Maybe that's normal at my age, but my doctor says the cause may be my slow heartbeat. Can a slow heartbeat be dangerous?

A. Yes, it could be. To explain why, let's begin with the basics. Your heart beats in order to pump blood around the body. The circulating blood brings the nutrition that every cell in your body needs, and it removes cellular waste material: blood brings the food and takes away the garbage. The effectiveness of the circulation depends on how much blood your heart pumps with each heartbeat and how many times per minute it beats. Even if each heartbeat pumps a lot of blood, if your heart doesn't pump often enough, your body won't get the blood it needs. And when you exert yourself, the body needs more blood.