Medications Archive

Constipation from pain medication – such as opioids – is a common problem

Prescription opioids provide pain relief, but constipation from pain medication is an all too common side effect.

As we age, pain and pain control become an important issue. Many of the conditions that cause pain disproportionately affect people starting at about age 65. In some surveys, half of respondents ages 60 and older have said that they suffer from chronic pain. About 70% of cancer deaths occur in people ages 65 and older, so cancer pain is frequently the older person's problem.

Sharing readings from a home monitor with your physician may help you reach your blood pressure goal more quickly.

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For treating certain health problems, finding the best drug or combination of drugs at the correct dose often requires some trial and error. High blood pressure is a good example. Because this common problem raises heart attack and stroke risk, the sooner you can get your blood pressure down to a healthy range (130/80 millimeters of mercury [mm Hg] or lower), the better. New research suggests that people could speed things up a bit by taking a more active role in the process (see "Tracking your blood pressure at home: Does it help?").

"The study showed that a period of home blood pressure monitoring — one week per month — was sufficient to guide people to better blood pressure control," says Dr. Paul Conlin, professor of medicine at Harvard Medical School and chief, Medical Service, at the VA Boston Healthcare System.

Advancing age may warrant changes to preventive therapies for heart disease. But one size does not fit all.

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Currently, the average life expectancy in the United States is about 79 years. But among people who survive to age 80 and beyond, health status can vary quite a bit. Some stay hale and hearty for years, while others gradually become weak and frail.

These differences are one reason there aren't any set guidelines for preventing heart disease in octogenarians. But there's a larger underlying issue — one that also explains why heart attack risk calculators (such as www.health.harvard.edu/heartrisk) don't allow you to enter an age above 79.

This heart rhythm disorder is linked to thinking and memory problems. But anti-clotting drugs may lower the risk.

Bouts of atrial fibrillation, or afib — a rapid, chaotic heartbeat — make some people feel lightheaded and dizzy, while others don't notice any symptoms. But the most serious threat of this condition is the higher risk of stroke among people with afib compared with those without the disorder (see "Blood clot dangers, large and small"). Now, there's a growing recognition that people with afib also face an increased risk of thinking and memory problems — even if they do not experience a stroke.

Known as cognitive impairment, these problems include trouble remembering, learning new things, concentrating, or making routine decisions. The presumed underlying cause? Tiny blood clots that cause "silent" (that is, unrecognized) strokes and gradually injure parts of the brain involved with cognition.

Research we're watching

About four in 1,000 adults in this country are born with a genetic condition marked by abnormally high cholesterol levels, known as familial hypercholesterolemia (FH). Their "bad" LDL cholesterol can be two to three times as high as the common target LDL value of 100 milligrams per deciliter (mg/dL) or lower for healthy people. But only about half of people with FH are getting proper treatment for the disease, according to a report in the May 22 issue of Circulation.

For the study, researchers analyzed health surveys done between 1999 and 2014 with nearly 42,500 adults in the United States. Although more than 80% of people with FH or severely high cholesterol were aware of their condition, only half were taking cholesterol-lowering statins. And among those who were, only one-third were taking optimal doses of the drugs.

Be proactive by learning about and tracking your conditions and medications, and by speaking up when you have concerns.

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We don't want our golden years to be spent juggling a long list of health issues. But that's the reality for most older adults in the United States.

The CDC reports that 75% of Americans ages 65 or older have several chronic health problems. And a 2013 analysis of Medicare claims published online by Preventing Chronic Disease found that 68% of beneficiaries had two or more chronic conditions and 36% had at least four.

Ask the doctor

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Q. Home remedies aren't stopping my hiccups. Is there something my doctor can prescribe to help?

A. In the May 2018 issue, I answered a question about hiccups, saying they are common but typically short-lived, and that simple home remedies often can end them. However, I ran out of space to say something about treatments for the very unusual cases of hiccups that don't respond to simple treatments.

Ask the doctor

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Q. I understand there's a genetic test that can tell you how well you might respond to antiplatelet drugs. Do you recommend this test?

A. The short answer is no, not yet. For now, I think it is best to wait for the results from studies looking at personalized antiplatelet therapy. Also known as tailored medical therapy, personalized therapy refers to treatments that are based on your own information, including genetics. But first, I will address two other relevant questions: (1) what is antiplatelet therapy, and (2) who needs it?

For people at high risk, PCSK9 inhibitors may prevent heart attacks and save lives. But gaining access to these pricey drugs remains a challenge.

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Three years ago, the FDA approved two drugs that lower harmful LDL cholesterol values dramatically — by more than 50%. The drugs, alirocumab (Praluent) and evolocumab (Repatha), belong to a new category of medications known as PCSK9 inhibitors. Both are given by a self-administered injection once or twice a month.

They're intended for people whose cholesterol levels remain stubbornly high, despite making lifestyle changes (such as diet and exercise) and taking the maximum dose of a high-potency statin and other cholesterol-lowering drugs. In the past two years, results from two large studies found that both PCSK9 inhibitors lowered the risk of serious heart-related events such as heart attack and stroke by 15%.

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Newer medications, which may be safer than earlier drugs, have expanded the options for treating obesity.

Obesity is now considered more than a risk factor for other conditions; it's a disease itself. It has been the subject of intense scientific and medical research to develop effective treatments. But the quest has been elusive.