Medications Archive

Ask the doctor

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Q. I was recently diagnosed with long QT syndrome, which was apparently caused by a medication I was taking. But I understand that there are also genetic causes for this problem. Can you tell me more about this disorder?

A. Long QT syndrome is a rare disorder of the heart's electrical system. Electrical signals coordinate your heartbeat, telling the heart to contract and relax to pump blood. After each beat, the heart's muscle cells are busy recharging themselves for the next contraction by moving sodium, potassium, and calcium through tiny pores on their surfaces.

New medications and side effects warrant an evaluation.

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A medication regimen isn't something you can set and forget. You and your doctor need to keep tabs on what you're taking and how it's affecting your health. "We are required to do a medication 'check-up' at every visit, regardless of the specialty, which means that every clinician who sees you is supposed to review your medications and check off a box," says geriatrician Dr. Suzanne Salamon, an assistant professor at Harvard Medical School.

Sometimes things change between visits, and adjustments need to be made. It's up to you to schedule an appointment. Here are seven reasons why that may need to happen.

Research we're watching

Cholesterol-lowering statins may be underused in younger people at risk for heart attack, new research suggests.

The study, in the Jan. 23, 2018, Journal of the American College of Cardiology, included more than 1,600 people ages 50 and younger who had experienced a heart attack. Only one in eight was taking a statin before the heart attack.

On call

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Q. I am about the same age as President Trump, and I also had a recent physical. My LDL (bad) cholesterol reading was 136, which my doctor thought was too high. But Mr. Trump's doctor said his LDL cholesterol of 143 was "excellent." Which is it?

A. The report of President Trump's health status brought out many armchair cardiologists — and real cardiologists — to comment on his cholesterol levels and risk for heart disease. The White House doctor's report stated that the president's "heart health" (not his cholesterol) was deemed excellent based on a normal exercise test and heart ultrasound. However, his LDL level of 143 was felt to be too high, and his doctor recommended doubling the president's statin medication. While the president doesn't show evidence of current heart disease, what is his future risk? A 71-year-old man with his cholesterol value would have a 10-year risk of heart attack, stroke, or cardiac death of 16% (about a one-in-six chance).

In the journals

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Migraine sufferers may be able to prevent future attacks with a new medication called galcanezumab, suggests a study published online Dec. 18, 2017, by JAMA Neurology. Currently, there are five FDA-approved drugs for migraines, but none were designed specifically for treating attacks or addressing the mechanisms at work.

In comparison, galcanezumab works to suppress the activity of calcitonin gene–related peptide (CGRP) in people. That molecule is believed to play an integral role in migraines and cluster headaches.

In the journals

A prescription cream called 5-fluorouracil (5-FU, sold as Adrucil and other brands) may help people reduce their risk for squamous cell carcinoma (SCC), according to a study published in the Jan. 3, 2017, JAMA Dermatology. SCC, the second most common cancer in the United States, strikes twice as many men as women.

Researchers recruited 932 people, 98% of whom were men, with an average age of 71. Each had experienced at least two skin cancers — SCC, basal cell carcinoma (BCC, the most common skin cancer), or both — on their face or ears within the past five years. They were randomly assigned to receive either the 5-FU cream or a placebo cream. Everyone applied a thin layer twice a day to their face and ears for up to four weeks. Over the course of a year, the 5-FU group had a 75% lower incidence of SCC compared with the placebo group. They also had a 11% lower incidence of BCC, but this difference was not statistically significant. It's not known why 5-FU helped prevent SCC but not BCC, according to the researchers.

You can head off problems from nonprescription drugs by following instructions carefully and communicating with your doctor.

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Relief for your symptoms can be as close as the nearest drugstore. Over-the-counter medicines and supplements can offer quick results, whether you've got heartburn, a headache, or a stuffy nose. And many people assume these products are safe, simply because they don't need to visit the doctor to get them. Unfortunately, that's not always the case.

Any medication that works cannot be completely safe, says Dr. Gordon Schiff, associate professor of medicine at Harvard Medical School and associate director of Brigham and Women's Center for Patient Safety Research and Practice. The decision to make a drug available over the counter is often more a matter of marketing than safety, he says.

Research we're watching

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If you have an egg allergy, you may have been told not to get a flu shot. That's because the vaccine is grown in eggs and may contain a small amount of egg protein, which — it was feared — could trigger an allergic reaction. But a new guideline from the American College of Allergy, Asthma and Immunology (ACAAI) dispenses with that old advice and says even people with an egg allergy should roll up their sleeves and get the shot to protect themselves from the flu.

"When people get flu shots, health care providers often ask if they are allergic to eggs," allergist Dr. Matthew Greenhawt, chair of the ACAAI Food Allergy Committee and lead author of the practice parameter, said in a written release. "We want health care providers and people with egg allergy to know there is no need to ask this question anymore, and no need to take any special precautions. The overwhelming evidence since 2011 has shown that a flu shot poses no greater risk to those with egg allergy than those without." Numerous studies have found that patients with egg allergy — even those with life-threatening allergies to egg — have gotten the shot and did not suffer any ill effects. This suggests there isn't enough egg protein in the vaccine to cause a reaction.

Here's what Harvard physicians advise you to do at your next appointment.

You know the routine: you're waiting in the exam room, and your doctor comes in for what seems like a very quick visit before leaving to see the next person. You're left feeling that you didn't ask all of your questions or get a good understanding of your treatment plan. What happened?

"We're under incredible pressure, and we're scrutinized to be sure we're seeing enough patients," explains geriatrician Dr. Suzanne Salamon, an assistant professor at Harvard Medical School. "We don't have many minutes, and yet we have to go over each person's medical issues, medications, and even end-of-life issues. That doesn't leave a lot of time to talk."

Lifestyle changes are vital, but new medications may help.

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Two of the most prevalent health problems in this country — type 2 diabetes and heart disease — are closely linked. People with diabetes are more than twice as likely to die from heart disease than those without diabetes. An array of overlapping risk factors (such as being overweight and having high blood pressure and cholesterol levels) probably explains part of this association.

On the plus side, a diet that emphasizes vegetables, fruits, whole grains, lean protein, and healthy fats, coupled with regular moderate exercise (at least 30 minutes daily, most days of the week) can help people dodge the dangers associated with both heart disease and type 2 diabetes. Even so, most people with type 2 diabetes must also take the drug metformin (or other medications) to help reduce their high blood sugar levels, the hallmark of the disease.