Medications Archive

In the journals

Corticosteroid injections are used to ease short-term knee osteoarthritis pain, but a new study in the May 16, 2017, Journal of the American Medical Association suggests the treatment may not help in the long term.

Researchers recruited two groups of 70 people, average age 58, with knee osteoarthritis. One group received 40 milligrams of the steroid triamcinolone (Kenacort, Kenalog, Artistocort) every three months for two years, while the other group got placebo injections. By the end, pain scores — measured on a scale from zero for no pain to 20 for extreme pain — had dropped by only 1.2 points among the steroid group, while the placebo group's score dropped by 1.9 points, neither of which was clinically significant.

Some of these prescription medications are linked to daytime sleepiness, a risk of falls, and more.

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Millions of Americans rely on prescription sleep medications, called sedative hypnotics, to fall asleep. While the drugs can help people get a decent night's rest, they are not designed for long-term use. "Each of the pills has its own risks," says sleep expert Dr. Lawrence Epstein, an instructor in medicine at Harvard Medical School.

Types of sleep aids

Sedative hypnotics fall into three categories.

Melatonin-receptor agonists such as ramelteon (Rozerem) leave the body quickly. They target melatonin receptors in the brain and are not thought to be habit-forming.

Ask the doctor

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Q. I have a mechanical heart valve, so I'm taking warfarin. But the frequent blood tests and occasional dose changes are bothersome. When, if ever, will I be able to take one of the new blood thinners instead of warfarin? Off-label use of other drugs is not uncommon. Why isn't that an option in this case?

A. Your question is a good one, and it requires a two-part answer. When doctors prescribe drugs "off-label," that means they believe the drug will help you, even if it has not been FDA-approved specifically for your condition. Sometimes, subsequent research provides strong evidence to support a specific off-label use, which may lead to the drug's FDA approval for that condition. But sometimes, research shows the exact opposite: a medication that doctors assumed would be beneficial is, in fact, not helpful — and sometimes even harmful.

A high HDL cholesterol level may not be as beneficial as once believed.

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If you're hoping to avoid heart disease, you probably keep tabs on your blood cholesterol values — especially your low-density lipoprotein (LDL), or "bad" cholesterol. Too much LDL in the bloodstream helps to create the plaque that accumulates inside arteries, raising the risk of a heart attack. The lower your LDL, the lower your risk of having a heart attack.

In contrast, high-density lipoprotein (HDL) has long been known as the "good" cholesterol. These particles are known to patrol blood vessels, grabbing cholesterol from both the bloodstream and artery walls and ferrying it to the liver for recycling and disposal. In population-based studies, people with high HDL levels tend to have fewer heart attacks, while those with lower HDL values have more.

Research we're watching

People in drug studies sometimes experience positive effects even when they take inactive, fake pills (the so-called placebo effect). But sometimes, they experience negative effects from the fake drug — a phenomenon known as the nocebo effect. A new study suggests that the nocebo effect may explain some of the muscle pain and weakness reported by people who take cholesterol-lowering statins.

The study, in the May 2, 2017, Lancet, involved more than 10,000 people randomly assigned to take a statin or a placebo. The study was "double blind," meaning neither the participants nor the researchers knew who was taking statins. After about three years, the statin proved effective, and all the participants were offered the choice of taking the drug. Most of them continued in this "unblinded" study for an additional two years, and 65% opted to take the statin.

On call

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Q. I've noticed recently that I sweat excessively, regardless of the temperature. Should I be concerned?

A. Your genes can determine whether you sweat a lot, but a sudden change in your regular sweating may suggest an underlying condition. Sweating is regulated by your nervous system and can be triggered by a number of causes. The primary signal for perspiration originates in the brain in response to a temperature-related or emotional cue, and then is carried by the autonomic nervous system to the sweat glands in the skin.

Ask the doctors

Q. My bad cholesterol has been rising, and my doctor suggested that I start taking a statin. I've read that red yeast rice has many of the cholesterol-lowering benefits of a statin, and I would rather go the natural route. However, I recently heard on a newscast that red yeast rice can have adverse effects on the kidneys. Is it still safe for me to take this supplement?

A. It's true that red yeast rice, which contains monacolin K, a chemical that's identical to the active ingredient in the cholesterol-lowering drug lovastatin (Mevacor), may reduce your LDL (bad) cholesterol and lower your total cholesterol. However, an independent analysis of a dozen 600-milligram (mg) capsules of red yeast rice products conducted a few years ago found that the actual monacolin K content varied widely — from 0.1 mg to 10.9 mg. (The lowest dose of lovastatin is 20 mg.) In addition, one-third of the products were contaminated with a potentially toxic compound called citrinin, which can damage the kidneys. The Food and Drug Administration (FDA) has blocked the sale of red yeast rice supplements that contain enough of the active ingredient to make them as effective as lovastatin because they haven't undergone the drug approval process. Unlike FDA-approved drugs, supplements can be sold without proof of effectiveness and purity.

Research we're watching

Recent evidence suggests that antibiotics, which affect the makeup of intestinal bacteria, might be associated with an increased risk of colorectal cancer. A team led by researchers from Harvard Medical School wanted to see if antibiotic use is also associated with adenomatous polyps, precursors of colon cancer that significantly increase the risk of developing the disease.

The team analyzed data from 16,642 women ages 60 or older participating in the Nurses' Health Study. They first looked at participants' antibiotic use from ages 20 through 59 and in the most recent four years. They also checked the results with the women's colonoscopies and found 1,195 cases of adenomatous polyps.

The scope of the opioid crisis in the US has led some communities to revise their view of substance use disorders. One idea is creating supervised injection facilities that would provide a safe environment and make treatment resources available.

Some aspects of diet may diminish or heighten the effect of prescription drugs or cause harmful side effects.

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You take your pills on time each day and get your prescriptions refilled before they run out. But all that hard work to stick to your medication plan can be scuttled if your diet is undermining the drugs' effects. "I see a lot of people who don't believe in the importance of following dietary recommendations for medications. That's a concern," says Dr. Randall Zusman, a cardiologist and Harvard Medical School associate professor.

Dietary risks

The following foods, drinks, or ingredients can interfere with specific drugs.