Medications Archive

Ask the doctor

 Image: © Hailshadow/Thinkstock

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.

 Image: © JFalcetti/Thinkstock

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

 Image: © EunikaSopotnicka/Thinkstock

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.

 Image: © Ralf Nau/Thinkstock

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.

News briefs

 Image: © BackyardProduction/Thinkstock

In March, we reported that long-term use of a class of prescription painkillers known as opioids, such as oxycodone (Oxycontin), comes with the risk of dependence, addiction, falls, and even death. Now, a study published March 14, 2017, in The BMJ finds that opioid users who also take a benzodiazepine — such as alprazolam (Xanax) — for sleep or anxiety are more likely to end up in an emergency room. Researchers made the connection after looking at a sample of more than 300,000 privately insured adults (ages 18 to 64) over a 12-year period. People who were prescribed both types of drugs had twice the risk of ending up in a hospital as did people who used opioids only.

The study is observational and does not prove that using both medications increases overdose risk. However, the authors say we already know that about 30% of deadly opioid overdoses involve benzodiazepines in some way. Researchers suggest that opioids should be prescribed cautiously — even if only for a short-term course — among people who are also using benzodiazepines.

On call

Q. I have had acid reflux for many years, but it is well controlled with a proton-pump inhibitor. However, I am concerned about long-term damage from my reflux, even though I feel fine now. Should I have an upper endoscopy to look for possible damage?

A. Long-term acid reflux can damage the esophagus and may lead to a condition known as Barrett's esophagus, which is a precursor to esophageal cancer. Barrett's affects about 3% to 10% of older men, but within this group the risk of developing esophageal cancer is only about four in every 1,000 cases. Over all, men with Barrett's are more likely to die from another cause.