Medications Archive

Ask the doctor

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Q. My doctor prescribed Lovaza to help lower my high triglyceride level, which is 530 milligrams per deciliter (mg/dL). But I'm a vegetarian and don't want to take a drug made from fish oil. Are there other options?

A. You're not alone: several of my vegetarian patients also have asked me this question. But let's begin with some background. Triglycerides — which are the main form of fat found in our bodies — are part of a standard lipid panel blood test. Values higher than 150 mg/dL are associated with a higher risk of heart disease.

Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro­intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding — a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.

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For years, doctors prescribed cholesterol-lowing statins based largely on cholesterol test results. The goal was to lower total cholesterol to under 200 mg/dL, and LDL (bad) cholesterol to under 100 mg/dL. But in late 2013, new guidelines on statin use issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) proposed a major change to that strategy.

These guidelines shifted from a numbers-based approach to a risk-driven approach. Instead of aiming for a specific cholesterol value, doctors were urged to look at a person's entire cardiovascular risk profile when considering treatment. This is a reasonable approach that can help better define when to initiate drug therapy.

Prescription prices can rise without warning, but there are things you can do to pay less for the drugs you need.

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Recent news has brought reports of sudden jumps in medication prices. In August 2015, the price of pyrimethamine (Daraprim), a drug used to treat the parasitic infection toxoplasmosis, leaped from $13.50 to $750 per capsule. From May 2011 to May 2015, the price for a two-pack of EpiPens, the epinephrine autoinjectors that treat potentially fatal allergic reactions, rose from $160 to $608.

Even commonly used drugs that have been on the market for decades have been subject to unexpected price increases. In the past few years, the prices of generics — antibiotics like doxycycline and erythromycin and heart medications like captopril and digoxin — have shot up.

Ask the doctors

Q. I'm currently taking a pill that combines 5 milligrams (mg) of oxycodone and 325 mg of acetaminophen. It keeps my pain under control and doesn't seem to interfere with other medicines I'm taking. However, I was reading about opioids and wonder if it falls in that category. If it does, should I be taking it?

A. Oxycodone is an opioid, but acetaminophen, the generic form of Tylenol, isn't. A combination of the two, sold as Endocet, Percocet, and Roxicet, as well as in a generic version, is a popular medication for pain control. Both oxycodone and acetaminophen should be used with caution. Oxycodone should be taken for the shortest time possible because long-term use of oxycodone has been associated with addiction and dependence. High doses of acetaminophen can cause liver damage.

Research we're watching

To provide more information on the value of statins for older people, which is still a matter of debate, researchers analyzed data on people over 65 who were enrolled in ALLHAT-LLT, a large study conducted between 1994 and 2002.

All participants (average age 71) had high cholesterol and high blood pressure but not heart disease. They were randomly assigned to two groups. One group, of 704 women and 763 men, took pravastatin (Pravachol). The other group, of 711 women and 689 men, didn't take a statin. The analysis indicated that during the five-year study period, there was no significant difference between the groups in the frequency of heart attacks, deaths from heart disease, or deaths from any cause, either among participants ages 65 to 74 or among those 75 or older. The results were published online May 22, 2017, by JAMA Internal Medicine.

Research we're watching

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Heart attack risk may rise within a week of taking daily high doses of certain over-the-counter pain relievers, according to a new study.

Previous research has linked the use of pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) to a heightened risk of heart attack. The new report, published in the May 9, 2017, issue of The BMJ, analyzed data from nearly half a million people, of whom about 61,000 had heart attacks.

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.