Medications Archive

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.

The Surgeon General has issued an advisory recommending that people carry and know how to use naloxone, and although it is an effective treatment for overdose, it does not address the larger issues around the opioid crisis.

Do these heavily promoted hormones justify the claims made for them?

"Bioidentical" hormones have been promoted as safer and more effective than FDA-approved hormones. The exaggerated claims go beyond relief of menopausal symptoms, suggesting they are a veritable fountain of youth.

It's understandable that women would be interested in a different approach now that long-term use of conventional hormone therapy (HT) does not prevent cardiovascular disease as researchers had hoped.

You may need to stop taking blood thinners, certain painkillers, herbs, and supplements to reduce your risk for bleeding.

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No one wants to have surgery, even minor surgery, but sometimes minor procedures, such as a tooth extraction or a colonoscopy, are unavoidable. When that happens, you may hear that it's important to stop taking certain medications. Understanding exactly which drugs to suspend — and when — can be confusing. "I get a lot of questions about this," says Joanne Doyle Petrongolo, a pharmacist at Harvard-affiliated Massachusetts General Hospital.

Blood thinners

All surgery involves cutting body tissue, and that leads to bleeding. Blood thinners—medications like anticoagulants and antiplatelet drugs—can boost the risk for bleeding by keeping the blood from clotting.

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).