Medications Archive

Proton-pump inhibitors are among the most-prescribed medications, but is long-term use safe?

Proton-pump inhibitors reduce stomach acid, which helps to treat symptoms of acid reflux.
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Proton-pump inhibitors (PPIs), which are used to treat a variety of gastrointestinal problems, are among the most popular drugs in the United States. In fact, the FDA estimates about one in 14 Americans has used a PPI.

Each of your medications may be affecting how the others work, leading to harmful side effects and complications.

Each additional medication you take increases the risk of drug interactions.
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Are you taking more than one drug? Are you taking a few different types of medications? Are you seeing several different doctors? If so, you may be at increased risk for drug interactions, which occur when a drug, a supplement, or even a food affects the way your body processes a medication. Such interactions can make a drug more powerful—so that a standard dose becomes an overdose—or can render it less potent or altogether ineffective.

About one in six strokes can be traced to atrial fibrillation. Doctors now have newer and better options to lessen this risk.

Close to one in 10 people ages 65 or older have atrial fibrillation (afib), the most common heart rhythm disorder. During a bout of afib, the usually rhythmic contractions of the heart's upper chambers (the atria) are replaced by an ineffectual quiver. While the symptoms, which include a racing heartbeat, dizziness, and shortness of breath, are troublesome for some people, the real threat lies in the increased risk of stroke that accompanies the condition.

When the heart takes on the afib rhythm, blood does not completely move out of the atria. Instead, it tends to pool and clot in a pouchlike extension in the upper left quadrant of the heart, called the left atrial appendage. If these clots break loose, they may travel to the brain and cause a blockage. This is known as an ischemic stroke.

It may be time to re-evaluate if it's been a while since you started using proton-pump inhibitors.

Long-term use of some heartburn medications appears to be associated with an increated risk of dementia, heart attack, and chronic kidney disease. 
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You may think you're reaching for heartburn relief when you take a proton-pump inhibitor (PPI), a type of medication that helps block the production of stomach acid. PPIs are effective, and some—such as lansoprazole (Prevacid) and omeprazole (Prilosec)—are readily available over the counter. Others, such as pantoprazole (Protonix), are frequently prescribed for long-term use. But PPIs may have risks when taken over a long period.

Even the newer, targeted cancer therapies may harm the heart.

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About 14 million people in the United States are living with cancer, a number that reflects the steady rise in cancer survivorship in recent decades. In 1980, only about half of people with cancer lived five years after diagnosis. Today, five-year cancer survival rates are greater than 70%.

Unfortunately, many cancer-suppressing treatments can have undesirable effects on the heart and blood vessels. The increasing awareness of these effects—coupled with the surge of older people being diagnosed with and surviving cancer—has spurred a new specialty known as cardio-oncology. Experts in this burgeoning field focus on promoting heart health in people with cancer, both during and after their treatment.

Supplements aren't held to the same standards as FDA-approved drugs. Evidence indicates that few are effective, many are useless, and others may be harmful.

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Dietary supplements—including herbs, vitamins, minerals, and other products—are a $37-billion industry in the United States, and 60% of women are taking them regularly. At the same time, mounting research is suggesting that supplements—even mainstays like calcium—may be harmful at high doses.

The use of supplements and other alternatives to standard treatments is centuries old, but Dr. David Eisenberg, adjunct associate professor at the Harvard T.H. Chan School of Public Health, was the first to document the widespread use of alternative therapies in the United States. In a 1993 article in The New England Journal of Medicine, Dr. Eisenberg and colleagues reported that more than a third of Americans were using unconventional therapies, largely for chronic conditions, and most were doing so without letting their clinicians know. That report covered acupuncture, spinal manipulation, massage, and yoga, but it also focused public attention on all unconventional treatments, including the growing use of herbal remedies and other dietary supplements. In 1998, the Office of Alternative Medicine in the National Institutes of Health (NIH) was revamped as the National Center for Complementary and Alternative Medicine and charged with funding rigorous studies into the safety and effectiveness of alternative physical treatments as well as popular dietary supplements and herbs.

Although risk calculators disagree, at some point age becomes the deciding factor in the decision to take a cholesterol-lowering medication.

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If you've been diligent about monitoring your risk factors for developing heart disease, you may have realized that online calculators can be helpful. If you have the results from your latest cholesterol test, these online calculators can compute your chance of having a heart attack or stroke in the next decade:

• Framingham Risk Calculator http://cvdrisk.nhlbi.nih.gov

• ACC/AHA Heart Risk Calculator www.cvriskcalculator.com

• Reynolds Risk Score www.reynoldsriskscore.org

However, each may give you a slightly different number. And while the Framingham calculator might indicate that your risk is low and therefore you don't need a cholesterol-lowering statin drug, the ACC/AHA calculator could indicate that you should be taking a statin to reduce your risk.

Millions of postmenopausal women are taking a bisphosphonate like oral alendronate (Fosamax) or intravenous (IV) zoledronic acid (Reclast) to increase bone density. But because long-term use of these drugs has been associated with an increased risk of bone death in the jaw and unusual thighbone fractures, experts have debated how long women should stay on the drugs to minimize the risk of hip or vertebral fractures without raising their risk for these rare but serious complications.

After considering major randomized controlled clinical trials, a task force of the American Society for Bone and Mineral Research has released guidelines on the optimal duration of bisphosphonate therapy for osteoporosis. The guidelines, published in the January 2016 issue of the Journal of Bone and Mineral Research, recommend reassessing a woman's fracture risk after five years of oral bisphosphonates or three years of IV therapy. They advise that women whose risk is still high should continue to take oral bisphosphonates for up to 10 years or IV therapy for up to six years. However, fracture risk should be reassessed every two to three years during extended therapy.

Thorough risk assessment and family assistance may help you take them more safely.

Prescription pain pills such as oxycodone (Oxycontin) and hydrocodone (Vicodin) are in a class of drugs known as opioids. They're typically used to treat severe pain after surgery, and sometimes to treat chronic pain. But these drugs come with many risks, including addiction. Does that put you at risk if you take opioids? "You have to look at it on a case-by-case basis," says Dr. Hilary Connery, an addiction psychiatrist at Harvard-affiliated McLean Hospital.

Risks and benefits

Opioids are powerful painkillers that block messages of pain to the brain and decrease the body's perception of discomfort. They may also create a feeling of euphoria. Opioids are especially useful in the short term, such as the initial weeks following joint replacement. Common side effects include nausea, itching, drowsiness, or constipation.

There's encouraging news for people who take dabigatran (Pradaxa), a newer type of blood thinner that's had a rare side effect of uncontrolled bleeding during surgery or accidents. In October 2015, the FDA approved an antidote called idarucizumab (Praxbind), which may be able to reverse dabigatran's blood-thinning effects.

Dabigatran was approved by the FDA in 2010 and welcomed as a convenient alternative to warfarin (Coumadin) for people with certain types of atrial fibrillation, deep-vein thrombosis, or pulmonary embolism. While warfarin is generally safe and inexpensive, it takes about a week for it to become effective, and dosing is so complicated that people taking warfarin need frequent blood tests to see if the dose needs to be adjusted. Dabigatran is effective within two hours and doesn't require dose adjustment or lab monitoring. But dabigatran has caused more episodes of major bleeding than had been expected, without a way to reverse the problem.