Medications Archive

There is no evidence that so-called "bioidentical" alternatives to prescription hormones are either safe or effective.

Over the past couple of years, science has validated what many women already know: hot flashes and other symptoms of menopause can persist long after menstrual periods stop. It's also well established that estrogen—alone or combined with a progestin—is the most reliable treatment for menopausal symptoms and that, for most postmenopausal women, it is safe to take these hormones for up to five years at doses that relieve hot flashes.

But in 2002 the Women's Health Initiative reported that Prempro—an FDA-approved preparation combining synthetic estrogens with a progestin—increased the risk of cardiovascular disease and breast cancer. Since then, women have shied away from pharmaceutical companies' hormones. A third of women who use hormones for relief of menopausal symptoms are now choosing custom-mixed preparations from compounding pharmacies, according to research sponsored by the North American Menopause Society (NAMS). Women surveyed by NAMS commonly said they believed "natural" or "bioidentical" hormones from compounding pharmacies to be safer than the available FDA-approved hormones.

A Spanish clinical trial of 400 people—two-thirds of whom were women—has indicated that waiting to fill an antibiotic prescription may be a good idea for people with sniffles, coughs, sore throats, and other respiratory symptoms.

Researchers recruited volunteers who sought care for respiratory symptoms in primary care clinics throughout Spain. The volunteers were randomly assigned to four equal groups. One was given antibiotics and told to take them immediately. Another was sent home without antibiotics but told to return to the clinic if they hadn't improved after several days. The two remaining groups were told to wait to take antibiotics—one was asked to return to the clinic to get their mediation after three days; the other group was given an antibiotic, but told to take the medication only if their symptoms hadn't improved after five to 10 days.

Research we're watching

A nationwide survey conducted by researchers at Harvard T.H. Chan School of Public Health indicates that prescription drug use rose from 51% of U.S. adults in the 1999–2000 calendar year to 59% in 2011–2012. In 2012, women were taking more prescription medications than men, with 65% taking at least one drug and 16% taking more than five.

Although the use of postmenopausal hormones declined, women's prescriptions for blood pressure medication, cholesterol-lowering drugs, antidepressants, and diabetes medications rose significantly. The study was published in the Nov. 3, 2015, issue of The Journal of the American Medical Association.

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Tau proteins, and not necessarily beta-amyloid, may be the key to unlocking a viable treatment.

Alzheimer's disease affects more than five million people, and that number is expected to more than double by 2050. While there is no cure, attention has refocused on what many researchers believe is a major player in Alzheimer's: tau proteins.

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Targeted cancer therapies have limits, but some may offer a better option than standard chemotherapy.

Mention cancer treatment, and most men think of chemotherapy—complete with hair loss and extreme fatigue. But for some men, there is another option. Targeted therapies can sometimes treat certain cancers with fewer side effects and better outcomes.

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Ask the doctor

Q. I would like to take generic drugs instead of brand-name drugs whenever possible, because they're cheaper. But are they really as effective?

A. First of all, generic drugs contain the exact same active ingredients as the brand-name versions. Second, in the United States, before approving a generic drug, the FDA must test it to be sure that the manufacturer has produced the same molecule, and that it achieves the same levels in the blood as the brand-name drug. Third, there have been many careful studies comparing generic drugs (once they have been approved) to their brand-name equivalents.

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Flibanserin is the first treatment of its kind. But it comes with a steep price tag and severe health risks.

It's now six months since the FDA approved flibanserin (Addyi), which is the first medication for sexual desire disorders. The drug was hailed as a "female Viagra," but is it living up to the hype? "It's not the solution we were hoping for," says Dr. Hope Ricciotti, editor in chief of Harvard Women's Health Watch and an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.

News Briefs

New guidelines from the American College of Physicians (ACP) urge doctors to prescribe generic medications whenever possible, rather than more expensive brand-name medications. The guidelines were published online Nov. 24, 2015, in Annals of Internal Medicine. An ACP committee, led by Harvard Medical School's Dr. Niteesh Choudhry, analyzed more than 2,500 studies and found that brand-name prescription medications are more likely to be prescribed, but not filled. The committee also observed that people do a better job of sticking to a medication regimen if they take generics, since the drugs are cheaper and people are more likely to get prescriptions filled. (If you're more likely to take a medication, you're more likely to get better.) Do generics work just as well? The committee found that the vast majority of the evidence showed generic drugs are as effective as brand-name medications when it comes to health outcomes. If your doctor prescribes a brand-name medication, ask if there's a generic that will do the same job and save you money.

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In the Journals

Adding muscle relaxers or narcotic pain relievers to the nonsteroidal anti-inflammatory drug (NSAID) naproxen (Aleve) did not improve pain or function for people who went to emergency rooms seeking help for severe low back pain, according to a study in The Journal of the American Medical Association.

The study followed a group of 320 people who visited the same emergency room in the Bronx, N.Y. None had symptoms that would suggest disk-related back pain, like shooting pain down the back of the legs (sciatica). They were all advised to take naproxen for 10 days and were chosen at random to add one of three additional pills: the muscle relaxer cyclobenzaprine (Flexeril); ox-ycodone (Percocet), a narcotic pain reliever; or a placebo.

In the Journals

Alpha blockers, a type of medication that many men take for urinary difficulties caused by an overgrown prostate, are associated with a dangerous but very small risk of falling, according to a recent study in BMJ. This should reassure men who have heard that the drugs could cause dizziness from a sudden drop in blood pressure.

The Canadian study identified more than 147,000 men in Ontario prescribed one of three drugs: alfuzosin (Uroxatral), silodosin (Rapaflo), and tamsulosin (Flomax). Most of the men (84%) took Flomax, although all three drugs work the same way.