Medications Archive

New warnings suggest that even people without heart problems may be at risk for heart attack and stroke with NSAID use.

Q. My doctor used to check my liver function once a year after I started taking a statin drug to lower my cholesterol, but he doesn't anymore. Why not?

A. Your doctor appears to be following the latest recommendations from the American Heart Association and the FDA. When statin medications were first approved, doctors did periodic blood tests to check for liver injury. Three decades later, it is clear that serious liver injury from statins is a rare side effect and that routine blood testing does not help identify people at risk for statin-related liver problems. Therefore, routine monitoring is not a good use of money and time.

But if you are healthy, deciding if these commonly prescribed drugs are right for you is a personal choice.

NSAID users: Take the lowest effective dose for the shortest possible time.

If you have heart disease, national guidelines recommend that you take a low-dose (81-mg) aspirin every day. It's an inexpensive and effective way to lower your risk of a heart attack or stroke. According to a report in the July 17 Morbidity and Mortality Weekly Report, about seven in 10 adults with heart disease follow this advice.

The study relied on telephone surveys done by the CDC about health behaviors. It included data from more than 17,900 adults from 20 states and the District of Columbia.

A study in JAMA Internal Medicine may help to explain the controversial connection between cholesterol-lowering medications and memory loss. Researchers scrutinized health records of more than 11 million people who saw their primary care doctors from 1987 to 2013. They compared reports of memory problems by three groups of people:

• 483,000 who were prescribed a statin to lower their cholesterol

• 26,000 who were given another type of cholesterol-lowering drug (not a statin) to lower cholesterol, such as a fibrate or niacin

• 483,000 who didn't take any cholesterol drug.

People who took any kind of cholesterol drug—a statin or some other type—were nearly four times more likely to report memory loss right after starting on the drug, compared with people who didn't take any kind of cholesterol drug.

Alternating two types of over-the-counter drugs can relieve pain while reducing the risk of serious side effects.

If you're in a drugstore trying to decide which over-the-counter pain reliever to buy, there are scores of products from which to choose. But there really are only two basic types: nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn); or acetaminophen (Tylenol). If you want to maximize pain relief and minimize side effects, you might want to stock up on both types.

A novel class of drugs has the potential to pick up the slack where other cholesterol medications leave off.

Q . Can you explain exactly what "ejection fraction" means? And is there any way to increase it?

A. Ejection fraction refers to the volume of blood that's pumped out of the heart's left ventricle each time it contracts. Contrary to what many people believe, a normal ejection fraction is not 100%. Even a healthy heart pumps out only about half to two-thirds of the volume of blood in the chamber in one heartbeat. So a normal ejection fraction lies somewhere in the range of 55% to 65%.

Q. My cardiologist told me to take clopidogrel for a year after I received a stent. Now the year is up. I haven't had any bleeding problems. Should I keep taking it?

A. In addition to aspirin, doctors routinely prescribe clopidogrel (Plavix) for people who receive stents, the tiny metal mesh tubes placed in clogged blood vessels to improve blood flow. This medication stops blood components called platelets from clumping together and forming clots. The current guidelines generally recommend that people take the drug for a year. This advice assumes they don't have any side effects such as unusual bleeding, which can show up as severe nosebleeds or blood in the urine or stools. However, these guidelines are still evolving. Experts are currently reviewing new findings from large studies on the benefits and risks of taking clopidogrel and similar drugs for extended periods of time.