Medications Archive

Q. I've been taking dabigatran (Pradaxa) for atrial fibrillation for a few years and haven't had any problems. But I've seen ads on television suggesting that this drug and others like it aren't safe. What's your advice?

A. Known as novel oral anticoagulants, these drugs make the blood less likely to clot, which helps prevent strokes. Others in the class include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). They work as well as the older anti-clotting drug warfarin (Coumadin) but don't require frequent testing for clotting function and are less likely to interact with food and other drugs.

By Anne Fabiny, M.D., Editor in Chief

Every so often, medical professional organizations issue new guidelines for treating diseases, based on an accumulation of new evidence. In 2013 the American College of Cardiology and American Heart Association issued a guideline on treating blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) risk, using a new risk calculator (online at health.harvard.edu/heartrisk) to estimate a person's risk of developing ASCVD over the next 10 years. The guideline created a controversy because using the new risk calculator gives everyone over 75 a risk score of at least 7.5%—the threshold for prescribing statins to prevent heart disease in younger people. By that measure, everyone over the age of 75 should be on a statin!

Daily aspirin use has increased among U.S. adults, according to a survey published May 2015 in the American Journal of Preventive Medicine. The survey asked more than 2,500 people ages 45 to 75 about their current aspirin use. The overall use was 52%, up from 41% in a similar survey in 2004. The most common reasons for taking daily aspirin were prevention of heart attack and stroke. Eighteen percent of aspirin users cited cancer prevention as their reason for taking aspirin. And while most users said they'd talked to their doctor before starting aspirin therapy, 25% of the respondents had not. That finding is troubling, since aspirin is a blood thinner. "Aspirin can increase the risk of bleeding in the brain or elsewhere in the body. This risk might be justified if there is a good reason for aspirin use, but might be entirely unjustifiable if not. That is why I always recommend discussing any medication or supplement use with one's primary care provider," says Dr. Natalia Rost, associate professor of neurology at Harvard Medical School. 

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Women are at greater risk for dementia. Joining clinical trials can help to speed the development of promising drugs.

A study published online April 13, 2015, in JAMA Internal Medicine indicates that a single infusion of the bisphosphonate drug zoledronate (Reclast) can be used to increase bone density in women who can't take oral versions of bisphosphonates. Taking an oral bisphosphonate like alendronate (Fosamax) is effective in building bone for women with osteoporosis, but it requires a commitment—taking the drug on an empty stomach and remaining upright for 30 minutes afterward. Because this may not be practical for women in assisted living facilities, they often aren't given bone-building drugs, even though their risk of hip fracture is eight to nine times that of women living at home.

The researchers studied 181 women with osteoporosis residing in assisted living facilities. The average age was 85. The women were randomly assigned to one of two treatments—1,200 milligrams of calcium and 800 IU of vitamin D daily as supplements plus a single intravenous infusion of zoledronate or the same daily doses of the supplements alone.

Physical therapy and weight loss can relieve knee pain and protect your mobility.

Q. I am scheduled to have my prostate removed and am concerned about the risk of erectile dysfunction (ED) after the surgery. I've heard that taking an ED drug daily during my recovery could help. Do you recommend this?

A. About half of men lose some erectile function after radical prostatectomy, which removes the entire prostate gland. ED drugs help men to have erections after surgery, but so far research has not shown that taking it daily produces better results than taking the medication as-needed—when you anticipate sexual activity.

Maintaining a healthy weight is the best way to rein in gastroesophageal reflux disease (GERD), or chronic heartburn, according to a study in The American Journal of Gastroenterology. Researchers found that GERD symptoms increased for every incremental rise in body mass index (BMI), which measures the ratio of weight to height.

In GERD, the acidic contents of the stomach back up into the lower esophagus, causing burning pain. The most effective treatment for GERD is taking an acid-reducing proton-pump inhibitor medication, such as omeprazole (Prilosec). People who are overweight are much more likely to develop GERD.

People with high blood pressure could benefit from a B vitamin known as folate if they are not getting enough from their diets, according to a study in The Journal of the American Medical Association (JAMA).

The study included more than 20,000 adults in China with high blood pressure who had never had a stroke or heart attack. Participants who took folate supplements along with a blood pressure medication had fewer strokes over the four-and-one-half-year trial than those who only took the medication.

Many different medications can potentially harm the liver, so doctors sometimes do liver function tests to ensure safety. The worst-case scenario is liver failure, but when this happens, the cause is usually not prescription medications, but rather the over-the-counter painkiller acetaminophen (Tylenol) or herbal supplements, according to a study in Gastroenterology.

Researchers scrutinized 5.4 million records of patients in the Kaiser Permanente Northern California system from 2004 to 2010. They identified only 62 cases of liver failure, 32 of which were linked to medications. This may not precisely reflect national rates, but it does suggest that liver failure from medications is relatively uncommon.