Health ShortsDrugs
Accidental Drug Deaths Increasing
Accidental deaths from drug poisoning have been increasing in the United States, rising 68.3 percent between 1999 and 2004, according to the Centers for Disease Control. The majority of these deaths were attributed to misuse of prescription drugs, including psychotherapeutic drugs, hallucinogens and narcotics.
Men in their 40s accounted for the majority of deaths associated with opioid pain killers such as oxycondone, hydrocodone, fentanyl and methadone. Accidental deaths associated with painkillers were up 91 percent from 1999 to 2002.
[SOURCE: “Accidental drug-poisoning deaths on the rise in the US,” Reuters Health, February, 2008; Miranda Hitti, “U.S. Rx painkiller deaths up,” WebMD Medical News, July 24, 2006] A Headache? Or a Pain in the Gut? If you take aspirin or another NSAID frequently for a headache, you may eventually end up with a pain in the stomach. Individuals who take NSAIDs regularly have a three-fold increased risk of gastrointestinal bleeding and ulcers. NSAIDs–including ibuprofen, naproxen sodium and ketoprofen as well as aspirin–work by blocking the production of prostaglandins and other chemicals that cause pain and inflammation. These same chemicals also protect the lining of the stomach. Acetaminophen does not have the same effect on prostaglandins and does not cause stomach irritation or gastrointestinal bleeding. [SOURCE: R. Morgan Griffin, “Many Familiar Over-the-Counter Pain Relief Drugs Can Cause Harmful Side Effects for Those with Ulcers. Here’s What You Need To Know,” WebMD feature, May, 2005] If you're bothered by recurrent yeast infections, you may be able to prevent them by taking an antifungal pill once a week. In a study reported in the New England Journal of Medicine [August 26, 2004], 91 percent of women taking weekly doses of fluconazole (but only 36 percent of those taking placebo) for six months remained free of Candida albicans infections. Over time, however, yeast infections tended to recur. Over the next six months, 43 percent of subjects taking fluconazole and 22 percent of those taking placebo were free of yeast infections.
[SOURCE: "Study Shows Regular Drug Regimen Can Prevent Recurrent Yeast Infections," Obesity, Fitness & Wellness Week, September 18, 2004] An Aspirin a Day? Take It Literally Many persons with heart disease are told by their doctors to take an aspirin a day (typically a small 81-milligram dose) to inhibit blood clotting and reduce the risk of heart attack or stroke. Other NSAIDs such as ibuprofen, naproxen sodium and ketoprofen, however, do not reduce the risk of a heart attack or stroke and should not be substituted for this purpose. [SOURCE: R. Morgan Griffin, “”Many Common Over-the-Counter Drugs Taken for Pain Can Push Your High Blood Pressure Even Higher,” WebMD feature, May, 2005, medically updated April 6, 2006] An eight-week study found that the antidepressant drug citalopram (Celexa) performed no better than placebo in treating the depression of 174 subjects aged 75 and over. One third of the subjects in both groups, however, showed a marked improvement in their symptoms. The author pointed out that all subjects were given an "active intervention"-a free medical workup, an MRI scan, weekly visits with health professionals and free rides to and from their appointments. Whether improvements were caused by the drug or the supportive environment could not be determined. Celexa is an SSRI, and this class of antidepressant does not appear to be as effective as other medications in treating older patients. Tricyclic antidepressants have side effects that make them unsafe for many persons with heart disease.
[SOURCE: Alison McCook, "Effectiveness of Antidepressant Unclear in Elderly," Reuters News, November 25, 2004; Steven P. Roose, et al, American Journal of Psychiatry, November, 2004] Aspirin a Day for Prostate?
Men taking an aspirin a day had a 15 percent reduced risk of prostate cancer, according to a Baltimore study of 887 men. Men using other nonsteroidal antiinflammatory drugs had a 24 percent reduced risk. Daily aspirin is often prescribed for heart disease patients. More research is needed to confirm the benefit for prevention Studies have found that aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors tend to inhibit the formation and proliferation of polyps in the colon, many of which are premalignant. This may be in part because the medications block the growth of blood vessels that grow up around a tumor to nourish it (angiogenesis).
Other factors frequently associated with a lower incidence of colorectal cancer include a high-fiber, low-fat diet; exercise; calcium; vitamin D; and selenium.
[SOURCE: Tina B. Stacy, “Colorectal Cancer: Screening, Treatment and Prevention,” Drug Topics, May 17, 2004; Charlie H. Viala and John K. Olynyk, “Screening Sigmoidoscopy for Colorectal Cancer: Further Pieces in the Jigsaw,” The Medical Journal of Australia, May 17, 2004] Patients treated for colorectal cancer who took 325 milligrams daily of aspirin had a 35 percent reduced risk of developing recurrent colon polyps than subjects taking a placebo, according to a North Carolina University study published in the New England Journal of Medicine [March 6, 2003]. In the subjects taking aspirin, the average number of polyps was lower, and aspirin delayed the appearance of polyps and slowed their development. "Although aspirin may be of some benefit in preventing colorectal cancer, it cannot yet be recommended for this indication and is not a substitute for screening and surveillance," wrote Dr. Thomas F. Imperiale of Indiana University in an accompanying editorial. Other studies have shown nonsteroidal antiinflammatory drugs (NSAIDs) and calcium supplements to reduce the recurrence of polyps in colon cancer patients.
[SOURCE: Major Study Shows Aspirin Can Reduce Polyp Return in GI Cancer Patients," Cancer Weekly, April 1, 2003] COX-2 Gastro Protection Overstated?
Pain relieving medications known as COX-2 inhibitors were introduced as a "safer" alternative to conventional nonsteroidal antiinflammatory drugs (NSAIDs) because they were less likely to cause ulcers and other gastrointestinal problems. This benefit may have been overstated, however. While patients taking COX-2 inhibitors have had fewer ulcers and gastrointestinal symptoms, long-term studies have not shown a significant reduction of the most serious complications such as bleeding or perforation.Two of the three COX-2 inhibitors approved by the FDA have been removed from the market by their manufacturers because of studies showing an increased risk of heart attacks and strokes among those taking the medications.
[SOURCE: "Benefit of COX-2s vs Conventional NSAIDs?" Pharma Marketletter, January 17, 2005] Controlling Hot Flashes without a Pill
As an alternative to hormone replacement therapy and supplements such as black cohosh, behavioral modification can be used to combat hot flashes and other menopausal symptoms: · Keep a symptom diary to try to find what triggers or relieves hot flashes. o · Wear layered clothing that can be removed easily. o · Open the window or turn on the air conditioner. o · Avoid spicy food, alcohol and caffeine. o Try deep abdominal breathing (six to eight breaths a minute)-found in one study to reduce hot flashes by about 40 percent. o [SOURCE: Judi L. Chervenak, "When Your Menopausal Patient Chooses Alternative Therapy," Contemporary OB/GYN, May, 2003] Drug Effective in Prevention Trial
Finasteride, a drug now approved for the treatment of benign prostatic hyperplasia (BPH), was found effective in lowering the rate of detected prostate cancer over a seven-year period in a recent study. Among 18,882 subjects over age 55 with normal digital rectal examinations and PSA levels below 3.0 ng/mL, 18.4 percent of those taking finasteride developed prostate cancer compared to 24.4 percent of those taking placebo Finasteride blocks the conversion of testosterone to dihydrotestosterone, a form implicated in the development of cancer. The drug has sexual side effects and, in this study, was associated with an increased incidence of high-grade cancers. The authors wrote that “the increase in high-grade cancers in the finasteride group may occur because these aggressive cancers are less dependent on androgens for growth and may have had a selective advantage in an environment of decreased dihydrotestosterone.”
[SOURCE: Bill Zepf, “Finasteride in Preventing Prostate Cancer,” American Family Physician,” February 1, 2004] Drug Interactions To Avoid
Any time you take two or more medications or one medication plus a herbal supplement, there's the possibility of a negative drug interaction. Unless you check specifically with your doctor or pharmacist, possible interactions may get over looked. Some important drug interactions cited by Dr. David Bates, author of a, 2003 article on adverse drug effects in the Journal of the American Medical Association, include: · Warfarin (Coumadin), a "blood thinner" often prescribed to heart patients, can cause serious bleeding if combined with antibiotics such as cotrimoxasole (Bactrim, Septra). · Potassium is theoretically good for your blood pressure, but potassium supplements can cause serious problems, including cardiac arrest, if taken with a potassium-sparing diuretic such as triamterene or spironolactone. · When combined with nitrate-based drugs, all three erectile dysfunction medications (Viagra, Levitra and Cialis) can cause a sudden dangerous drop in blood pressure. · If you're taking a statin drug to lower your cholesterol, you should avoid oral anti-fungal medications. The combination can cause muscle damage. [SOURCE: "Bad Combinations: Drug Interactions You and Your Doctors Need To Worry About," Harvard Health Letter, April, 2004] ER Visits Related to Ecstasy Up 58%
Emergency room visits related to use of Ecstasy (MDMA) were up 58 percent in the period from 1999 to 2000, during a time when overall drug-related visits remained about the same. About 80 percent of Ecstasy-related ER cases involved persons aged 25 years and younger, according to the Drug Abuse Warning Network (DAWN) survey of more than 400 American hospitals.
[SOURCE: Winnie Anne Imperio, "Ecstasy-Related ER Visits Up," Clinical Psychiatry News, September, 2001] How Does Ecstasy Affect a Fetus?
A five-year study currently underway will assess the effects of the drug Ecstasy (MDMA) on a developing fetus. Researchers will study 150 infants (75 who have been exposed to the drug and 75 in a control group) and their mothers in an effort to measure the drug's effect on growth and development. Preliminary studies on rats exposed to MDMA in utero found spatial learning to be affected.
[SOURCE: "Team Will Study Effects of Ecstasy on Fetus," Health and Medicine Week, December 10, 2001] Injections Faster but PT Works Too
Shoulder pain patients getting corticosteroid injections tended to have a more rapid response but those treated with physical therapy fared equally well, according to a United Kingdom study. And the physical therapy patients required fewer physician visits.Of subjects getting an injection of methylprednisolone and lignocaine, 52 percent returned with shoulder pain. Only 39 percent of those getting physical therapy returned with pain.
[SOURCE: "Physiotherapy Is As Effective as Steroids," GP, April 28, 2003] Liver Toxicity Mimics Flu Symptoms Acetaminophen (Tylenol, Panadol) is usually considered the safest over-the-counter pain remedy, but an overdose of this medication can cause liver toxicity. The risk may occur when a person self-treating flu symptoms exceeds the maximum dose (four grams a day for an adult) by taking the pain-killer as well as several other products containing acetaminophen. Treatment for liver toxicity is nearly always successful if started within the first eight hours. Symptoms such as nausea, vomiting and loss of appetite, however, are easily mistaken for flu effects, prompting additional doses of flu remedies. Fluids and food which might help clear the liver toxicity are avoided. [SOURCE: Susan E. Farrell, M.D., “Toxicity, Acetaminophen, emedicine from WebMD, last updated January 3, 2006] Many Americans taking aspirin as preventive action against heart attack or stroke New Drugs Fight Advanced Cancer
Two experimental drugs have been shown in early studies to be effective in fighting colon or rectal cancer that has spread to other tissues, significantly increasing survival time. Bevacizumab (Avastin), which disrupts a tumor's blood/ vessel supply, shrank cancers by at least half in 45 percent of patients and gave them an average of 11 months of remission, according to a study at Duke University. Cetuximab (Erbitux) reactivates chemotherapy by targeting a molecule displayed on cancer cells. In a British study, subjects getting a combination of cetuximab plus irinotecan had greater tumor shrinkage and longer remission time than subjects taking either drug alone.
[SOURCE: N. Seppa, "Treatment Combinations Stall Colorectal Cancer," Science News, June 7, 2003] OTC Painkillers: Follow the Rules For a headache or minor aches and pains, you can choose from a number of effective over-the-counter remedies that are safe as long as you follow the rules: · Read the product label and take the proper dose for your age and weight. · Take into account that cough, cold and fever medications may contain the same OTC painkiller, increasing the risk of an overdose. · To avoid a rebound headache, avoid taking any OTC pain medication more than twice a week. · If you’re under age 19, take acetaminophen (Tylenol) since taking aspirin for a cold or fever can put you at risk of Reye’s syndrome. Acetaminophen differs from the other pain medications in that it fights pain and fever but not inflammation. It is safer on the stomach, but an overdose increases the risk of liver toxicity, particularly in persons who drink alcohol regularly. [SOURCE: “Choose Your Painkiller with Caution,” Current Health 2, February, 2005] If you have high blood pressure, you should take extra care–and talk to your doctor or pharmacist–before you start popping over-the-counter pain relief pills. NSAIDs such as ibuprofen, naproxen sodium and ketoprofen carry the greatest risks. Aspirin is less likely to raise blood pressure, and acetaminophen is probably the drug of choice. The 1990s saw a sharp increase in the prescribing of psychiatric drugs to American children and teens. The number of young people using psychiatric drugs rose from 2.5 percent in 1987 to 6.2 percent by 1996. Ritalin and other stimulants used to treat attention deficit hyperactivity disorder were the most commonly abused prescription drugs.
[SOURCE: "Psychiatric Drugs Surge among Kids," Science News, February 1, 2003] Surgery Patients: Report Supplements
Patients scheduled for surgery should be sure to report to their doctors any supplements they are taking. To ensure safety, some supplements must be discontinued well in advance of the surgery date. Garlic, ginkgo and ginseng, for example, could promote unwanted bleeding; kava and valerian could have sedative effects.
[SOURCE: Norra MacReady, "Evidence Can Clarify Complementary Medicine Use: Assessing Dietary Supplements," Family Practice News, March 1, 2004] The Dirty Dozen: Products To Avoid
Consumer Reports recently published a list of the "dirty dozen" dietary supplements-products that may cause cancer, kidney or liver damage or even the risk of death. The list includes aristolochic acid (birthwort), comfrey, germander, androstenedione, chaparral, kava, bitter orange, organ or gland extracts, lobelia, pennyroyal oil, scullcap and yohimbine.
[SOURCE: David Bjerklie, "Supplements: The Dirty Dozen," Time, April 12, 2004; Lisa Stein, "Poison-Pill Watch," U.S. News & World Rep0ort, April 12, 2004] When you suffer from thick phlegm, chest congestion and heavy coughing, you can get some relief with several over-the-counter remedies such as Mucinex DM, Robitussin and Tobitussin DM. One simple way to break up the phlegm and make expectorants more effective is to drink more water.
[SOURCE: “From the Pharmacy,” Saturday Evening Post, November-December, 2005] In a dangerous trend, many men are combining Viagra, the erectile dysfunction medication, with Ecstasy and other illicit drugs, according to a survey of 844 male patients at a clinic to treat sexually transmitted diseases. Respondents frequently report getting Viagra from friends and have insufficient information regarding possible effects and drug interactions.
[SOURCE: "Men Combining Viagra, Illicit Drugs," Alcoholism & Drug Abuse Weekly, September 3, 2001] Wait and See Approach Works
Two thirds of children treated for middle ear infections with a “wait and see” approach plus pain medication got better without eventually needing antibiotics, according to a recent study.
Children who received antibiotics immediately had faster relief of symptoms and required fewer pain medications but also developed more antibiotic-resistant bacterial strains in their nasal passages, putting them at future risk. Parents of the subjects in both groups were equally satisfied, given that they were educated about the reason for the wait and see approach.
[SOURCE: David P. McCormick, M.D., et al, Pediatrics, June, 2005] Which Pill for a Headache?
Which pill to take for a headache? For an adult, any over-the-counter painkiller should give relief. For children age 19 and younger, acetaminophen (Tylenol) is recommended since aspirin increases the risk of Reye's syndrome, a life-threatening disease that sometimes occurs after a viral infection. Aspirin (Bayer, Bufferin), ibuprofen (Advil, Motrin, Nuprin) and naproxen sodium (Aleve) all have an anti-inflammatory action and are useful for sore muscles as well as pain and fever. Acetaminophen will reduce pain and fever but is not anti-inflammatory. Whatever the medication, take no more than the label indicates. Using any over-the-counter pain medication more than twice a week can inhibit production of the body's natural painkillers and lead to rebound headaches.
[SOURCE: "Choose Your Painkiller with Caution," Current Health 2, February, 2005] Women on Warfarin: Avoid Antifungals
Women taking warfarin, the prescription blood-thinner, should talk to a doctor or pharmacist before using an over-the-counter medication to treat a yeast infection. Miconazole, an ingredient in many of these preparations, has been found to cause abnormal blood clotting in persons taking warfarin. This adverse reaction might manifest itself as abnormal bruising, bleeding gums or nosebleeds.
[SOURCE: Food and Drug Administration; "Yeast Infections; Lifestyle Tips," NWHRC Health Center-Yeast Infections, February 22, 2002]
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