Drugs and Supplements
High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But an unanswered question remains: how low should you go? New research published online today in The New England Journal of Medicine suggests that lower is better. In a large clinical trial, participants who took a cholesterol-lowering statin plus ezetimibe, a different type of cholesterol-lowering drug, had lower levels of harmful LDL cholesterol and experienced fewer heart attacks and strokes than participants taking a statin alone. The new findings provide a strong rationale for using ezetimibe when a statin alone isn’t enough.
When appendicitis strikes, an operation to remove the appendix has long been the route to recovery. But a new strategy called “antibiotics first” could help some people avoid surgery for appendicitis. A clinical practice article in today’s New England Journal of Medicine explores the idea of antibiotics first for appendicitis. The main advantage is that it could eliminate the need for surgery in some people with appendicitis. The drawbacks are that it leaves open the possibility of repeat bouts of appendicitis, with an appendectomy still down the road. It could also lead to lingering symptoms and a sense of uncertainty that could affect quality of life. Although immediate surgery is the standard of care for appendicitis, an antibiotics first approach could be appropriate now for individuals who prefer not to have surgery, aren’t healthy enough for surgery, or aren’t near a medical center that routinely does laparoscopic appendectomy.
Each year, several million people with neck or back pain get injections of anti-inflammatory steroid medications. When they work (they don’t always), such injections can bring profound relief. But injecting these medications into the spine can cause partial or total paralysis, brain damage, stroke, and even death. Case reports beginning in 2002 highlighted serious problems linked to spinal steroid injections. In 2014, the FDA started requiring a warning on the labels of injectable steroids. A Viewpoint article in this week’s Journal of the American Medical Association spotlights new safety recommendations to help prevent these rare but real problems. The new recommendations are part of the FDA’s Safe Use Initiative.
Each year, an alarming number of babies born in the United States spend their first few days withdrawing from drugs, often prescription painkillers their mothers took during their pregnancies. This problem, called neonatal abstinence syndrome (NAS), has increased fourfold since 2004, according to a report published online yesterday in The New England Journal of Medicine. NAS occurs in many babies whose mothers took a type of medication called an opioid during pregnancy. (Two commonly used opioids are OxyContin and Vicodin.) These drugs easily pass from the mother’s bloodstream to the baby’s. In effect, NAS is a baby’s withdrawal from opioids. With medication and time, babies with NAS get better, but they have to spend time in the hospital. In short, they get a rough start on life that can set them back and possibly have long-term repercussions. With so many safe options for pain control, women who are pregnant should use opioids only if these medications are absolutely necessary.
If you’re among the one in three American adults with high blood pressure, be sure you’re getting plenty of the B vitamin known as folate. Doing so may lower your odds of having a stroke, an often disabling or deadly event linked to high blood pressure. That’s the conclusion of a large trial conducted in China, where many people don’t get enough folate. Most Americans get plenty of folate or its synthetic version, folic acid. That’s largely because grain folic acid is added to most grain products, including wheat flour, cornmeal, pasta, and rice. It’s a good idea for everyone to do a diet check to make sure it delivers enough folate. Good sources include green leafy vegetables, beans, and citrus fruits.
Every so often, a medical advance comes along that rewrites the script for treating a disease or condition. After today’s announcement of impressive results of a new type of cholesterol-lowering drug, that scenario just might happen in the next few years. The results of three clinical trials presented today at the annual meeting of the American College of Cardiology, and simultaneously published in the New England Journal of Medicine, suggest that a class of new drugs called PCSK9 inhibitors can dramatically reduce the amount of harmful LDL cholesterol circulating in the bloodstream and prevent heart attacks, strokes, and other problems related to cholesterol-clogged arteries. The drawbacks are that PCSK9 inhibitors must be given by injection every 2 to 4 weeks, may cause mental confusion or trouble paying attention, and, if approved, will likely be expensive.
Marijuana-laced brownies have long been a way to get high. Now a new generation of “food companies” is taking the concept of edible marijuana in a somewhat scary new direction: marijuana-laced foods that mimic popular candies. These sweets could pose a danger to children, warns a Perspective article in today’s New England Journal of Medicine. From a marketing perspective, it’s a cute concept to sell Buddahfingers that look like Butterfingers, Rasta Reese’s that mimic Reese’s Peanut Butter Cups, or Pot Tarts that resemble Pop-Tarts. But the availability of edible marijuana products has led to an increase in emergency visits to hospitals because of kids accidentally eating edible marijuana products and in marijuana-related calls to poison and drug hotlines.
Medications can do wonderful things, from fighting infection to preventing stroke and warding off depression. But medications don’t work if they aren’t taken. Some people don’t take their medications as prescribed because they forget, or are bothered by side effects. A new report from the National Center for Health Statistics shines the light on another reason: nearly 1 in 10 people skip medications because they can’t pay for them. Other strategies for saving money on drug costs included asking doctors for lower-cost medications, buying prescription drugs from other countries, and using alternative therapies. Not taking medications as prescribed can cause serious problems. It can lead to unnecessary complications related to a medical condition. It can lead to a bad outcome, like a heart attack or stroke. It can also increase medical costs if hospitalization or other medical interventions are needed. Safe money-saving options include using generic drugs when possible, pill splitting, shopping around, and making lifestyle changes such as exercising more and following a healthier diet, which can sometimes decrease the number and dose of drugs needed.
A new report from the University of Washington links long-term use of anticholinergic medications and dementia. Anticholinergic drugs block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinson’s disease. The study found that people who used anticholinergic drugs were more likely to have developed dementia as those who didn’t use them. Dementia risk increased with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less. Safer alternatives to anticholinergic drugs exist.
Opioid painkillers like hydrocodone and oxycodone offer blessed relief from pain. But the body gets used to them, requiring ever-higher doses. They are also addictive, cause side effects, and can kill. A report in the New England Journal of Medicine says prescription painkiller abuse accounts for about 17,000 deaths a year. Doctors are learning to say no to opioids, but have limited scientific guidance on when and how to best use them for chronic pain. Ideally, these drugs should prescribed for the shortest time possible and, if pain persists, a transition made to a non-addictive form of pain control. This may be other medications or specialized counseling from a pain specialist that might include complementary and alternative treatments, like acupuncture and meditation.