Millions of people depend on the blood thinner warfarin to prevent clots from forming in their blood. It’s an important drug, but tricky to use. One problem with warfarin (Coumadin, Jantoven, generic) is that it interacts in potentially harmful ways with other medications. Two problematic types are antibiotics and antifungal agents. As we write in the June issue of the Harvard Heart Letter, this isn’t just a problem with pills, but can also happen with ointments, creams, and suppositories. Adding an antibiotic such as cotrimoxazole, cephalexin, or penicillin, or an antifungal medicine such as itraconazole or ketoconazole on top of warfarin can heighten warfarin’s blood-thinning ability. This raises the risk of internal bleeding or sustained bleeding after an injury.
Drugs and Supplements
Aspirin, ibuprofen, and naproxen can subdue a pounding headache and ease arthritic aches. Could these and other nonsteroidal anti-inflammatory drugs (NSAID) serve double duty, protecting against skin cancer even while they relieve pain? A new study published online in the journal Cancer suggests they might. But based on the current evidence, cancer prevention alone doesn’t […]
Calcium supplements are being called on the carpet after new research showed they significantly increased risk of heart attack among women getting extra calcium from pills, but not among those who got their calcium from food. What’s the connection? Over time, calcium can accumulate in arteries. It also builds up in plaque, the cholesterol-filled pockets that can cause angina or a heart attack. Three Harvard professors say the new study doesn’t prove that calcium supplements cause heart disease, but advocate that it’s almost always best to get vitamins and minerals from food, not pills.
If you’ve battled bronchitis or endured an ear infection, chances are good you were prescribed the antibiotic azithromycin (Zithromax), which is commonly available in a five-day dose known as the Z-Pak. But a recent study suggests that the Z-Pak may do some harm even as it heals. The 14-year study, published in the New England Journal of Medicine, found that people taking azithromycin have a 2.5-fold increased chance of heart-related death within five days of starting a Z-Pak, compared to people taking the antibiotic amoxicillin. Individuals with heart failure, diabetes or a previous heart attack, as well as those who have had bypass surgery or had stents implanted, are at even higher risk.
Since bisphosphonates such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast) were first introduced in the mid-1990s, they’ve become a staple of osteoporosis treatment. Yet an FDA review recently published in The New England Journal of Medicine questions whether there’s any benefit to staying on these drugs long-term—especially considering their potential for side effects. A report released today in the Archives of Internal Medicine highlights one of those side effects, linking bisphosphonate use to a higher risk of unusual fractures in the femur (thighbone). If you’ve been taking bisphosphonates long-term, you may be wondering, “What now?” If you’ve been taking bisphosphonates for less than five years you probably don’t need to change what you’re doing. But if you’ve been on these drugs for more than five years, talk to your doctor about whether it’s worth continuing.
Millions of people with heart disease who take the blood thinner clopidogrel (Plavix) can now look forward to having fatter wallets. Plavix lost its patent protection this month, and on May 17 the Food and Drug Administration gave several companies the okay to sell its generic form. Clopidogrel users can now buy brand-name Plavix for a premium price, or equally effective generic clopidogrel in a 75-mg dose at a much lower cost. The change may also save lives. “We have seen more than a few patients have heart attacks because they had stopped taking clopidogrel due to the expense,” said Dr. Thomas Lee, professor of medicine at Harvard Medical School and Co-Editor in Chief of the Harvard Heart Letter. “I think the lower price is going to save some lives.” Before a company can sell a generic version of a drug, it must prove to the FDA that the drug is as effective and safe as the original.
Eating yogurt or taking a so-called probiotic when you have to take antibiotics may help prevent the diarrhea that often accompanies antibiotic treatment. That’s the conclusion of a study just published in the Journal of the American Medical Association. A team of California-based researchers combined the results of 63 randomized trials pitting probiotics versus placebo among almost 12,000 men and women taking antibiotics. Those who took antibiotics plus probiotics were 42% less likely to develop diarrhea as those who got the placebo. About one in three people who take antibiotics develop diarrhea. Antibiotics kill these “good” microbes along with bacteria that are causing an infection. This upsets the balance of the normal flora in the intestines. The result is often loose, watery stools known as antibiotic-associated diarrhea.
A new ruling from the FDA offers good news and some warnings for people who take a cholesterol-lowering statin. The good news—no more periodic blood tests for liver function. The warnings—taking a statin may increase the odds of developing type 2 diabetes or suffering reversible memory loss or problems thinking. The FDA warned that one statin, lovastatin, shouldn’t be taken with some antibiotics, anti-fungal agents, or medications used to treat AIDS.
Worrisome shortages of important medications—from drugs to manage the symptoms of ADHD to standard cancer drugs—have been in the headlines lately. A shortage can be frightening to the people who need a hard-to-get medication, and frustrating for the clinicians who prescribe it. Manufacturing and quality control issues are among the primary reasons for drug shortages. The FDA can sometimes help ease a drug shortage. What can you do if you are affected? Ask your doctor if another medication might work for you. Be especially wary of Internet or faxed advertisements for alternatives (often highly priced and sometimes counterfeit).
Some medications can cost as much as $2,000 a year. But according to a post on the Medical Billing and Coding blog, that’s peanuts. The price tag for a year’s worth of Soliris, a drug used to treat a rare blood disease known as paroxysmal nocturnal hemoglobinuria, is $409,500. The blog lists 10 other drugs that cost $200,000 or more a year. All 11 are so-called orphan drugs, developed specifically to treat rare conditions. The post raises questions about how much is too much when it comes to drug costs. If one of these drugs is keeping you or a family member alive, the sky’s the limit. If not, the cost can seem excessive.