Drugs and Supplements

Howard LeWine, M.D.

Common painkillers boost risk of repeat heart attack

Most people don’t think twice about taking Motrin, Advil, Aleve, or similar over-the-counter painkillers. A new study suggests that heart attack survivors should use these drugs, known as nonsteroidal anti-inflammatory drugs (NSAIDs), as little as possible. A team of Danish researchers found that among heart attack survivors, those who used an NSAID were about 60% more likely to have died during each year of the five-year study than those who didn’t use an NSAID. Of all the NSAIDs, diclofenac (Cataflam, Voltaren, generic) was linked to the largest increases in death or heart attack rates, while naproxen (Naprosyn, Aleve, generic) appeared to carry the lowest risk. The lower risk with naproxen confirms what has been seen in older studies. If you have heart disease and need pain relief, try acetaminophen first. If you need an NSAID, naproxen is probably the best choice for your heart. But whatever you and your doctor decide is best for you, use the lowest dose possible for the shortest period of time.

Heidi Godman

Medication errors a big problem after hospital discharge

After a hospitalization, being discharged is a key step on the road to recovery. But that road can take a dangerous turn—namely, a serious problem with one or more medications. It’s a common problem that many people experience within a few weeks of leaving the hospital. Researchers at Brigham and Women’s Hospital now report in […]

Stephanie Watson

Proposed recommendations question the value of calcium, vitamin D supplements

The U.S. Preventive Services Task Force (USPSTF) has stirred up a maelstrom of debate by proposing that healthy postmenopausal women lay off daily calcium and vitamin D supplements, which the task force says may do more harm than good. The USPSTF concluded that, based on the available evidence, supplements containing up to 400 IU of vitamin D and 1,000 milligrams (mg) of calcium don’t reduce fractures in postmenopausal women. Plus, these supplements may slightly increase the risk of kidney stones. As a result, the USPSTF says that postmenopausal women who aren’t at risk for osteoporosis shouldn’t be taking these supplements to prevent fractures. The jury is still out on whether it’s worth it for women and men to take higher doses of calcium and vitamin D to prevent fractures, or to take vitamin D to prevent cancer. Our experts say that most of your daily calcium should come from your kitchen, not your medicine chest.

Holly Strawbridge

Some antibiotic, antifungal drugs don’t mix with warfarin

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.

Stephanie Watson

NSAIDs—pain relief and skin cancer protection in one pill?

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 […]

Holly Strawbridge

Link between calcium supplements and heart disease raises the question: Take them or toss them?

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.

Heidi Godman

Z-Pak users: be on the alert for heart-rhythm problems

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.

Stephanie Watson

Thigh fractures linked to osteoporosis drugs; long-term use questioned

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.

Holly Strawbridge

Wallets rejoice as Plavix goes generic

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.

Howard LeWine, M.D.

Probiotics may help prevent diarrhea due to antibiotic use

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.