Medications and treatments Archive

Grapefruit can mean danger when combined with some popular drugs used for high blood pressure, high cholesterol and depression

Grapefruit and grapefruit juice are healthful, providing enough vitamin C, potassium, dietary fiber, and other nutrients to earn the American Heart Association's "heart-check" mark. That's the good news. The bad news is that grapefruit juice can interact with dozens of medications, sometimes dangerously.

Doctors are not sure which of the hundreds of chemicals in grapefruit are responsible. The leading candidate is furanocoumarin. It is also found in Seville (sour) oranges and tangelos; although these fruits have not been studied in detail, the guidelines for grapefruit should apply to them as well.

On call

Q. I had a major heart attack earlier this year and received a drug-eluting stent. My doctor tells me that it's now safe to exercise and engage in sexual activity. But is it safe to use erectile dysfunction (ED) medications?

A. Most men who have recovered from a heart attack can resume their usual sex life. Once your doctor allows you to engage in moderate aerobic activity — sexual activity is often equated to the exercise level of brisk walking — you may safely use ED medications with certain precautions.

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Q. I've read that getting the flu shot annually will weaken my immune system over time. Is this true?

A. A study published in the March 1, 2017, issue of The Journal of Infectious Diseases investigated whether getting an annual vaccination against influenza (flu) can weaken your body's natural ability to protect itself from the disease. Past studies have raised similar concerns. Researchers at the University of Bergen in Norway followed 250 health care workers. Some of them got a flu vaccination every year from 2009 through 2013. The others only received the vaccine once in 2009 and not in the years from 2010 to 2013. The researchers then took blood samples before the influenza season (and before people were vaccinated that season), from the members of both groups and looked at different markers to gauge how well their immune systems would respond to the influenza virus. They found that getting an annual flu vaccination did not weaken the immune system. As a group, the people who got the flu shot annually appeared to have a better immune response to influenza than those vaccinated only once.

On call

Q. What is the significance of mild narrowing of the carotid artery detected by an ultrasound? I have never had any symptoms of stroke.

A. "Mild" narrowing ranges from 15% to 49% blockage of the artery. Over time, this narrowing can progress and lead to a stroke. Even if it doesn't progress, mild narrowing is a sign of early blood vessel disease and calls for preventive measures.

Benzodiazepines and drugs with strong anticholinergic effects have been linked to Alzheimer's disease in people who take them. There are alternatives to both types.

Research we're watching

Reliable blood pressure readings are vital for diagnosing high blood pressure and estimating a person's risk of heart disease. New research suggests that using a home blood pressure monitor may be more dependable than other methods.

Doctors have long relied on office visits to check people's blood pressure. But growing evidence shows that readings done outside a doctor's office are more closely linked to a person's risk of heart-related problems. Ambulatory blood pressure monitoring (ABPM) involves wearing a device that automatically records blood pressure every 30 to 60 minutes for 24 hours, but it's not widely available.

They're not yet FDA-approved, but the devices are available and safe — if you know what to look for.

When Congress passed the Over-the-Counter (OTC) Hearing Aid Act in 2017, it opened up a new world of possibility for people with hearing loss. Instead of paying $5,000 for a pair of FDA-approved hearing aids and follow-up service, you could pay hundreds of dollars for an OTC pair from any seller — no doctor appointments, hearing tests, or fittings needed. The devices would have the same fundamental technology as traditional hearing aids, they'd be targeted to people with perceived mild-to-moderate hearing loss, and the FDA would ensure quality by regulating and approving the OTC devices.

But almost four years later, the OTC hearing aid category and its safety and labeling rules are still tied up in red tape.

Research we're watching

There are a number of different approaches to treating a condition called adhesive capsulitis, better known as frozen shoulder. This common condition causes significant shoulder pain and reduced mobility. While it generally goes away on its own over time, it can take up to a year or longer to heal. But there hasn't been consensus on whether any particular therapy leads to more rapid pain relief and full range of motion.

A study published online Dec. 16, 2020, by JAMA Network Open looked at various treatment options for frozen shoulder to determine which was the most effective. Researchers analyzed 65 different studies with more than 4,000 total participants and found that the first line of therapy should be to inject a steroid directly into the joint to reduce inflammation. This treatment helped to reduce pain and led to the fastest recovery. The study authors said the steroid injection should be accompanied by a home exercise program that includes stretches and exercises to improve range of movement in the shoulder.