Medications and treatments Archive

While the drug therapy is becoming more widely available, the science is still not clear on how it may help.

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Medical marijuana has been approved in 28 states and the District of Columbia, but researchers are still trying to connect the dots as to how, and if, it works.

"Unfortunately, there are almost no uses of medical marijuana that have been subjected to the kind of rigorous testing you'd want for a pharmaceutical," says Dr. Kenneth Mukamal, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. "This does not mean that it has no benefits, but only that the lack of human studies prevents us from being sure if medical marijuana can really help."

Research we're watching

A growing number of older adults are misusing opioids, according to a new report by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. The 2014 National Survey on Drug Use and Health showed that the percentage of adults ages 50 and older using heroin or misusing prescription opioids jumped from 1.1% to 2% between 2002 and 2014. In contrast, opioid use in adults ages 18 to 25 dropped from 11.5% to 8.1% over the same period.

Drug use can bring particular risks to the health and well-being of older adults because they are more likely than younger people to have other illnesses and often take medications that can interact with opioids, according Center for Substance Abuse Treatment. "These findings highlight the need for prevention programs for all ages as well as to establish improved evidence-based treatment, screening, and appropriate referral services," Dr. Kimberly Johnson, director for the Center for Substance Abuse Treatment, said in a written statement.

A daily low-dose aspirin may help prevent stroke and certain cancers, but the therapy carries certain risks you'll want to discuss with your physician.

It used to be that you would reach for an aspirin only if you had a headache or an achy joint, but current research shows that low doses of the drug may reduce your risk of stroke and even help prevent colorectal cancer.

So, does this mean you should head to the pharmacy, grab a bottle, and pop a tablet every morning to ward off disease? The short answer is, maybe — but only after you have a detailed conversation with your doctor about the potential benefits and risks. A low-dose aspirin regimen is certainly not appropriate for every woman.

In the journals

The erectile dysfunction drugs collectively known as phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra), may not cause melanoma, the most dangerous form of skin cancer, according to a study published online May 19, 2017, by the Journal of the National Cancer Institute.

In 2016, the FDA put PDE5 inhibitors on its watch list of medications with possible safety issues after some studies suggested they might increase the risk for melanoma. In response to the FDA's action, researchers analyzed data from five large-scale studies of the issue, involving 866,049 men, published between 2014 and 2016.

Ask the doctor

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Q. My doctor prescribed Lovaza to help lower my high triglyceride level, which is 530 milligrams per deciliter (mg/dL). But I'm a vegetarian and don't want to take a drug made from fish oil. Are there other options?

A. You're not alone: several of my vegetarian patients also have asked me this question. But let's begin with some background. Triglycerides — which are the main form of fat found in our bodies — are part of a standard lipid panel blood test. Values higher than 150 mg/dL are associated with a higher risk of heart disease.

Research we're watching

Roughly half of Americans ages 75 or older take a daily, low-dose aspirin to prevent a heart attack or stroke. New research suggests these people might benefit from taking a stomach-protecting drug to prevent a higher-than-expected risk of gastro­intestinal (GI) bleeding.

The study, published online June 13, 2017, by The Lancet, involved nearly 3,200 people who were prescribed aspirin because of a previous heart attack or stroke. Researchers followed them for up to 10 years to see how many were hospitalized for bleeding — a well-known side effect of aspirin use. Upper GI bleeding usually results from a stomach ulcer, which can cause anemia, heartburn, and abdominal pain.

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For years, doctors prescribed cholesterol-lowing statins based largely on cholesterol test results. The goal was to lower total cholesterol to under 200 mg/dL, and LDL (bad) cholesterol to under 100 mg/dL. But in late 2013, new guidelines on statin use issued by the American Heart Association (AHA) and the American College of Cardiology (ACC) proposed a major change to that strategy.

These guidelines shifted from a numbers-based approach to a risk-driven approach. Instead of aiming for a specific cholesterol value, doctors were urged to look at a person's entire cardiovascular risk profile when considering treatment. This is a reasonable approach that can help better define when to initiate drug therapy.

Prescription prices can rise without warning, but there are things you can do to pay less for the drugs you need.

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Recent news has brought reports of sudden jumps in medication prices. In August 2015, the price of pyrimethamine (Daraprim), a drug used to treat the parasitic infection toxoplasmosis, leaped from $13.50 to $750 per capsule. From May 2011 to May 2015, the price for a two-pack of EpiPens, the epinephrine autoinjectors that treat potentially fatal allergic reactions, rose from $160 to $608.

Even commonly used drugs that have been on the market for decades have been subject to unexpected price increases. In the past few years, the prices of generics — antibiotics like doxycycline and erythromycin and heart medications like captopril and digoxin — have shot up.

Ask the doctors

Q. I'm currently taking a pill that combines 5 milligrams (mg) of oxycodone and 325 mg of acetaminophen. It keeps my pain under control and doesn't seem to interfere with other medicines I'm taking. However, I was reading about opioids and wonder if it falls in that category. If it does, should I be taking it?

A. Oxycodone is an opioid, but acetaminophen, the generic form of Tylenol, isn't. A combination of the two, sold as Endocet, Percocet, and Roxicet, as well as in a generic version, is a popular medication for pain control. Both oxycodone and acetaminophen should be used with caution. Oxycodone should be taken for the shortest time possible because long-term use of oxycodone has been associated with addiction and dependence. High doses of acetaminophen can cause liver damage.

Research we're watching

To provide more information on the value of statins for older people, which is still a matter of debate, researchers analyzed data on people over 65 who were enrolled in ALLHAT-LLT, a large study conducted between 1994 and 2002.

All participants (average age 71) had high cholesterol and high blood pressure but not heart disease. They were randomly assigned to two groups. One group, of 704 women and 763 men, took pravastatin (Pravachol). The other group, of 711 women and 689 men, didn't take a statin. The analysis indicated that during the five-year study period, there was no significant difference between the groups in the frequency of heart attacks, deaths from heart disease, or deaths from any cause, either among participants ages 65 to 74 or among those 75 or older. The results were published online May 22, 2017, by JAMA Internal Medicine.