Medications and treatments Archive

Ask the doctor

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Q. I've been taking the blood thinner warfarin (Coumadin) for a few years. I know there are new kinds of blood thinners, but I've heard they have downsides. Should I stick with warfarin?

A. Here's what you need to know. Some medical conditions lead to blood clots. The most common one is the irregular heart rhythm called atrial fibrillation. About 20% of all strokes are caused by clots that result from atrial fibrillation — usually because of inadequate treatment with blood thinners.

Research we're watching

Dietary supplements made from red yeast rice contain substances called monacolins, which are similar to the active ingredient in cholesterol-lowering statin drugs. And like statins, red yeast rice products may cause rare but serious side effects, such as muscle injury and liver damage, as noted in a study published online January 19, 2017, by the British Journal of Pharmacology.

The study, based on a review of 13 years of patient data by Italian researchers, notes that people who can't tolerate statins often take red yeast rice supplements. But there are no studies testing the safety of red yeast rice compared with statins. In the United States, the FDA considers red yeast rice products that contain more than trace amounts of monacolins to be unapproved new drugs and therefore illegal to sell. Yet dozens of these unregulated products remain on the market.

Almost one-third of older adults take statins to help lower cholesterol levels, but new guidelines and research have restarted the conversation on the role statins play in your health.

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Since they were introduced two decades ago, statins have been touted as a driving force in helping many older men reduce their risk of heart attack and stroke.

New research even suggests these drugs might treat other conditions, like Alzheimer's disease, and lower your risk of death from cancer (see "Other statin uses?").

Ask the doctor

Q. I've heard that bioidentical hormone pellets injected near the hip are more effective than bone-building drugs in stopping bone loss and preventing hip fracture. Is this true?

A. The FDA hasn't approved hormone pellets for preventing or treating bone loss. Moreover, there are no randomized controlled trials on record, so we don't know whether hormone pellets are more effective — or even as effective — as the FDA-approved medical therapies. Finally, there aren't any published reports explaining how the hormones are metabolized in the body or the side effects they may have.

Some doctors are more likely to prescribe opioids to their patients, and those patients are more likely to end up taking them long-term. It's crucial for consumers to educate themselves about the risks of taking opiates, and to consider alternatives if possible.

Author and migraine sufferer Joan Didion once wrote, "That no one dies of migraine seems, to someone deep into an attack, an ambiguous blessing." At that time, migraines weren't something that could be prevented. Today, that's a possibility for some people who have severe migraines, frequent migraines (more than three or four times a month), or migraines that don't respond well to treatment.

The cornerstone of migraine prevention is managing triggers like stress or certain foods or strong perfumes. Alternative and complementary therapies (like acupuncture) help some migraine sufferers keep headaches at bay.

Aspirin therapy can help prevent a second heart attack and stroke, but for otherwise healthy older men, its use depends on their 10-year risk for a heart attack or stroke as determined by their doctor. 

Prescription drug ads are a multibillion-dollar industry that promotes treatments you may or may not need. Here's how to use that information to your advantage.

Ads for prescription drugs are everywhere. You can't watch a sporting event without seeing an ad touting a treatment for erectile dysfunction, high cholesterol, high blood pressure, or joint pain.

Drug marketing is a big business, and companies are willing to spend a lot of money to offer you an easy solution to a health problem you may or may not have. From 2012 to 2015, yearly spending on prescription drug advertising in all media outlets (except digital) rose from $3.2 billion to $5.2 billion, and that figure is expected to only go up.

Denosumab (Prolia) is recommended for people at high risk for fractures for whom other bone-loss treatments were ineffective or had intolerable side effects.

When the risks of medication outweigh the benefits.

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Taking over-the-counter or prescription painkillers may seem like a simple solution for chronic pain. It's actually a bit more complicated, yet many older adults aren't aware of potential problems. "They think that if it doesn't require a prescription, it's safe. But there are some long-term health risks," says Dr. Edgar Ross, director of the Pain Management Center at Harvard-affiliated Brigham and Women's Hospital.

Here's what you should know about some commonly used pain relievers.