Medications Archive

Millions of postmenopausal women are taking a bisphosphonate like oral alendronate (Fosamax) or intravenous (IV) zoledronic acid (Reclast) to increase bone density. But because long-term use of these drugs has been associated with an increased risk of bone death in the jaw and unusual thighbone fractures, experts have debated how long women should stay on the drugs to minimize the risk of hip or vertebral fractures without raising their risk for these rare but serious complications.

After considering major randomized controlled clinical trials, a task force of the American Society for Bone and Mineral Research has released guidelines on the optimal duration of bisphosphonate therapy for osteoporosis. The guidelines, published in the January 2016 issue of the Journal of Bone and Mineral Research, recommend reassessing a woman's fracture risk after five years of oral bisphosphonates or three years of IV therapy. They advise that women whose risk is still high should continue to take oral bisphosphonates for up to 10 years or IV therapy for up to six years. However, fracture risk should be reassessed every two to three years during extended therapy.

Thorough risk assessment and family assistance may help you take them more safely.

Prescription pain pills such as oxycodone (Oxycontin) and hydrocodone (Vicodin) are in a class of drugs known as opioids. They're typically used to treat severe pain after surgery, and sometimes to treat chronic pain. But these drugs come with many risks, including addiction. Does that put you at risk if you take opioids? "You have to look at it on a case-by-case basis," says Dr. Hilary Connery, an addiction psychiatrist at Harvard-affiliated McLean Hospital.

Risks and benefits

Opioids are powerful painkillers that block messages of pain to the brain and decrease the body's perception of discomfort. They may also create a feeling of euphoria. Opioids are especially useful in the short term, such as the initial weeks following joint replacement. Common side effects include nausea, itching, drowsiness, or constipation.

There's encouraging news for people who take dabigatran (Pradaxa), a newer type of blood thinner that's had a rare side effect of uncontrolled bleeding during surgery or accidents. In October 2015, the FDA approved an antidote called idarucizumab (Praxbind), which may be able to reverse dabigatran's blood-thinning effects.

Dabigatran was approved by the FDA in 2010 and welcomed as a convenient alternative to warfarin (Coumadin) for people with certain types of atrial fibrillation, deep-vein thrombosis, or pulmonary embolism. While warfarin is generally safe and inexpensive, it takes about a week for it to become effective, and dosing is so complicated that people taking warfarin need frequent blood tests to see if the dose needs to be adjusted. Dabigatran is effective within two hours and doesn't require dose adjustment or lab monitoring. But dabigatran has caused more episodes of major bleeding than had been expected, without a way to reverse the problem.

There is no evidence that so-called "bioidentical" alternatives to prescription hormones are either safe or effective.

Over the past couple of years, science has validated what many women already know: hot flashes and other symptoms of menopause can persist long after menstrual periods stop. It's also well established that estrogen—alone or combined with a progestin—is the most reliable treatment for menopausal symptoms and that, for most postmenopausal women, it is safe to take these hormones for up to five years at doses that relieve hot flashes.

But in 2002 the Women's Health Initiative reported that Prempro—an FDA-approved preparation combining synthetic estrogens with a progestin—increased the risk of cardiovascular disease and breast cancer. Since then, women have shied away from pharmaceutical companies' hormones. A third of women who use hormones for relief of menopausal symptoms are now choosing custom-mixed preparations from compounding pharmacies, according to research sponsored by the North American Menopause Society (NAMS). Women surveyed by NAMS commonly said they believed "natural" or "bioidentical" hormones from compounding pharmacies to be safer than the available FDA-approved hormones.

A Spanish clinical trial of 400 people—two-thirds of whom were women—has indicated that waiting to fill an antibiotic prescription may be a good idea for people with sniffles, coughs, sore throats, and other respiratory symptoms.

Researchers recruited volunteers who sought care for respiratory symptoms in primary care clinics throughout Spain. The volunteers were randomly assigned to four equal groups. One was given antibiotics and told to take them immediately. Another was sent home without antibiotics but told to return to the clinic if they hadn't improved after several days. The two remaining groups were told to wait to take antibiotics—one was asked to return to the clinic to get their mediation after three days; the other group was given an antibiotic, but told to take the medication only if their symptoms hadn't improved after five to 10 days.

Research we're watching

A nationwide survey conducted by researchers at Harvard T.H. Chan School of Public Health indicates that prescription drug use rose from 51% of U.S. adults in the 1999–2000 calendar year to 59% in 2011–2012. In 2012, women were taking more prescription medications than men, with 65% taking at least one drug and 16% taking more than five.

Although the use of postmenopausal hormones declined, women's prescriptions for blood pressure medication, cholesterol-lowering drugs, antidepressants, and diabetes medications rose significantly. The study was published in the Nov. 3, 2015, issue of The Journal of the American Medical Association.

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Tau proteins, and not necessarily beta-amyloid, may be the key to unlocking a viable treatment.

Alzheimer's disease affects more than five million people, and that number is expected to more than double by 2050. While there is no cure, attention has refocused on what many researchers believe is a major player in Alzheimer's: tau proteins.

Image: Thinkstock

Targeted cancer therapies have limits, but some may offer a better option than standard chemotherapy.

Mention cancer treatment, and most men think of chemotherapy—complete with hair loss and extreme fatigue. But for some men, there is another option. Targeted therapies can sometimes treat certain cancers with fewer side effects and better outcomes.

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Ask the doctor

Q. I would like to take generic drugs instead of brand-name drugs whenever possible, because they're cheaper. But are they really as effective?

A. First of all, generic drugs contain the exact same active ingredients as the brand-name versions. Second, in the United States, before approving a generic drug, the FDA must test it to be sure that the manufacturer has produced the same molecule, and that it achieves the same levels in the blood as the brand-name drug. Third, there have been many careful studies comparing generic drugs (once they have been approved) to their brand-name equivalents.

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Flibanserin is the first treatment of its kind. But it comes with a steep price tag and severe health risks.

It's now six months since the FDA approved flibanserin (Addyi), which is the first medication for sexual desire disorders. The drug was hailed as a "female Viagra," but is it living up to the hype? "It's not the solution we were hoping for," says Dr. Hope Ricciotti, editor in chief of Harvard Women's Health Watch and an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.