Medications Archive

Results have been discouraging for Alzheimer's disease, but they may help stroke patients in a variety of ways.

Alzheimer's disease and the depression that often affects people starting at about age 65 can easily be mistaken for one another. Depression can cause dementia-like deficits in memory and other mental functions, and Alzheimer's disease can cause depressive-like apathy and withdrawal.

Q. My wife has morphea spots on many areas of her body. We are currently treating them with Dovonex cream, which seems to help a little but is very expensive. Do you have a better way to treat this disease? We have been told that very little is known about how to treat it.

A. Morphea (pronounced more-FEE-ah) is a fairly unusual skin condition. I see perhaps one or two cases a year. The plaque type — which is the most common and probably what your wife has — affects women more often than it does men and typically is seen on the trunk. It's caused by an overproduction of collagen by cells in the skin called fibroblasts. Why fibroblasts start overproducing collagen is unclear.

A procedure as simple as having a tooth pulled can pose problems for someone on aspirin plus clopidogrel (Plavix). Taking this combination for at least a year is a must for everyone who has had a drug-coated stent implanted during artery-opening angioplasty. Aspirin plus Plavix helps prevent blood clots from forming inside a stent, which can cause a heart attack or cardiac arrest.

One downside of this combination is that it interferes with the formation of blood clots when they are needed, such as after surgery or after having a tooth removed. Some surgeons and dentists prefer that their patients stop taking the drugs a week or so before the procedure. But this temporarily boosts the chances a clot could form inside the stent.

When starting drug therapy to fight high blood pressure, a two-drug combination may work better than a single blood pressure drug.

A team of Colorado researchers compared drug prescriptions written for more than 160,000 men and women with newly diagnosed high blood pressure, also known as hypertension. The percentage of those people initially treated with two drugs rose from 22% in 2002 to 45% in 2007, and is likely higher now.

Some lifesaving cancer therapies can harm the heart and arteries (Harvard Heart Letter, March 2010). Trastuzumab (Herceptin), a drug used to treat one type of breast cancer, has improved survival for women, but it can also weaken the left ventricle, the heart's main pumping chamber.

One study suggests that the problem may be more common than researchers had initially suspected, especially among older women. A team of researchers from Vall d'Hebron University Hospital in Barcelona, Spain, reviewed the medical records of 45 women ages 70 and older who were treated with trastuzumab. Four developed heart failure, and another eight had declines in a measure called left ventricular ejection fraction, indicating a problem in the left ventricle. Eleven of the women recovered after stopping trastuzumab, though recovery sometimes took as long as 21 weeks. In one woman, heart failure persisted (Annals of Oncology, published online Aug. 9, 2011).

Q. When a friend of mine had a stress test, his doctor gave him a medication to make his heart work harder, instead of having him run on a treadmill. Does that mean medications could replace exercise to strengthen the heart?

A. When a person can't or shouldn't exercise, doctors use medications instead of a treadmill to conduct a stress test. Some of these medicines (such as dobutamine) make heart muscles work harder; others (such as adenosine) widen the coronary arteries.

Q. I'm looking for information on Prolia and Reclast as alternatives to Boniva.

A. All of the drugs you mention are used to treat postmenopausal women with osteoporosis, although they're in different drug classes. Ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) are bisphosphonates; denosumab (Prolia) is a monoclonal antibody. Bisphosphonates interfere with the activity of osteoclasts, bone cells that are involved in normal remodeling. Osteoclasts break down (resorb) old bone. Bisphosphonates work by reducing the rate of resorption. Denosumab also reduces bone resorption but does so by inhibiting the formation of osteoclasts rather than their activity.

It has been on the market for over a century, and its major chemical ingredient has been in medical use for more than 3,500 years, yet it's still the subject of intense scientific study and controversy. About 40,000 tons are produced every year worldwide, and over 50 million Americans take it regularly, but many who should use it don't do so. It costs only a few pennies a day, but it's often overlooked in favor of much more expensive drugs that have similar benefits but more side effects. It earned its good name from its ability to relieve pain, soothe arthritis, and reduce fever, but its most important benefit is the ability to prevent heart attacks and strokes in people at high risk. It's found in nearly every medicine cabinet in America, but it doesn't get the respect it deserves. It's aspirin — and research suggests this old friend may soon find a new role in fighting cancer.

Aspirin, up close and personal

Aspirin is known to chemists as acetylsalicylic acid. It is the first, and in many ways the best, representative of a large group of medications today known as the NSAIDs, or nonsteroidal anti-inflammatory drugs. The best known NSAIDs include ibuprofen (Motrin, Advil, generic) and naproxen (Aleve, Naprosyn, generic). A closely related drug, celecoxib (Celebrex), shares some properties with true NSAIDs.

Blood vessel disease linked to dementia

Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S. Vascular contributions to cognitive impairment and dementia. Stroke 2011.

Angioplasty via wrist artery safe, effective

Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011; 377:1409-20.

Q. I read something about antidepressants causing cataracts. Is there any truth to it?

A. Results from a Canadian study reported in June 2010 did show that older people (ages 65 and up) who were taking selective serotonin reuptake inhibitor (SSRI) antidepressants were 15% more likely to develop cataracts than those not taking these medications. The SSRI antidepressants include fluoxetine (Prozac), and several other medications, although when the researchers broke down the data by individual drugs, fluoxetine was not among those associated with cataract risk.