Medications Archive

Q. My doctor just started me on Zocor to lower my cholesterol. I have had just one side effect, forgetfulness. It's not as bad as it sounds, since my memory remains excellent, except that I often forget to take my pill in the evening. So I'd like to know if it would be okay for me to take Zocor in the morning with my other pills, which I never forget.

A. Many people have trouble remembering to take medications; drugs that are administered several times during the day are particularly troublesome.

Q. I have pain from osteoarthritis in both knees. I'm curious about the cream made from a substance in hot peppers. How does it relieve pain?

A. You're referring to capsaicin, the substance in chili peppers that gives them their hot taste. Capsaicin is an ingredient in many over-the-counter topical pain-relief preparations, which include creams, gels, lotions, patches, and sticks. When first applied, topical capsaicin causes a burning sensation. This sensation lessens within a few minutes, and also over time with repeated applications. There are few, if any, systemic side effects.

Do these heavily promoted hormones justify the claims made for them?

"Bioidentical" hormones have been promoted as safer and more effective than FDA-approved hormones. The exaggerated claims go beyond relief of menopausal symptoms, suggesting they are a veritable fountain of youth.

It's understandable that women would be interested in a different approach now that long-term use of conventional hormone therapy (HT) does not prevent cardiovascular disease as researchers had hoped.

If you are one of the millions of Americans trying to quit smoking, keep up the good work. It isn't easy, but the payoffs are huge. If you are using the quit-smoking drug Chantix (varenicline), there's a new bump in the road: for people with heart disease, the FDA says the drug slightly increases the chances of having a heart attack or other cardiovascular problem. A Canadian study concludes that use of the drug increases the risk of heart attack, stroke, and heart failure in all users (CMAJ, July 4, 2011).

The FDA approved Chantix in 2006 based on clinical trial results that it doubled the quit rate (10% for placebo, 23% for Chantix). The drug works by latching onto nicotine receptors in the brain and activating them, much as nicotine does. This reduces a smoker's craving for nicotine and eases withdrawal symptoms.

Q. I'm 64 and have had lone atrial fibrillation for about a decade. I have an echocardiogram every year to make sure the rest of my heart is okay. (It is.) My doctor hasn't prescribed any medications for me, but she wants me to take a blood thinner when I hit my 65th birthday. I'd rather not do this. Should I follow her recommendation? Also, is it possible that the endurance-type exercise regimens I have performed over many years led to my developing lone atrial fibrillation?

A. The decision to start taking warfarin (generic, Coumadin, Jantoven) for lone atrial fibrillation (atrial fibrillation not caused by underlying heart disease) or any other type of this heart rhythm disorder depends on several factors, not just age. Most cardiologists use the CHADS2 score (it stands for Cardiac failure, Hypertension, Age, Diabetes, and Stroke [doubled]) to help make the decision. As you can see in the table, age does not accrue any points until 75 years and older. If your CHADS2 score is zero, and you truly have lone atrial fibrillation, then it should be fine to hold off on taking warfarin. Some doctors recommend anticoagulation for people who are often or always in atrial fibrillation even though they have a CHADS2 score of zero, but this approach is not part of current guidelines for treating atrial fibrillation.

Ideal CV health

Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121:586-613.

Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of "ideal cardiovascular health" in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation 2011; 123:850-7.

Niacin, also known as vitamin B₃ and nicotinic acid, is an essential nutrient. We need a small amount of it to ward off a disease called pellagra.

But like many vitamins these days, niacin has gotten more attention lately because of the benefits it might have when consumed in large amounts. Daily doses of 1,000 milligrams (mg) or more increase "good" HDL cholesterol and also reduce triglycerides. Many people, including quite a few doctors, view niacin as a useful, inexpensive — and perhaps more natural — way to bring about desirable cholesterol levels and reduce the risk of heart disease. Research going back to the early 1980s has shown that to be the case. Drug companies have sensed an opportunity and are selling products like Advicor (niacin plus lovastatin) and Simcor (niacin plus simvastatin) that combine high doses of HDL-raising niacin with statin drugs that lower "bad" LDL cholesterol.

Q. I am taking furosemide (Lasix) once a day. I was told to also take potassium pills, but I don't like pills. Can I replace the potassium pill with foods high in potassium?

A. Maybe, with permission from your doctor.

Diuretics like furosemide encourage your kidneys to make more urine. They help people who have conditions like heart failure that cause extra fluid to build up in the body. However, many diuretics cause the kidneys to excrete potassium along with the extra fluid. If potassium levels get too low, serious problems can develop, including dangerous heart rhythms.

Aiming high is usually a good strategy for achieving a goal... except when it backfires. That's what happened with a large clinical trial dubbed AIM-HIGH. It was suddenly stopped more than a year ahead of schedule, casting a cloud over the use of niacin, a safe, effective medication with a proven track record for raising levels of protective high-density lipoprotein (HDL).

AIM-HIGH was designed to gauge whether adding a prescription form of niacin (Niaspan) to a cholesterol-lowering statin makes sense for people with low HDL. This combination had been tested in earlier trials, all of which showed a benefit. The big difference in AIM-HIGH was the very low target for low-density lipoprotein (LDL, the so-called bad cholesterol): between 40 and 80 milligrams per deciliter (mg/dL).