Medications Archive

People with heart disease should take aspirin; the decision is trickier for those without it.

For survivors of a heart attack or a clot-caused (ischemic) stroke, and for almost everyone else with coronary artery disease, there's an across-the-board recommendation to take an aspirin a day. But what about folks who haven't been diagnosed with heart disease? Can an aspirin a day help them, too?

In 2010, a controversial analysis suggested that angiotensin-receptor blockers (ARBs) increased the risk of developing cancer, especially lung cancer. Not so, says an FDA safety alert issued in June 2011.

ARBs are widely used to treat high blood pressure. They include azilsartan medoxomil (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar, generic), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan). Several combination drugs include an ARB plus a diuretic or a calcium-channel blocker.

Q. I had a heart attack three years ago at age 78. My doctor started me on lisinopril, carvedilol, and aspirin. My total cholesterol is 190, and my LDL is 128. Should I be taking a statin?

A. Almost everyone who has had a heart attack should be on a statin for life. There are some exceptions, of course, such as individuals whose heart attacks stemmed from unusual causes, like an infection, and those who have had an exceptionally severe problem from taking a statin, like severe skeletal muscle breakdown (called rhabdomyolysis). I recommend that you ask your doctor why you aren't taking a statin; if he or she doesn't know, then you should see a cardiologist.

Our April 2011 article "Meet the statins" contained an error in Table 2. The correct interactions between grapefruit juice and statin drugs are listed here:

Drug levels boosted by grapefruit: atorvastatin, lovastatin, simvastatin.

Levels not affected by grapefruit: fluvastatin, pitavastatin, pravastatin, rosuvastatin.

A large international trial of exemestane (Aromasin), a drug that reduces the risk of breast cancer recurrence, has found that it can also help prevent breast cancer from developing in the first place. That makes exemestane a third option for preventing breast cancer in postmenopausal women who are at elevated risk for the disease. Two other drugs, tamoxifen (Nolvadex, generic) and raloxifene (Evista), are already approved for prevention, but few women take them for that purpose because they can have serious (although rare) side effects such as stroke and blood clots. Exemestane appears to have less frightening side effects — for example, hot flashes, joint pain, and loss of bone density.

All three of these drugs target estrogen, which fuels the growth of most breast cancers, but exemestane works by a different mechanism than the other two. Tamoxifen and raloxifene are selective estrogen-receptor modulators, which bind to estrogen receptors in the breast and block their interaction with estrogen. Exemestane belongs to a different class of drugs, called aromatase inhibitors, which work by blocking the body's production of estrogen. Previous studies have shown that aromatase inhibitors are more effective than tamoxifen in preventing breast cancer from recurring. The study, funded by the drug's maker, Pfizer, and conducted under the auspices of the National Cancer Institute's clinical trials unit, looked at whether exemestane could reduce the likelihood of a first occurrence of breast cancer. Results were presented at the American Society of Clinical Oncology meeting in Chicago on June 4, 2011, and simultaneously published online in The New England Journal of Medicine.

Also called painful bladder syndrome, this frustrating disorder disproportionately affects women.

Interstitial cystitis is a chronic bladder condition that causes recurring bouts of pain and pressure in the bladder and pelvic area, often accompanied by an urgent and frequent need to urinate — sometimes as often as 40, 50, or 60 times a day, around the clock. Discomfort associated with interstitial cystitis can be so excruciating that, according to surveys, only about half of people with the disorder work full-time. Because symptoms are so variable, experts today describe interstitial cystitis as a member of a group of disorders collectively referred to as interstitial cystitis/painful bladder syndrome. (In this article, we'll call it interstitial cystitis, or IC.)

Among the one to two million Americans with IC, women outnumber men by as much as eight to one, and most are diagnosed in their early 40s. Several other disorders are associated with IC, including allergies, migraine, irritable bowel syndrome, fibromyalgia (a condition causing muscle pain), chronic fatigue syndrome, and vulvodynia (pain or burning in the vulvar area that isn't caused by infection or skin disease).

Q. I have chronic sinusitis and nasal polyps. I switched doctors and the new specialist suggested trying oral steroids, something that my previous doctor never mentioned. What do you think?

A. I think a short course of five to seven days of oral steroids is worth a try, particularly if your sinusitis isn't getting any better.

Each year, the National Center for Health Statistics publishes a report card of sorts on the nation's health. Health, United States is chock full of graphs, charts, tables, and analysis. The latest edition includes a section on the use of statins, the family of cholesterol-lowering drugs we often mention. (First introduced in the late 1980s, seven statins are currently on the market, including Crestor, Lipitor, and Zocor.) One in four adults ages 45 and older now takes a statin. Data from another chart suggest that statins are contributing to the decline in Americans with high cholesterol.

Statins don't work miracles, and in some people cause muscle pain and other unwanted side effects. Diet and exercise are the first and best places to start if you need to lower the amount of harmful low-density lipoprotein (LDL) in your bloodstream. If they don't work, a statin or other cholesterol-lowering medication can help.

Q. My hair's been thinning. Could it be due to simvastatin, which I started taking several months ago?

A. Hair loss, or alopecia, is a very rare side effect of all statin drugs. Widely prescribed in the treatment of high cholesterol, statins work by blocking the action of an enzyme the liver uses to make cholesterol. About 1% of people taking statins report hair loss. This figure hasn't changed since 1987, when statins were introduced. We don't know exactly why statins might cause hair loss. But we do know that cholesterol is an important building block for steroid hormones, which play a role in hair growth.

ICDs save lives, but sometimes medications and other options make more sense.

The heart's ability to beat steadily for a lifetime is a testament to tough muscle and an amazing electrical system. Sometimes, though, the heart veers into an abnormal rhythm. Two potentially deadly ones are ventricular tachycardia and ventricular fibrillation. One effective way to abort these rhythms and restore a normal one is with an electrical shock.