Medications Archive

Q. I am 92 years old. I have atrial fibrillation and high blood pressure, both controlled by medication. Every so often when I am relaxed in my chair after dinner, my heart feels like it stops and then starts up again with a jerk. Is this something I should worry about?

A. If you have atrial fibrillation, it is common to feel your heart pause and then start up with a bit of a kick. Here's why:

Q. For several years, I have been taking warfarin because of atrial fibrillation. I recently suffered several nosebleeds, which took two days to control. The trauma of those episodes makes me want to swear off warfarin, but I am not sure what other options I have.

A. People with atrial fibrillation are at risk of having a stroke because when the atria (the top two chambers of the heart) fibrillate (beat chaotically), blood collects in the heart, giving clots a chance to form. One of those clots can travel to the head, get stuck in a blood vessel there, and cause a stroke.

The statins are the best-selling prescription drugs in the United States. That's no surprise, since heart disease is America's leading cause of death, and the statins can reduce the risk of heart attacks and other major cardiac events by up to 37%, with the greatest benefit going to the men at highest risk.

All seven statin drugs act in the same way, by inhibiting the liver enzyme that's responsible for cholesterol production; when the enzyme is blocked, liver cells make less cholesterol, and blood levels of LDL ("bad") cholesterol fall. But the drugs have another benefit: as cholesterol production falls, the liver takes up more cholesterol from the blood, so blood levels fall even further. The statins produce only small elevations in HDL ("good") cholesterol, and only two, atorvastatin (Lipitor) and rosuvastatin (Crestor), lower triglycerides to an important degree.

These drugs may harm more than help after a stroke linked to a degenerative brain condition.

The drugs known as statins do many good things. They are the most powerful cholesterol-lowering agents discovered so far. They help prevent heart attacks in people who have had one, as well as in those at high risk for one. They lessen the risk of having an ischemic (clot-caused) stroke, the most common kind of stroke in the United States. Use of statins has been linked to stronger bones, better brain health in old age, and other noncardiovascular benefits.

Hypertension is one of the most common medical problems in the United States; at present, one of every three adults in our country has high blood pressure. It's a shame since many, if not most, cases could be prevented by simple lifestyle measures such as dietary salt restriction, weight control, and moderate exercise.

Hypertension is also one of the most important medical problems in America; it sharply increases the risk of heart attack, stroke, heart failure, and kidney failure. That's also a shame, since excellent drugs are available to lower blood pressure and prevent these deadly complications.

But be vigilant about over-the-counter acetaminophen, too.

In January 2011, the FDA ordered makers of prescription acetaminophen drugs — mostly acetaminophen-plus-opioid combinations such as Vicodin and Percocet — to put no more than 325 milligrams (mg) of acetaminophen (better known as Tylenol) in each pill or capsule; currently, these combinations may contain as much as 750 mg. Manufacturers were also told to include a "black box" warning (the most serious kind) on product labels highlighting the risk of severe liver injury. Acetaminophen overdose causes most cases of acute liver failure in the United States, and acetaminophen-containing prescription drugs account for nearly half of them. It happens especially when people try to get additional pain relief by taking more of the prescription drug.

Many postmenopausal women and their clinicians are avoiding hormone therapy (HT) because of the health risks, but there's been some hope that it might be safer in younger women near or at menopause. In the case of breast cancer, at least, that isn't so, according to results from the Million Women Study in the United Kingdom. In this study, taking HT in early menopause was actually associated with a higher than average risk of breast cancer. Also important — for the many women wondering about the impact of their past HT use — results showed that soon after quitting HT, a woman's breast cancer risk was no greater than that of a woman who never had HT. Finally, the study found little or no increased breast cancer risk among women taking estrogen-only HT who waited at least five years after menopause to start taking hormones. Results were published online Jan. 28, 2011 in the Journal of the National Cancer Institute.

Other research has consistently found higher rates of breast cancer in women taking HT — in particular, combined estrogen and progestin. But few studies have investigated the timing of HT and how that influences breast cancer risk. The Million Women Study is the first to look specifically at the relationship between breast cancer incidence and when women started HT.

Proton-pump inhibitors are the strongest type of medicine available for treating stomach acid. There is some concern about their potential side effects and interactions with other medications.

Is it time to rewrite the book on postmenopausal hormone use?

What a difference a decade makes! When the new millennium dawned, hormone therapy (HT) was a mainstay of postmenopausal health care. Besides relieving hot flashes and other troublesome symptoms, it was thought to offer protection against a host of degenerative disorders. In 2001, perimenopausal women were commonly urged to consider HT, not just for symptom relief but also for benefits that included protection against osteoporosis and possibly heart disease, colon cancer, and Alzheimer's disease. Its risks were thought to be limited — mainly increased susceptibility to breast cancer and gallbladder disease. Today, however, HT is linked not only to these conditions but also to an increased risk for stroke, blood clots, and Alzheimer's disease. Amid the growing evidence of harmful effects, many women are loath to consider HT even for short-term symptom relief.