Medications Archive

Q. Some doctors strongly advise against the use of generic drugs with the argument that manufacturing processes are better controlled in branded medicines. What is your view?

A. Over the past several years, the FDA has found manufacturing problems at some of the factories that make generic medicines. The agency has also come under some criticism for not keeping up with inspections of the growing number of factories overseas that make generic drugs for the American market. We need a strong FDA to ensure that drugs are safe. But the problems are actually pretty rare, and there are, of course, lapses and quality-control issues at factories that make brand-name drugs, too. Odds are that there will be more problems identified with generics than with brand-name drugs, simply because there are so many more generic drugs manufactured.

Q. I am a 50-year-old woman with newly diagnosed high blood pressure. As diets go, mine is definitely on the healthy side. I do not exercise at a health club, but I do a lot of housecleaning and gardening, and I do walk a fair amount, which I feel is equal to what I would accomplish at a health club. I weigh 150 pounds and my height is 5 feet, 6 inches. I take Toprol-XL. My blood pressure seems to be normal in the morning, averaging 121/74, but in the afternoon the upper number is often in the 140s to 150s. Is it normal for blood pressure to rise like this as the day goes on, especially while on a medication?

A. It's great that you are paying close attention to your blood pressure readings. Beta blockers like metoprolol (Lopressor, Toprol-XL) are not great medications for lowering blood pressure when used all by themselves. So, as the day goes on, and you eat and exert yourself physically, my guess is that the metoprolol is just not strong enough to control your blood pressure. One option is to switch to another medication, such as a diuretic or an ACE inhibitor. If your doctor thinks you need the beta blocker for some other cardiac condition, adding a diuretic or ACE inhibitor to the beta blocker makes sense. In fact, combining low doses of medications that fight high blood pressure in different ways is probably a more effective way to do it than with a high dose of a single medication.

Caution, attention should accompany routine use of any pain medicine.

For people with cardiovascular disease who need relief from aches and pains, acetaminophen (Tylenol, generic) has long been touted as a safer alternative to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. A small but important Swiss trial warns that it may not be. This work doesn't mean you should ditch acetaminophen if it helps you, but does suggest you should give it the caution that it — and every medication — deserves.

Acetaminophen may boost blood pressure

Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation 2007; 115:1634-42.

Sudano I, Flammer AJ, Periat D, et al. Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation 2010; 122:1789-96.

Don't stop taking aspirin, Plavix, or any other antiplatelet before dental work without asking your cardiologist.

The physical, emotional, and psychological stresses of surgery create conditions inside arteries that sometimes lead to a heart attack or stroke. This has long been known for coronary artery bypass grafting, hip replacement, and other major operations. Now it appears that tooth extraction and other oral surgeries also temporarily — but slightly — increase the risk of a heart attack or stroke.

An immediate switch is right for some people, but not necessary for all.

A newly approved alternative to warfarin, a drug called dabigatran (sold under the brand name Pradaxa), fights stroke better than warfarin, with less bleeding into the brain, among people with atrial fibrillation. It could also make life a little bit easier for them.

Q. What amount of psyllium should I take each day to lower cholesterol?

A. Psyllium (SILL-ee-um) is the main ingredient in many over-the-counter laxatives, such as Metamucil, Fiberall, and others. It can also lower harmful low-density lipoprotein (LDL) cholesterol by 5% to 10%.

Top five habits that harm the heart

Kvaavik E, Batty GD, Ursin G, Huxley R, Gale CR. Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Archives of Internal Medicine 2010; 170:711-8.

Myint PK, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk). BMJ 2009; 338:b349.

Ranibizumab (Lucentis) and bevacizumab (Avastin) have become the drugs most commonly used to treat the wet form of macular degeneration. Both drugs are administered with injections into the eye. Wet macular degeneration is the form of the disease that is most likely to lead to severe vision loss; "wet" in this case refers to bleeding from the tiny blood vessels in the retina.

A study of Medicare claims for treatment of macular degeneration for 2005 and 2006, the years the drugs came into use, shows neither Lucentis (which is FDA-approved for this use) nor Avastin (a cancer drug that is being used "off-label" for macular degeneration) were associated with any greater risk for death or heart attack over a one-year period compared with the treatments they replaced, which included photodynamic therapy and a drug called pegaptanib (Macugen). Differences in strokes and bleeding events didn't reach statistical significance.

Q. I heard about a study that found that ARBs can cause cancer. I am taking one, Cozaar, because of high blood pressure. Should I stop taking it?

A. ARB stands for angiotensin-receptor blocker, a class of medications that is used to control high blood pressure, treat heart failure, and prevent kidney disease in people with diabetes or high blood pressure. ARBs are often prescribed when an ACE inhibitor isn't effective, or the side effects are intolerable. The generic name for Cozaar is losartan; the generic names for ARBs end in –sartan: candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), and so on.