Medications Archive

Q. Because of the recent news about Avandia, my physician has advised me to stop taking it. Is that wise?

A. It's a good idea for all patients with diabetes to keep their blood sugar levels under control, and there's no doubt that Avandia (the generic name is rosiglitazone) is effective in lowering blood sugar. However, in September 2010, the FDA advised people to stop taking the drug unless they couldn't lower their blood sugar with any other treatment. The FDA stated that, while not conclusive, there was considerable evidence that Avandia increased the risk for heart disease and stroke, and of death from these and other cardiovascular conditions. At about the same time, the European Medicines Agency (the European equivalent of the FDA) recommended that all use of the drug be stopped. So your doctor has good cause to be concerned about you taking Avandia.

Readers often ask us about the use and safety of Plavix after angioplasty. We turned for answers to Dr. Patrick O'Gara, a member of the Heart Letter editorial board, who helped write a clinical alert about Plavix for the American Heart Association.

Almost every medical advance raises issues that demand creative problem-solving. Take artery-opening angioplasty. It uses a tiny balloon to flatten a cholesterol-filled plaque, restoring blood flow through a narrowed or blocked coronary artery without open-heart surgery. A wire-mesh stent is usually left behind to hold open the artery. However, blood clots sometimes form on a stent. This can block blood flow through the artery, causing a heart attack or sudden cardiac arrest. Taking a drug called clopidogrel (Plavix) with aspirin can fight this problem. But this combination, often called dual antiplatelet therapy, can be hard on the stomach, interacts with some drugs, and must be taken without interruption for a specified period.

Imagine a legion of microscopic healers patrolling the bloodstream to find and fix injured artery walls. That's the idea behind tiny drug-carrying particles called nanoburrs that have been developed by a team from the Massachusetts Institute of Technology and Harvard Medical School.

Nanoburrs are spheres 60 billionths of a meter (60 nanometers) in diameter. Thousands of them could sit on the period at the end of this sentence. Each has an inner core containing a drug linked to a slowly degradable polymer known as polyethylene glycol. The core is surrounded by a single layer of fat derived from soybeans. The outer wall is another polymer that protects the particle as it travels through the bloodstream. Coating the outer wall are protein fragments that resemble burrs, the hooks that bristle around the outside of certain seeds. In this case, the researchers created burrs that stuck to proteins found in the lining of blood vessels. In a healthy artery, these proteins are hidden by other tissues. In an injured artery, they are exposed to nanoburrs circulating through the bloodstream.

For some people with hypertension, exercise, diet, and three or four pills aren't enough to bring blood pressure under control. A pacemaker-like device called the Rheos system, made by Minneapolis-based CVRx, could someday offer extra help for fighting resistant hypertension.

The device works with the body's baroreceptors. These are sensors that continually monitor blood pressure from their posts on each carotid artery in the neck. When blood pressure rises, the baroreceptors send messages to the brain. It responds by sending signals that lower blood pressure. The opposite happens when the baroreceptors and brain detect low blood pressure.

Taking an aspirin can protect you from heart attack, blood clots and more

First marketed by the Bayer Company in 1897, aspirin (acetylsalicylic acid) is one of our oldest modern medications — and its parent compound is much older still, since Hippocrates and the ancient Egyptians used willow bark, which contains salicylates, to treat fever and pain. Over the past 100 years, aspirin has made its way into nearly every medicine chest in America. Indeed, this old drug is still widely recommended to control fever, headaches, arthritis, and pain.

Although aspirin remains an excellent medication for fever and pain, other drugs can fill these roles equally well. But aspirin has a unique role that was not even suspected by its early advocates. In patients with coronary artery disease, aspirin prevents heart attacks.

People who have been taking antidepressants for some time may wish to stop taking them due to unpleasant side effects. This can be accomplished, but it is best to taper the dosage slowly and be aware of the potential for discontinuation symptoms.

Some men use growth hormone as an anti-aging treatment, even though it is illegal to market it for this purpose. Studies of test subjects who took growth hormone found a high incidence of side effects such as joint pain and carpal tunnel syndrome.

Hair loss is a surprisingly common problem for women, particularly after menopause. This condition is typically treated with a medication such as minoxidil, though other options are available, including hair transplant surgery.

Many overdoses are accidental, so the FDA may require new warnings on the popular pain reliever and lower the daily limit.

For a long time, acetaminophen, the active ingredient in Tylenol, has seemed to be the safe bet among the commonly available pain relievers.