Jul
16
Acebutolol
July 16, 2009 | Leave a Comment
Generic Name
Acebutolol (ah-seh-BUTE-uh-lol) 91
Brand Name Sectral
Type of Drug
Beta-adrenergic blocking agent. Prescribed For
High blood pressure and abnormal heart rhythms.
General Information
Acebutolol hydrochloride is one of many beta-adrenergic blocking drugs, or beta blockers. These drugs interfere with the action of adrenaline and other chemicals in the body that affect many body functions. Individual beta blockers have different characteristics that can make them more suitable for certain conditions or people.
Cautions and Warnings
Do not take acebutolol if you are allergic or sensitive to any of its ingredients or to beta blockers.
You should be cautious about taking acebutolol if you have asthma, severe heart failure, a very slow heart rate, or heart block (disruption of the electrical impulses that control heart rate) because the drug may worsen these conditions.
People with angina taking acebutolol for high blood pressure risk aggravating their angina if they suddenly stop taking the drug. These patients should have their acebutolol dosage reduced gradually over 1-2 weeks.
Acebutolol should be used with caution if you have liver or kidney disease because your ability to eliminate this drug from your body may be impaired.
Acebutolol reduces the amount of blood pumped by the heart with each beat. This reduction in blood flow may aggravate the condition of people with poor circulation or circulatory disease.
If you are undergoing major surgery, your doctor may want you to stop taking acebutolol at least 2 days before surgery.
People with a history of severe anaphylactic reaction to alergens may be unresponsive to usual doses of epinephrine while taking beta blockers.
Possible Side Effects
Side effects are relatively uncommon and usually mild; normally they develop early in the course of treatment and are rarely a reason to stop taking acebutolol.
✓ Most common: fatigue.
✓ Common: dizziness and headache.
✓ Less common: chest pain, swelling in the legs or arms, depression, sleeplessness, abnormal dreams, rashes, constipation, diarrhea, upset stomach, stomach gas, nausea, frequent urination, back pain, joint and muscle pain, difficulty breathing, stuffy nose, and vision changes.
♦ Rare: cough, low blood pressure, slow heart beat, anxiety, impotence, changes in response to touch stimulation, itching, vomiting, abdominal pain, painful urination, nighttime urination, liver changes, sore throat, wheezing, eye irritation, pain or dry eye, and lupus erythematosus (extremely rare). Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Acebutolol may interact with surgical anesthetics to increase the risk of heart problems during surgery. Some anesthesiologists recommend gradually stopping the drug by 2 days before surgery.
• Acebutolol may interfere with the normal signs of low blood sugar and with the action of oral antidiabetes drugs.
• Acebutolol increases the blood-pressure-lowering effects of other blood-pressure-reducing agents, including clonidine, guanabenz, and reserpine, and calcium channel blockers such as nifedipine.
• Aspirin-containing drugs, nonsteroidal anti-inflammatory drugs (NSAIDS), and sulfinpyrazone may interfere with the blood-pressure-lowering effect of acebutolol.
• Cocaine may reduce the effectiveness of all beta blockers.
• Acebutolol may worsen the problem of cold hands and feet associated with ergot alkaloids, used to treat migraine. Gangrene is a possibility in people taking both an ergot and acebutolol.
• Acebutolol will counteract thyroid hormone replacements.
• Calcium channel blockers, flecainide, hydralazine, contraceptive drugs, cimetidine, propafenone, haloperidol, phenothiazine sedatives (molindone and others), quinolone antibacterials, and quinidine may increase the amount of acebutolol in the bloodstream and lead to increased acebutolol effects.
• Acebutolol should not be taken within 2 weeks of taking a monoamine oxidase inhibitor (MAGI) antidepressant.
• Acebutolol may interfere with the effects of some antiasthma drugs, including theophylline and aminophylline.
• Combining acebutolol with digitalis drugs may result in excessive slowing of the heart, possibly causing heart block.
• If you stop smoking while taking acebutolol, your dose may have to be reduced because your liver will break down the drug more slowly afterward.
• Aluminum salts, barbiturates, calcium salts, cholestyramine, colestipol, ampicillin, and rifampin may reduce the effectiveness of acebutolol.
• Beta blockers may block the effects of epinephrine.
Food Interactions
None known.
Usual Dose
High Blood Pressure
Adult: starting dose-100 mg a day, taken all at once or in 2 divided doses. The daily dose may be gradually increased. Maintenance dose-400-800 mg a day.
Senior: Older adults may respond to lower doses and should be treated more cautiously, beginning with 100 mg a day, increasing gradually to a maximum of 400 mg a day.
Child: not recommended.
Abnormal Heart Rhythms
Adult: starting dose-200 mg a day. Maintenance dose-200600 mg a day in 2 divided doses.
Senior: Older adults may respond to lower doses and should be treated more cautiously, beginning with 100 mg a day, increasing gradually to a maximum of 400 mg a day.
Child: not recommended.
Overdosage
Symptoms of overdose include extremely slow or irregular heartbeat, very low blood pressure, breathing difficulties, and seizures. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Acebutolol is meant to be taken continuously. When ending acebutolol treatment, dosage should be reduced gradually over a period of about 2 weeks. Do not stop taking this drug unless directed to do so by your doctor.
Do not take other medications, including over-the-counter medications, without consulting with your doctor. The use of some nasal decongestants with acebutolol may result in severely high blood pressure.
Acebutolol may cause drowsiness or dizziness. Be careful when driving or performing complex tasks.
It is best to take acebutolol at the same time each day. If you forget a dose, take it as soon as you remember. If you take acebutolol once a day and it is within 8 hours of your next dose, skip the dose you forgot and continue with your regular schedule. If you take acebutolol twice a day and it is within 4 hours of your next dose, skip the missed dose and continue with your regular schedule. Never take a double dose.
Special Populations
PregnancylBreast-feeding. Acebutolol crosses into the placenta. Infants born to women who took a beta blocker while pregnant had lower birth weights, low blood pressure, and slow heart rates. Acebutolol should be taken during pregnancy only if the potential benefit outweighs the risk.
Large amounts of acebutolol pass into breast milk. Nursing mothers taking acebutolol should use infant formula.
Seniors: Seniors taking acebutolol may need a reduced dosage.
Jul
16
Depression. Diagnosis, Treatment and FAQ.
July 16, 2009 | Leave a Comment
Drug Therapy
Fifty years ago “talking therapy” was considered essential in the treatment of depression. Psychologists and psychiatrists saw lots of patients who suffered from mild to moderate depression. But during the 1970s biological psychiatry took off. The medical profession embraced the theory that depression was primarily caused by an imbalance of chemicals in the brain. Many health professionals adopted the belief that a depressed person only needed antidepressant medication to normalize brain biochemistry. All you had to do was “feed your head” the right chemicals and the depression would disappear.
During those heady days many patients were given tricyclic antidepressants to soothe their troubled psyches. Medications like amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Janimine, Tofranil), and nortriptyline (Aventyl, Pamelor) were prescribed in huge numbers. Never mind that such drugs caused drowsiness, fatigue, constipation, dry mouth, dental problems, weight gain, blurred vision, urinary difficulties, dizziness, disturbed concentration, impaired memory, mental confusion, sexual dysfunction, and impotence.
Although these medications did help many people get out of the depths of despair, the side effects were sometimes as depressing as the depression itself. Imagine what it would be like to put on 30 or 40 pounds, feel mentally cloudy and constipated most of the time, and have no sex life. But insurance companies liked these medications. It seemed far more cost-effective to have an internist or a family practice doctor prescribe an antidepressant than to approve a lengthy series of counseling sessions with a psychologist or psychiatrist.
Then along came Prozac (fluoxetine). In 1987 when it was introduced, this antidepressant hardly made a splash. First-year sales were just barely respectable, but more than doubled in the second year. By the third year, Americans spent more on Prozac than on all other antidepressants combined. Everyone seemed to fall in love with Prozac—physicians, pharmacists, patients, and, most of all, the big payers (insurance companies and HMOs).
Prozac—a selective serotonin reuptake inhibitor, or SSRI—was so successful because it got great PR, and because it seemed to have fewer side effects than traditional tricyclic antidepressants. At least it was less likely to cause sedation, dizziness, constipation, or dry mouth. It also was more effective—or at least that was the impression among physicians and patients. There were never any data to support that belief, but that didn’t stop the media blitz. Prozac even made the cover of Newsweek and Time magazines. Once people decided it was the new wonder drug, other pharmaceutical manufacturers were desperate to get in the game. The race was on.
It wasn’t long before the wannabes started showing up, trying to claim a piece of the Prozac pie. Today the competitors include bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor). Almost 190 million prescriptions are written for these antidepressants each year, with sales exceeding $12 billion.
Such coeds are being prescribed enthusiastically for a wide range of other health problems, too. The pharmaceutical industry has promoted some of these antidepressants for conditions such as obsessive-compulsive disorder, panic attacks, hot flashes, premenstrual distress, nervousness, and shyness (”social anxiety disorder”).
Almost from the beginning, though, these drugs have been controversial. In the original clinical trial for Prozac, 15 percent of patients in the study dropped out because they felt worse instead of better—a statistic that was not widely publicized. Anxiety, insomnia, restlessness, nausea, and tremors caused distress for some people. There also was a high incidence of sexual dysfunction with the SSRIs. But the real controversy has always swirled around whether Prozac and similar compounds could trigger thoughts of suicide or homicide in some people.
Antidepressants and Suicide
In 1988, we received a letter from a grieving physician. His daughter had been prescribed Prozac for an eating disorder; a month later she took her er life by hanging herself. This oph- thalmologist was convinced that Prozac had contributed to her tragic death. At the time, we discounted this story—which we now regret—and told him that depressed people sometimes take desperate action and may try to harm themselves when they start treatment. Later, he responded that his daughter had never been depressed, nor had she been acting like a person who planned to take her life.
In 1990 an article appeared in the American Journal of Psychiatry describing a half-dozen patients who developed “intense violent suicidal preoccupation after 2 to 7 weeks of fluoxetine treatment.” This report stirred up quite a lot of concern, but many psychiatrists downplayed the connection. When we asked the drug company and the FDA about this report, we were told that depressed people sometimes commit suicide and that the drug was not to blame.
Over the last 18 years we have heard of many other instances in which people became preoccupied with harming themselves or others after starting on an antidepressant. A man taking Zoloft awoke in the middle of the night with a strong urge to kill himself. A woman reported wild thoughts on Prozac about ramming her car into other cars and getting a gun to kill an irritating co-worker. Another woman told us that she experienced an overwhelming urge to open her car door and jump-out of the vehicle while it was going at 50 miles an hour down the highway.
My son Mike was prescribed Paxil for depression while he was a graduate teaching assistant at New Mexico State University. Around day 13 he slipped into a mood that I had never seen before. He never came out of it. Four days later he shot himself in the temple with a rifle. He had taken Paxil for 17 days.
I hold the FDA and GlaxoSmithKline (maker of Paxil) responsible for my son’s suicide. No one should ever have to look at a son or daughter’s tombstone!
Whenever we discussed our concerns with psychiatrists, drug companies, or FDA officials, we were told that such events were purely coincidental. Our federal watchdog insisted that the medicines could not have been responsible for such tragic outcomes. But when British drug regulators began warning physicians that SSRI-type medications might trigger suicidal thoughts, agitation, and self-injury in young patients, the whole ball of yarn began to come unraveled.
Eventually, an FDA staffer, Andrew Mosholder, MD, MPH, was given the task of analyzing 22 studies. His conclusion: “Short-term pediatric trials of antidepressant drugs demonstrate an increased rate of suicidal events with active drug compared to placebo.” He also said that there is not adequate information to tell if antidepressants other than Prozac are effective for children.
FDA JULY 1, 2005, PUBLIC HEALTH ADVISORY
• Adults being treated with antidepressant medicines, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.
• Close observation of adults may be especially important when antidepressant medications are started for the first time or when doses for the specific drugs prescribed have been changed.
• Adults whose symptoms worsen while being treated with antidepressants, including an increase in suicidal thinking or behavior, should be evaluated by their health-care professional.
The idea that drugs designed to fight depression and prevent suicide could potentially make things worse for some kids seemed to shock FDA officials to the core. Initially, Dr. Mosholder was muzzled. Eventually, though, the data convinced even the FDA hardliners. Belatedly, the agency issued warnings about suicidal thinking and antidepressants. These cautions came far too late to prevent many terrible tragedies over nearly 2 decades. As difficult as it has been for psychiatrists and FDA officials to contemplate, people taking SSRI-type antidepressants are sometimes preoccupied with thoughts of suicide or homicide. Harvard psychiatrist Joseph Glenmullen,’ MD, has criticized the makers of SSRI-type antidepressants for delaying adequate warnings.”‘ The maker of Effexor XR added “homicidal ideation” to its label years after the drug was introduced. The company considers this a very rare adverse event and does not believe the drug can be causally linked to actual homicides. But there have been a number of high-profile violent events associated with antidepressants. Causal or not, this controversy continues to simmer. The entire SSRI-suicide story strikes us as mishandled. Just as with the Vioxx (rofecoxib) scandal, it has seemed to us that FDA officials have been more intent on protecting the pharmaceutical companies’ profits than the public health. To add even more confusion to this already sordid affair, the reputation these drugs have enjoyed as being highly effective against depression is now suspect. Remember that placebo-controlled trials are the gold standard that everyone is supposed to adhere to. Drug companies are required to show that their expensive antidepressants are significantly superior to a placebo. But an “analysis of 96 antidepressant trials between 1979 and 1996 showed that in 52 percent of them, the effect of the antidepressant could not be distinguished from that of placebo. In other words, “more than half of all recent clinical trials of commonly used antidepressants failed to show statistical superiority for the drug over placebo.”
That, dear reader, is almost beyond belief. It suggests that either placebos—sugar pills—are amazingly effective in relieving depression or that current antidepressants are not all that impressive.
Another overview of many clinical trials concludes that the latter is the case. It goes even further and suggests that “recent meta-analyses show selective serotonin reuptake inhibitors have no clinically meaningful advantage over placebo…. Antidepressants have not been convincingly shown to affect the long-term outcome of depression or suicide rates.” Of course, this kind of analysis relies on the statistical manipulation and combining of many smaller studies. As compelling as the conclusions may be, they do not substitute for really big, well-conducted trials.
The largest and most definitive study of depression and antidepressant medications was a $35 million project, funded by the National Institutes of Health, called the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial. This was no drug company whitewash. This was your tax money at work. What made this research so valuable was that the investigators looked at actual recovery from depression (”remission”), not just some symptom improvement. Recovery is, after all, what depressed patients really care about. The antidepressants used in the STAR*D trial were bupropion SR (Wellbutrin SR), citalopram (Celexa), sertraline (Zoloft), and venlafaxine XR (Effexor XR). When the long-awaited results were published in the New England Journal of Medicine (March 2006), they were surprisingly disappointing. About one-fourth of the patients achieved real remission, regardless of the type of antidepressant that was taken. What makes this so discouraging is that these patients got optimal treatment. They received intense evaluation and a level of care not usually available to the average patient. If the depressed folks in this study had been treated in a more typical manner, “the remission rate probably would have been significantly lower—perhaps even in the single digits.”That’s abysmal. If there is any good news that came out of the STAR*D research, it is that when a different antidepressant medication was substituted after initial treatment failure, about one in three patients finally did achieve remission. What this means is that antidepressants actually do what they are supposed to do (cure depression) about half the time. Depending upon your perspective, that means the glass is either half full or half empty.
We are happy to learn that 50 percent of the patients in this trial got better. But even under these ideal conditions, half did not, regardless of the type of medicine used. That means that an awful lot of people are suffering drug side effects without benefit. And since there were no placebo controls in STAR*D, we have no idea how many folks might have improved if they had received sugar pills instead of drugs. So how can you determine which antidepressant is best for you? In truth, it is extremely difficult for physicians and patients to make clear decisions about safety and effectiveness when it comes to these medications. Despite all the hype from the drug companies, it is hard to prove that one type of antidepressant is better than another one.
Newer drugs like Cymbalta affect both serotonin and another neurotransmitter called norepinephrine (hence their name serotonin/norepinephrine reuptake inhibitors, or SNRIs). This dual action is supposed to make such drugs more effective. It has certainly driven up the cost. A single Cymbalta pill can cost between $3 and $4. A Wall Street Journal review reported that when Cymbalta was compared head-tohead with venlafaxine (Effexor), an older drug in this class, “Cymbalta wasn’t significantly different from Effexor in treating depression.”
The bottom line is that there are no “best choices” when it comes to these kinds of antidepressants. All these drugs are roughly similar in effectiveness, and all have the potential to cause serious adverse reactions for some people. Anyone who experiences anxiety, agitation, irritability, and especially thoughts of violence toward himself or others should contact a health professional immediately!
Watch Out for Withdrawal!
There is one other complication associated with these antidepressants that is rarely discussed. Sudden discontinuation of drugs like Effexor, Paxil, Serzone, and Zoloft may cause unexpected symptoms. We have heard from many patients that they experienced dizziness, nausea, insomnia, headaches, nervousness, sweating, shakiness (like a bad hangover), weakness, visual disturbances, and an inability to concentrate. One reader called the problem “Paxil Head,” like having your head stuck in a blender.
I take Zoloft, and have tried to stop taking it several times. Each time I stop I experience a-very strange thing. Doctors, nurses, and pharmacists dismiss me like I’m a nut case, but I swear this is true. I get electrical shocklike sensations in my head and become extremely dizzy. I absolutely know this is associated with not taking Zoloft. Not 2 hours after I resume taking it again the symptoms, which are overwhelming, disappear completely. I would like to get off of this drug but have no idea how to do so, especially when I cannot function without it and no one recognizes I’m having any trouble. They just think I’m crazy.
What is so sad about this particular problem is that no one really knows how common withdrawal symptoms are. There are, as far as we can tell, few good guidelines for helping people overcome this complication. So we do not know how long people will experience dizziness, shocklike sensations, or nausea after they stop a drug like Zoloft. Drug companies are not particularly interested in developing protocols for discontinuing SSRI/SNRI-type medications, since they would then need to admit they have a problem on their hands. That means that patients and physicians are on their own. Gradual tapering over several weeks may be necessary. We have heard from some doctors that they switch patients over to fluoxetine and then taper it very slowly. That’s because Prozac lingers in the body and may be less likely to trigger withdrawal symptoms.
Fluoxetine (Prozac)
Fluoxetine is a stand-in for all SSRI-type drugs. Although there are subtle variations between medications in this class, there are more similarities than differences.
Side effects: Headache, nausea, dizziness, diarrhea, nervousness, anxiety, and insomnia are relatively common and may affect up to one-fourth of the patients who take SSRI-type medications. Some people may experience drowsiness or dizziness. Delayed ejaculation, inability to achieve orgasm, and decreased sexual desire are common complications of this entire class of drugs. Less frequent problems may include decreased appetite, indigestion, sweating, mania, dry mouth, heart palpitations, tremor, chills, constipation, blurred vision, memory problems, confusion, rash, and joint pains. Blood sugar control or thyroid function may be altered. Seizures, while uncommon, have been reported in roughly 0.1 to 0.2 percent of patients, an incidence comparable to that seen with older antidepressants. Any thoughts of suicide or violence must be reported to a physician immediately).
Downside: SSRI-type medications like Prozac can interact with many other drugs. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant.
Cost: Approximately $130 to $140 for a month’s supply of Prozac. Generic fluoxetine costs $16 to $20 for the same amount.
Despite all the controversy, we still think Prozac is worthy of consideration, especially since it is less likely to precipitate withdrawal symptoms when discontinued. And we are not convinced that other SSRI/SNRIs are more effective. Many people benefit dramatically from this or another SSRI or SNRI. Prozac is now available generically as fluoxetine, so the cost factor is less problematic. We’re not convinced, though, that all generic fluoxetine is created equal.
Bupropion (Wellbutrin)
This antidepressant is less likely to interfere with sexuality and may even be helpful for people who have experienced diminished libido. It is also available generically, so there is a cost savings. People tend to feel energized rather than sluggish when taking bupropion.
Side effects: Common complaints include insomnia, dry mouth, anxiety or agitation, headache, nausea, and dizziness. Less common adverse reactions that we are aware of include mania, seizures, irregular heart rhythms, skin rash, hallucinations, paranoia, high blood pressure, and migraine.
Downside: Bupropion can interact with many other medications. Make sure your physician and pharmacist double-check to verify that any other medicine, herb, or dietary supplement you take is safe with your antidepressant. Any thoughts of suicide or violence must be reported to a physician immediately!
Cost: Approximately $130 to $150 for a month’s supply of brand-name Wellbutrin SR; generic bupropion SR runs roughly $60 to $70 for a similar amount.
efit more from one antidepressant than another, this is mostly a process of trial and error. It may take 4 to 6 weeks to begin to see improvement, so it is important to give each medication a fair trial. If no success is achieved after a few drugs in the same class are tried, then it may be time to move on to another category.
Bupropion (Wellbutrin) may offer certain advantages over other SSRI-type drugs. For one thing, it is far less likely to interfere with sexuality. Some have even reported that it restores libido.
Some people do benefit from old-fashioned tricyclic-type antidepressants such as desipramine, imipramine, and nortriptyline. For people who become agitated or anxious on an SSRI/SNRI or find that bupropion keeps them wide awake, tricyclics may offer an acceptable alternative.
There is also a completely different kind of antidepressant that comes as a skin patch (Emsam). We will discuss it at the end of this chapter.
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs)
July 5, 2009 | Leave a Comment
NSAIDs
After the roller-coaster ride with cortisone, you would think that the medical establishment would have been more careful about the next big thing. Maybe doctors were so anxious to find something safer for arthritis that they didn’t appreciate that they might be jumping from the frying pan into the fire.
Aspirin was the first nonsteroidal anti-inflammatory drug (NSAID). It was introduced in 1899 and was a mainstay of arthritis treatment for most of a century. Aspirin works a little differently from other drugs in this class and has advantages that make it unique. For almost 100 years aspirin was the Rodney Dangerfield of the drugstore. It got relatively little respect. Because aspirin was available over the counter, it took physicians a long time to appreciate how valuable it could be against heart attacks, strokes, and even cancer. Because it has been around for so many years, doctors have often assumed that newer medicines would provide better pain relief. And they (and their patients) have often been disappointed.
The launch of prescription indomethacin (Indocin) in 1965 really put NSAIDs on the map. These drugs became some of the most successful pharmaceuticals of their time. Whenever a new anti-inflammatory drug came along, it generated tremendons excitement. Drugs like sulindac (Clinoril), piroxicam (Feldene), ibuprofen (Motrin), and naproxen (Naprosyn) had their time in the limelight. Then along would come something newer and doctors would switch their allegiance.
NON-ASPIRIN NSAIDS
• Celecoxib (Celebrex)
• Diclofenac (Cataflam, Voltaren)
• Etodolac (Lodine)
• Fenoprofen (Nalfon)
• Flurbiprofen (Ansaid)
• Ibuprofen (Advil, Motrin, etc.)
• Indomethacin (Indocin)
• Ketoprofen (Orudis, Oruvail)
• Ketorolac (Toradol)
• Meloxicam (Mobic)
• Nabumetone (Relafen)
• Naproxen (Aleve, Anaprox, Naprosyn)
• Oxaprozin (Daypro)
• Piroxicam (Feldene)
• Sulindac (Clinoril►
• Tolmetin (Tolectin)
Those of us who have observed this game of medicinal musical chairs for more than 40 years have become somewhat cynical about this class of pain relievers. The fickle switching from one drug to another suggests to us that no particular NSAID really stands out. There have not been really great head-to-head clinical trials that prove one drug is superior to another or significantly safer than others in the class.
If truth be told, these drugs really don’t work all that well when it comes to relieving the pain and inflammation of arthritis, especially of the knee. Despite the fact that tens of millions of people have spent countless billions of dollars on these medications, there are surprisingly few data demonstrating long-term benefit with their use. A scientific analysis of 23 different studies was published in the British Medical Journal in 2004. This meta-analysis involved more than 10,000 patients and revealed a shocking discovery: “NSAIDs can reduce short-term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support prolonged use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.”‘
What a bombshell! This review of the world’s medical literature on NSAIDs concluded that such drugs are reasonable only for short-term use. But arthritis is a long-term affair. The only conclusion we can draw: Regular use of such drugs is inappropriate for a chronic condition like arthritis.
Even more alarming, some evidence suggests that these medications may actually be harmful to arthritic joints. Researchers in the Netherlands followed more than 1,600 patients for several years. Patients who had been taking the NSAID diclofenac (Arthrotec, Cataflam, Voltaren) experienced greater joint deterioration as determined by x-ray evidence. The authors concluded, “Our data suggest that diclofenac may not be harmless and may induce accelerated progression of hip and knee OA [osteoarthritis].
OTC Mistake?
When NSAIDs like ibuprofen (Advil, Cap-Profen, Excedrin 113, Genpril, Haltran, lbuprin, Ibuprohm, Ibu-Tab, Medipren, “OTC analgesics including NSAIDs are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects.
Midol IB, Motrin IB, Nuprin, Pamprin IB, Profen, etc. and naproxen (Aleve) were approved for over-the-counter (OTC) sale, millions of people were delighted to have access to these powerful anti-inflammatory drugs. An Rx-to-OTC switch was a radical concept back in 1984. Even though the FDA assured consumers that such drugs were so safe that they did not require medical supervision, many physicians opposed the plan. They feared that side effects such as rash, fluid retention, high blood pressure, gastritis, and ulcers might make these drugs too dangerous for casual use. The FDA ignored the worriers.
Dear reader, we cannot tell you whether the decision to make NSAIDs available OTC was a blessing or a curse. The FDA has been incredibly inept at keeping track of adverse reactions to prescription medications. The agency’s track record on nonprescription pills is even worse. So, we really do not know how many ulcers, heart attacks, or other serious complications have occurred because of easy access to NSAIDs.
What we do know is that people are gobbling down these drugs almost like candy. Based on scientific surveys (Roper and the National Consumers League), it is estimated that 23 million Americans use a nonprescription NSAID (ibuprofen or naproxen) every day.” Only about one in five consumers bothers to read the directions on the label and fewer than one in three checks out dosing instructions. Perhaps that’s why one-fourth of them take more than the recommended dose. Scarier still, roughly half of the people surveyed were unaware of the potential for NSAID toxicity or just plain didn’t care.
Jul
5
Corticosteroids in Arthritis Treatment
July 5, 2009 | Leave a Comment
Corticosteroids
When cortisone was first introduced in the 1950s it was heralded as a wonder drug. Doctors became overnight heroes because they helped patients who had been crippled by rheumatoid arthritis get out of bed and begin functioning again. Even people with milder conditions like osteoarthritis, allergies, asthma, and eczema were thrilled because corticosteroids relieved their symptoms amazingly well. But the very reason these medications were so successful was also their Achilles’ heel. As great as they are at easing inflammation, they profoundly affect cells throughout the body. Taking high doses for long periods of time is a little like dancing with the devil.
Once people woke up to the downside of steroids, the drugs lost their luster and fell into disfavor. Don’t get us wrong, though. These medications are incredibly valuable, especially for short-term use. People experiencing an arthritis flare-up, a bad ’sunburn, or a terrible case of poison ivy will benefit im- mensely from a pulsed dose of corticosteroids. When Joe went deaf in one ear, a course of prednisone restored his hearing. If used cautiously and with respect for their risks, these drugs can be extremely valuable. But using corticosteroids regularly to treat arthritis is a slippery slope.
COMMON CORTICOSTEROIDS
• Cortisone
• Dexamethasone
• Hydrocortisone
• Methylprednisolone
• Prednisolone
• Prednisone
• Triamcinolone
• Cataracts
• Osteoporosis
• Diabetes
• Spontaneous fractures
• Bone deterioration
• Insomnia
• Irritability
• Glaucoma
• Fluid retention
• Weight gain
• Moon face
CORTICOSTEROIDS
• Infections
• High blood pressure
• Blood clots
• Potassium loss
• Stomach ulcers
• Muscle weakness
• Menstrual disturbances
• Impaired wound healing
• Fatigue
• Steroid “psychosis”
Jul
3
Allergy: Corticosteroid Nasal Sprays
July 3, 2009 | Leave a Comment
Corticosteroid Nasal Sprays
The big revolution in allergy treatment involves the use of steroid nasal sprays. Allergists have known for decades that cortisone-like drugs (prednisone, for example) can dampen the reactions of an overactive immune system and calm allergy symptoms amazingly well. The trouble is that relief comes at a stiff price. So many side effects are associated with oral corticosteroids that few physicians would ever consider prescribing such medications for nasal allergy symptoms except as a last resort. Even then, cautious doctors prescribe medications like prednisone for the shortest period of time necessary. Adverse reactions can include irritability, insomnia, anxiety, high blood pressure, potassium depletion, headache, nausea, and dizziness.
Not surprisingly, people wanted the benefits of steroids without the risks. That’s where nasal sprays come in. There are about a half- dozen different intranasal corticosteroids available by prescription. Most experts would say that these formulations are the most effective allergy treatment available. Although it may take a week for the benefits to reach peak effect, these sprays should relieve allergy symptoms such as itching, sneezing, and congestion quite well. They are pricey, however. A small bottle can run $85 to $95. At the time of this writing, generic flunisolide costs around $40. We cannot say whether one spray is better or safer than another.
The general consensus is that there are few, if any, systemic side effects associated with topical steroids. In other words, the experts do not believe people absorb enough of the drugs into the system to cause much, if any, concern.55 One study did report growth suppression in children, but other research has not confirmed this complication. There have been rare reports of nasal perforation (creating a hole between the nostrils) and increased pressure within the eyes. More common are local reactions such as irritation and burning in the nose, sore throat, nasal dryness, nosebleed, and headache.
GENERIC/BRAND NAME
Beclomethasone
Beconase AQ
Budesonide
Rhinocort Aqua
Flunisolide
Nasarel
Fluticasone
Flonase
Mometasone
Nasonex
Nasacort AQ
Triamcinolone
Still generic Singulair is widely prescribed to ease the breathing problems because of asthma.