Prescription for Health: “Take Exactly as Directed” Look inside your medicine cabinet at your prescription bottles and ask: Have I read the label, stickered warnings and instructions? Have I discarded medications past their expiration dates? The Centers for Disease Control (CDC) reports that 80 percent of patients do not take their medications as prescribed. The prevalence of non-adherence to prescription …

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Prescription for Health: “Take Exactly as Directed” Look inside your medicine cabinet at your prescription bottles and ask: Have I read the label, stickered warnings and instructions? Have I discarded medications past their expiration dates? The Centers for Disease Control (CDC) reports that 80 percent of patients do not take their medications as prescribed. The prevalence of non-adherence to prescription …

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Statins – A viable option for improving your cholesterol profile With heart disease the single leading cause of death in America and stroke the third leading cause, the use of statins offers many patients viable treatment and prevention options not previously available. Controlling your cholesterol level is an important factor in maintaining good health. Cholesterol contributes to heart disease, which can lead to strokes and heart attacks. The World Health Organization estimates that almost 20 percent of all strokes and over 50 percent of all heart attacks can be linked to high cholesterol. But despite the very best efforts at healthy eating and regular exercise, people with a genetic predisposition have bodies that make too much cholesterol no matter what they eat. Certainly, a healthy diet helps, but taking a statin turns down the body’s ability to make new cholesterol. Statins are a class of drugs prescribed to lower blood cholesterol levels. These drugs block the action of a chemical in the liver that is necessary for making cholesterol. Cholesterol is important for metabolizing fat soluble vitamins like A, D, and E, helping manufacture bile, which helps digest fats. It is also critical for building and maintaining cell membranes. Too much cholesterol in your blood can clog arteries, causing them to narrow or in the most severe cases, blocking them. This can lead to heart attacks and stroke. In some instances, statins can also help the body reabsorb the problematic plaque that has built up on the arteries, thereby preventing further blockage and reducing the chance of a heart attack. There are many different brands of cholesterol medication, but as yet there is no convincing evidence that any one medication is better than another. Some of the well known medications currently prescribed include Lipitor (atovastatin), Zocor (simivvastatin) and Mevacor (lovastatin). Generic versions, which are less costly, also are available for prescription and may be appropriate in certain situations. Are statins right for you? When prescribing a statin, physicians consider other risk factors including: family history of high cholesterol or heart disease; degree of activity in your lifestyle; blood pressure; age—55 or older for men, 60 or older for women; general health condition; diabetes; weight; smoking; and narrowing of the arteries in the neck, arms or legs. If it is determined that statins are a good option for you, a specific dose will be prescribed. Depending on the severity of your high cholesterol, the dose and brand can vary. Once you begin taking a statin, you may need to continue taking it indefinitely. Some people make significant lifestyle changes, lowering their cholesterol enough to go off statins if their doctor advises it. There can be side effects and risks that come with taking statins as with any prescription drug. Together we will weigh the risks along with the anticipated benefits from taking statins. Common side effects include muscle and joint pain, nausea, diarrhea and constipation. Some people can tolerate statins well, and even those who experience some of the side effects may see them go away over time as their bodies adjust to the medication. Please consult with our office or your pharmacist on whether or not statins may adversely interact with any of your other medications. It is wise to be aware that a more potentially severe side effect includes liver damage. Statins work by interfering with the production of cholesterol in your liver. As a result, statin use may cause an increase in liver enzymes. We strongly advise having a blood test several weeks after beginning this drug to check liver function, and then periodic blood tests to continue monitoring liver enzymes. If an increase in liver enzymes becomes severe, patients may need to discontinue statin use because this can result in permanent liver damage. Keep our office apprised of any unusual or persistent pain that you may experience if you start taking statins. Research continues into the impact of statins on our bodies. Some investigation has already shown other benefits beyond lowering cholesterol, including their anti-inflammatory abilities that stabilize the lining of the blood vessels. This could contribute to lower blood pressure and reduced risk of blood clots. Very importantly, statins apparently decrease the potential rupture of plaque on the blood vessel linings, which is one of the most common causes of stroke and heart attack. There is also early indication that statins may help prevent diseases not related to the heart, including reduced risk of arthritis and bone fractures, some forms of cancer, dementia and Alzheimer’s disease and kidney disease. Statins hold great potential for improving the health of people with chronic high cholesterol who are at risk for increased incidences of heart attack and stroke. If you would like to discuss whether this medication option is a good one for you, please call our office to make an appointment.

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 Aspirin? Tylenol? Advil? Aleve? What’s the Difference? You’ve no doubt heard the question, “Does anyone have an aspirin?” Most of the time, people don’t have a particular brand in mind, just as people ask for a Kleenex when they want a tissue or Xerox when they want to make a copy. But, with aspirin-like products – Bayer, Bufferin, Motrin, Advil, Tylenol, Aleve and others – there are clear differences and their desired effects and disadvantages can be significant. Acetylsalicylic acid/aspirin (Bayer, Bufferin) Aspirin was the first over-the-counter pain reliever to be mass produced. In 1900, aspirin was sold as a powder, and by 1915 the first aspirin tablets were made. Aspirin is used to treat headaches, to quell minor aches and pains, and to reduce inflammation. However, it can cause stomach upset, heartburn, and it is also an anticoagulant (blood thinner) which means that people on certain medications, such as Coumadin, should not take pain relievers containing aspirin. That said, aspirin is still the most common over-the-counter pain reliever, available in both brand names and generic versions. Importantly, it is now playing a positive role in the prevention and treatment of heart disease because it is an anticoagulant. Ibuprofen (Motrin, Advil) Ibuprofen belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Ibuprofen is chemically similar to regular aspirin and functions in the body in a comparable way. So how is it different from aspirin? Most importantly, it is usually less irritating to the esophagus and stomach. For patients with ulcers or acid reflux disease, for example, ibuprofen may be the better product. It is also prescribed frequently to reduce menstrual cramps, inflammation from arthritis, sprains, etc. with better results than aspirin. Naproxen (Aleve) Although some patients use this medication for headache relief, it is most effective as an anti-inflammatory medication. For arthritis, sprains, sunburn and other inflammation-based pain, naproxen seems to be one of the best products in the over-the-counter pain-reliever marketplace. In comparable doses, it also has a longer-lasting effect in the body, tending to last 8-12 hours rather than 4-8 hours. Note: always be careful to follow dosing instructions. This strong medication can cause serious gastrointestinal problems, sometimes without warning and at any time while you are taking this medication. It is always wise to check with our office before selecting this medication. Acetaminophen (Tylenol) All of these aspirin-like products are definitely not the same…as exemplified by acetaminophen. This pain reliever lowers fevers and usually soothes headaches, but is not useful or effective as an anti-inflammatory aid. One of its major benefits is that it causes very few problems with the digestive tract overall, making it the best headache treatment for people with any stomach sensitivities. It is also safer for people on blood-thinning medications, for hemophiliacs, and for children. However, taken regularly over a prolonged period of time, or taken in excessive doses, acetaminophen can be toxic to the liver. The usual dosage for pain relief and its overdose amount are not incredibly different, therefore acetaminophen is sometimes considered to be more dangerous than aspirin, arguing that it is easier to overdose unintentionally. In summary, make certain to read the ingredients label of these and all over-the-counter medications, to see what else it is partnered with and whether there are additional side-effects. There are various combinations of acetaminophen, ibuprofen and aspirin available – cough and flu, sinus, etc. If you take certain products together you may accidentally take too much of one type of medication. For example, if you take Tylenol and a cough medication in combination, make sure the cough medicine does not also contain acetaminophen. Inadvertently you may be exceeding the recommended dosage. It is always important to read the drug product labels very carefully. Some, such as aspirin products, have been linked to Reyes Syndrome and should never be administered to children or teenagers with viral or flu-like symptoms. Others, such as Aleve, recommend that you avoid alcohol and prolonged exposure to sunlight. All of these over-the-counter pain relievers may interact with certain prescription medications that you may already be taking. If you have any questions or concerns about which of these over-the-counter medications may be best for your symptoms, please call our office and we will be happy to talk with you about your options.

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Shingles Vaccine You’ve probably had chickenpox. Perhaps your parents even exposed you to the virus as a small child, when you were likely to have a mild case and be done with it. However, the virus remains dormant in your body throughout your lifetime, and could reappear at any time as a painful disease called “shingles” (medical term herpes zoster). Shingles can be very unpleasant, starting as a skin rash and often erupting with blisters. Its symptoms usually last a week or ten days, sometimes longer, and may include severe pain, chills, fever, headaches, and an upset stomach. About a million Americans get shingles each year, and they all have had chickenpox or received the chickenpox vaccine. It is estimated that half the people who reach age 85 will get shingles at some point. As people age, they become more susceptible to the disease and it can be more severe. The good news is there is now a shingles vaccine. Approved by the FDA in 2006, the vaccine has been successful in helping prevent the disease. Some of your friends have probably already had the shingles shot, and you may be wondering if it is right for you. The Centers for Disease Control and Prevention (CDC) recommends it for people age 60 and older, with some exceptions. You should not get the vaccine if you have a weakened immune system or if you have ever had an allergic reaction to gelatin, neomycin, or any of the vaccine’s other ingredients. Other reasons to avoid the shot include a history of certain cancers or tuberculosis, or if you are undergoing radiation or chemotherapy. Studies show the vaccine prevents shingles in about half the people vaccinated. However, even when it doesn’t prevent the disease itself, it usually reduces the pain and severity of the disease, including permanent scarring and skin discoloration. Importantly, it helps inhibit a lingering and debilitating condition called “postherpetic neuralgia” that affects some 20 percent of shingles patients, can last months, and may even become chronic. The shingles vaccination involves a single injection of a live, weakened virus. Because it is a live vaccine, side effects might include headache as well as tenderness, redness, swelling, and pain at the injection site. If you develop a rash from the vaccine, it is possible to transmit the virus to a susceptible person, who may get chickenpox but not shingles. If you are age 60 or older, have had chickenpox, and don’t believe you have any health issues that would prevent you from being a candidate, I recommend that you consider the shingles vaccination. If you have any questions, please call my office and I will be happy to talk further with you. As mentioned earlier, even if you receive the injection and still get shingles, the vaccine could help you avoid more serious complications. Patients Inquire… Since shingles is a herpes virus, is it related to other herpes disorders, such as cold sores or genital herpes? The answer is “No.” The only connection is that each of these conditions is a form of herpes, defined as “a viral disease causing skin eruptions.”

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Things to Know about Your Medications Here are some common medication questions—with answers! Are generics and branded drugs identical? Patients wonder why generics don’t look or taste the same as branded drugs, and they worry about generics’ side-effects. According to the Food and Drug Administration (FDA), “The active ingredient (in generic drugs) is chemically the same as the branded counterpart.” Regarding appearance, they cannot look identical because in the United States, trademark regulations prevent the sale of generic drugs that look exactly like the brand-name drug. Also, inactive ingredients such as flavors and preservatives, and the manufacturing process may differ. Side effects and treatment efficacy may vary based on these and other subtle differences. So while these drugs are not exactly identical, generics will often be recommended when they are available. Most patients will ask for the generic prescription option, since it is almost always a cost savings. Not all drugs have a generic counterpart. In being your own health care advocate, I suggest if the pharmacist offers a generic substitution, check with our office to determine what is most appropriate for you. What about off-label drugs? In the United States new drugs are tested in three phases of clinical trials (research studies) before they are approved for use by the general public. The clinical trials are done to prove that the drug effectively treats a certain medical condition, works the way it is supposed to, and is safe when used as directed. When the FDA is satisfied that the drug is safe and effective, it works with the maker of the drug to create the drug label. This is not an actual label that sticks onto a container, but a report of very specific information. The FDA also must approve this report, which is made available to physicians and pharmacists who prescribe and dispense the drug. The drug label contains information about the drug, including the approved doses and how it is to be given to treat the particular medical condition for which it was approved. When a drug is used “off-label” it is most commonly given for a different disease or medical condition than described in the FDA-approved label. Or, it may be given by a different route, or in a different dosage. For example, most of us are familiar with the benefits of Botox Cosmetic as a facial wrinkle treatment. Botox injections for migraines were discovered accidentally during clinical testing for Botox Cosmetic. When test patients who normally suffered from headaches reported fewer facial lines and fewer migraines, Botox began its progression from popular cosmetic treatment to medical remedy. Botox injections for migraines are currently in Phase III of their clinical studies. While the treatment has not yet been FDA-approved for migraines, these injections for headaches are commonly administered by physicians as a viable treatment option. This is considered off-label use. When doctors discover that an off-label use works well, it can become the “standard of care.” Is it OK to split pills in half? The answer is – sometimes. Generally, a pill that is twice your normal dosage costs about the same as the smaller dose. So, by splitting double-dose pills in half, your savings could be substantial. The pills best suited to splitting – and according to some medical professionals, the only pills – are those scored down the middle, making them easier to divide. But splitting only works well for certain medications, and numerous reports warn that some pills should never be split. Examples include: longacting, extended- or continued-release tablets or capsules, any capsules that contain powders or gels, birth control pills, and chemo therapy drugs. If you are thinking about splitting your pills, talk to my office about which of the medications you take can be split safely… and be sure to purchase an inexpensive pill-splitting device rather than using a knife. What are the effects of medication on taste? Some drugs cause food to taste differently, or they can cause a metallic, salty, or bitter taste in your mouth. Clinical studies have implicated over 250 drugs that can alter taste sensations. And, while it is not known exactly how these medications influence taste, it has been established that medications can have an impact on taste through decreased secretion of saliva. This side effect from certain medications can also lead to problems with chewing and swallowing food. In turn, some patients decrease their food intake, which can be dangerous for many people—especially those who are older or who already have health problems. If your symptom is significant, please call our office as sometimes there can be alternative solutions. Is it safe to take drugs that have expired? Today the general consensus from pharmaceutical professionals is that most expired drugs are safe to take for a limited period of time after the expiration date. The expiration date on both prescription and non-prescription medication signifies that the drug will remain at full potency up until that date. However, this does not mean that drugs past this expiration date are necessarily unsafe to use or are spoiled. Before taking a pill beyond the expiration date, keep in mind that liquid medications and medications that have been stored in a warm, moist environment degrade more quickly than solid medications that have been stored in a cool dry place. All of the above being stated, use your own good judgment. The wisest choice with an expired drug is to call your pharmacy and ask before you take even one dose. After all, good health is a collaborative effort!

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