Johns Hopkins Health Alerts - Prescription Drugs

Protecting Yourself From a Serious Fall

Tue, 02 Mar 2010 06:00:00 CST

Of all the potential side effects from prescription medications, accidental falls are a particular concern for older people. At a younger age, a fall usually results in nothing more than a bruised ego -- we get up, rub the affected area, and get on with the day.

Not so for many older adults, for whom falls can be a serious or even fatal event. In 2005 nearly 1.8 million Americans age 65 and older were treated in emergency rooms for nonfatal injuries from a fall -- according to the Centers for Disease Control and Prevention (CDC). Injuries range from mild (bruises and abrasions) to moderate (hairline fractures) to life-threatening problems, such as a broken hip or bleeding in the brain.

The good news is that you can prevent injurious falls due to prescription medications by working with your pharmacist and your doctor(s). They can assess whether you are at a higher risk for falls and need to take extra precautions with your medications.

What Are the Risk Factors? Among older people, various risk factors strongly indicate a higher fall risk. The CDC and a 2008 review article in Neurology cite the following factors:

Age. Fall risk continues to rise with increasing age. In 2001, adults age 85 and older had four to five times more fall injuries than those ages 65 to 74.

Diseases and conditions. Dementia, stroke, or illnesses that create an abnormal walk raise the risk of a fall. An increased risk also is likely among people with Parkinson's disease, peripheral neuropathy, weakness or sensory loss in the lower limbs, and substantial loss of vision.

History of falls. An individual who suffered a fall during the previous year has a 55% higher risk of having another fall. Geriatricians strongly recommend routine fall-risk assessments. If you or your loved one has not been assessed for fall risk, ask your doctor about it. If you have taken a fall in the past year, insist on such an assessment.

Further Steps -- In addition, some basic lifestyle measures can help you to decrease the risk of a fall. Studies show that regular exercise improves strength and balance, which help to prevent falls. Even a weekly tai chi class or light strength training several times per week can make a difference.

Also look around your home and remove any physical hazards that could cause a fall, such as unsecured throw rugs or clutter in walkways. Proper lighting, particularly on your path to the bathroom at night, is another good idea. Installing handrails on stairways and grab bars in bathrooms can be helpful, too.

Warning Signs of Prescription Drug Abuse in the Elderly

Tue, 09 Feb 2010 06:00:00 CST

Prescription drug abuse is difficult to detect in the elderly. That’s partially because symptoms of drug abuse such as forgetfulness and irritability may be dismissed as the person "just getting old." Here’s what you should look for …

To help avoid becoming "hooked" on a drug, make sure you know whether any treatments you take has addictive potential. If you do take a potential drug of abuse – an opioid or benzodiazephine -- use it only as directed. That means carefully following your doctor's instructions on how much of the drug to take, when to take it, and for how long. If you do not get the benefit you expect, ask your doctor before popping extra pills. Also ask your doctor about a safer, alternative drug you can take, particularly if you have a history of addiction.

If you think you may be dependent on a drug, talk to the doctor who prescribed it. Depending on the drug and your level of addiction, you may need to enter an inpatient rehabilitation program. In any case, you need to "detox" -- clear the addictive drug from your system. This must be done under the supervision of your doctor to prevent withdrawal symptoms and, in the case of benzodiazepines, seizures. So never try to treat a drug addiction on your own.

To prevent an addictive relapse, it's key to explore any feelings or life situations that may have driven you to abuse drugs in the first place. Your doctor or insurance provider may be able to refer you to counselors with specific experience in treating addiction problems. The U.S. Substance Abuse and Mental Health Services Administration hosts a substance abuse facility locator search engine on its website: www.findtreatment.samhsa.gov.

Watch for These Danger Signs -- Following are some of the typical behaviors associated with drug addiction. If many of these symptoms sound like things you or someone close to you is experiencing, be sure to seek assistance from a health professional:

memory lapses

unsteady gait, falls

changes in sleeping pattern

irritability, sadness, or depression

unexplained chronic pain

changes in eating habits

increased isolation from friends and family

poor personal hygiene

inability to concentrate

general loss of interest

Is It Safe to Split My Pills?

Tue, 19 Jan 2010 06:00:00 CST

Prescription medication is expensive, so many patients split their pills to save money. Is this a good idea? Here’s advice from Johns Hopkins.

Pill splitting is a good way to save on the cost of prescription medication, since a 200-mg dose typically costs the same as a 100-mg dose of a particular drug.

But it is essential to ask your doctor and pharmacist whether your medication can be split safely, because it is very easy to split pills unevenly. For people with certain medical conditions, like epilepsy and some heart problems, an inadequate dose can be dangerous. Correct dosage is also essential for hormone medications. Other medication that shouldn't be split:

Extended-release pills that deliver medication over time

Combination tablets that contain more than one medication

Pills coated to protect the stomach from irritation

Pills that crumble easily or are awkwardly shaped

Pills that are difficult to swallow because of bitter taste

Powder or gel capsules

That said, other medications can be split, like sildenafil (Viagra), certain blood pressure medications, many antidepressants, and most statins. Pills that are scored to make cutting easier indicate approval from the U.S. Food and Drug Administration to split the tablets.

Don't split pills with your hands or a knife -- this could lead to inaccurate doses. Buy a pill splitter at your local drugstore. Most cost $5-10; ask your pharmacist for a demonstration.

Drug Safety and the Elderly

Tue, 27 Oct 2009 06:00:00 CDT

A reader asks: In the past year or two, my elderly mother has received a lot of new prescriptions. How can I make sure the drugs will not mix badly and make her sick? In this Health Alert Johns Hopkins answers this question and addresses the larger issue of drug safety and the elderly.

If you are age 65 or older, drug safety takes on special importance. Older adults are more likely to experience side effects from prescription drugs than young people, in part because of physiological changes in the body that commonly accompany aging.

Also, as people age, they tend to develop chronic illnesses such as heart disease, diabetes, high blood pressure, arthritis, and osteoporosis. As a result, it is quite common for the elderly to be on multiple drugs -- a practice referred to as polypharmacy. The average older adult takes between three and five prescription drugs, and many older adults take over-the-counter drugs and supplements as well.

In answer to our reader’s question: Have your mother bag up all her drugs and supplements and bring them to medical appointments for a quick review. Another alternative is to bring a detailed list of drugs and doses. Ask the doctor if all the prescriptions are necessary, whether the doses are at the lowest effective level, and if anything can be done to reduce the number of pills she has to take.

Using combination products that contain fixed doses of drugs often used together is one option to reduce the number of pills taken each day. Or sometimes it is possible to switch to a sustained or extended-release version of a drug that you can take once per day rather than twice or three times. These alternative regimens may not be covered under your mother's insurance, so check before changing prescriptions.

When Your Health Insurance Company Asks You to Switch Medications

Tue, 17 Nov 2009 06:00:00 CST

Has your health insurance company ever urged you to switch medications? Johns Hopkins explains the risks of "drug flipping," and offers advice.

People sometimes encounter problems with their medications when they switch insurance companies. A brand of drug that is covered with a small co-pay on their former plan may not be on the formulary (the list of drugs approved by a health insurer for use by its beneficiaries) of the new one. In these cases, the company may create financial pressure to switch from one drug to another, or from a brand-name drug to a generic -- a practice sometimes referred to as "drug flipping".

If this happens to you, start by asking your doctor or pharmacist if the new drug is as safe and effective as the one you were using before. Certain classes of drugs are interchangeable at equivalent doses, meaning you may have to take a different dose of the new drug for the same effect you got from the former medication. When this happens, drug flipping can lead to confusion and can thereby increase the chance of medication errors.

It is also possible that your individual response to the “equivalent” dose of a different drug actually may not be equivalent, in which case flipping your brand might not be in your best interest. For instance, if you are getting a good result from a certain drug for high blood pressure, switching brands could be risky.

Bottom line advice. Nobody enjoys these bureaucratic problems, but they are part of the complex American healthcare system. By becoming familiar with your insurer’s formulary and drug-benefit policies, you can avoid inconvenience and unnecessary out-of-pocket expenses. Many insurers provide a condensed “pocket formulary” you can take with you when you visit your doctor. When the doctor reaches for the prescription pad, reach for your formulary and check your coverage. It may save you aggravation and expense at the pharmacy.

The Wisdom of Timing Your Meds

Tue, 08 Dec 2009 06:00:00 CST

Many individuals take their medications at times of the day that are convenient or easy to remember -- in the morning, at lunchtime, or before bed, for example. But this strategy may not always give you the most benefit. Instead, an approach called chronotherapy takes into account your body's rhythms to tailor the timing and dosage of your drugs so that they work better and produce fewer side effects.

The human body follows multiple natural rhythms to regulate physiological functions and behavior. The most important one for chronotherapy is circadian rhythm -- your body's daily biological clock that follows the sun's 24-hour cycle and regulates sleeping and waking. Circadian rhythm also affects important biological processes such as hormone secretion, cell growth, and metabolism.

Biological rhythms are known to influence health. For example, jet lag describes the unpleasant symptoms we experience after breaking with the normal circadian rhythm of sleeping and waking related to travel. Scientists have also discovered that biological rhythms play a role in disease and its treatment, since these rhythms cause symptoms to vary throughout the day. Consequently, chronotherapy times administration of a drug so that its peak concentration in the blood occurs around the time of day when the symptoms are worst -- not necessarily because the drug works any better at that time.

Studies to date suggest that by timing drug therapy to biological rhythms, it is possible to reap greater benefits with fewer downsides. For example, symptoms of allergic rhinitis, a condition that affects the mucus membranes of the nose and includes seasonal allergies (hay fever), are often worst in the morning when histamine levels in the body are elevated. That's why some allergists recommend that individuals take a long-acting antihistamine drug at bedtime so it will be in their systems when they wake up.

Chronotherapy is an active area of research, and its applications may extend to other health conditions. For example, researchers have discovered that cholesterol production in the liver appears to be higher in the evening, whereas many people take their cholesterol-lowering statin drugs in the morning. The timing of statin therapy and other drug treatments may change in the future if clinical trials show a benefit to watching the clock as we take our drugs. In the meantime, ask your doctor or pharmacist for the ideal time to take your prescription drugs. Most important, never change the timing of your drugs without first consulting your physician.

What Is a Lifestyle Drug?

Tue, 06 Oct 2009 06:00:00 CDT

There is no official definition for lifestyle drugs, but generally speaking they are medications designed to improve a person's quality of life by treating less serious conditions that some individuals believe are not life threatening.

Antidepressant medications make up the largest percentage of the lifestyle drug market, followed by oral contraceptives and treatments for sexual dysfunction, smoking addiction, obesity, skin aging, and hair loss. Insurers do not pay for certain lifestyle drugs, such as those for baldness or wrinkles. But they may reimburse for certain others, like drugs for erectile dysfunction.

Popular lifestyle drugs are sildenafil (Viagra) and similar medications, Botox, bupropion (Zyban) for smoking cessation, and the weight-loss aid orlistat (Xenical) and its lower-strength, over-the-counter version, Alli. Despite the out-of-pocket cost to users, the market for lifestyle drugs continues to grow. Pharmaceutical companies have invested heavily in research to develop them. The global market in lifestyle drugs currently totals $23 billion.

While lifestyle drugs may seem more benign than conventional medications, they can still pose a hazard. If you are prescribed one of these drugs, be sure to fully discuss the risks and benefits with your doctor.

Medication Sharing -- Common and Dangerous

Tue, 25 Aug 2009 06:00:00 CDT

In the United States, a prescription is required for many of the medications we take regularly. Indeed, safe and effective use of any prescription drug is a partnership between the healthcare professional who signs that slip of paper and you, the patient. Yet a recent study shows that medication sharing – loaning prescription drugs without authorization -- is a common practice.

In a study reported in the American Journal of Public Health (Volume 98, page 1115) about a quarter of people admitted loaning or borrowing prescription medications, putting themselves and others at risk.

Researchers interviewed 700 people in 10 U.S. cities. About 23% said they had loaned medications to others and 27% said they had borrowed other people's drugs. Among the more commonly "shared" medications were allergy drugs, pain relievers, and antibiotics. The leading scenarios in which they would be most likely to share medications were if it came from a family member, they ran out of a medication or did not have it with them, or there was an emergency.

Medication sharing can be dangerous because recipients haven't been evaluated by a doctor to know whether a given medication is safe for them. A classic example is sharing of acne drugs that cause birth defects in pregnant women or women who could become pregnant.

People may also self-diagnose a medical condition and then borrow medications in hopes of treating it. The treatment might end up being ineffective, allowing the health condition to worsen, or the treatment could be harmful.

The widespread sharing of antibiotics also poses a risk for society at large. Taking these medications improperly can foster the growth of antibiotic-resistant infections that may prove much more difficult to treat when a doctor finally gets involved.

Viagra for Women?

Tue, 14 Jul 2009 06:00:00 CDT

Once a prescription drug is approved for at least one indication, physicians are free to prescribe it for any other disorders or symptoms for which they believe it would be effective, a practice called off-label prescribing. Now some doctors are prescribing sildenafil (Viagra) off-label for women with sexual dysfunction.

Sexual dysfunction is common for women taking selective serotonin reuptake inhibitor (SSRI) antidepressants, encompassing decreased interest in sex and physical arousal, painful intercourse, and difficulty reaching orgasm.

That's why many women stop taking SSRIs, but a new study suggests that the erectile dysfunction drug sildenafil (Viagra) can help. The study was reported in the Journal of the American Medical Association (Volume 300, page 395).

Researchers enrolled 98 women treated with SSRIs for major depression, average age 37, who were experiencing sexual dysfunction. Half were randomized to take 50 to 100 mg of Viagra one to two hours before sexual activity; the others were given a placebo. The participants' sexual function was measured using standard questionnaires.

After eight weeks, nearly three out of four women experienced better sexual response. Only 28% of women taking Viagra reported no improvement in sexual interest and satisfaction compared with 73%of placebo takers. The most common side effects were headaches, flushing, and indigestion -- but no women dropped out of the trial because of these.

In men, Viagra inhibits an enzyme that results in improved blood flow to the penis, and it appears that the same enzyme is in female genital tissue. Viagra is not yet approved for women, but doctors may start prescribing it for this purpose.

Health Reporting Comes Up Short

Tue, 04 Aug 2009 06:00:00 CDT

Reports in the media are commonly the first opportunity you have to learn about new drugs as well as safety issues with existing prescription medications. However, the depth and accuracy of the medical news you receive depend greatly on the skills and experience of reporters, editors, and producers. They also depend to some extent on where you get the news -- for example, from a brief segment on local TV news or from a large national newspaper or magazine. Here are results from a recent survey, which rated health reporting in the U.S.

Health news in this country often does not provide the type of information consumers need to make informed decisions about medical tests, products, and procedures, according to a recent survey reported in the Public Library of Science Medicine.

Over 22 months, media researchers rated 500 health news reports from major newspapers, the Associated Press wire, and three TV networks according to how well they fulfilled certain quality standards. They concluded that 62 to 77% of stories didn't adequately address costs, risks, benefits, the quality of the evidence, and other treatment options when covering healthcare products and procedures.

Specific shortcomings include the following:

77% did not discuss costs of the treatment.

72% did not quantify health benefits— for example, how much more effective is a new medication than the standard treatment?

67% did not quantify potential harms—for example, what is the actual risk of having a serious side effect?

65% did not discuss the quality of the scientific evidence for the effectiveness of the new treatment.

62% did not discuss treatment alternatives.

The authors hope their evaluation will lead health news organizations to re-evaluate their practices to better serve consumers.

Why Generic Drugs Cost Less

Tue, 23 Jun 2009 06:00:00 CDT

Between 2005 and 2010, brand-name drugs with a market share of about $100 billion will lose their patent protection. Taking advantage of these generics could save you up to $5,000 a year in out-of-pocket expenses. Here's what you should know …

Once the patent for a drug expires, any company can manufacture and sell the drug as long as it proves to the U.S. Food and Drug Administration (FDA) that its generic meets the following criteria:

The generic drug contains the same active ingredient as the branded product.

The generic drug is available in the same dosages and is administered in the same way.

The generic drug is of equal purity and quality.

The generic drug enters the bloodstream as quickly as the brand and results in similar blood levels of the drug.

Because federal regulations stipulate that the generic version of a drug must look different than the branded version, the generic drug will contain different inactive ingredients.

In general, a generic drug costs less than the brand, but how much less depends on a number of factors. Typically, the first generic drug to receive FDA approval is awarded six months of market exclusivity, which means that no other generic drug can enter the market during that time. Because of a lack of competition, the first generic usually sells for 94% of the branded medication -- not much of a cost savings.

But after this half-year period, as the market floods with generic drugs from other companies, the generic drug price begins to drop, often dramatically. For example, with two generic drugs on the market, the price drops to half that of the brand; with five generics it falls to a third and then hovers at a fifth of the brand price once seven or more generics are available.

Generic companies are able to offer the same medication as the branded companies for far less money because they spend little on research, development, and marketing. They do not need to conduct extensive trials to prove a drug's safety and effectiveness.

Taking Advantage of Savings: As more drugs go generic in the coming years, taking advantage of them could make a considerable dent in your drug expenditures, even if you have prescription drug coverage. The copays for generics are usually lower, and some plans require no copay for generic drugs.

To keep abreast of new generic drug approvals, visit www.fda.gov/cder/ogd/approvals. And it also makes sense to comparison shop, because price can vary considerably. Many chain pharmacies and mail-order and Internet drug retailers have websites that list prices. For convenience, check out www.destinationrx.com, a site that compares prices from major online pharmacies. Consumer Reports offers advice on best buys at www.crbestbuydrugs.org.

How Antibiotics and Other Drugs Work

Tue, 02 Jun 2009 06:00:00 CDT

Ever wonder how the medications you take act in your body? This brief guide explains how several classes of popular drugs work.

Thousands of medications are in use today. Here are some of the most common mechanisms by which these drugs achieve their effects:

Antibiotic Drugs -- The development of safe and effective drugs to cure infections was arguably the most significant advance in drug development of the 20th century. Perhaps the most famous example is penicillin, which is derived from a toxin produced by the fungus Penicillium notatum that contaminated a laboratory experiment. The Scottish scientist Alexander Fleming noticed that the Penicillium fungus had done something to kill the bacterium Staphylococcus, which is responsible for many human infections.

Antibiotics have several modes of action. Penicillin disrupts the cell walls of bacteria, causing them to die. Some other antibiotics interfere with the ability of microorganisms to manufacture essential proteins or to reproduce.

Replacement-Therapy Drugs -- Some drugs work by replacing a substance the body lacks. For example, an iron supplement can correct iron deficiency, and daily insulin injections can treat diabetes. Another common example of a replacement-therapy drugs is a synthetic form of natural thyroid hormone (levothyroxine) that remedies the effects of a thyroid gland that has stopped working or was removed because of disease.

Drugs That Act on Enzymes -- Many body processes involve enzymes, which are proteins that facilitate biochemical reactions. An enzyme might, for example, bind to a molecule and break it down into smaller pieces, as occurs during digestion. Or an enzyme might build a larger molecule by joining small molecular building blocks.

Modulating the undesirable action of enzymes can correct disease processes. In fact, the top-selling drugs in the world, the cholesterol-lowering “statin” drugs, inhibit the action of a liver enzyme called HMG-CoA reductase. HMG-CoA reductase performs a key step in the biochemical assembly line that manufactures cholesterol. By blocking this enzyme, statin drugs foil the process, reducing blood levels of cholesterol -- particularly LDL, the “bad” cholesterol that raises the risk of heart disease.

Drugs That Act on Cell Receptors -- Cell receptors are structures on the surfaces of body cells. They are often compared to locks. The “key” that fits into the lock (a protein or some other molecule) is called a ligand. When the ligand binds to the surface of the receptor, forming a chemical bond, it signals the machinery inside the cell to do something.

For example, insulin binds to cell receptors and allows sugar (glucose) in the blood to enter cells. Some new drugs, such as the osteoporosis drug raloxifene (Evista), actually alter the shape of a receptor in ways that modify its action. Evista binds to the estrogen receptor, helping to prevent the bone loss associated with reduced estrogen.

Receptor-Blocking Drugs -- Sometimes known as antagonists, these drugs prevent the natural ligand “keys” from entering the cell receptor “locks,” much as two people can’t occupy the same seat in musical chairs.

In beta-blockers, an important class of cardiac drugs, the active ingredient is a molecule that prevents the hormone noradrenaline from binding to receptors in the heart. Blocking these “beta1” receptors slows the contractions of the heart muscle and makes them less forceful, which leads to reduced demand on the heart muscle and also lowers blood pressure.

Drugs That Alter Cell Transport -- There are still other ways to interfere with the transfer of molecular messages.

For example, the antidepressant drug fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI). This drug works by preventing (or inhibiting) brain cells from collecting (or “re-uptaking”) and subsequently processing for recycling used molecules of the brain messenger chemical known as serotonin. Thus, Prozac has the effect of increasing the amount of this messenger molecule available to brain cells, which helps to alleviate the symptoms of depression for many people.

How Long Do Medications Last?

Tue, 21 Apr 2009 06:00:00 CDT

Readers want to know: Are medications that have passed their expiration dates good to use, or should they be discarded? Here's the answer from Johns Hopkins.

Think of expiration dates -- which the U.S. Food and Drug Administration (FDA) requires be placed on most prescription and over-the-counter medications -- as a very conservative guide to longevity. The expiration date is a guarantee from the manufacturer that a medication will remain chemically stable -- and thus maintain its full potency and safety -- prior to that date. Most medications, though, retain their potency well beyond the expiration date, and outdated medications, whether prescription or over-the-counter, are not usually harmful.

In a study conducted by the FDA on a large stockpile of medications purchased by the military, 90% of more than 100 medications were safe and effective to use years after the expiration date. The drugs in the FDA study, however, were stored under ideal conditions -- not in a bathroom medicine cabinet, where heat and humidity can cause drugs to degrade.

If your medications have been stored under good conditions, they should retain all or much of their potency for at least one to two years following their expiration date, even after the container is opened. But you should discard any pills that have become discolored, turned powdery, or smell strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked.

To help maintain potency, store your medications in a closet or cabinet located in a cool, dry room. Also, don’t mix medications in one container: chemicals from different medications can interact to interfere with potency or cause harmful side effects. If two or more medications have been mingled for any period of time, discard them.

A few medications, like insulin and some liquid antibiotics, do degrade quickly and should be used by the expiration date. Also, consider replacing any outdated medications that you’re taking for a serious health problem, since its potency is more critical than that of an over-the-counter drug you take for a headache or hay fever. If in doubt, consult a pharmacist.

Why You Should Talk to Your Pharmacist

Tue, 12 May 2009 06:00:00 CDT

Developing a personal relationship with your pharmacist can yield many important benefits, especially if you take numerous medications. Here's why you should get to know this "underutilized resource."

Do you know your pharmacist’s name? If you don’t, that’s one of several questions you might want to ask. A survey commissioned by the American Pharmacists Association (APhA) found that people who know their pharmacists by name also tend to keep their pharmacists up to date on all the medications they take, read the labeling information on their prescriptions, know the active ingredients of their medications, and more often ask their pharmacists questions about their medications.

The survey suggests that for many of us, pharmacists remain an underutilized resource. In fact, 58% of people who responded to the survey said they hardly ever or never asked their pharmacists questions.

Pharmacists oversee the proper dispensing of your medications. They are also experts on pharmaceuticals and, ideally, strive to provide you with comprehensive “pharmaceutical care.” This concept means that they know about the chemical composition of drugs, how they function in the body, the conditions that various drugs are generally used to treat, how drugs are absorbed and metabolized by the body, common side effects of drugs, and worrisome interactions between them. It requires at least five years of study and clinical experience with patients to become a pharmacist.

Pharmacists can help ensure that you get the most benefit from your prescriptions. Certainly your personal physician can and should advise you about your drugs; but your pharmacist, the APhA emphasizes, is “one of the most accessible members of the health care team.” The medication issues that a pharmacist can help you with include:

The potential for harmful interactions between your prescription medications and over-the-counter drugs, dietary/herbal supplements, foods, or alcohol

Negative side effects you are most likely to encounter when taking medications, and what you can do about them

Activities that might be a problem while you take certain medications (for example, some drugs put you at higher risk for sunburn or heat exhaustion, requiring you to take extra care during the warm months)

What you should do if you miss a dose

How to store your medications so that they retain their potency

Ways you might be able to cut your medication costs, such as switching to a generic

How to take drugs properly if they are not in pill form, such as inhalers, skin patches, and nose and eyedrops

Advice about over-the-counter medications

Remembering to Take Your Medication

Tue, 31 Mar 2009 06:00:00 CST

Not taking your prescription medication can have serious consequences. One study found that 125,000 deaths from cardiovascular disease occur each year because patients don't take their medication. Luckily there are several ways to make it easier to adhere to your treatment. In this article from our Health After 50 newsletter, Johns Hopkins doctors offer practical advice.

It might seem obvious: Take your medicine and you'll feel better. But the reality is often very different. Some medications have side effects that make you feel worse, or you may take so many different medications that keeping up with it all often proves too difficult.

Side effects. Unpleasant side effects, such as nausea, dizziness, and headaches, are one of the biggest reasons people stop taking their medication. Medications that treat risk factors for cardiovascular disease are common culprits. Niacin, a common cholesterol treatment, can cause uncomfortable flushing, for example, and dizziness can occur with ACE inhibitors prescribed to treat hypertension.

Solution: Don't give up on your treatment. There are ways to manage side effects. Explain your symptoms to your doctor and ask if changing drugs or dosages can help. Sometimes treatment is available to limit particular side effects.

Too many pills. Many people with chronic conditions such as diabetes or heart failure rely on several prescriptions to treat various symptoms and risk factors. Often the sheer volume of medications makes it difficult to remember when to take what treatment.

Solution: Blister packages, rather than pill bottles, make it easier to see if you've taken your medication. Some blister packages are even marked with the days of week. Ask your doctor if getting your medication in blister packages is an option. Remembering to take your medication is also easier if you can time doses to meals.

Plastic pill calendars or pill boxes are other options. Make sure that the box is easy to open. Medicine bottles should also be easy to open. Ask your pharmacist not to use childproof caps. More expensive electronic pill boxes with reminder alarms also are available. Some units are linked to a central computer system, similar to a home alarm. If the system discovers that you've missed a dose, you or a designated contact person will receive a reminder call from the company.

It costs too much. Medications are expensive, even with insurance. Government-sponsored prescription drug benefits to help cover the costs of medication are available through Medicare and Medicaid, and many independent companies and organizations, such as the AARP, offer pharmacy programs.

Solution: In addition to finding a drug benefit program that fits your needs, you can talk to your doctor about prescribing a generic, rather than a brand-name medication. If cost is truly prohibitive, you may qualify for assistance programs run by many drug manufacturers, or your doctor may be able to prescribe an alternate, less expensive medication.

The FDA Approval Process

Tue, 10 Mar 2009 06:00:00 CST

In 1906, the Pure Food & Drug Act established authority for a regulatory agency that eventually became the FDA. Today, the FDA alone decides whether and how pharmaceutical companies may test drugs in Americans and, ultimately, whether the companies will be allowed to sell a drug. Here's an overview of the FDA drug approval process.

What occurs between the first news report about a promising drug and the prescription in your hand is a lengthy process that involves a structured series of studies. If all goes well, the testing process leads to FDA approval: the legal right to sell the drug in the United States.

When a newspaper article ends with the statement "further testing is required," that's a reference to the three phases of clinical testing that occur between the laboratory tests in animals and FDA approval.

FDA Approval: Phase I -- The first clinical studies involve a relatively small number of patients or healthy volunteers, usually 20–80 individuals. In Phase I studies, researchers determine the biological effects of the drug in the human body at various doses -- including any harmful side effects -- and measure how well the drug is absorbed, how it is metabolized, and how long it stays in the body before it is eliminated. A candidate drug could be rejected in this phase for a number of reasons. The drug may turn out to be too toxic or the body simply may not absorb it well enough. Many drugs that look promising in mice and in test tubes fail to pass muster during Phase I clinical trials.

FDA Approval: Phase II -- If the Phase I trials are favorable, the next step is to test the drug in a larger number of subjects, typically around 100–300 individuals. Again, researchers look at safety, but now they also try to establish whether the drug provides a benefit in treating people with a specified disease or condition. Pharmacologists refer to this as a drug's "indication." For example, the FDA-approved indication for cetirizine (Zyrtec) is to treat allergy symptoms. In Phase II testing, it was tested in people with respiratory allergies to see if their symptoms improved without causing important side effects.

FDA Approval: Phase III -- To reach Phase III testing, a drug must be sufficiently safe in Phase II testing and show clear signs of being effective for a specific indication. Phase III trials usually involve about 1,000–3,000 people. At this stage, researchers better define the risks and benefits of the drug, its side effects, and how frequently the side effects occur, especially compared with other drugs used for the same disease. In short: How good is this new drug? Whom does it help? How much does it help? And what can go wrong?

One important goal of Phase III trials is to determine the circumstances under which the drug would be dangerous to prescribe. These conditions are called contraindications. For example, if a drug is somewhat toxic to the liver, it could be life threatening for a person with pre-existing liver disease. For this hypothetical drug, therefore, liver disease is a contraindication.

Understanding How Our Body Responds to Drugs As We Age

Tue, 27 Jan 2009 06:00:00 CST

What medications are available to treat my condition? How do they interact with other medications I'm taking? What are the risks and benefits? As we get older, physiological changes can affect the way our bodies react to medications. In this Health Alert, Johns Hopkins talks about this important subject.

If you're over 50, chances are you're taking more medications and in greater quantities than you ever did in previous decades. Indeed, people between the ages of 55 and 64 are given an average of eight different prescriptions during the course of a year. And those over age 70 take an average of 6.5 medications per day.

It's only logical that the more medication you take concurrently, the more likely it is that an adverse drug reaction could occur. And for older people, such risks are further compounded by physiological changes that make the body more sensitive to the effects of medications.

Beginning sometime during our middle thirties and continuing throughout life, measurements of functional capacity of most major organ systems show a gradual decline. Such changes, which are natural and inevitable, do not necessarily have any noticeable effect on one's quality of life. But they can affect the way that our bodies respond to medication, and make us more susceptible to untoward reactions and side effects.

For one thing, there is an overall decrease in body fluid volume. This results in proportionally higher concentrations of medication or other substances in the bloodstream, thus increasing the risk of toxicity. This effect may be further compounded by an age-related decline in liver and kidney function. These organs are primarily responsible for metabolizing the medication and eliminating toxins. Therefore, a decrease in their function means chemical substances remain in the body longer and are more likely to build up to potentially hazardous levels.

Conversely, a sluggish digestive system can slow the rate that the medication is absorbed into the bloodstream, meaning that less of the medication is available to produce the desired therapeutic effect. Diminished blood flow to the brain may boost the likelihood that certain medications will cause dizziness, fainting, loss of coordination, forgetfulness, confusion, or other signs of cognitive impairment. In some people the heart functions less efficiently with age, which in turn may deprive other organs of an adequate blood supply, causing further disruptions in how medications are distributed in the body.

Finally, age-associated decrements in vision, hearing, and memory may affect an older person's ability to properly understand prescription label, package inserts, or doctors' instructions. Bear in mind, however, that chronological age alone is not necessarily a good predictor of the degree of functional decline; there is considerable variability from one person to another in the rate at which such changes occur.

Using Pain Relief Patches Safely

Tue, 06 Jan 2009 06:00:00 CST

The prescription pain relief patch, fentanyl (Duragesic), has caused more than 100 deaths -- most of these due to improper use by patients. If you use fentanyl or another pain relief patch, follow the prescribed dose carefully and stay alert to signs of an overdose.

Patches that contain pain relief medication are an alternative to oral pain relievers, which carry an increased risk of stomach upset and gastrointestinal bleeding. The medicine in a patch is absorbed through your skin into your bloodstream. Because the drug bypasses the digestive process, less medication is needed to achieve the same effects as a pill. Also, patches provide more consistent relief, whereas pain relief from pills often wanes between doses. But a constant dose also means that people who use any type of pain patch must be extra vigilant to avoid accidental overdoses.

The prescription pain relief patch fentanyl (Duragesic) relieves pain when other painkillers no longer help. A powerful narcotic, it should be used only by people who need around-the-clock opiates to control pain. Such people include those with long-term pain, like some cancer patients -- not surgery patients or people with short-term or occasional pain from conditions like bursitis or muscle strains. Signs of an overdose include difficulty breathing, extreme tiredness, feeling faint, and dizziness. If you experience these symptoms, you should call your doctor immediately.

Less Pain Equals Less Potent Patches Some pain relief patches are used for less severe, short-term pain. In February 2008 the FDA approved the first nonsteroidal anti-inflammatory drug (NSAID) patch, diclofenac (Flector). Diclofenac has been available for many years in pill form (Voltarin), and the patch has been sold outside the United States since 1993. Both the pill and the patch require a prescription. Flector is less potent than fentanyl, but it's still serious medicine.

The least potent but safest pain patches are those sold at drugstores without a prescription. These patches typically contain camphor or menthol -- they are less messy versions of favorites like Bengay, Aspercreme, and Tiger Balm creams.

5 Steps To Help You Avoid Common Drug Side Effects

Tue, 25 Nov 2008 06:00:00 CST

A study linking drug side effects and emergency room admissions found that a large number of Americans -- as many as 700,000 annually -- land in the hospital from taking medications. But the good news is that there are precautions you can take to avoid some of the worst adverse drug events detailed in the study.

Most severe adverse drug events are caused by unintentional overdoses. These overdoses generally involve a small number of medications, all of which must be monitored closely to prevent users from having too much -- or too little -- in their blood.

A common culprit is the blood thinner warfarin (Coumadin); two others are insulin (for diabetes) and digoxin (a heart drug). These three medications caused nearly one third of the adverse drug events reported among older adults in the study. Another medication that ranks high in causing adverse drug events is the antibiotic amoxicillin.

Steps for Safety -- Should you avoid these medications? Not at all. Taken properly, these medications seldom cause serious side effects, but you must be informed about your medications -- know how to take them and what sorts of adverse reactions can occur.

So here's some general advice on how to avoid adverse drug events.

Ask your doctor about side effects. What are the most common adverse effects of your medications? How can you recognize them? What can you do to prevent them? What should you do if a side effect occurs?

Take your medications as directed. Even if you are only slightly unsure about the right way to take your medicine, ask your doctor or pharmacist to explain the instructions again. If you have problems understanding your doctor's instructions, ask the doctor to write them down or bring along a family member or friend to take notes.

Always keep follow-up appointments. If you are supposed to return to the doctor regularly for physical examinations or blood tests to check your response to the drug, make sure you go.

Inform others about your risk. Make sure family, friends, and coworkers know that you're at risk for a serious adverse drug event, and make sure they know what to do if one happens. Also consider wearing a medical alert bracelet or carrying a medication card in your wallet, so that people know you are taking a medication that is associated with serious side effects.

Make sure you really need to take the drug. At least once a year, bring all your medication bottles to your doctor's office -- it's known as a brown-bag visit. Your doctor will evaluate whether any of your medications are unnecessary, redundant, or interact with each other.

Adverse Drug Reactions and Other Age-Related Medication Concerns

Tue, 14 Oct 2008 06:00:00 CDT

Have you noticed that as you get older you react differently to the medications that your doctor prescribes? Many of us do. In this health alert, Johns Hopkins doctors explain age-related physiological changes that can affect the way our bodies react to medications.

If you’re over 50, chances are you’re taking more medications and in greater quantities than you ever did in previous decades. Indeed, people between the ages of 55 and 64 are given an average of eight different prescription medications during the course of a year. And those over age 70 take an average of 6.5 medications per day. It’s only logical that the more medications you take concurrently, the more likely it is that an adverse drug reaction could occur. And for older people, such risks are further compounded by physiological changes that make the body more sensitive to the effects of medications.

Beginning sometime during our middle thirties and continuing throughout life, measurements of functional capacity of most major organ systems show a gradual decline. Such changes, which are natural and inevitable, do not necessarily have any noticeable effect on one’s quality of life. But they can affect the way that our bodies respond to medications, and make us more susceptible to untoward reactions and side effects of medications.

For one thing, there is an overall decrease in body fluid volume. This results in proportionally higher concentrations of medications or other substances in the bloodstream, thus increasing the risk of toxicity. This effect may be further compounded by an age-related decline in liver and kidney function. These organs are primarily responsible for metabolizing medications and eliminating toxins. Therefore, a decrease in their function means chemical substances remain in the body longer and are more likely to build up to potentially hazardous levels.

Conversely, a sluggish digestive system can slow the rate that medications are absorbed into the bloodstream, meaning that less of the medications is available to produce the desired therapeutic effect. Diminished blood flow to the brain may boost the likelihood that certain medications will cause dizziness, fainting, loss of coordination, forgetfulness, confusion, or other signs of cognitive impairment. In some people the heart functions less efficiently with age, which in turn may deprive other organs of an adequate blood supply, causing further disruptions in how medications are distributed in the body.

Finally, age-associated decrements in vision, hearing, and memory may affect an older person’s ability to properly understand prescription label, package inserts, or doctors' instructions. Bear in mind, however, that chronological age alone is not necessarily a good predictor of the degree of functional decline; there is considerable variability from one person to another in the rate at which such changes occur.

What Is an Authorized Generic Drug?

Tue, 23 Sep 2008 06:00:00 CDT

The term generic drug usually refers to a medication whose patent has expired. But what is an authorized generic drug? In this health alert, Dr. Brent G. Petty, a pharmacologist at Johns Hopkins, explains this important drug category.

When a drug is first discovered or produced in the laboratory, it is assigned a generic name to distinguish it from other drugs. This generic name refers to the medication's active ingredient: the chemical that cures diseases or treats symptoms. Throughout the FDA approval process, the generic name is used. Then, when the FDA grants permission to market (sell) the drug, the pharmaceutical company coins a brand name for the medication. For example, atorvastatin is the generic name for the active ingredient in the brand-name drug Lipitor.

Q. What is an authorized generic?

Dr. Petty: When a pharmaceutical company sells one of its brand-name drugs as a lower-priced generic, the product is called an authorized generic. Brand-name companies can do this after the patent on their drug expires and the FDA approves the first generic.

For example, an authorized generic of Zoloft, called sertraline, is sold by a subsidiary of Pfizer, the company that holds the patent on Zoloft. And Merck gave permission to a generic drug company to produce authorized generics of Zocor and Proscar -- simvastatin and finasteride, respectively.

Authorized generics allow brand-name companies to maintain some of their market share in the face of generic competition. But many generic companies are unhappy with the practice, since authorized generics are introduced just as the first company to sell an FDA-approved generic introduces their version. By law, this company gets the exclusive right to be the only seller of the generic for 180 days, to recover the cost of challenging a patent and filing an Abbreviated New Drug Application (ANDA) with the FDA. The brand-name company, meanwhile, can market its drug as a generic without an ANDA because their generic is already approved as a brand.

Generic companies argue that authorized generics take business away from them and could ultimately result in fewer generics and less savings to consumers. But an authorized generic also adds another generic to the market, and the more generics the lower the price to you, the consumer.

The Connection Between Sedatives and Fractures in Elderly Patients

Tue, 16 Dec 2008 06:00:00 CST

All drugs have potential side effects. Indeed, at some point you've probably squinted down the laundry list of possible side effects on the package insert of your medications. Common drug-related side effects include blurred vision, drowsiness, dizziness, dry mouth, heart palpitations, erectile dysfunction, memory impairment, and nervousness. Fortunately, many of these drug side effects occur in only small numbers of people.

Now researchers have called into question the connection between sedatives which can cause dizziness and the potential for falls in elderly patients. They point out that well-meant policies discouraging sedative use in older people to prevent falls and fractures may not be necessary.

Starting in 1989, New York State required doctors to fill out prescriptions in triplicate for benzodiazepines, the most widely used class of sedatives. Twenty-one months later, use of these drugs plummeted by more than half. However, the number of hip fractures did not fall accordingly.

Benzodiazepines can make elderly people unsteady on their feet, potentially increasing the risk of falls and hip fractures. Policy makers hoped that restricting access to these drugs might help prevent these fractures. In fact, since January 2006, benzodiazepines have been excluded from coverage under the Medicare drug benefit.

But this study, which was reported in the Annals of Internal Medicine (Volume 146, page 96), did not confirm the alleged link between hip fractures and benzodiazepines. Thus, Medicare beneficiaries may not receive a class of drugs that might, in appropriate situations, benefit them. Commonly prescribed benzodiazepines include Xanax (alprazolam), Librium (chlordiazepoxide), Valium (diazepam), and Ativan (lorazepam).

What Is Pharmacogenomics?

Tue, 02 Sep 2008 06:00:00 CDT

The goal of taking any medication is to deliver a sufficient dose to produce the desired effect at the right location in the body. But each body is different and often people respond differently to the same medication. Pharmacogenomics – part of the growing field of personalized medication -- addresses this widespread problem.

Pharmacogenomics is the study of matching drug therapy to an individual’s genetic profile in the hopes of avoiding serious side effects and boosting effectiveness.

Genetic variability is one reason people respond differently to the same medication. Gene variations affect how quickly or slowly a medication is metabolized as well as the medication’s ability to have the desired effect.

For example, the FDA recently introduced new labeling for the drug warfarin (Coumadin) that reflects pharmacogenomics. Warfarin prevents blood clots, but too high a dose can lead to life-threatening bleeding. Doctors typically use a patient’s age, gender, weight, and medical history to estimate an appropriate starting dose and then modify the dose after blood tests show the extent of blood thinning. But research now shows that tests for certain gene variations may offer valuable information, too.

The warfarin label now states that a lower starting dose should be considered in people with variations in the following two genes— CYP2C9 and VKORC1. Variants of CYP2C9 slow the metabolism of warfarin; variants of VKORC1 make the body more sensitive to warfarin. Blood tests are available to detect these gene variants.

Personalized medication is already well established for certain cancer medication, like trastuzumab (Herceptin). This medication is only effective in women whose breast cancer cells have a specific genetic variation that results in the overproduction of the protein Her2. Women are tested for this variation before the medication is prescribed.

Ask the Doctor About Nanopharmaceuticals

Tue, 12 Aug 2008 06:00:00 CDT

Welcome to the brave new world of nanomedicine. In this Health Alert, Johns Hopkins specialists explain how drugs called nanopharmaceuticals are changing the treatment of cancer.

Q. What are nanopharmaceuticals? Are they safe?

A. Nanopharmaceuticals are drugs designed using extremely small materials -- a billionth of a meter, or a nanometer, in size. For comparison, the width of a strand of hair is 100,000 nanometers, and a nanometer is smaller than a single cell in your body.

At this tiny scale, materials have novel and often useful properties. For example, drugs packaged in nanoscale particles can enter hard-to-reach parts of the body, or nanoparticles themselves may be used as a medicine.

Nanopharmaceuticals show the most promise for the treatment of cancer. One such product called Doxil contains the chemotherapy drug doxorubicin encapsulated in liposomes -- tiny fat bubbles less than 200 nanometers in diameter. These liposomes target tumor cells, penetrating the altered and often damaged blood vessels of the tumor and slowly releasing doxorubicin. This drug-delivery system allows doctors to administer larger amounts of the drug, while sparing healthy tissue and thus reducing the typical toxic side effects of chemotherapy.

Some experts have raised concerns about possible hazards of nanoparticles. Because these particles have a large surface area relative to their size, they are highly chemically reactive. Their small size also means they could escape to unintended parts of the body, penetrating the membranes of healthy cells and interfering with cell processes or causing DNA damage.

How To Dispose of Your Medications

Tue, 01 Jul 2008 06:00:00 CDT

If you’ve ever wondered what to do with leftover or expired prescription medications, the federal government recently released some important advice. Here are guidelines from the Office of National Drug Control Policy. For more information go to: http://www.whitehousedrugpolicy.gov/pda/022007.html.

Here are your three options:

1. Throw drugs in the trash. To do this, remove pills from their original containers, mix the pills with coffee grounds or kitty litter and place in an empty can or sealable bag to ensure that the drugs are not diverted or accidentally ingested by children or pets.

2. Flush drugs down the toilet only if the accompanying patient information specifically instructs it is safe to do so. Medications that should be flushed down the toilet rather than thrown in the trash include narcotic pain medications, such as fentanyl (Actiq, Duragesic Transdermal System, Fentora), oxycodone (Oxycontin, Percocet), meperidine, and morphine (Avinza); the narcolepsy drug sodium oxybate (Xyrem); the hepatitis drug entecavir (Baraclude); the attention deficit–hyperactivity disorder drug methylphenidate (Daytrana Transdermal Patch); and the HIV drugs atazanavir (Reyataz) and stavudine (Zerit).

3. Utilize drug take-back programs. If you are concerned about the environmental effects of flushing medications down the toilet or throwing them in the trash, take advantage of take-back programs, which allow you to bring unused drugs to a central location for proper disposal. Ask your local pharmacy or municipal waste collection system if they have such a program.

Affording Your Medications

Tue, 10 Jun 2008 06:00:00 CDT

Big clinical trials may show that the new medications work, but not their cost-effectiveness. A recent MEDLINE study looks into this under-discussed subject.

The best-possible medications can’t offer you much if you can’t afford them. Even with health insurance, you may pay a significant amount each month in co-payments for medications alone.

The large randomized, controlled trial has become the accepted standard for assessing the value of a new treatment or medication. But more than half of these studies fail to assess in a meaningful way whether the new medication is actually worth the investment when compared with the old treatment, a new study reported in Value in Health (Volume 9, page 334 ) shows.

The researchers searched MEDLINE, a huge database of medical publications, for economic evaluations based on data collected from major randomized trials published in 2003. Of the 115 they found, only 37% included a cost-effectiveness ratio. Incomplete cost data were reported in 58% of studies, and only two of them reported how they analyzed cost data that had been censored in the original clinical study.

In 2003, the authors say, the quality of statistical evaluations conducted as part of randomized, controlled trials was poor. Unless this improves, they assert, people will not be able to make fully informed policy decisions about the value of new medications.

Bottom line: Meanwhile, if you have “sticker shock” about the cost of a new medication, ask your doctor whether the benefit is large enough to justify the expense. Your judgment about this and your doctor’s may be the best available for now.

The Risks of Drug Flipping

Tue, 20 May 2008 06:00:00 CDT

Has your health insurance company ever urged you to switch medications? Johns Hopkins explains the risks of "drug flipping," and offers advice.

People sometimes encounter problems with their medications when they switch insurance companies. A brand of drug that is covered with a small co-pay on their former plan may not be on the formulary (the list of drugs approved by a health insurer for use by its beneficiaries) of the new one. In these cases, the company may create financial pressure to switch from one drug to another, or from a brand-name drug to a generic -- a practice sometimes referred to as "drug flipping".

If this happens to you, start by asking your doctor or pharmacist if the new drug is as safe and effective as the one you were using before. Certain classes of drugs are interchangeable at equivalent doses, meaning you may have to take a different dose of the new drug for the same effect you got from the former medication. When this happens, drug flipping can lead to confusion and can thereby increase the chance of medication errors.

It is also possible that your individual response to the “equivalent” dose of a different drug actually may not be equivalent, in which case flipping your brand might not be in your best interest. For instance, if you are getting a good result from a certain drug for high blood pressure, switching brands could be risky.

Nobody enjoys these bureaucratic problems, but they are part of the complex American healthcare system. By becoming familiar with your insurer’s formulary and drug-benefit policies, you can avoid inconvenience and unnecessary out-of-pocket expenses.

Many insurers provide a condensed “pocket formulary” you can take with you when you visit your doctor. When the doctor reaches for the prescription pad, reach for your formulary and check your coverage. It may save you aggravation and expense at the pharmacy.

Monitoring Your Medications

Tue, 29 Apr 2008 06:00:00 CDT

When your doctor prescribes a new medication, are the dosing and potential side effects thoroughly discussed? For many patients they are not, as a recent study discovered.

There is no single ideal dose of any medication for all patients, because people often respond differently to the same medications. The dose must be tailored to you and your specific medical needs. The goal is to identify the minimum effective dose: one that provides sufficient benefit, with minimum side effects, and at the lowest cost.

On the other hand, the maximum useful dose is the point beyond which increasing the dose offers no additional benefit and, potentially, confers an increased risk of side effects.

And it is often left to the consumer to determine how best to use their medications, this according to a study reported in the Archives of Internal Medicine (Volume 155, page 1855). A study of physicians in Sacramento, California, found “spotty” and "overall poor" patient counseling about new prescriptions and over-the-counter drugs.

Researchers used surveys and tape recordings to document 185 doctor-patient encounters involving a new prescription medication or recommendation. The doctors were evaluated on how well they communicated five types of information about a new medication: its name, its purpose, how long to take it, how often to take it, the amount to take each time, and potential side effects.

The doctors got relatively good marks for citing the proper name of the medications and the purpose of the prescription. A little more than half the time they said how many tablets to take and how often. However, they discussed adverse side effects and the duration of dosing (whether it was a one-time prescription or the patient needed refills) only about a third of the time.

These findings don’t necessarily represent the practice of all physicians. But it would be smart to educate yourself about your own medications, by reading labels and asking the pharmacist questions if you find the doctor hasn’t told you all you want to know.

Using Acetaminophen Safely

Tue, 18 Mar 2008 06:00:00 CST

Recent research indicates that acetaminophen overuse is on the rise and can lead to acute liver failure. What should you do? Johns Hopkins offers advice.

The fact that the average lifespan in the United States continues to inch upward suggests that most people who use medications are better off for the experience. However, it’s also obvious from the daily news that even though drugs are tested thoroughly they can have unexpected side effects.

Acetaminophen Liver Damage on the Rise

For example, a recent study reported in the journal Hepatology (Volume 42, page 1364), indicates that overuse of acetaminophen, the active ingredient in Tylenol and some other pain medications, is the leading cause of acute liver failure in the United States. The study is based on an analysis of hospital records in people age 17–76.

In part, the problem arises because acetaminophen is present in many prescription and over-the-counter medicines. For most healthy individuals, the safe limit for acetaminophen is 4,000 mg per day.

Researchers looked at the causes of liver failure in 662 people at 22 U.S. medical centers. They concluded that acetaminophen overdose was the cause in 275, or 42% of cases. Of these, 44% were people intentionally overdosing on acetaminophen to attempt suicide. But in 48% of cases, the acetaminophen overdose was unintentional.

Most patients (178) survived, although 23 needed liver transplants and 74 (27%) died. Over the six-year study period, the incidence of liver failure caused by acetaminophen overdose grew alarmingly, from 28% to 51%.

Before the 1980s, acetaminophen rarely arose in the medical literature as a cause of liver failure, the researchers noted. Besides people with depression and substance abusers, those most likely to overdose are people who have chronic pain or who must take several medications simultaneously. Check whether your medications, combined, contain more than the daily dose limit for acetaminophen.

Chemical Culprit in Grapefruit-Drug Interactions Identified

Tue, 05 Feb 2008 06:00:00 CST

People are discouraged from consuming grapefruits or grapefruit juice while taking certain medications because they can affect the way the medications are metabolized. Now scientists are closer to understanding why this dangerous interaction occurs.

Certain foods and drinks don’t mix well with certain medications. For example, grapefruits or grapefruit juice may interact badly with a number of medications, because natural grapefruit contains a substance that affects the activity of an enzyme in the intestines and liver that processes these medications. This could result in a dangerous increase in the level of the drug in your blood.

Another potentially dangerous interaction is between the blood thinner warfarin (Coumadin and generic brands) and vitamin K. The vitamin, present in many multivitamins and supplements, neutralizes or reduces the effect of the medication warfarin. This raises the risk of a blood clot, which the warfarin is intended to prevent.

Now scientists have identified the specific chemical in grapefruit juice responsible for many drug–food interactions, according to an article in the American Journal of Clinical Nutrition (Volume 83, page 1097).

Previous research implicated a family of chemical compounds called furanocoumarins (FCs) as the culprit in grapefruit juice. To confirm this suspicion, the scientists created FC-free grapefruit juice and compared its effects with those of whole grapefruit juice or orange juice.

Eighteen study volunteers drank 8 oz of whole or FC-free juice along with a dose of felodipine (Plendil), a blood pressure medication. (The blood level of Plendil is higher if taken with grapefruit juice, potentially causing dangerously low blood pressure.) The blood concentration of Plendil was nearly three times higher when people took it with 8 oz of whole grapefruit juice, compared with blood levels after subjects took it with the FC-free juice or orange juice. The researchers said their finding could assist in the study of other drug–food interactions.

Should Physicians Use Secret Placebos?

Tue, 26 Feb 2008 06:00:00 CST

Have you ever been given a placebo? In a recent study, the AMA Ethics Board concludes that secret placebo treatment is improper.

The American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) has decided that it is unethical for doctors to offer placebo therapy without patient consent. To be incorporated into the AMA’s Code of Medical Ethics, the AMA House of Delegates, the organization’s national policy-making body, must vote in favor of the ruling. This ruling was reported in the journal Virtual Mentor (Volume 8, page 377).

A placebo therapy is one that the doctor does not know to be helpful, but a patient believes may be an effective medicine. Sometimes people in clinical studies who take placebo pills improve even more than people taking an actual drug.

While use of inactive placebos is common in research, placebo use in routine clinical practice is controversial. A fictitious scenario presented to explain the policy is that of a 39-year-old woman who complains of fatigue and asks for an energy booster. An unethical response, the CEJA decision indicates, would be to give her an injection of inactive saline (the placebo), calling it a “vitamin boost” that could cure the fatigue. If the famous placebo effect kicks in, she might feel more energetic, but at the cost of being deceived and misinformed. The doctor would have failed to engage her in a truly informed discussion of her problem and her treatment options.

Big Pharma and Generic Drugs

Tue, 15 Jan 2008 06:00:00 CST

Generic drugs can save the consumer a lot of money. But some pharmaceutical manufacturers work aggressively to keep their market for a drug that goes off patent, limiting the availability of the generic brand. Here’s an example.

The term "generic drug” usually refers to a drug that has come off patent and is manufactured by one or more generic-drug companies in addition to the company that originally held the patent. Most generic drugs reach the market when the manufacturer’s patent on the product lapses. This is good news for consumers, because generics are less expensive than the brand-name drug but provide the same medical benefit. For instance, in 2006 the anticholesterol drugs pravastatin [Pravachol] and simvastatin [Zocor] went generic, offering people who switched to the generic form a savings of about 20% for the former and 10% for the latter, judging from the prices quoted on Drugstore.com. This is not good news for the original manufacturers, which lose the exclusive right to market a brand-name product.

An interesting article reported in The New England Journal of Medicine (Volume 355, page 1297) shows just how far big pharma will go to protect its interests. This article explains that an executive at pharmaceutical manufacturer Bristol-Myers Squibb agreed to make a secret cash payment of $40 million to Apotex, a Canadian generic drug company, to maintain its monopoly over sales of clopidogrel (Plavix) until 2011.

Plavix, a top-selling drug for preventing heart attacks and strokes, costs $4 per day. The generic would cost 20% less. In the end, the deal fell through and came under investigation by the U.S. Department of Justice, although a court injunction temporarily halted marketing of the generic version.

Such secret deals to keep cheaper generic drugs off the market are not uncommon, says an editorial in The New England Journal of Medicine. Manufacturers invent new drugs and take out multiple patents to protect their exclusive right to market them. When the patents start to expire, generic manufacturers often face years of legal battles to win the right to sell the drug. As a result, these companies may turn to special deals to avoid litigation. The generic manufacturer makes money by not selling its product. The brand-name company makes money by keeping its exclusive market for a while. Patients seldom know that they have lost money in the bargain.

Shingles Vaccine Update

Tue, 04 Dec 2007 06:00:00 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Shingles Vaccine Update is no longer current, and has therefore been removed.

If you would like to read related articles about prescription drugs, please go to the Prescription Drugs topic page. Thank you.

Direct-To-Consumer Drug Ads -- What's in them for you?

Tue, 13 Nov 2007 06:00:00 CST

Johns Hopkins Health Alerts | Prescription Drugs | Direct-To-Consumer Drug Ads

Do drug ads help patients or harm them? Critics of drug ads assert that the ads foster artificial demand for brand-name drugs, drive up the cost of health care, potentially expose people to side effects from unproven drugs, and complicate the doctor-patient relationship.

If you are an American adult who has read a magazine or watched television in the past decade, chances are you have seen many direct-to-consumer (DTC) drug advertisements. Commonly these ads identify a disease or health problem and then suggest that you ask your doctor whether the medication may help you.

The pharmaceutical industry contends that this kind of advertising is a valuable service that alerts consumers to new drugs and stimulates helpful conversations with their doctors. But there are many critics and direct-to-consumer advertising remains controversial. The issue has been studied in depth by the U.S. Food and Drug Administration (FDA), by independent researchers, and by the pharmaceutical industry to establish whether, on balance, DTC advertising helps patients or harms them.

The balance shifts somewhat depending on which drug study you read, but important insights have emerged that can guide you in interpreting drug advertisements. If you understand their limitations, the drug ads could benefit you and lead to a more productive relationship between you and your doctor.

Surveys and studies show that DTC ads often do lead to discussions between patients and their doctors. Recently, the FDA surveyed 250 general practitioners and 250 specialists pulled at random from the American Medical Association’s membership database. Most of the physicians said that patients asked them about advertised prescription drugs either often (62%) or all the time (23%). Most patients asked about drugs by brand name, which reflects the ads’ focus on creating awareness of specific products.

Another study, carried out by researchers at Massachusetts General Hospital, Harvard University, and the marketing research firm Harris Interactive Inc., found that 72% of the physicians surveyed believed that advertising had increased their patients’ understanding of possible drug treatment.

Another interesting finding: One in four doctor visits spurred by DTC advertising resulted in a new diagnosis. This suggests that advertising may help some people to recognize that they have a treatable health problem.

However, DTC advertising can also cause confusion. In the Harvard-Harris survey, many physicians said that ads often left their patients with a lopsided view of the risks and benefits of medications, with a bias toward potential benefits. The FDA survey, too, concluded that people tended to view drugs they learned about through these ads as more effective than they actually were.

Another hot-button issue is whether DTC ads fuel demand for unnecessary prescriptions. According to doctors polled in the FDA study, about three out of four patients do leave their doctor’s office with a new drug prescription. At least some of the time, patients actively pressure their doctors to prescribe the drug, according to the Harvard-Harris survey. Of the physicians who did prescribe a specific drug a patient requested, 46% said they did so because it was the most effective drug. However, 48% wrote a new prescription even though the drug was no more effective than available alternatives, just to accommodate the patient’s request. About 6% of the doctors admitted to complying with their patients’ requests for a particular drug even though other medications were more effective.

Johns Hopkins Health Alerts | Prescription Drugs | Direct-To-Consumer Drug Ads

Medication and the Media

Tue, 23 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Prescription Drugs | Medication and the Media

The average medical news report on local TV stations lasts for only 33 seconds, which means that reporters have very little time to explain the details of a study, let alone discuss which of their listeners it might actually affect.

Did you get your dose of medical news today? Print and broadcast news serve up a daily feast of health news, including frequent reports on prescription drugs. Sometimes you learn that the U.S. Food and Drug Administration has approved a new drug; sometimes you hear that research has revealed unexpected side effects of an old drug. The question is whether -- and how -- to make use of medical news that the media dispenses.

An intelligent answer requires considering one basic fact about the news media: It’s their job to tell you what’s new, but "newsworthy” information is not always "news you can use.”

You can glean useful information about drugs from the media if you keep the following four questions in mind:

Drug tip 1 -- What type of study was involved? Keep in mind the critical difference between an experimental drug working on a culture of isolated cells and a major clinical trial involving thousands of patients. A preliminary experimental study searching for a biological effect that might affect a disease is a long shot that only rarely -- and slowly -- leads to a new drug that might help you, the patient. Experimental drugs that have cured cancer or kidney disease in inbred mice may never make it to a pharmacy shelf.

Drug tip 2 -- For whom does a new drug offer a clear benefit? How much of a benefit would it offer, compared with drugs already on the market?

Drug tip 3 -- What are most common or most serious side effects of the drug? Who is most likely to experience these drug side effects?

Drug tip 4 -- What is the bottom line for you, as an individual? Is there evidence that the drug is “better” enough to prompt your doctor to change the drug you are currently taking? Is the potential benefit worth the risk of already known side effects or currently unknown side effects likely to be recognized only after much greater use among thousands of patients?

Johns Hopkins Health Alerts | Prescription Drugs | Medication and the Media

Using Generic Drugs Safely

Tue, 21 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Prescription Drugs | Using Generic Drugs Safely

Health insurance companies love generic drugs, because they cost less money than branded versions – but are generic drugs right for you?

Are generic drugs safe? The short answer is yes, because in the United States, manufacturers must prove to the FDA that the generic version of a drug has the same active ingredient as the original, branded version and that it is absorbed into the body approximately as well (with no more than a 20% difference in absorption).

In short, a generic drug should be interchangeable with the brand-name version, if used in the same way for the same medical conditions. According to an FDA website, studies show no difference in the rate of side effects between generic drugs and brand-name drugs.

Health insurers love generic drugs, because they cost less money than branded versions -- on average, 30% less. But there are some instances when your doctor may not think it’s a good idea to switch to a generic drug. This is often the case for medications that have a narrow therapeutic range (NTR).

When you take an NTR drug, the most effective dose with the fewest side effects lies in a narrow range between too little and too much. These are medications in which small changes in the dose and/or blood concentration could result in clinically important changes in drug efficacy or safety. Usually, these drugs require frequent adjustments in the dosage and the user needs to be monitored carefully, regardless of whether the drug is a brand-name or generic drug product.

One such drug in common use is Coumadin. If you have taken brand-name warfarin for a long time, your doctor may not want to switch you to a generic because slight differences in the generic version could alter the concentration of the drug in your blood. This could thin your blood too much, causing bleeding, or too little, raising the risk that a clot could form. Other common NTR medications include digoxin (a cardiac treatment) and certain drugs used to control epileptic seizures.

For more Alerts and Special Reports, please visit the Prescription Drugs Topic page.

Johns Hopkins Health Alerts | Prescription Drugs | Using Generic Drugs Safely

Safe Use of Antibiotics

Tue, 02 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Prescription Drugs | Safe Use of Antibiotics

When do you really need an antibiotic for a respiratory illness? Probably not very often. However, some doctors still prescribe antibiotics inappropriately despite the risks, in large part because patients expect them.

The common cold, sore throats, sinus infections, coughs, and bronchitis -- these acute respiratory infections (ARIs) send more people to the doctor than any other kind of illness. About 75% of the time, people go home with a prescription for an antibiotic— -- whether they need -the antibiotic or not.

Indeed, over 90% of respiratory infections trace to viruses, upon which antibiotics have no effect whatsoever because they kill only bacteria, not viruses. Studies show that patients like to receive a prescription for an antibiotic; but there are real downsides to unwarranted use of antibiotics.

Medical researchers continue to refine understanding of just who should get antibiotics for ARIs and why. Here are some general rules of thumb:

Antibiotics do not combat the common cold. They could make you sick and offer no benefit. The only proven treatment effective for shortening the duration of the common cold (slightly, if you start quickly at the first sign of symptoms) is zinc, and the taste of zinc lozenges is so bad that the treatment may be worse than the disease. During flu season, immediate treatment with an antiviral drug such as oseltamivir (Tamiflu) may help you recover from influenza somewhat sooner.
For an otherwise healthy individual who has a “chest cold” (acute bronchitis), research shows that antibiotics offer little to no benefit in reducing either the severity or duration of symptoms.
For sinusitis (sinus infection), immediate use of antibiotics is not necessarily beneficial. However, when symptoms have persisted for more than about 10 days, or if you have severe symptoms such as fever, facial swelling, or facial pain, antibiotics may help.
Generally, antibiotics are not helpful for sore throat, unless a test confirms the presence of a bacterial infection with Streptococcus ("strep throat”).
Antibiotics are used to treat pneumonia, a viral or bacterial infection of the lungs.
Diarrhea is a common side effect of antibiotics and develops more frequently with longer durations of antibiotic treatment.

For more Alerts and Special Reports, please visit the Prescription Drugs Topic page.

Johns Hopkins Health Alerts | Prescription Drugs | Safe Use of Antibiotics

Your Pharmacist -- An Underutilized Resource

Tue, 31 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Prescription Drugs | Your Pharmacist -- An Underutilized Resource

Developing a personal relationship with your pharmacist can yield many important benefits, especially if you take numerous medications.

Do you know your pharmacist’s name? If you don’t, that’s one of several questions you might want to ask. A survey commissioned by the American Pharmacists Association (APhA) found that people who know their pharmacists by name also tend to keep their pharmacists up to date on all the medications they take, read the labeling information on their prescriptions, know the active ingredients of their medications, and more often ask their pharmacists questions about their medications.

One possibility is that people who form personal connections with their pharmacists feel more comfortable asking for information about their medications. Or it may be that people who ask questions simply get to know their pharmacists better over time -- including their names. Either way, the survey suggests that for many of us, pharmacists remain an underutilized resource. In fact, 58% of people who responded to the survey said they hardly ever or never asked their pharmacists questions.

Pharmacists oversee the proper dispensing of your medications. They are also experts on pharmaceuticals and, ideally, strive to provide you with comprehensive "pharmaceutical care.” This concept means that they know about the chemical composition of drugs, how they function in the body, the conditions that various drugs are generally used to treat, how drugs are absorbed and metabolized by the body, common side effects of drugs, and worrisome interactions between them. It requires at least five years of study and clinical experience with patients to become a pharmacist.

Pharmacists can help ensure that you get the most benefit from your prescriptions. Certainly your personal physician can and should advise you about your drugs; but your pharmacist, the APhA emphasizes, is “one of the most accessible members of the health care team.” The medication issues that a pharmacist can help you with include:

The potential for harmful interactions between your prescription medications and over-the-counter drugs, dietary/herbal supplements, foods, or alcohol

Negative side effects you are most likely to encounter when taking medications, and what you can do about them

Activities that might be a problem while you take certain medications (for example, some drugs put you at higher risk for sunburn or heat exhaustion, requiring you to take extra care during the warm months)

What you should do if you miss a dose

How to store your medications so that they retain their potency

Ways you might be able to cut your medication costs, such as switching to a generic

How to take drugs properly if they are not in pill form, such as inhalers, skin patches, and nose and eyedrops

Advice about over-the-counter medications.

For more Alerts and Special Reports, please visit the Prescription Drugs Topic page.

Johns Hopkins Health Alerts | Prescription Drugs | Your Pharmacist -- An Underutilized Resource

Drug Safety in the News

Tue, 10 Jul 2007 07:06:55 CDT

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Drug Safety in the News is no longer current, and has therefore been removed.

If you would like to read related articles about prescription drugs, please go to the Prescription Drugs topic page. Thank you.

The High Cost of Chemotherapy

Tue, 19 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Prescription Drugs | High Cost of Chemotherapy

Survival comes dear for cancer patients who need some new anticancer drugs.

In some cases, paying for cancer treatment can be an issue in itself. This is especially true when cancer treatment continues for an extended time and involves chemotherapy. Among cancer survivors younger than 65, one in five delay getting necessary cancer treatment or avoid it entirely just because of the cost, according to a study by the U.S. Centers for Disease Control and Prevention. This is especially true for the uninsured, but even with medical insurance the financial impact on the cancer patient can be considerable.

The dilemma is more difficult for cancer survivors than for other kinds of patients, according to the study, which was based on a national survey involving 52,000 people. Compared with 21% of cancer survivors, only 12% of those with other health problems found treatment too expensive to consider (at least temporarily).

Some chemotherapy drugs are relatively inexpensive, such as 5-FU and leucovorin. However, newer anticancer drugs are very expensive, especially when they are used in combinations. Whereas the drug costs for eight weeks of treatment with 5-FU and leucovorin will run in the $100–$300 range, adding oxaliplatin or irinotecan will increase this cost to $10,000 or more. The further addition of bevacizumab (Avastin) or cetuximab (Erbitux) will raise this cost to $20,000–$30,000. This is for the cost of the drugs alone.

When these therapies improve survival by only a few months, this presents troubling issues for cancer patients, their doctors, insurers, and society as a whole. As an editorial in The New England Journal of Medicine pointed out, ultimately their high cost could lead to across-the-board increases in copays and policy premiums that would be insurmountable even for relatively affluent individuals.

In the long run, therefore, to achieve a short-term benefit for some cancer patients, many people with other medical conditions may suffer earlier death or disability because they cannot afford effective treatment. Society continues to avoid grappling with these difficult issues of equity.

For an individual colon cancer patient, for example, the issue of high cost is not theoretical, but immediate. There is often a time lag between approval by the U.S. Food and Drug Administration and insurance coverage. Also, although insurance may cover part or all of the costs, some policies have a cap: a maximum amount the policy will pay for a person over a lifetime. Those on Medicare without any other insurance pay 20% of the cost, which can be substantial.

If the cost of your chemotherapy is prohibitive, check whether you qualify for one of the programs that some pharmaceutical companies sponsor to help pay for their drugs. They may even provide them free of charge. Many communities also have such programs. A list of pharmaceutical companies that offer help to patients is available toll free at 1-888-4PPANOW (1-888-477-2669) or at https://www.pparx.org.

For more Alerts and Special Reports, please visit the Prescription Drugs Topic page.

Johns Hopkins Health Alerts | Prescription Drugs | High Cost of Chemotherapy

Drugstore Aisle Updates on Warfarin, DHEA, Black Cohosh

Tue, 08 May 2007 06:00:00 CDT

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Drugstore Aisle Updates on Warfarin, DHEA, Black Cohosh is no longer current, and has therefore been removed.

If you would like to read related articles about prescription drugs, please go to the Prescription Drugs topic page. Thank you.

Generic Drugs

Fri, 05 Jan 2007 14:03:48 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Generic Drugs is no longer current, and has therefore been removed.

If you would like to read related articles about prescription drugs, please go to the Prescription Drugs topic page. Thank you.

Drugstore Aisle Updates on Amplichip, St. John's Wort and Gleevec, and medication mistakes

Tue, 17 Apr 2007 06:00:00 CDT

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Drugstore Aisle Updates on Amplichip, St. John's Wort and Gleevec, and medication mistakes is no longer current, and has therefore been removed.

If you would like to read related articles about prescription drugs, please go to the Prescription Drugs topic page. Thank you.

How Aging Affects the Body's Response to Drugs

Tue, 27 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Prescription Drugs | Medications and Aging

Johns Hopkins doctors explain age-related physiological changes that can affect the way our bodies react to medications.

If you’re over 50, chances are you’re taking more medications and in greater quantities than you ever did in previous decades. Indeed, people between the ages of 55 and 64 are given an average of eight different prescription medications during the course of a year. And those over age 70 take an average of 6.5 medications per day. It’s only logical that the more medications you take concurrently, the more likely it is that an adverse drug reaction could occur. And for older people, such risks are further compounded by physiological changes that make the body more sensitive to the effects of medications.

Beginning sometime during our middle thirties and continuing throughout life, measurements of functional capacity of most major organ systems show a gradual decline. Such changes, which are natural and inevitable, do not necessarily have any noticeable effect on one’s quality of life. But they can affect the way that our bodies respond to medications, and make us more susceptible to untoward reactions and side effects of medications.

For one thing, there is an overall decrease in body fluid volume. This results in proportionally higher concentrations of medications or other substances in the bloodstream, thus increasing the risk of toxicity. This effect may be further compounded by an age-related decline in liver and kidney function. These organs are primarily responsible for metabolizing medications and eliminating toxins. Therefore, a decrease in their function means chemical substances remain in the body longer and are more likely to build up to potentially hazardous levels.

Conversely, a sluggish digestive system can slow the rate that medications are absorbed into the bloodstream, meaning that less of the medications is available to produce the desired therapeutic effect. Diminished blood flow to the brain may boost the likelihood that certain medications will cause dizziness, fainting, loss of coordination, forgetfulness, confusion, or other signs of cognitive impairment. In some people the heart functions less efficiently with age, which in turn may deprive other organs of an adequate blood supply, causing further disruptions in how medications are distributed in the body.

Finally, age-associated decrements in vision, hearing, and memory may affect an older person’s ability to properly understand prescription label, package inserts, or doctors’ instructions. Bear in mind, however, that chronological age alone is not necessarily a good predictor of the degree of functional decline; there is considerable variability from one person to another in the rate at which such changes occur.

For more Alerts and Special Reports, please visit the Prescription Drugs Topic page.

Johns Hopkins Health Alerts | Prescription Drugs | Medications and Aging

Ask the Doctor About Your Prescriptions

Tue, 06 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Prescription Drugs | Drug Expiration Dates

Prescription Medication Question 1 -- Are medications that have passed their expiration dates good to use, or should they be discarded?

Think of expiration dates -- which the U.S. Food and Drug Administration (FDA) requires be placed on most prescription and over-the-counter medications -- as a very conservative guide to longevity. The expiration date is a guarantee from the manufacturer that a medication will remain chemically stable—and thus maintain its full potency and safety -- prior to that date. Most medications, though, retain their potency well beyond the expiration date, and outdated medications, whether prescription or over-the-counter, are not usually harmful.

In a study conducted by the FDA on a large stockpile of medications purchased by the military, 90% of more than 100 medications were safe and effective to use years after the expiration date. More recently, the FDA approved two-year extensions on expiration dates for a number of drugs, including the antibiotics Cipro (ciprofloxacin), penicillin, and tetracycline; the Tagamet (antiulcer/antireflux drug cimetidine); and Valium (diazepam), a tranquilizer. The drugs in the FDA study, however, were stored under ideal conditions -- not in a bathroom medication cabinet, where heat and humidity can cause drugs to degrade.

If your medications have been stored under good conditions, they should retain all or much of their potency for at least one to two years following their expiration date, even after the container is opened. But you should discard any pills that have become discolored, turned powdery, or smell strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked. To help maintain potency, store your medications in a closet or cabinet located in a cool, dry room. Also, don’t mix medications in one container: chemicals from different medications can interact to interfere with potency or cause harmful side effects. If two or more medications have been mingled for any period of time, discard them. A few medications, like insulin and some liquid antibiotics, do degrade quickly and should be used by the expiration date. Also, consider replacing any outdated medications that you’re taking for a serious health problem, since its potency is more critical than that of an over-the-counter drug you take for a headache or hay fever. If in doubt, consult a pharmacist.

Prescription Drug Question 2 – Where’s the best place to store your medications?

It’s not the medicine cabinet in your bathroom. The heat and humidity from showers and baths can cause medications to break down, lose potency, and, in rare cases, even become toxic. To keep your medications in the best condition, keep them in a dry area away from heat and light, such as a dresser drawer. Kitchen cabinets are also a good choice, as long as they aren’t next to the stove, sink, or dishwasher. Wherever you keep your medications, make sure that bottles are tightly sealed after use.

Johns Hopkins Health Alerts | Prescription Drugs | Drug Expiration Dates

Prescription Drugs That Cause Weight Gain

Tue, 23 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Prescription Drugs | Prescription Drugs That Cause Weight Gain

Lawrence Cheskin, M.D., Director of the Johns Hopkins Weight Management Center, talks about the common problem of medication-related weight gain.

Most people put on weight as they get older, often because their eating habits change and they become less active. But there can be another, hidden reason for weight gain: taking certain prescription medications. “Medication-related weight gain has become far more important over the past decade as obesity increases in prevalence and more people are taking medications for chronic illnesses,” says Lawrence Cheskin, M.D., Director of the Johns Hopkins Weight Management Center.

Weight gain can range from a few pounds to more than a hundred pounds, which can occur with corticosteroids. This excess weight is dangerous because it can cause or worsen problems like high blood pressure, other cardiovascular conditions, diabetes, high blood cholesterol, and osteoarthritis—the very conditions for which people often need medications. “Also, some people see they’re gaining weight and stop taking their medication,” says Dr. Cheskin. In one study of people with anxiety disorders who were taking tricyclics, weight gain was the most common reason people discontinued treatment.

The reasons why some medications cause weight gain are not always clear, but in many cases a drug increases appetite or makes people crave certain foods. For example, the weight gain associated with the use of insulin is probably due to the fact that insulin can lead to periods of hypoglycemia, which stimulates appetite. Some drugs alter metabolism, causing the body to burn calories more slowly or to store fat. Some corticosteroids, for example, make the body less able to absorb blood glucose, and this can lead to fat deposits in the trunk and weight gain. Other medications produce fatigue or shortness of breath, making the person less active (the antihypertensive drugs known as beta-blockers are thought to have this effect), or can cause water retention (a side effect of antihypertensive calcium channel blockers).

Weight gain is so common that it’s not always possible to pinpoint a medication as the cause, especially because medication-related weight gain may take weeks, months, or even years to occur. “In some cases, a person will become ravenous an hour or two after taking a medication,” says Dr. Cheskin, “but usually the link is not that clear.” Dr. Cheskin also points out that just because a medication is associated with weight gain doesn’t mean that everyone taking it will experience weight gain.

If you suspect that you’re putting on weight because of a medication you’re taking, talk to your doctor. You may be advised to stop taking the medication, switch to one associated with less or no weight gain or even weight loss, or take a lower dose. You also may need to change your eating habits and boost physical activity. But don’t discontinue a medication without first talking to your doctor. Keeping your blood pressure, diabetes, or depression under control is more important than the few excess pounds that may be associated with a particular drug. People concerned about their weight gain should ask their doctor about the possibility of weight gain when they receive a new prescription. As Dr. Cheskin points out, “Prevention is better than dealing with weight gain later.”

For more Alerts and Special Reports, please visit the Prescription DrugsTopic page.

Johns Hopkins Health Alerts | Prescription Drugs | Prescription Drugs That Cause Weight Gain