Eight drugs some doctors say they wouldn't take

Easy Eight

“8 Drugs Doctors Wouldn’t Take”

One of my colleagues at HSI recently sent me an article from Men’s Health magazine with that intriguing headline.

Unfortunately, the author of the piece, Morgan Lord, doesn’t reveal much about her method. She writes, “Of course, plenty of M.D.’s do know which prescription and over- the-counter drugs are duds, dangers, or both. So we asked them, ‘Which medications would you skip?'”

Right. So this is a sampling of opinion from “plenty of M.D.’s.” And how many is that? A dozen? Two hundred? All the MDs in Ms. Lord’s address book? We’ll never know. But the list is still illuminating, because while most of the suggested alternatives deserve raspberries, a couple of them are surprisingly good.

A safer swap

First up on the list: Advair

Good choice. The Advair website states: “ADVAIR contains salmeterol. In patients with asthma, medicines like salmeterol may increase the chance of asthma-related death.”

Just what you’re looking for in an asthma medication! But the suggested alternative is an inhaled corticosteroid – which presents an “out of the frying pan” scenario for women. In the e-Alert “Hearts Aflutter” (5/17/06), I told you about a Harvard study that showed how the regular use of inhaled steroids causes bone loss at the hip in women between the ages of 18 and 45. The more “puffs” taken each day, the greater the rate of bone loss.

Number two: Avandia

In 2003, HSI first reported on an association between the diabetes drug Avandia and an increased risk of congestive heart failure. And in the e-Alert “Catching Up” (5/29/07), I told you about a New England Journal of Medicine study that linked the drug to a significant increase in heart attack risk.

I was impressed and repelled by the alternatives offered for this one. Suggestion one: statins. Uhno. Statins should have appeared near the TOP of the list of the awful eight. Suggestion tw Take a gram of niacin each day to raise HDL while lowering LDL and triglycerides. Start with the second suggestion – forget the first.

Number three: Celebrex

The heart attack and stroke risks linked to Celebrex have been well chronicled in the e- Alert (see “Forehead Slapper” 6/17/08). And this time Ms. Lord’s alternative suggestion impresses. After pointing out that over-the-counter nonsteroidal anti-inflammatory drugs may cause gastrointestinal bleeding problems, she writes: “A safer swap is acupuncture.”

I have to admit, choosing acupuncture over a popular drug is not a suggestion I expect to find in an article like this.

Getting the red out

Number four: Ketek

This antibiotic is a “choose your poison” drug. It’s effective in fighting off pneumonia (which can be life threatening), but as noted in the e-Alert “Owning Up” (3/19/07), side effects include risk of severe liver injury (also life threatening). That’s why an FDA panel advised that the drug’s approval to treat sinusitis and bronchitis be discontinued.

Ms. Lord’s alternative suggestion: Get a flu shot to avoid pneumonia. Needless to say, we’re not going to sign on with that advice.

Number five and six: the proton pump inhibitors Prilosec and Nexium

PPIs suppress stomach acid. In the e-Alert “What’s the Diff?” (2/2/06), I told you about a study that found PPI use sharply increased the risk of digestive inflammation and diarrhea caused by a bacterium that’s usually kept under control by stomach acid. Ms. Lord suggests using Zantac 150 or Pepcid AC instead. But these drugs just take another route in suppressing stomach acid. In the e-Alert “Fire Down Below” (12/23/02), HSI Panelist Allan Spreen, M.D., outlined a simple non-drug treatment for heartburn that controls the problem without obliterating stomach acid (which, after all, is there for a reason: to help you digest food!).

Number seven: Visine Original

Apparently this product works by shrinking blood vessels in the eye, so overuse can create problems. Ms. Lord smartly advises to treat the cause of redness. For instance: If the redness is caused by dry eye, some cod liver oil might easily take care of the problem (see the e-Alert “Forehead Slapper” 6/17/08).

Number eight: Pseudoephedrine

You may recall the absurd 2004 FDA ban on the herb ephedra. This was a misguided reaction to deaths caused mostly by people who were misusing weight-loss supplements that contained pseudoephedrine – a synthetic drug that highly concentrates the active ingredient of ephedra. So in FDA World it made perfect sense to ban the herb and not pseudoephedrine, which is still widely available in over-the-counter decongestants, even though its use has been linked to heart attacks and strokes. The brand name Sudafed sounds a lot like pseudoephedrine for obvious reasons.

So kudos to Ms. Lord and her “plenty of M.D.’s” for rounding out the gang of eight with this dangerous drug. The alternative: Ms. Lord suggests using a neti pot – an ancient Ayurvedic method of irrigating the sinuses with warm water. Risk of heart attack or stroke: zero.

Talk to your doctor before adding new supplements to your daily regimen. But it’s up to you whether you tell him about the neti pot. [Jen: please use this link for the highlighted text above: http://www.hsionline.com/ealerts/ea200212/ea20021223.html ]

“8 Drugs Doctors Wouldn’t Take” Morgan Lord, Men’s Health, 6/22/08, menshealth.com