Community ClicksQ: I have heard that the Food and Drug Administration has approved a new drug to treat symptoms of prostate enlargement.
The trouble is that I didn’t catch the name. If it is less likely to cause sexual difficulties than finasteride or an alpha-blocker like terazosin, I am very interested. Can you tell me more about this new drug, please?
A: The new drug has actually been on the market for several years for another purpose. Cialis (tadalafil) was the third erectile-dysfunction medication approved by the FDA (after Viagra and Levitra). The recent approval is for benign prostatic hypertrophy (BPH). An enlarged prostate can make it difficult for men to urinate. Drugs like finasteride (Proscar) and terazosin (Hytrin) can help with this symptom, but both may interfere with sexual performance.Because Cialis is used to treat erectile dysfunction, it should overcome this problem while easing urinary symptoms due to BPH. Side effects associated with Cialis include headache, indigestion, nasal congestion, back or muscle pain, flushing, cough, stomachache and diarrhea. Changes in hearing or vision are rare but should be reported to a doctor immediately. Always check with a pharmacist to make sure you are not taking any medicines incompatible with Cialis.
Q: I am a physician. Often, we are afraid to stop medications because if something bad happens, we could be sued for causing Mom’s stroke, heart attack or death. I love it when my patients stop their medications themselves or refuse to take more, because then I am safe from our culture of blame. Many of my geriatric patients are on far too many medications and would be better off without them. It takes enormous moral courage to do the right thing in our current litigious environment.
A: Older people often take a handful of pills every day. Some are prescribed to treat side effects from other medications.
Far too many senior citizens may be overmedicated. In some cases, this can lead to depression, confusion or a false diagnosis of dementia. We discuss this dilemma and list drugs that are inappropriate for older people in our brand-new book, Top Screwups Doctors Make and How to Avoid Them. We recognize that individual doctors are under tremendous time pressure and are doing the best they can for their patients. That said, it is critical for patients and their family members to be vigilant against overmedication and drug interactions that could be harmful.
Q: I want to get all the written, credible medical information possible about my prescription. In the old days, the pharmacist would include printed information from the manufacturer along with the drug. That version was FDA-approved. These days, we usually get a one-page summary with the Rx. These are prepared by an outside service, and they are not the fine-print detailed version that I trust. I have repeatedly asked my pharmacists for the more detailed printed form, and I’ve been told it’s not available.Can you tell us where we can find the FDA-vetted information? Perhaps from a library book, or on the Internet somewhere?
A: You can get the prescribing information online. Go to www.dailymed.nlm.nih.gov, and you will find the detailed version you seek for most of the drugs now available. People without computer access can check the Physicians’ Desk Reference at their local library. It contains the same information.
Q: I really love chocolate, and if there are proven health benefits, I will be very happy indeed! I still have doubts whether chocolate can be healthy. How about sharing information on side effects and disadvantages?
A: Chocolate can lower blood pressure, improve the flexibility of blood vessels, help prevent blood clots, reduce insulin resistance and help keep bad LDL cholesterol from causing mischief. New research shows that Swedish women who eat more chocolate are less likely to suffer a stroke (Journal of the American College of Cardiology, Oct. 18, 2011). The main drawback to chocolate is that it tastes so good, people may overdo. That means too many calories. Concerns have been raised that chocolate may contribute to heartburn, migraine headaches or irregular heart rhythms in susceptible individuals.
Q: My cardiologist insists that I have to take low-dose aspirin and Plavix to prevent a heart attack. The trouble is that I have arthritis and bursitis. Because of the Plavix and aspirin, I can’t take the usual ibuprofen or naproxen. Sometimes I cheat, but then I worry that my aspirin won’t work as well as it should to protect my heart. What alternatives can I use to ease my pain?
A: Although NSAIDs (nonsteroidal anti-inflammatory drugs) are the first treatment most people try for joint pain, they can have serious side effects and may undo the benefits of aspirin. Someone in your situation really needs to find a home remedy that will ease your discomfort. Fortunately, there are quite a few that may work, and most will not interact with your heart medicines. Tart cherries, for example, contain anti-inflammatory compounds. Many readers find them helpful; others are enthusiastic about gin-soaked golden raisins. Grape juice, apple-cider vinegar, pineapple extract and herbs such as boswellia, ginger and stinging nettle can all be beneficial. You will learn more about these and other options in the Guide to Alternatives for Arthritis that we are sending you. For a copy, send $3 in check or money order with a long (No. 10), stamped (64 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. AA-2, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from: www.peoplespharmacy.com.
Q: My primary-care doctor prescribed Cymbalta for neuropathy, a very painful burning sensation in three of my toes. It seemed to work, but it is pretty expensive. The doctor I saw at the VA recommended capsicum, since Cymbalta is not on their list.The capsicum really works. In fact, I can go as long as two months between a dosing series. One toe is completely healed, and the others are much better.
A: Capsicum is the technical name for peppers, both bell as well as hot peppers. Capsaicin, the spicy essence of chile peppers, has been used to treat peripheral neuropathy, including the nerve pain that may linger after an outbreak of shingles.
Capsaicin cream must be applied repeatedly to deplete the nerve endings of something called substance P. At that point, they are less able to transmit pain sensations. Be careful not to get the cream in your eyes or nose, as that can be extremely painful. Some people may develop an allergic reaction to capsaicin.
