Drugs Not All Doctors Agree to Use
By Morgan Lord
With 3,480 pages of fine print, the Physicians' Desk Reference (a.k.a. PDR) is not a quick read. That's because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication—a humongous sleeping pill.
Doctors count on this compendium to help them make smart prescribing decisions—in other words, to choose drugs that will solve their patients' medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don't stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body.
Of course, plenty of MDs know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it.
It's asthma medicine . . . that could make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19 trials, published in the Annals of Internal Medicine, found that regular use of LABAs can increase the severity of an asthma attack. Because salmeterol is more widely prescribed than other LABAs, the danger is greater—the researchers estimate that salmeterol may contribute to as many as 5,000 asthma-related deaths in the United States each year. In 2006, similarly disturbing findings from an earlier salmeterol study prompted the FDA to tag Advair with a "black box" warning—the agency's highest caution level.
Diabetes is destructive enough on its own, but if you try to control it with rosiglitazone—better known by the brand name Avandia—you could be headed for a heart attack. Last September, a Journal of the American Medical Association (JAMA) study found that people who took rosiglitazone for at least a year increased their risk of heart failure or a heart attack by 109% and 42%, respectively, compared with those who took other oral diabetes medications or a placebo.
The reason? While there have been some reports that Avandia use may cause dangerous fluid retention or raise artery-clogging LDL cholesterol, no one is sure if these are the culprits. That's because the results of similar large studies have been mixed. So the FDA has asked GlaxoSmithKline, the maker of Avandia, to conduct a new long-term study assessing users' heart risks. There's only one problem: The study isn't expected to start until later this year.
Once nicknamed "super aspirin," Celebrex is now better known for its side effects than for its pain-relieving prowess. The drug has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. But according to a 2005 New England Journal of Medicine study, the biggest threat is to your heart: People taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk, compared with people taking a placebo.
And yet Celebrex, a COX-2 inhibitor, is still available, even though two other drugs of that class, Bextra and Vioxx, were pulled off the market due to a similar risk of heart damage. The caveat to the consumer? In 2004, the FDA advised doctors to consider alternatives to Celebrex.
Most bacteria in the lungs and sinuses don't stand a chance against Ketek, but you might not either. This antibiotic, which has traditionally been prescribed for respiratory-tract infections, carries a higher risk of severe liver side effects than similar antibiotics do. "Ketek can cause heart-rhythm problems, can lead to liver disease, and could interact poorly with other medications you may be taking," says Philip Rodgers, Pharm.D., a clinical associate professor at the University of North Carolina school of pharmacy. "Unfortunately, it's still available, and although many doctors are aware of the risks, some may still prescribe it without caution." In February 2007, the FDA limited the usage of Ketek to the treatment of pneumonia.
Prilosec and Nexium
Heartburn can be uncomfortable, but heart attacks can be fatal, which is why the FDA has investigated a suspected link between cardiac trouble and the acid-reflux remedies Prilosec and Nexium. In December 2007, the agency concluded that there was no "likely" connection. Translation: The scientific jury is still out. In the meantime, there are other reasons to be concerned. Because Prilosec and Nexium are proton-pump inhibitors, they are both incredibly effective at stopping acid production in the stomach—perhaps too effective.
A lack of acid may raise your risk of pneumonia, because the same stuff that makes your chest feel as if it's burning also kills incoming bacteria and viruses. You may also have an elevated risk of bone loss—in the less acidic environment, certain forms of calcium may not be absorbed effectively during digestion. "The risk of a fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term, and the risk clearly increases with duration of therapy," says Dr. Rodgers.
What possible harm to your peepers could come from these seemingly innocuous eye drops? "Visine gets the red out, but it does so by shrinking blood vessels, just like Afrin shrinks the vessels in your nose," says Thomas Steinemann, M.D., a spokesman for the American Academy of Ophthalmology. Overuse of the active ingredient tetrahydrozoline can perpetuate the vessel dilating-and-constricting cycle and may cause even more redness.
Forget that this decongestant can be turned into methamphetamine. People with heart disease or hypertension should watch out for any legitimate drug that contains pseudoephedrine. See, pseudoephedrine doesn't just constrict the blood vessels in your nose and sinuses; it can also raise blood pressure and heart rate, setting the stage for vascular catastrophe. Over the years, pseudoephedrine has been linked to heart attacks and strokes. "Pseudoephedrine can also worsen symptoms of benign prostate disease and glaucoma," says Dr. Rodgers.
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