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For Men, Living Alone May Mean Poorer Control of Blood-Thinning Meds

MONDAY, Sept. 2, 2019 — Men who are on the blood-thinning drug warfarin have more difficulty taking the medication if they live alone, but the same is not true for women, a new study finds.

Warfarin (brand-name Coumadin) is a common anti-clotting treatment to prevent stroke in people with atrial fibrillation, the most common type of heart rhythm disorder.

Continuous blood-monitoring is required for warfarin to be safe and effective. Too little of the drug may allow a blood clot to form and cause a stroke. Too much causes bleeding.

Having ideal warfarin concentrations in the blood to prevent stroke and avoid bleeding is called time in therapeutic range (TTR). European Society of Cardiology (ESC) guidelines say patients should be in TTR at least 70% of the time.

In this study, researchers assessed nearly 4,800 patients in Denmark with six months of continuous warfarin use and monitoring. Median TTR in men living alone was 57% — 3.6% lower than in men who lived with partners. (Median means half had longer times, half shorter.)

Women who lived alone had a 0.2% lower TTR than those who lived with partners, but the difference wasn’t significant, according to the study authors.

The findings were presented Monday at the annual meeting of the ESC in Paris. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

“Men living alone had low, poor anticoagulation control. The impact of living on their own was larger than several factors previously known to affect TTR, such as cancer, use of interacting medication or heart failure,” study author Dr. Anders Bonde said in an ESC news release.

“‘Ask my wife’ is a common reply among older men to questions about their medication, disease and treatment,” he noted.

“Our study suggests that when it comes to anticoagulation control, men are more dependent on their partner than women,” said Bonde, who practices at Gentofte University Hospital in Copenhagen, Denmark.

He added that women living alone often have better relationships with their children and a broader network of people around them.

Bonde suggested that men who live alone and use warfarin may need extra support — such as education, home visits, telephone calls or additional follow-up visits — or another medication.

“They might also consider using a newer type of drug, a non-vitamin K antagonist oral anticoagulant [such as Pradaxa or Eliquis], which is easier to manage and has fewer interactions with food and drugs compared to warfarin,” Bonde said.

More information

The American Heart Association has more on atrial fibrillation medications.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

Migraine Meds Recalled for Bacteria Risk

Aug. 16, 2019 — Pfizer Inc. has recalled two lots of migraine medication because they may be contaminated with bacteria.

Pfizer issued the recall for Relpax (eletriptan hydrobromide) in 40-milligram tablets. The specific lots are AR5407 and CD4565.

The bacteria, from the genus pseudomonas and the genus burkholderia, can enter the bloodstream and cause serious, life-threatening infections. There is also a risk of temporary digestive illness without a serious infection. Risks are generally low for most people, while those with compromised immune systems, cystic fibrosis, and other disorders are at higher risk of life-threatening infections.

Pfizer says there have been no reports of injury.

Patients with the affected lots should return the medication to their pharmacy or contact Stericycle Inc. at 877-225-9750 for instructions on how to return it and be reimbursed.

Sources

FDA.gov: “Pfizer Inc. Issues a Voluntary Nationwide Recall for 2 Lots of RELPAX (eletriptan hydrobromide) 40 mg Tablets Due to Potential Microbiological Contamination of Non-Sterile Products.”

© 2019 WebMD, LLC. All rights reserved.

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WebMD Health

Teens Are Getting Hooked on Leftover Prescription Meds

FRIDAY, Aug. 2, 2019 — Many American teens who misuse prescription drugs get them from a variety of sources, researchers report.

They conducted two studies; the first one involved more than 18,000 high school seniors. It found that about 11% of them said they misused prescription drugs in the past year, and of those, 44% had multiple sources for the drugs.

More than 70% of teens who got prescription drugs from multiple sources had a substance use disorder — prescription medications, other drugs and alcohol — within the previous year.

The national average of substance use disorder among teens is 5%, said researcher Sean Esteban McCabe, a professor in the University of Michigan’s School of Nursing.

McCabe said a “very concerning” finding is that 30% of prescription drug misusers took their own leftover medications, with girls more likely to do so than boys. Boys were more likely to get prescription drugs from friends or to buy them.

The second study, involving nearly 104,000 12- to 17-year-olds, found that the most common sources of prescription drugs were: getting them free from friends and relatives, physician prescriptions for opioids, and buying stimulants and tranquilizers illegally.

This is the first known research to look at teen misuse of leftover medications across these three prescription drug classes, according to McCabe.

“The implications from these two studies could not be clearer,” he said in a university news release.

“Parents, public health experts and clinicians must rally to address this problem. There is a critical need for clinical workforce training to support clinic and school-based education, screening, prevention and early intervention,” said McCabe, co-director of the university’s Center for the Study of Drugs, Alcohol, Smoking and Health.

“These adolescents are most in need of intervention to address their substance use and any other medical and mental health issues,” added study co-author Ty Schepis, an associate professor at Texas State University.

The two studies were published in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

More information

The U.S. Substance Abuse and Mental Health Services Administration has more on teens and prescription drug abuse.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

Drugs.com – Daily MedNews

Some Meds and Driving a Dangerous Duo

SATURDAY, July 27, 2019 — Be careful about what medications you take before you get behind the wheel.

Most drugs won’t affect your ability to drive, but some prescription and over-the-counter (OTC) medicines can cause side effects that make it unsafe to drive, the U.S. Food and Drug Administration warns.

Those side effects can include: sleepiness/drowsiness, blurred vision, dizziness, slowed movement, fainting, inability to focus or pay attention, nausea and excitability.

Some medicines can affect your driving ability for just a short time after you take them, but the effects of others can last for several hours, or even into the next day.

Some medicine labels warn to not operate heavy machinery when taking them, and this includes driving a car, the FDA said in a news release.

There are a number of types of medications — or any combination of them — that can make it dangerous to drive or operate any type of vehicle whether a car, bus, train, plane or boat.

These drugs include: opioid pain relievers; prescription drugs for anxiety (for example, benzodiazepines); antiseizure drugs (antiepileptic drugs); antipsychotic drugs; some antidepressants; products that contain codeine; some cold remedies and allergy products such as antihistamines (both prescription and OTC); sleeping pills; muscle relaxants; medicines to treat or control symptoms of diarrhea or motion sickness; diet pills; “stay awake” drugs, and other medications with stimulants (such as caffeine, ephedrine, pseudoephedrine).

Also, never drive when you’ve combined medication and alcohol, the FDA stressed.

Ask your doctor or pharmacist about medication side effects, including those that interfere with driving, and/or ask for printed information about the side effects of any new medicine.

To manage or minimize medication side effects that can affect driving, your health care provider may be able to adjust your dose, adjust the timing of when you take the medicine, or change the medicine to one that causes fewer side effects, the FDA said.

Always follow a medication’s directions for use and read warnings on the packaging or on handouts provided by the pharmacy.

Tell your health care provider about all health products you are taking, including prescription, non-prescription and herbal products, and also about any reactions you experience.

Don’t stop using a medicine unless told to do so by your doctor, the FDA said.

More information

The U.S. Food and Drug Administration has more on medications and driving.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

ADHD Meds Help Keep Kids Out of Trouble

TUESDAY, July 23, 2019 — Some parents may be reluctant to give their kids powerful stimulants to treat the symptoms of attention-deficit/hyperactivity disorder (ADHD), but a new review shows the medications bring significant benefits.

In addition to helping kids calm down and concentrate in school, the review also found that the drugs help children avoid a lot of long-term negative consequences associated with ADHD, including depression, substance abuse and even driving problems.

“Treating ADHD can help children avert some of the serious complications associated with ADHD,” said study author Dr. Joseph Biederman. He’s chief of clinical and research programs in pediatric psychopharmacology and adult ADHD at Massachusetts General Hospital, in Boston.

Specifically, the study suggested that early use of ADHD stimulant medications was linked to a lower risk of:

  • Major depression
  • Anxiety
  • Oppositional defiant disorder
  • Conduct disorder
  • Bipolar disorder
  • Smoking
  • Substance abuse
  • Driving problems, such as car accidents
  • Poor performance in school

Although the current study can’t prove a definitive cause-and-effect relationship, Dr. Alan Geller, a psychiatrist from Gracie Square Hospital in New York City who treats children and adolescents, said it makes sense that treating ADHD symptoms can help prevent other problems.

“A hyperactive child who interrupts and disrupts class is annoying. They end up getting marginalized, which can lead to substance abuse or conduct disorders, or depression and anxiety if they’re constantly frustrated,” he explained.

Geller said adults with ADHD can have trouble at work and have difficulty in their personal lives.

“It can start around 7 or 8, when they’re not able to navigate life the way other kids do. They end up feeling alone and like no can help. It’s a major problem without treatment,” he said.

But, Geller said, this research shows that if you treat a child with medications that help them control their ADHD symptoms, there’s less risk of marginalization or of seeking stimulation in things like cigarettes or driving recklessly.

Geller said the findings point to the benefits of ADHD medications outweighing their risks. Adverse effects from these drugs include a slight height suppression, appetite suppression and a potential risk of addiction.

The review included three studies. Two were long-term prospective studies of children with and without ADHD. Some of the children diagnosed with ADHD were treated with stimulant medications and some were not.

The average age of the youngsters in the study was 11 when the study began. They were 20 at the follow-up.

The third study looked at young adults (18 to 26) with ADHD. Researchers checked the volunteers’ performance on a driving simulator before they started taking stimulant medication and then again six weeks after they had started treatment.

The researchers calculated the number of people who needed to be treated with medication for a benefit to be seen. They found:

  • Three people needed to be treated with ADHD medication to prevent one child from repeating a grade or developing anxiety, conduct disorder or oppositional defiant disorder.
  • Four people needed treatment to prevent one person from having major depression or an accident during the driving simulation.
  • Five people needed treatment to prevent bipolar disorder.
  • Six people had to be treated to prevent one person from smoking cigarettes, and 10 people needed treatment for one person to avoid a substance use disorder.

The researchers are planning future research to see if treating ADHD with medications can help lessen the risk of post-traumatic stress disorder, traumatic brain injuries and suicide. They also plan to study if ADHD treatment is linked to work success, Biederman said.

The review was published July 23 in the Journal of Adolescent Health.

Funding for the studies in the review came from several places, including the U.S. National Institutes of Health, and for one study, pharmaceutical manufacturer Shire. Shire is now part of Takeda, and manufactures ADHD stimulant medications such as Adderall XR, Mydayis and Vyvanse. Research funders had no role in the design, implementation or reporting of the review, the study authors said.

More information

Read about available treatments for ADHD from the American Academy of Pediatrics.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

Keep Unused Meds Out of the Hands of Addicts

SUNDAY, July 7, 2019 — As America grapples with an opioid epidemic, it has become even more important to dispose of your leftover prescription medications properly, one pharmacist says.

“Many people don’t realize that simply throwing away leftover medications or flushing them down the toilet is actually very dangerous,” said Karen Youmbi, manager of pharmacy regulatory surveillance and outpatient pharmacies at Cedars-Sinai, in Los Angeles.

“People suffering from substance abuse disorders may scour trash cans for drugs, and flushed substances can end up in the water supply,” she explained in a Cedars Sinai news release.

Keeping unused drugs also is risky because others could get their hands on them, including children.

The most common prescription medicines that result in excess doses include those for pain, chronic heart issues, anxiety or depression, according to Youmbi.

You should read the medication’s label and follow any disposal instructions, she advised.

Find a medication take-back location, such as a local pharmacy, where you can anonymously deposit unused medications in a drop box.

Check the U.S. Drug Enforcement Administration’s website for a nearby take-back location, or contact your local sheriff’s department or area trash and recycling program for other options.

If there are no disposal instructions on the label and you can’t find a take-back program, here’s what you should do. Grind up the leftover pills, and mix them with used coffee grounds, dirt or cat litter. This makes it harder for children, pets or people looking through trash to find the medications.

Put the mixture in a can with a lid or a sealable bag to avoid spillage.

Recycle the plastic pill bottles, but remember to remove the prescription label or scratch out personal information to protect your privacy and avoid identity theft.

Rita Shane, chief pharmacy officer and professor of medicine at Cedars-Sinai, said, “By following these simple disposal instructions, we can help keep our community safe.”

More information

The U.S. Food and Drug Administration has more on medication disposal.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

Pot a Substitute to Opioids or Sleep Meds for Many

By Steven Reinberg
HealthDay Reporter

TUESDAY, July 2, 2019 (HealthDay News) — In places where it’s legal, people are often turning to pot to relieve pain and insomnia, a new study finds.

For many, cannabis is replacing over-the-counter painkillers, prescription opioids and sleep aids.

“These aren’t the only reasons people are using marijuana, but it’s one of the drivers for use,” said study author Dr. Gwen Wurm, an assistant professor of clinical pediatrics at the University of Miami Miller School of Medicine.

“People who are using it for those reasons are finding it to be effective,” she said.

The findings stem from a survey of 1,000 people who use marijuana in Colorado, where it is legal. Of the 65% who said they use pot to quell pain, 80% said it was very or extremely helpful.

A similar percentage said they had been able to cut back on use of over-the-counter painkillers by using pot instead, and 88% said they stopped taking opioids, the study found.

Three-quarters of the interviewees said they used pot to help them sleep. Of those, 84% said it helped, and 83% said they were no longer using over-the-counter or prescription sleep aids.

Compared with other drugs, cannabis is safe, Wurm believes.

On the plus side, marijuana users are not at risk of the respiratory arrest opioids can cause, and pot won’t make you dependent as some sleep medicines do, she said.

“That doesn’t mean that it doesn’t have its own risks,” Wurm cautioned. “But until we can begin to study cannabis use, we are really not going to know how best to counsel patients.”

Other pain and sleep medications can have serious side effects, Wurm noted. Opioid addiction is an epidemic in the United States, and fatal overdoses are not uncommon. And over-the-counter pain relievers like ibuprofen can cause stomach bleeding if used for extended periods, Wurm said.

Also, people can become dependent on sleeping pills, which leave them groggy during the day and affect their work, she said.

However, marijuana is still a drug with its own addictive properties and risks, another expert warned.

Continued

Emily Feinstein, the Center on Addiction’s chief operating officer and executive vice president, previously told HealthDay, “Misinformation and misunderstanding about marijuana is rampant. Marijuana is addictive, and people who are dependent on the drug exhibit the same symptoms as those with other addictions, including cravings and withdrawal.”

For the study, Wurm’s team relied on a survey of people who bought pot at two retail stores in Colorado, where any adult with a valid ID can purchase it for medical or recreational use.

But if states like Colorado think legalizing weed will help curb the opioid epidemic, a study in the June 10 issue of the Proceedings of the National Academy of Sciences casts doubt on that assumption.

In that study, researchers found no association between medical marijuana laws and opioid overdose death rates.

In fact, the overdose death rate increased by about 23% between 1999 and 2017 in states that legalized medical pot, though only an association was seen, researchers emphasized.

Paul Armentano is deputy director of NORML, a group working to legalize marijuana nationwide. He called the findings in the new study “significant, though not altogether surprising.”

Other studies have found that use of medical marijuana is associated with the reduced use or even elimination of prescription opioids, he noted.

Another researcher thinks cannabis has a role to play in relieving pain and aiding sleep.

“Is use of cannabis for pain relief and improvement of sleep defensible?” said Dr. David Katz, director of the Yale-Griffin Prevention Research Center in New Haven, Conn. “The answer is yes, whenever cannabis can contribute a therapeutic effect with less risk than the established alternatives.”

Treatments need not be completely risk-free, and few, if any are, Katz said, adding their use is justified when benefits outweigh risks.

Using cannabis to treat pain and insomnia seems worthwhile when you consider the risks of opioids and sleep medications, he said. But a survey alone doesn’t prove its effectiveness, he added.

“We need trials directly comparing the efficacy and safety of therapeutic alternatives,” Katz said. “The best treatments are those that win these contests of comparative efficacy.”

The report was published July 2 in the Journal of Psychoactive Drugs.

WebMD News from HealthDay

Sources

SOURCES: Gwen Wurm, M.D., M.P.H., assistant professor of clinical pediatrics, University of Miami Miller School of Medicine, Coral Gables, Fla.; Paul Armentano, deputy director, NORML; David Katz, M.D., M.P.H., director, Yale-Griffin Prevention Research Center, New Haven, Conn.;Journal of Psychoactive Drugs, July 2, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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WebMD Health

For Many, Pot Is Now an Alternative to Opioids or Sleep Meds

TUESDAY, July 2, 2019 — In places where it’s legal, people are often turning to pot to relieve pain and insomnia, a new study finds.

For many, cannabis is replacing over-the-counter painkillers, prescription opioids and sleep aids.

“These aren’t the only reasons people are using marijuana, but it’s one of the drivers for use,” said study author Dr. Gwen Wurm, an assistant professor of clinical pediatrics at the University of Miami Miller School of Medicine.

“People who are using it for those reasons are finding it to be effective,” she said.

The findings stem from a survey of 1,000 people who use marijuana in Colorado, where it is legal. Of the 65% who said they use pot to quell pain, 80% said it was very or extremely helpful.

A similar percentage said they had been able to cut back on use of over-the-counter painkillers by using pot instead, and 88% said they stopped taking opioids, the study found.

Three-quarters of the interviewees said they used pot to help them sleep. Of those, 84% said it helped, and 83% said they were no longer using over-the-counter or prescription sleep aids.

Compared with other drugs, cannabis is safe, Wurm believes.

On the plus side, marijuana users are not at risk of the respiratory arrest opioids can cause, and pot won’t make you dependent as some sleep medicines do, she said.

“That doesn’t mean that it doesn’t have its own risks,” Wurm cautioned. “But until we can begin to study cannabis use, we are really not going to know how best to counsel patients.”

Other pain and sleep medications can have serious side effects, Wurm noted. Opioid addiction is an epidemic in the United States, and fatal overdoses are not uncommon. And over-the-counter pain relievers like ibuprofen can cause stomach bleeding if used for extended periods, Wurm said.

Also, people can become dependent on sleeping pills, which leave them groggy during the day and affect their work, she said.

However, marijuana is still a drug with its own addictive properties and risks, another expert warned.

Emily Feinstein, the Center on Addiction’s chief operating officer and executive vice president, previously told HealthDay, “Misinformation and misunderstanding about marijuana is rampant. Marijuana is addictive, and people who are dependent on the drug exhibit the same symptoms as those with other addictions, including cravings and withdrawal.”

For the study, Wurm’s team relied on a survey of people who bought pot at two retail stores in Colorado, where any adult with a valid ID can purchase it for medical or recreational use.

But if states like Colorado think legalizing weed will help curb the opioid epidemic, a study in the June 10 issue of the Proceedings of the National Academy of Sciences casts doubt on that assumption.

In that study, researchers found no association between medical marijuana laws and opioid overdose death rates.

In fact, the overdose death rate increased by about 23% between 1999 and 2017 in states that legalized medical pot, though only an association was seen, researchers emphasized.

Paul Armentano is deputy director of NORML, a group working to legalize marijuana nationwide. He called the findings in the new study “significant, though not altogether surprising.”

Other studies have found that use of medical marijuana is associated with the reduced use or even elimination of prescription opioids, he noted.

Another researcher thinks cannabis has a role to play in relieving pain and aiding sleep.

“Is use of cannabis for pain relief and improvement of sleep defensible?” said Dr. David Katz, director of the Yale-Griffin Prevention Research Center in New Haven, Conn. “The answer is yes, whenever cannabis can contribute a therapeutic effect with less risk than the established alternatives.”

Treatments need not be completely risk-free, and few, if any are, Katz said, adding their use is justified when benefits outweigh risks.

Using cannabis to treat pain and insomnia seems worthwhile when you consider the risks of opioids and sleep medications, he said. But a survey alone doesn’t prove its effectiveness, he added.

“We need trials directly comparing the efficacy and safety of therapeutic alternatives,” Katz said. “The best treatments are those that win these contests of comparative efficacy.”

The report was published July 2 in the Journal of Psychoactive Drugs.

More information

The U.S. National Institute on Drug Abuse offers more about marijuana.

© 2019 HealthDay. All rights reserved.

Posted: July 2019

Drugs.com – Daily MedNews

Your Gut Bacteria Could Affect How Your Meds Work

By Robert Preidt

       

         HealthDay Reporter        

MONDAY, June 3, 2019 (HealthDay News) — Ever wonder why a drug that works for someone else doesn’t seem to work for you? You might want to check your gut for the answer.

Gut bacteria that process more than 150 medicines have been pinpointed by researchers, who also identified genes that give the bacteria this ability.

The findings underline the role gut bacteria play in how well people respond to medications, according to the Yale University team.

“It is possible that we can use genes or species of bacteria to predict the capacity of an individual’s gut flora to metabolize a certain drug,” study co-lead author Maria Zimmermann-Kogadeeva said in a university news release.

“The work is a first step in identifying biomarkers that could help doctors prescribe the drugs that are the safest and most effective for individual patients,” added Zimmermann-Kogadeeva. She’s a postdoctoral fellow in the lab of senior study author Andrew Goodman, of Yale’s Microbial Sciences Institute and the department of microbial pathogenesis.

For the new study, the researchers investigated whether and how 271 drugs are chemically modified by 76 kinds of gut bacteria. Nearly two-thirds of the drugs were metabolized by at least one of the bacteria species, the findings showed.

The researchers then identified many of the genes that enable the bacteria to metabolize the drugs.

The team found wide variations in the number of these genes in healthy people. In some cases, these differences explain why some people’s gut bacteria populations (microbiomes) metabolize drugs rapidly, while others act on the same drugs slowly or not at all.

It was once thought that drug metabolism was carried out only by organs, such as the liver, Goodman’s team noted.

“We hope this study provides a useful first step in understanding the microbiome contribution to drug metabolism,” co-lead author Michael Zimmermann said in the news release. He’s a postdoctoral fellow in the Goodman lab.

“We think these approaches could shed light on how the gut microbiome also modulates our response to non-drug compounds, such as dietary nutrients and environmental agents,” Zimmermann said.

The study was published June 3 in the journal Nature.

WebMD News from HealthDay

Sources

SOURCE: Yale University, news release, June 3, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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WebMD Health

Patients Who Read Docs’ Notes Take Meds Better

By Robert Preidt

HealthDay Reporter

FRIDAY, May 31, 2019 (HealthDay News) — Reading the notes your doctor makes during your visit appears to be good medicine.

An online survey of 20,000 adults treated at three U.S. health systems that have made clinical notes available to patients for several years finds that those who actually read them may be more likely to take medications as prescribed.

Patients listed several benefits of reading the notes: 64% said doing so helped them understand why a medication was prescribed; 62% felt more in control of their medications; 57% said the notes answered questions about medications; and 61% felt more comfortable with their prescriptions.

And 14% of patients at two of the health systems — Beth Israel Deaconess Medical Center (BIDMC) in Boston and Geisinger in rural Pennsylvania — said they were more likely to take their medications as prescribed after reading doctors’ notes, the study found.

Meanwhile, 33% of patients at the University of Washington Medicine in Seattle, the third health system studied, considered clinical notes very helpful.

“Sharing clinical notes with patients is a relatively low-cost, low-touch intervention,” lead author Catherine DesRoches, executive director of OpenNotes at BIDMC, said in a news release.

Though sharing notes is a cultural shift, electronic health record systems make it easier, she said, adding that the payoff could be “enormous” because poor adherence to medications costs the health care system about $ 300 billion a year.

“Anything that we can do to improve adherence to medications has significant value,” DesRoches said.

Patients whose primary language was not English and those with lower levels of education were more likely to report benefits from being able to read their doctor’s notes, according to the study published May 28 in the Annals of Internal Medicine.

Still, this kind of transparent communication initially makes doctors uneasy, said study co-author Dr. Tom Delbanco, co-founder of OpenNotes.

“They worry about many things, including potential effects on their workflow, and scaring their patients. But once they start, we know of few doctors who decide to stop, and patients overwhelmingly love it,” he added in the news release. “The promise it holds for medication adherence is enormous, and we are really excited by these findings.”

An accompanying editorial by Dr. David Blumenthal and Melinda Abrams of the Commonwealth Fund noted that transparency is mandated by federal law and policy.

“Our challenge now is to make the best and most of shared health care information as a tool for clinical management and health improvement,” Blumenthal and Abrams wrote.

WebMD News from HealthDay

Sources

SOURCE: Beth Israel Deaconess Medical Center, news release, May 28, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Could Common Heart Meds Lower Prostate Cancer Risk?

By Dennis Thompson

HealthDay Reporter

FRIDAY, May 3, 2019 (HealthDay News) — Good news for men: That blood pressure medication you’re taking might be doing double duty, helping reduce your risk of developing prostate cancer, a new study shows.

Researchers found that a beta blocker called atenolol cut men’s risk of intermediate-grade prostate cancer about in half, compared with men not taking a beta blocker.

It also appeared to significantly reduce the risk of low-grade prostate cancer, the findings showed.

However, the effect only was found with atenolol (Tenormin). Two other beta blockers — metoprolol (Lopressor/Toprol XL) and carvedilol (Coreg) — did not appear to provide any protection against prostate cancer.

“Atenolol was the only one that was significantly associated with a protection in having a diagnosis of prostate cancer,” said co-researcher Dr. Paul Frenette. He is chairman and director of the Institute for Stem Cell and Regenerative Medicine Research at Albert Einstein College of Medicine in New York City.

Beta blockers lower blood pressure by blocking the effects of the adrenaline hormone, allowing your heart to beat more slowly and with less force, according to the Mayo Clinic. The drugs also relax blood vessels, helping them to open up and improve blood flow.

Beta blockers also have another effect, inhibiting the cells lining the inside of veins and arteries, and making it more difficult to form new blood vessels.

“You basically change the metabolism of these cells, and they cannot make new blood vessels very well,” Frenette said.

Since cancerous tumors rely on new blood vessels for sustenance, researchers theorized that beta blockers might slow or block the progression of prostate cancer.

To test their theory, the investigators looked at nearly 4,200 men who received a prostate biopsy between 2006 and 2016.

Of those men, about 670 had been taking beta blockers. The researchers compared the beta blocker they were taking against whether they had been diagnosed with prostate cancer and, if they had, how advanced their cancer was.

Atenolol might have had an effect where the others didn’t, because it possibly could linger in the prostate longer, Frenette said.

Continued

“It’s known that some drugs concentrate in the prostate. It’s possible there’s some difference of the drugs to be able to act in the prostate,” he suggested.

Men taking a beta blocker shouldn’t immediately reach out to their doctor to switch their prescription to atenolol, however. “At this point, I think it’s too early,” Frenette said. “I think it should be looked at with bigger studies to be able to confirm this is indeed an effect.”

Dr. Sam Chang, chairman of urologic surgery at Vanderbilt University Medical Center in Nashville, Tenn., agreed that it’s too soon to turn this finding into clinical action.

“Bottom line, this appears interesting,” Chang said. “Much larger epidemiological studies are going to be necessary to see if there really is a potential benefit.”

The findings were presented Friday at the American Urological Association’s annual meeting, in Chicago. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

The study was funded by the U.S. National Cancer Institute.

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Sources

SOURCES: Paul Frenette, M.D., chairman and director, Institute for Stem Cell and Regenerative Medicine Research, Albert Einstein College of Medicine, New York City;  Sam Chang, M.D., M.B.A., chairman, urologic surgery, Vanderbilt University Medical Center, Nashville, Tenn.; May 3, 2019,  American Urological Association annual meeting, Chicago

Copyright © 2013-2018 HealthDay. All rights reserved.

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Many Secretly Use Alternative Meds For Cancer

By Robert Preidt

HealthDay Reporter

THURSDAY, April 11, 2019 (HealthDay News) — One out of every three U.S. cancer patients uses alternative or complementary therapies, but many keep that info from their doctors, a new study finds.

That’s a real concern, the study’s lead author said, especially when it comes to supplements and cancer radiation therapy.

“You don’t know what’s in them,” said Dr. Nina Sanford, assistant professor of radiation oncology at UT Southwestern Medical Center in Dallas.

“Some of these supplements are kind of a mishmash of different things,” she said. “Unless we know what’s in them, I would recommend patients avoid using them during radiation because there’s likely not data on certain supplements, which could interfere with treatment. With radiation specifically, there is concern that very high levels of antioxidants could make radiation less effective.”

The new study looked at U.S. Centers for Disease Control and Prevention data on over 3,100 cancer patients. Sanford’s team found that herbal supplements were the most common complementary and alternative therapy used by cancer patients, followed by chiropractic.

Other therapies include meditation, yoga and acupuncture.

The study also found that 29% of patients who use complementary and alternative therapies did not tell their doctor.

“Younger patients are more likely to use complementary and alternative medicines, and women were more likely to, but I would have thought more people would tell their doctors,” Sanford said in a UT Southwestern news release.

Why the secrecy? Many patients said they didn’t inform their doctors because their doctors didn’t ask, or because they thought their doctors didn’t need to know they were using alternative or complementary therapies.

But physicians do need to know if cancer patients are using herbal products because they can alter traditional cancer treatments, explained Dr. David Gerber. He is a lung cancer specialist and professor of internal medicine and population and data sciences at UT Southwestern Medical Center.

“They may interact with the medicines we’re giving them, and through that interaction it could alter the level of the medicine in the patient,” he said in the news release. “If the levels get too high, then toxicities increase, and if the levels get too low, the efficacy would drop.”

Continued

Dr. John Ames directs radiation medicine at Northwell Health’s Imbert Cancer Center in Bay Shore, N.Y. He wasn’t involved in the new study, but said the findings ring true.

“As a practicing radiation oncologist for nearly 30 years, I have witnessed the evolution — indeed, revolution — of alternative health practices, such as the healing arts of meditation, yoga and the like, and the use of herbals and supplements among cancer patients,” he said.

Ames believes the use of these therapies has now “become mainstream in our society.”

“Anecdotally, I am asked by at least half of my patients, ‘can I take,’ ‘should I take,’ ‘is it OK if I am taking supplements’ while undergoing conventional cancer therapies,” he noted.

Ames urges his patients to be upfront about whatever complementary medicines they might be taking.

“If supplements/herbals/nutraceuticals are to be used, I caution my patients to obtain them from reputable sources and do their homework, which includes asking questions from knowledgeable individuals,” he said. Patients should also “be wary of the financial toxicity of expensive supplements with overblown or little, to no, real benefit,” he added.

Sanford added that, while wary of herbal products, doctors are open to meditation and yoga to help patients cope with the shock of a cancer diagnosis and the stress of chemotherapy, radiation and surgery.

“We strongly advise patients to stay active and engage in exercise during treatment,” Sanford said. “A common side effect of radiation is fatigue. I let the patients know that the patients who feel the most fatigue are the ones who are the most sedentary, and that those who are doing exercise are the ones who frequently have the most energy.”

Ames agreed.

He said he typically advises his patients “to eat and drink healthy, nutritious food (the specifics of which are outlined by the nutritionists on our staff); to stay well-hydrated; stay active (exercise) within their ability; and to engage in relaxing, calming, restorative activities as often as possible — quality sleep being chief among them.”

The study was published online April 11 in the journal JAMA Oncology.

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Sources

SOURCES: John W. Ames, M.D., physician in chief, department of radiation medicine, Northwell Health’s Imbert Cancer Center, Bay Shore, N.Y.; UT Southwestern Medical Center, news release, April 11, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Many With Opioid Addiction Don’t Get Meds That Can Help

WEDNESDAY, March 20, 2019 — Most people struggling with opioid addiction lack access to FDA-approved medications that can head off withdrawal symptoms and quell their cravings, a new report finds.

Methadone, buprenorphine and extended-release naltrexone all help opioid addicts by targeting the same brain receptors triggered by narcotics, and they have been proven effective and lifesaving, the report says.

More than 2 million people in the United States are thought to have opioid use disorder (OUD), and 47,000 died from an opioid overdose in 2017.

Studies have shown that opioid users are up to 50 percent less likely to die when they’re receiving long-term methadone or buprenorphine treatment, according to the report.

Unfortunately, most opioid users in the United States don’t receive any treatment at all, and only a fraction of those in treatment have been prescribed any of these medications, the researchers said.

The report, from the National Academies of Sciences, Engineering, and Medicine, argues for removing barriers that have made these medications inaccessible to many.

For example, methadone can only be administered through specialty opioid treatment programs, even though evidence shows it’s just as effective when handed out by a family doctor.

Buprenorphine can be prescribed by doctors, but only if they’ve had specialized training and received a waiver from the Drug Enforcement Administration, the report noted. Fewer than 3 percent of health care providers have bothered to jump through those hoops, and those who have face regulations limiting the number of patients they can treat with buprenorphine.

Additionally, most residential treatment centers don’t offer any of the medications, and if they do, they rarely offer all three.

“The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it, as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment,” said Alan Leshner.

Leshner is retired chief executive officer of the American Association for the Advancement of Science and head of the committee that conducted the study.

Only 6 percent of treatment facilities offered all three medications in 2016, Leshner said, while only 5 percent of those addicted to opioids received medication for their addiction.

“The regulations that currently exist restrict access to methadone and buprenorphine in ways that our committee believes are far too prohibitive, and that accounts for the fact that too many people who might provide these medications don’t,” Leshner said.

The report’s committee included Walter Ginter, a person with opioid use disorder who now serves as project director for the Medication-Assisted Recovery Support (MARS) network in New York City.

“I first entered medication-based treatment in 1977,” Ginter said. “It’s hard for me to envision a way in which I would still be alive if not for medication.”

Ginter agreed that regulations need to be revamped to better help addicts.

“The burden of regulatory compliance directly affects patients greatly,” Ginter said. “When I ask patients leaving medication-based treatment if they would stay if they could get their methadone from an office-based provider, as I do, they always say yes.”

The report highlights four barriers that prevent effective medication-based addiction treatment:

  • Misunderstanding and stigma about the nature of drug addiction and the medications used to treat it.
  • Inadequate education and training of professionals who most often deal with opioid addicts, including treatment providers, police and corrections staff.
  • Regulations restricting methadone and buprenorphine prescription that are not supported by the evidence or applied to medications used to treat other types of brain disorders.
  • A fragmented system of care for people with opioid use disorder, including insurance coverage for their treatment.

Lindsey Vuolo is director of health law and policy for the Center on Addiction in New York City. “This report underscores one of the greatest tragedies of the opioid epidemic. We have effective treatments but most people with opioid addiction don’t receive them, significantly increasing their risk for death,” she said.

“With 130 Americans dying every day from an opioid overdose, we’d expect more to be done to address the barriers identified in this report, and implement solutions to expand access to treatment,” Vuolo continued. “Stigma — against addiction and its treatment — prevents the type of response we’d see for any other disease.”

Use of these medications should be extended to many other health care settings, including pharmacies, mobile units, community health centers and hospital emergency departments, the report argues.

The medications also should be used more often in jails and prisons, the report suggests. Even though more and more people who are addicted to opioids are being incarcerated, OUD meds are often withheld from prisoners or provided only on a limited basis for medically supervised withdrawal.

As a result, few people in prison or under supervision of drug courts are prescribed these medications. The lucky few who do receive medication are not connected with care upon their release, leaving them on their own to deal with their addiction.

According to Leshner, “Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector — health care, criminal justice, people with OUD and their family members, and beyond — in order to make meaningful progress in resolving this crisis.”

More information

The American Psychiatric Association has more on opioid use disorder.

© 2019 HealthDay. All rights reserved.

Posted: March 2019

Drugs.com – Daily MedNews

Third of Uninsured Skimp on Meds to Save Money

March 19, 2019 — High drug prices prompt about one-third of uninsured American adults to not take their medicines as prescribed to save money, a new government report shows.

In 2017, nearly 60 percent of adults aged 18 to 64 said they’d been prescribed drugs over the past 12 months, according to the U.S. Centers for Disease Control and Prevention. Overall, 11.4 percent of them said they did not follow doctor’s orders on taking the drugs to lower their costs, CNN reported Tuesday.

The study said that 8.4 percent of people with private insurance did this, compared with 12.5 percent of Medicaid enrollees. Women were more likely than men to try to reduce drug costs.

Nearly 1 in 5 of those prescribed drugs asked their doctors for less expensive options. The rate was highest — 40 percent — among people without insurance, CNN reported.

Just over 5 percent of people used alternative therapies, including nearly 14 percent of those without insurance, according to the study.

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ADHD Meds Safe With Epilepsy, Study Finds

By Robert Preidt

HealthDay Reporter

TUESDAY, March 12, 2019 (HealthDay News) — Attention-deficit/hyperactivity disorder (ADHD) often occurs in people with epilepsy. Now, new research provides reassurance that taking ADHD medications won’t raise their risk of seizures.

For the study, researchers analyzed data from thousands of epilepsy patients in Sweden. Taking ADHD medications such as Ritalin (methylphenidate), was associated with a 27 percent reduction in seizures, compared with not taking the medications, the investigators found.

“When you compare risk between individuals, there’s a lot of factors that might explain associations that have nothing to do with the medication itself,” said study author Kelsey Wiggs, a Ph.D. candidate at Indiana University, in Bloomington.

The study was published online recently in the journal Epilepsia.

“It’s a good feature of this study that we were able to compare the same individual on and off the medication — we could rule out a lot of other confounders,” Wiggs said in a journal news release.

Another expert said the results are reassuring.

“This study provides another piece of evidence that medications for kids with ADHD do not increase the risk for seizures,” said Kimford Meador, a professor of neurology and neurosciences at Stanford University.

“I think that physicians should feel safe prescribing these medications within standard doses,” said Meador, who was not involved in the study.

Another expert, Torbjorn Tomson, a professor of neurology and epileptology at the Karolinska Institute in Stockholm, pointed out in the news release that people with epilepsy are often denied effective treatment for their psychiatric conditions out of fear the medications might negatively affect seizure control.

A study published last year in the journal Neurology found no evidence that taking ADHD medication increased seizure risk in people with and without epilepsy. The findings were based on data from more than 800,000 people in the United States.

Approximately 9 percent of children aged 2 to 17 have had an ADHD diagnosis, according to the U.S. Centers for Disease Control and Prevention. And ADHD is more common in people with epilepsy than in the general population. Among epilepsy patients, as many as half of children and 20 percent of adults have been diagnosed with ADHD, the researchers noted.

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SOURCE:Epilepsia, news release, March 11, 2019

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