8 drugs doctors wouldn't take

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8 drugs doctors wouldn't take

http://www.msnbc.msn.com/id/24777955/

If your physician would skip these medicines, maybe you should, too

By 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 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? " 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.

Advair

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 ls 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.

Your new strategy: No matter what you may have heard, a LABA, such as

the one in Advair, is not the only option, says Philip Rodgers,

Pharm.D., a clinical associate professor at the University of North

Carolina school of pharmacy. For instance, if you have mild asthma,

an inhaled corticosteroid such as Flovent is often all you need.

Still wheezing? " Patients can also consider an inhaled corticosteroid

paired with a leukotriene modifier, " says Dr. Rodgers. This combo

won't create dangerous inflammation, and according to a ish

review, it's as effective as a corticosteroid-and-LABA combo.

Avandia

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 percent and 42 percent,

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 GlaxoKline, 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.

Your new strategy: Stick with a proven performer. " I prefer

metformin, an older, cheaper, more dependable medication, " says Sonal

Singh, M.D., the lead author of the JAMA study. " Avandia is now a

last resort. " Dr. Singh recommends that you talk to your doctor about

cholesterol-lowering medicines, such as statins or the B vitamin

niacin. Swallowing high doses (1,000 milligrams) of niacin daily may

raise your HDL (good) cholesterol by as much as 24 percent, while at

the same time lowering your LDL and triglyceride levels.

Celebrex

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.

Your new strategy: What you don't want to do is stop swallowing

Celebrex and begin knocking back ibuprofen, because regular use of

high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) can lead

to gastrointestinal bleeding. A safer swap is acupuncture. A German

study found that for people suffering from chronic lower-back pain,

twice-weekly acupuncture sessions were twice as effective as

conventional treatments with drugs, physical therapy, and exercise.

The strategic needling may stimulate central-nervous-system pathways

to release the body's own painkillers, including endorphins and

enkephalins, says Duke University anesthesiologist Tong-Joo Gan, M.D.

You can find a certified acupuncturist in your area at

medicalacupuncture.org/findadoc/index.html.

Ketek

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 Dr. Rodgers. " 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.

Your new strategy: Can't imagine catching pneumonia? The last time

the Centers for Disease Control and Prevention calculated the top 10

killers of men, this deadly lung infection (along with the flu) came

in seventh. Avoid backing yourself into a corner where you might need

Ketek by always signing up for your annual flu shot — if you have

pneumonia, it'll reduce your risk of dying of the infection by 40

percent. And if you still end up staring at a scrip for Ketek, Dr.

Rodgers recommends asking to be treated with one of several safer

alternatives, such as Augmentin or the antibiotics doxycycline or

Zithromax.

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.

Your new strategy: When you feel the fire, first try to extinguish it

with Zantac 150 or Pepcid AC. Both of these OTC products work by

blocking histamine from stimulating the stomach cells that produce

acid. Just know that neither drug is a long-term fix.

" To really cure the problem, lose weight, " says Roizen, M.D.,

chief wellness officer at the Cleveland Clinic and co-author of " YOU:

The Owner's Manual. " That's because when you're overweight, excess

belly fat puts pressure on and changes the angle of your esophagus,

pulling open the valve that's supposed to prevent stomach-acid leaks.

This in turn makes it easier for that burning sensation to travel up

into your chest.

Visine Original

What possible harm to your peepers could come from these seemingly

innocuous eyedrops? " Visine gets the red out, but it does so by

shrinking blood vessels, just like Afrin shrinks the vessels in your

nose, " says 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.

Your new strategy: If you still want to rely on Visine, at least make

sure you don't use too many drops per dose and you don't use the

stuff for more than 3 or 4 days. But you'd really be better off

figuring out the underlying cause of the redness and treating that

instead. If it's dryness, use preservative-free artificial tears,

recommends Dr. Steinemann. Visine Pure Tears Portables is a good

choice for moisture minus side effects. On the other hand, if your

eyes are itchy and red because of allergies, pick up OTC antiallergy

drops, such as Zaditor. It contains an antihistamine to interrupt the

allergic response but no vasoconstrictor to cause rebound redness.

Pseudoephedrine

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.

Your new strategy: Other OTC oral nasal decongestants can contain

phenylephrine, which has a safety profile similar to

pseudoephedrine's. A 2007 review didn't find enough evidence that

phenylephrine was effective. Our advice: Avoid meds altogether and

clear your nasal passages with a neti pot, the strangely named system

that allows you to flush your sinuses with saline ($15,

sinucleanse.com). University of Wisconsin researchers found that

people who used a neti pot felt their congestion and head pain

improve by as much as 57 percent. Granted, the flushing sensation is

odd at first, but give it a chance. Dr. Roizen did: " I do it every

day after I brush my teeth, " he says.