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Do Not Mix Migraine Medications With Antidepressants

Headache medications that are available over the counter in the local drugstore are ineffective when it comes to a migraine headache, and migraine sufferers have received great help from medications that are targeting a migraine attack. They are non-narcotic prescription drugs, some of which have to be injected. They are available under names like Amerge, Axert, Frova, Imitrex, Maxalt, Relpax or Zomic, and the medication group is known in pharmacists' language as "triptans".
The medications are generally well tolerated, but the FDA has issued a warning.
In combination with another medication group, life threatening side effects can occur.
Any patient who is receiving medication for the treatment of depression in the form of a Selective Serotonin Reuptake Inhibitor (SSRI's) is strongly warned, not to take any of those listed triptans for migraine. The anti depressive drugs are Celexa, Fluvoxamin, Paxil, Prozac and Zoloft. Two other medications, namely Effexor and Cymbalta are Selective Serotonin/Norepinephrin Reuptake Inhibitors (SSNRI's), and they carry the same risk when taken in combination with the triptans.
The combination of the two medications can lead to a dangerous condition known as Serotonin syndrome. It occurs when the body has too much serotonin, a chemical found in the nervous system. Serotonin syndrome symptoms may include restlessness, hallucinations, loss of coordination, fast heartbeat, and rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea. Serotonin syndrome may be more likely to occur when starting or increasing the dose of a triptan, SSRI or SNRI.
It is up to the prescribing physician to carefully weigh the advantages against the serious side effects, and it can be a difficult choice, as both conditions, migraine as well as depression, need to be treated effectively. Any patient who has to take both medications has to be closely watched. The patient also has to be alert to any side effect.

FDA/Center for Drug Evaluation and Research, July 19, 2006

Autism Not Linked to MMR Vaccine

The fear that there could be a connection between the measles-mumps-rubella (MMR) vaccine and the development of autism (PDD) has stopped many concerned parents to have their children vaccinated against these common childhood diseases.
Canadian research found out that a different picture emerged. Dr. Fombonne and his team from Montreal calculated that PDD prevalence (pervasive developmental disorder) increased by about 10 % every year. The MMR coverage decreased by about 4%. From these figures it is clear that the MMR-autism connection has been a myth. The consequences of the scare however, have been severe after the 1998 scare that came from an article in the Lancet. MMR vaccination has dropped from 95% to 85%, and the UK is currently experiencing its worst measles outbreak in 20 years. Measles is not a "harmless" disease that affects small kids. People have to remember that measles are a disease that kills, and not just in developing countries.
The next item was the hypothesis that mercury exposure from vaccines could pose a problem. Mercury exposure however has dropped to nil ever since a compound called thimerosal has been discontinued and eliminated from vaccines in 1996.
Autism (PDD) and its increase still keep researchers busy. The vaccination myth has been debunked as the culprit for autism. Dr. Fombonne explains that there is increasing evidence for genetic factors giving rise to the disorder, but there could be contributing environmental factors.

National Review Of Medicine, July 30, 2006, page 3

New Aphrodisiac Nasal Spray

Sildenafil and other phosophodiesterase-5 inhibitors(PDE-5 inhibitors) have taken the drug market by storm for erectile dysfunction. Viagra-just to name one of the drug names- has certainly enhanced the treatment possibilities for a male problem that was difficult to treat in the past. The market has had its heyday with splashy TV commercials, creating hype like seldom before. The truth remains, that any drug has also possible side effects that are not mentioned in the upbeat commercials, and patients with preexisting heart disease have experienced heart attacks. The medications for the treatment of erectile dysfunction are not recreational fun, but serious prescription drugs.
In the meantime these drugs are facing competition from a new class of erectile dysfunction drugs, the melanocortin agonists.
They claim to have remarkable properties due to the fact that they will not only help men but also women with a range of sexual disorders, including lack of desire. Contrary to the previous drugs they are not working through the vascular system but through the central nervous system. Through receptors in the brain area called hypothalamus, they stimulate areas of the brain associated with sexual arousal. Preliminary experiments have shown that they are increasing libido, but also help a man to get better erections.
The melanocortin agonist closest to the market is known as bremelanotide. Previously known as PT-141, the nasal spray has been tested in about 300 men up to phase II with promising results. A study on women has been too small in numbers to give detailed results, but significantly more women reported increased libido after bremelanotide treatment as opposed to placebo. The drug's half-life is only two hours, but women have reported effects lasting 10 to 12 hours. They also reported that the quality of their sexual encounter had improved. The older group (women over 34) responded slightly better than their younger counterparts.
Bremelanotide still has some way to go till it will be on the market, but it is getting some positive press in magazines as the "first equal-opportunity aphrodisiac". Palatin Technologies, the manufacturer of the drug is more cautious and does not want bremelanotide to be perceived as a leisure drug, even more so as it has not seen its approval at this point.

National Review Of Medicine, July 30, 2006, page 11

Checking out the patient's heart disease risk factors used to be very basic. Lifestyle questions were one aspect: was the patient smoking? Did he have a lack of exercise? Did he have a risk of heart disease in the family? The patinet's diet was analyzed and the body weight was assessed. Cholesterol and triglyceride levels were the basic labs that provided more information. The risk factor assessment, as exemplified by criteria from the Framingham study, made a lot of sense.

In the meantime cardiologists are concerned that all these points are no longer sufficient in identifying individuals at risk for heart disease. Dr. Morteza Naghavi, president for the Association for the Eradication of Heart Attacks, is concerned that it is not only obesity and hypertension that bear the risk for heart attacks, but atherosclerosis. A lot of heart attacks occur in the low- and moderate risk groups. As far as he is concerned, every man aged 45-75 and every woman from 55-75 needs to be screened. We are better equipped to do something for people who have a high plaque burden (deposits in the blood vessels.) Statins are the medication of choice to help these patients.
Screening techniques have become less invasive, as imaging technology has made large progress in recent years. The condition of the carotid artery can be assessed by ultrasound (carotid intima-media thickness or CIMT). Coronary calcification score (CACS) can be measured by CT scanner. The tests are done in a few minutes, and the cost at the most is a few hundred dollars. A patient would only be screened every five years. Screening procedures work and save lives, as demonstrated in the screening for breast cancer. The SHAPE team (The Screening for Heart Attack Prevention and Education) has calculated that the screening cost is even better than breast cancer screening. There are other tests that improve the sensitivity of traditional criteria, like the blood test for C-reactive protein, but in assessing the patient's risk, it does make sense to go to the source of disease. The striking color image that demonstrates the atherosclerotic burden will allow the patients to see the problem with their own eyes. It may be a healing shock that has a beneficial effect on the compliance of patients. Test results of laboratory work are words, but here a picture is worth a thousand words when it comes to encourage the patient to actively work on prevention.

National Review Of Medicine, July 30, 2006, page 7

Non-Hormone Alternative Against Hot Flashes

Hormone replacement therapy has its positive and negative effects, and the proven risk of breast cancer has stopped many women from choosing hormone replacement for menopausal problems. Yet menopausal problems can be a source of suffering and frustration for those women who are affected. Menopausal hot flashes can be bothersome, and if they are severe, frequent and go on for years, women find it difficult to cope with this condition. Even if hormone replacement is not an option because of the risk factors, relief of those symptoms is very much needed. Herbal remedies are often not sufficient. As a result the day to day functioning of the patient is affected and even a restful night is interrupted by sweating.
Dr. Sireesha Reddy from the department of obstetrics and gynecology at the University of Rochester's school of medicine and dentistry has led a study of 60 postmenopausal women. A medication called gabapentin was used in a randomized study. Three equal groups were observed: the first received gabapentin titrated to 2,400 mg per day. The second group received 0.625 mg per day of estrogen, and the third group was given a placebo. The gabapentin group and the estrogen group achieved similar results, namely a 71% reduction, versus 72% in the estrogen group. The placebo group reported a 54 % reduction of hot flashes.
Dr. Reddy states that gabapentin against hot flashes is a good alternative. It works for patients who only have these particular problems, as it does not address other indications where estrogen is prescribed. Dr. Reddy also added that it might not be necessary to titrate to 2,400 mg gabapentin per day, because some women metabolize it at a higher rate than others.
Specific side effects such as headaches and dizziness occurred more frequently in the gabapentin group, but they were not statistically significant.

The Medical Post, July 18, 2006, page 4

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