Sufferers of hay fever and nasal allergies generally reach for anti-histamines to calm their itching, sneezing, congestion and profuse watery nasal discharge. More appropriately however nasal corticosteroid sprays offer superior benefits without some of the unwanted side effects of traditional oral therapies. Recently F.D.A. approved as an over-the-counter option, Flonase Allergy Relief offers 24 hour symptom control both for nasal complaints and itchy, watery eyes as well.
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Amlodipine or Norvasc treats high blood pressure. This inexpensive, generically available calcium blocker relaxes smooth muscle cells lining arteries and reduces the force against which the heart must pump. Additionally the drug helps protect against chest pain or angina. It ranks among the World Health Organization List of Essential Medicines.
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Wellbutrin, more commonly prescribed as the generic Bupropion, remains a widely prescribed therapy for depression. Popular in part because it may lead to less weight gain and sexual dysfunction compared to other antidepressants, it probably lacks significant major therapeutic advantages versus its competitors. While Bupropion may provide some relief, it neither cures depression nor completely eliminates the symptoms.
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Erectile Dysfunction or simply ED affects more than 40% of men beyond age 40. Cialis produces results within 30-45 minutes when combined with sexual stimulation. Alternatively a smaller dose on a daily basis offers advantages for unplanned activities. The drug also may offer minor assistance to men with urinary difficulty due to an enlarged prostate. Cialis neither functions as an aphrodisiac nor as a treatment for premature ejaculation.
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Lowering blood pressure with losartan, the generic form of Cozaar, works as well as more expensive and widely advertised drugs. Many people ultimately need several different drugs to optimize blood pressure control. Generally this is due to inadequate attention to diet and exercise. Success in treating high blood pressure requires a low salt diet, generous servings or fruit, vegetables and nuts with elimination of simple carbohydrates.
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Among the newer injectable “biologics” prescribed to treat severe psoriasis, Taltz and a competitor Cosentyx remain most likely to result in clear skin within 12 weeks. Unfortunately the cash price for one year of these drugs averages in excess of $60,000. While televised ads blanketing the airways claim discount copay cards limit out of pocket expense, insurance companies are not so fortunate. These and similar drugs largely account for the dramatic escalation in yearly drug insurance premiums.
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Trulicity aids in controlling type 2 diabetes with only one shot every 7 days. It simulates the pancreas to release insulin and in addition may assist in weight reduction. Prescribed in addition to other therapies, this GLP-1 stimulator rarely causes hypoglycemia. In the near future, a once weekly form of apparently heart healthy Victoza will probably capture considerable market share from cardiac neutral Trulicity.
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Containing a smaller amount of amino acids than a bite of steak, chicken or salmon, this supposed human growth factor booster makes preposterous appearing claims based on extraordinarily shaky evidence. While using such enticing catch-phrases as anti-aging, breakthrough and fountain of youth, the packaging promotes SeroVital to increase lean muscle mass, reduce wrinkles and more. A $100 investment buys one month of product but at best the “increase” in growth hormone raises it only into the low normal range.
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Also sold as Zestril and Prinivil, the generic ACE inhibitor lisinopril remains a mainstay for treating high blood pressure. This inexpensive and generally safe compound successfully combats hypertension protecting both the heart and brain. Additionally it also reduces the likelihood of death after a heart attack and prevents kidney damage especially in diabetics. However treating high blood pressure requires more than medicine alone. Diet, appropriate weight loss, sodium restriction, exercise, stress reduction and avoidance of cigarettes remain vital issues deserving of attention.
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While the extraordinarily expensive Repatha dramatically lowers LDL or “Bad Cholesterol” to levels of 30 mg, it fails to reduce the likelihood of death from all causes or even death from cardiovascular disease. Furthermore it barely budges the incidence of stroke or heart attack. Studies suggest a cost well in excess of $2,000,000 to prevent one heart related fatality. Originally thought of as a miracle drug, its lackluster results may lead to a reassessment of the importance of LDL in causing heart disease. As one eminent cardiologist says the drug may just be “performing cosmetic surgery on a laboratory value.”
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The diuretic variously referred to as HCT, HCTZ or more properly hydrochlorothiazide remains one of the most popular treatments for high blood pressure. This so-called water pill helps eliminate excess sodium and fluid from the body. In the process, the blood pressure falls. The price is cheap and the side effects few. This drug has rightly remained popular for many decades.
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Beta blockers like Bystolic typically represent second or third tier therapy for high blood pressure. Most drugs in this class share similar features and are available as relatively inexpensive generic versions. Bystolic offers no obvious advantage and remains extraordinarily pricey compared to metoprolol, atenolol or nadolol. Copay assistance cards temporarily shift the financial burden to the insurance company until they next year’s premium increase.
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Tresiba provides long lasting, once daily baseline insulin coverage for both type 1 and type 2 diabetics. It offers the greatest flexibility of any basal insulin. Tresiba continues providing coverage for more than 40 hours which relieves the burden of adhering to a more precise schedule necessary with shorter acting insulin.
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Lexapro or escitalopram may treat depression and anxiety. Actually Lexapro contains the same active component as Celexa. Aggressive marketing promoting the drug as superior to other available options succeeded in boosting total sales well in excess of $14 billion. Unfortunately studies fail to show Lexapro offers any unique advantages over other similar SSRIs such as Prozac, Paxil and Zoloft. Recent investigations suggest not only are antidepressants overprescribed but their effectiveness compared to inactive placebo therapy remains subject to debate.
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Once the standard, long acting, once daily baseline insulin, Lantus recently encountered significant competition. This opening of the insulin markets may finally bring some pricing relief to this still expensive necessity. For most Type 2 diabetics, the need for insulin marks the failure of diet and exercise to maintain normal body weight. By itself Lantus rarely suffices to control blood sugar.
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Lyrica and its relative Neurontin or gabapentin are widely overprescribed for pain related disorders. Although approved for treating pain after shingles, evidence for their benefit remains quite sketchy. Gabapentin now ranks as one of the top drugs of abuse with at least 50% or people abusing opioids like hydrocodone and oxycodone simultaneously taking these “johnnies” or “gabbies.” In fatal drug overdoses, gabapentin often appears as a contributing factor.
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As men age, the prostate enlarges which creates difficulty urinating. Although the prostate itself does not shrink with Flomax, the smooth muscle component of the gland relaxes. This effect on the involuntary muscle allows easier passage or urine with less hesitation and dribbling. Benefits appear extraordinarily rapidly. Also know as tamsulosin, the drug improves the symptoms of BPH rather than curing the condition. Lightheadedness frequently occurs on arising from a seated position. A recent evaluation of 500,000 men unexpectedly revealed those taking tamsulosin might face an increased risk of dementia. Studies to confirm or refute this possible association must be undertaken.
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Irritable Bowel Syndrome or simply IBS is a condition of unknown cause that manifests as abdominal pain associated with either diarrhea or constipation. A minority of experts believe the diarrhea may result from overgrowth of bacteria in the small intestine. An oral antibiotic Xifaxan remains in the gut and may temporarily improve the condition but at a whopping cost of almost $40 a pill. At best it’s temporarily effective with multiple courses required as the drug fails to cure the condition.
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Advertising suggests the oral anti-coagulant Eliquis offers significant advantages over warfarin in preventing stroke and bleeding. Actually the differences between the two drugs appear rather modest except in cost. The cash price of Eliquis is about $15 a day which translates to more than $5000 a year compared to a paltry $48 a year for warfarin. Additionally bleeding associated with warfarin can be rapidly reversed with vitamin K; bleeding from Eliquis has no antidote.
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An array of relatively newly approved, expensive therapies for diabetes complicates decision making with regard to treatment. A drug preventing the body from degrading incretin helps keep levels of insulin high while reducing concentrations of glucagon, a hormone intimately linked to boosting blood sugar. With a daily cash price of about $16, it lowers hemoglobin A1c, HbA1c, by a relatively small amount. Some experts wonder if the hefty price tag of these new therapies can be justified when advantages over traditional options often appear sketchy or non-existent.
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The inexpensive drug generically available as metformin remains the first choice for type 2 diabetics in whom diet and exercise fail to work. Not only does it dramatically improve blood sugar levels and hemoglobin A1c, but unlike other diabetes drugs, its use may lead to weight loss and is rarely associated with hypoglycemia. When necessary it may be combined with additional anti-diabetes medicines. Additionally preliminary reports suggest metformin may act to prevent a variety of tumors and even increase survival in colon cancer.
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Onexton combines benzoyl peroxide with the antibiotic clindamycin. Although this expensive topical preparation improves moderate acne by only about 50%, whether it offers significant advantage in excess of readily available, over-the-counter 10% benzoyl peroxide remains debatable. The manufacturer Valeant offers a discount card to blunt the more than $500 retail cost of the prescription drug.
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Heavily promoted as treatment for painful diabetic neuropathy and fibromyalgia, Lyrica advertisements blanket the airways. While some studies demonstrate a small benefit when compared to an inactive placebo, others fail to show any difference. Significant complications include dizziness, sleepiness and weight gain. Suicidal thoughts and altered vision are not infrequent side effects. For cash payers the daily cost may exceed $16.
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Recently approved Xiidra, a topical eye drop for the Dry Eye Syndrome, appears likely to dethrone Restasis as the treatment of choice for this common malady. Xiidra begins to work more quickly and causes fewer side effects. Unfortunately both of these drugs cost about $5000 each year and fail to eliminate the need for supplements of artificial tears.
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Persistent facial redness belonging to the spectrum of rosacea remains difficult to treat. Lasers and light therapy such as IPL and VBeam successfully improve the skin’s color. A new drug, Rhofade, contains the active ingredient in Afrin or oxymetazoline but in a more concentrated form. Topical application twice daily provides minimal improvement at a cost about 200 times greater than the Walmart brand of this long available over-the-counter nasal decongestant.
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The relatively new Vraylar falls into the family of atypical antipsychotics traditionally prescribed for schizophrenia. An advertising campaign seeks to boost its sales for mania associated with bipolar disorder. Whether this drug actually provides benefits commensurate with the $1400 monthly cash price or roughly $45 a pill remains to be determined. Studies leading to FDA approval failed to demonstrate significant difference between it and Abilify or Risperdal both of which are available as relatively inexpensive generics. Lithium offers an inexpensive option for mania and provides the lowest incidence of re-hospitalization for manic attacks. Atypical antipsychotic drugs often cause severe side effects and should be restricted to those truly in need.
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This heavily advertised product supposedly “supports healthy brain function, a sharper mind and clearer thinking.” Surprisingly the “scientific” studies offer little evidence the compound actually provides any benefit. The “active” ingredient appears to be a protein found in jellyfish that does not survive acid and pepsin assault in the stomach and intestine. The FDA has not approved this product and takes issue with promotional claims made by its manufacturer.
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Constipation as an integral part of the Irritable Bowel Syndrome refers to fewer than 3 weekly bowel movements and may be associated with abdominal pain. A recently approved and of course obscenely expensive drug, Linzess, seems to stimulate the bowels so well that it either causes diarrhea in as many as 1 in 5 people or results in only modest symptom improvement in others. Of course the drug company’s copay card shields the patient, but not the insurance company, until next year’s premium increase.
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The injectable anti-diabetic agent Victoza treats only type 2 or adult onset diabetes – a condition that regularly plagues the overweight and obese. Due to a variety of side effects, Victoza seems best considered for those already on therapy who fail to sufficiently improve on more traditional drugs. Common side effects include abdominal discomfort and headache while less frequent but more severe reactions raise concern. Thyroid tumors including cancer, non-fatal and fatal pancreatitis and kidney failure remain worrisome associations.
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Tramadol treats acute or chronic pain and works on the same opioid receptors as hydrocodone, oxycodone and Fentanyl. Additionally Tramadol boasts some of the same activities as the SSRI class of antidepressants including Celexa, Lexapro, Zoloft and Paxil. Initially authorities ignored the potential for abuse and addiction associated with the drug. It seems less toxic when administered as an intramuscular injection than when taken as a pill. The body metabolizes these forms quite differently. Originally not listed as a controlled substance, Tramadol was upgraded to a Schedule IV drug in 2014. Worldwide Tramadol appears to be a major cause of abuse. Widespread addiction exists throughout Africa and the Middle East. Side effects of the drug not only include those customarily associated with opioids, but additionally it may lead to problems associated with the SSRIs. Both an immediate and extended release form are available. The immediate release form is reasonably priced while the cost for the longer acting form varies between $125 and $270 a month for the generic version.
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Vitamins marketed to prevent progression of age-related macular degeneration or AMD combine Vitamins C and E along with zinc, copper and at times carotene family members lutein and zeaxanthin. Although claims suggest major benefits, the evidence favoring their use seems rather meager. At best they may slightly delay progression in those with moderate to advanced disease. They neither prevent AMD nor do they cure the disease. A low fat diet with generous quantities of fruit, vegetables and nuts along with participation in regular exercise and avoidance of tobacco offer more protection than vitamins.
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The newer shingles virus vaccine Shingrix provides much better coverage than the much weaker, shorter lasting Zostavax. It seems quite effective in preventing post-herpetic neuralgia. It contains no live virus but for full effect requires an initial injection and another 2-6 months later. Local side effects may last up to several days. Certainly a lot of hype urges consumers to get this expensive vaccine which is only partially covered by Medicare part D or its various supplements.
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Basaglar represents the first copycat version of Lantus. These insulin products mimic each other’s actions almost exactly; effectively they function identically within the body. Marketing prowess, insurance coverage and discounting to pharmacy benefit managers more than medical requirements dictate which product a person is likely to receive.
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Amitriptyline was approved over half a century ago as an antidepressant and still remains popular today. Interestingly amitriptyline provides a similar degree of relief from depression as more recent additions to our armamentarium. Selecting among the various options involves considering other circumstances: medical issues, patient preference and side effect profile. Over the years, the indications for amitriptyline expanded far beyond depression and often without either formal study or specific FDA authorization. Among the conditions routinely treated with amitriptyline are fibromyalgia, chronic fatigue, diabetic neuropathy, pain lingering after shingles, insomnia and low back pain. Amitriptyline ranks among the least expensive options to prevent migraine headache and may even remedy chronic itchiness. A major issue with amitriptyline involves tiredness or fatigue. For this reason most doctors recommend taking the medicine just before retiring for the evening. In fact many physicians prescribe low doses to treat insomnia rather than larger amounts necessary to combat depression. Among the many undesirable side effects of amitriptyline are dry mouth, blurred vision, constipation, weight gain, difficulty urinating and erectile dysfunction. Problems concentrating and the potential for cardiovascular issues pose further concerns. Common to all antidepressants, the FDA mandates a warning of increased suicidal thoughts and behaviors especially among those less than age 24. Amitriptyline interacts with a significant list of other drugs. Special cautions concern triptans used to treat acute migraine attacks, Lyrica, gabapentin, tramadol and anti-psychotics now commonly employed in treating schizophrenia, mania of bipolar disorder and agitation associated with autism in children. MAO inhibitors must not be used within 2 weeks of amitriptyline. Overlap with the popular SSRIs and SNRIs such as Prozac, Celexa, Lexapro and Zoloft may risk a nasty condition known as the serotonin syndrome. Consuming alcohol while taking amitriptyline poses further risks. After a course of therapy the dose must be gradually tapered rather than abruptly discontinued. Among the antidepressants, overdose of amitriptyline poses the greatest risk of death. When used appropriately, amitriptyline continues to offer significant relief for a number of conditions of uncertain origin. Unfortunately the scientific underpinnings of how we select our therapies lags far behind our confidence level and ability to write prescriptions.
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Dupixent treats moderate to severe atopic dermatitis, a common childhood skin rash that regularly persists into the adult years. Also known simply as eczema, the disease causes persistent itching that ultimately results in weepy, crusted, scaly and thickened skin. First line therapy includes minimizing bathing, liberal applications of moisturizer and avoiding irritants known to cause flares. Topical steroid creams of appropriate strength mostly eliminate active disease. Only when these simple measures fail are internal therapies warranted. Unfortunately this expensive drug is often offered in place of these simple, time honored methods. Dupixent injections every other week offer the chance for many but not all affected individuals to minimize their eruption and drastically reduce the associated itch. It achieves this without causing significant adverse reactions, although it may lead to conjunctivitis in up to 1 in 6 individuals. As an additional benefit, Dupixent appears quite effective in treating asthma – a condition often associated with atopic dermatitis. It may also have a role in treating itchy skin not apparently associated with atopic disease, eczema or rash. An aggressive marketing campaign designed to engage both the public and medical profession appears in the face of multiple competing drugs set to enter the market in the near future. The company hopes their first to market status will continue to provide name recognition as other options materialize. The yearly cost for the cash paying consumer is approximately $37,000 or $100 a day.
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Azithromycin popularly referred to as a Z-Pak is an antibiotic derived from erythromycin. While it treats a long list of common bacterial infections, it offers no assistance for the common cold or flu. Often incorrectly prescribed, it alters the normal bacteria in the intestine and regularly leads to abdominal upset and diarrhea. One, three and five days courses are available depending on the underlying condition.
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The new sleeping pill Belsomra offers a novel action - it reduces the concentration of Orexin – a chemical associated with wakefulness. More traditional sleeping pills typically boost substances involved in generating sleep. Unfortunately Belsomra’s effects are rather disappointing; it’s extremely expensive (around $10 a pill) and people often awaken feeling more drowsy than refreshed.
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Melatonin ranks as the most popular sleep aid potentially assisting those with jet lag, disordered sleep due to shift work, rotating schedules and even simple insomnia. Levels of this natural hormone are manufactured by the pineal gland as the sun goes down. Concentration peaks during the hours following midnight and vanishes as the sun rises. Melatonin allows synchronization of the body clock to a 24 hour day. In totally blind individuals and those living experimentally in complete darkness the day averages about 24.5 hours which significantly disrupts the sleep wake cycle. LED light produces excessive quantities of blue light as exemplified by computer screens, iPads, laptops and ebook readers. These delay production of melatonin and interfere with sleep. Incandescent light bulbs lack these troublesome wavelengths of light. Recent investigations suggest a more widespread but still undefined role of melatonin than previously assumed. It appears synthesis occurs in most tissues with potential implications for fertility, cancer, psychiatric disease and blood pressure control. It may function as an anti-inflammatory agent, modulate pain and protect the tissues from oxidants. Interestingly its ability to induce sleep and correct circadian disorders due to shift work and jet lag remain relatively weak.
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Prescriptions for Adderall are indicated only for ADHD – attention deficit hyperactivity disorder – and narcolepsy. Looser definitions of ADHD now include adolescents as well as adults. Increasingly abused as a recreational drug, a memory enhancer, an athletic booster and an aphrodisiac, this amphetamine preparation often leads to physical and psychological addiction. Side effects include paranoia, anxiety, palpitations, muscle tremors and even convulsions. Over 100,000 individuals seek emergency care each year related to adverse reactions to Adderall.
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While the name suggests unconsciousness due to excessive drinking, nothing could be from the truth. Alcohol blackouts occur when the elevated blood alcohol level prevents current events from entering normal memory storage sites within the brain. Alcohol blackouts represent a form of temporary amnesia lasting a few moments to several hours. During an alcohol blackout the affected individual looks and acts normally. The person does not slur their speech nor display any signs of incoordination. They carry on normal conversations, dance, watch television, dine and even engage in sexual activities. Unfortunately they lack judgment and place themselves at risk for harm yet do not remember any of the activities when the blood alcohol level returns to normal. Two forms of alcohol blackouts exist: fragmentary and en bloc. Fragmentary blackouts occur suddenly and last between 15 minutes to several hours. Partial memory may be restored with the aid of friends, cell phone videos and environmental clues. The more prolonged en bloc alcohol blackouts typically end hours later during sleep. No traces of memory are restored even with cues and videos. During alcohol blackouts the individual cannot remember events for more than 2 minutes. No memory exits for what happened even as recently as 15 minutes ago. While in an alcohol blackout, women often engage in sexual activities that they would not have in the absence of alcohol. This leads to thorny legal issues. Many supposed cases involving date rape drugs may actually occur during alcohol blackouts. Alcohol blackouts do not suggest chronic alcoholism. While no national data exists, studies indicate about half of college aged students who consume alcohol experience alcohol blackouts. The number exceeds 10% just during the summer between high school and college. With increasing age and greater responsibility, alcohol blackouts become somewhat less frequent. Men and women appear equally affected. During alcohol blackouts men may become aggressive and engage in fights, while women seem more likely to be preyed upon. Binge drinking may precede a blackout, but social drinkers are also at risk.
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ype 2 diabetes overwhelmingly results from too much of the wrong type of food. The condition places the life in jeopardy for a variety of complications involving the heart, brain, kidneys, eyes and nerves. Type 2 diabetes increases the risk for a variety of cancers as well. While our current medical treatments pay appropriate homage to diet and exercise, they rush to begin with a variety of progressively more unaffordable drugs not capable of significantly reducing the risk of important disease related preventable outcomes. Instead of correcting miseating, habits advertisements abound for expensive drugs like Ozempic, a glucagon like peptide receptor agonist. Although it can mildly lower the glycosylated hemoglobin or so-called A1c, it does not approach the benefits of proper nutrition and exercise. In spite of claims of reduced cardiovascular risk, the advantages are illusory. And the drug may be associated with some worsening of diabetic eye disease or retinopathy. Ozempic claims a minimal amount of weight loss associated with its use; but not sufficient to stanch the disease. For a drug with a cash price of about $800 or $25+ a day one should expect more. Adding further insult, Ozempic merely represents an add-on drug. It must be combined with other expensive anti-diabetic drugs – none of which reverse the disease process. Appropriate diet and exercise remain the best options with success equated with eliminating both disease and need for drug therapy.
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Diabetes affects tens of millions of Americans with the number growing alarmingly rapidly. Invokana represents a new concept in therapy. Rather than stimulating the body’s metabolism of sugar, this drug leads to elimination of glucose through the kidneys into the urine. Relatives include Jardiance and Farxiga. Recent concerns suggest some association with kidney failure, bone fractures, ketoacidosis, genital yeast infections and possibly an increased risk of amputations. Cash price may exceed $15 each day.
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Zoloft or sertraline remains among the top 20 prescriptions drugs more than 25 years after its introduction. This anti-depressant belongs to the SSRI – selective serotonin reuptake inhibitor – family which includes Prozac, Celexa, Lexapro and Paxil. Over time, indications expanded beyond depression. Now Zoloft or sertraline is also prescribed for anxiety, panic attacks, PTSD, pre-menstrual dysphoric disorder formerly PMS, obsessive compulsive disorder and social anxiety disorder. Other off-label uses lacking adequate study include alcoholism, migraine prevention, menopausal hot flashes, obesity, eating disorders, Tourette’s syndrome and premature ejaculation. Studies suggest all of the anti-depressants provide relatively similar results without any one drug obviously superior to its competitors. In spite of aggressive advertising campaigns suggesting unique improvement with specific agents, reality suggests doctors’ habits, drug company marketing and side effect profile decide which product will be prescribed. Therapy seems to be a hit of miss proposition. If this drug fails to help, another is tried. Among the more bothersome adverse reactions to Zoloft are loss of sexual interest or ability, weight gain, dry mouth and sleep problems. The serotonin syndrome may occur with Zoloft alone but seems more likely when combined with lithium, MAO inhibitors, other SSRIs, tramadol, amphetamines, lithium or tricyclic antidepressants (amitriptyline, nortriptyline). Symptoms include nausea, vomiting, diarrhea, agitation, hallucinations, delirium, seizures, tremor, incoordination, a racing heart rate and elevated body temperature. Considerable debate surrounds antidepressants like Zoloft. Prescriptions for these drugs frequently originate from brief interactions with a family physician, nurse practitioner or physician’s assistant rather than a trained mental healthcare expert following more in depth assessment. As a result therapy often seems misdirected. A significant number of people experience difficulty discontinuing treatment. Symptoms often are mistakenly confused with relapse of depression. Among the common complaints are dizziness, fatigue, tingling, blurred vision, sleeplessness, electric shock like sensations, agitation and crying spells. Experts continue to debate whether these drugs offer significant advantages compared to placebo therapy. The vast majority of people treated with Zoloft improve at least somewhat. However relatively few achieve complete resolution of their symptoms. Weighing the benefits against the risks seems appropriate prior to beginning treatment.
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Trazodone remains among the top 25 prescribed drugs in this country. Approved by the FDA only as an antidepressant, it tends to cause intense drowsiness As a consequence it finds widespread acceptance as a treatment for insomnia rather than its authorized indication. However medical studies fail to confirm its benefits as a sleeping pill, and it lacks approval for this purpose anywhere in the world. The American Academy of Sleep Medicine does not recommend trazodone and the widely respected Cochrane Collaboration suggests it fails to improve sleep efficiency when tested under laboratory conditions. Consumer Reports advises over-the-counter anti-histamines such as Benadryl instead of trazodone. No established dose exists for sleep problems. While the dose for depression averages 150 mg in divided doses, doctors regularly prescribe 12.5 mg - 50 mg for insomnia with some boosting recommendations to 300 mg at night. Developed in the 1960s, trazodone quickly developed a negative reputation due to a long list of side effects. Among the most prominent are cardiac arrhythmias, fainting, dangerous falls in blood pressure on arising and either weight gain or loss. Additionally it causes headache, blurred vision, confusion and may lead to cognitive and motor impairment. A relatively unique and uncomfortable adverse reaction relates to prolonged painful erections or priapism lasting in excess of 6 hours. This tends to occur early in therapy, often within the first month, and at relatively low doses. Dangerously low serum sodium concentrations may develop. Symptoms range from headache and difficulty concentrating to memory impairment, confusion and unsteadiness. Unless corrected hallucinations, seizures, respiratory arrest and death may supervene. For those in need of a sleeping pill, prudence suggests an alternative to trazodone.
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According to the FDA Cymbalta may treat depression, diabetic related nerve pain, anxiety, fibromyalgia and low back pain. Also known as Duloxetine, the quality of evidence supporting the medicine unfortunately remains of modest to low quality. Actually some studies indicate no benefit when compared to the SSRIs such as Prozac, Zoloft and Lexapro. Similarly effectiveness in fibromyalgia and diabetic neuropathy appears unimpressive. Discontinuing Cymbalta may lead to a peculiar Discontinuation Syndrome associated with headache, dizziness, irritability, sleeplessness, tremor and lack of energy. Some people experience electrical shock like sensations referred to as “brain zaps.”
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Combining an anti-depressant and smoking cessation medicine with a drug for narcotic dependence results in a new pill known as Contrave which supposedly leads to weight loss. Results unfortunately fail to impress. Weight loss averages as little as one pound every month or two with as many as half of individuals prematurely discontinuing therapy often due to troublesome side effects. An FDA mandated black box warns of suicidal thoughts and behavior as well as such neuropsychiatric reactions as depression and mania. Due to some corporate hanky-panky, it is currently unknown whether the drug increases heart related disease or death.
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Prescribed to rid the body of excessive fluid or edema, Lasix known generically as furosemide acts as a loop diuretic. It functions in a different area in the kidney than the more widely known thiazide diuretic hydrochlorothiazide. While thiazides find routine use in controlling high blood pressure, their effect appears weak in eliminating excessive body water. Lasix functions principally to remove fluid retained due to compromised function of the heart, liver or kidney. Volume overload often interferes with lung function and regularly results in pulmonary edema and leads to shortness of breath, difficulty breathing and inability to lie flat at night. Salt restriction must accompany furosemide therapy. Most people fail to realize that so many common foods, sauces, bread, pasta, cereal, condiments and processed meat contain excessive amounts of salt. Lasix begins working quite rapidly and must not be taken before bed. Since food interferes with its absorption from the gut, ideal timing of the medicine is an hour before or two hours after breakfast. The price of Lasix or its generic furosemide is a bargain at less than $15 a month.
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Currently the most popular drug in the family of Invokana and Farxiga, Jardiance stimulates the kidneys to expel glucose from the bloodstream into the urine. As a result patients with type 2 diabetes benefit by losing weight and improving their blood pressure. A relatively large study suggests Jardiance might also slightly reduce the risk of all cause mortality and decrease the likelihood of death from cardiovascular disease. Although these results appear statistically significant, the absolute improvement remains small at less than 3%. No reduction occurs in the incidence of heart attacks or stroke. Blood glucose and hemoglobin A1c fall only modestly.
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Among those with insomnia, Ambien remains the most popular sleeping pill approved by the FDA specifically for the purpose. Sleep disorders remain extremely frequent affecting between 6-10% of the population. Women suffer more sleep disturbances than men. Previously restricted to fewer than 7-14 days due to a supposed lack of continuing effect, Ambien and similar hypnotics may now be prescribed for long term use. Special precautions are warranted for the elderly, those with liver disease and the debilitated. Since Ambien acts to depress the central nervous system, extreme caution is warranted for those receiving other drugs that further deepen sedation. Among the dangerous pairings are Xanax, Valium, opioids, alcohol, trazodone, tramadol and certain antidepressants. Women seem especially prone to lingering sleepiness or “clouded brain” during the day after taking Ambien. Even 8 hours after the pill, blood levels are still measurable in 15% of women but fewer than 3% of men. This prolonged effect creates potential danger with activities requiring mental alertness such as driving to work the next day. Extended release tablets further compound the problem.
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Chronic use of opioids for pain control almost always results in severe constipation often with as few as one bowel movement a week. Relistor prevents binding of the pain medicine to the bowel wall and in the process modestly improves bowel function compared to an inactive placebo. Unfortunately this extremely expensive medicine must be injected just below the surface of the skin on a daily basis. Severe complications may occur. The company behind Relistor, Valeant Pharmaceuticals, gained unwanted notoriety for its business model of buying drug manufacturers and drastically raising prices.
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