8 Drugs your Doctor Won’t Take?
I was flipping through my June Men’s Health magazine when I came across an article entitled, “8 Drugs Doctors Would Never Take,” written by Morgan Lord. Unfortunately, it’s unclear to me how Lord compiled this list, or weighted the pharmaceuticals that are on it, though I don’t disagree that some of the drugs he lists, if not taken carefully, can be harmful.
First on the list is Advair, an asthma medication. He cites an analysis in 2006 of 19 trials that suggested that regular use of LABAs (long-acting beta-agonists) can increase the severity of an asthma attack, even to the point of death. Advair (also known by its generic name salmeterol), is the most popularly prescribed of the LABAs and could contribute to as many as 5,000 asthma-related deaths each year in the US. It lead to the FDA labeling the drug with a black-box warning, its most severe.
The next two on his list are probably familiar to readers of this blog: Avandia and Celebrex. I’ve written at length about the two, and their challenge to stay on the market in spite of being labeled with their own black-box warning by the FDA (search for “Avandia” or “Celebrex” and you’ll find multiple posts on this site). Avandia was removed from the market at one point because it was linked to cardiovascular disease in some patients. Celebrex, like its other CO2-inhibitor cousins Bextra and Vioxx, was also associated with cardiovascular risk.
The powerful antibiotic Ketek is next on his list, which is prescribed to fight bacteria in the lungs and sinuses, but has been liked to heart-rhythm problems, severe liver side effects and poor interaction with other medicines one may be taking. In February 2007, the FDA formally limited its use only in the treatment of pneumonia.
Heartburn medications Prilosec and Nexium were next, and again, there is an investigation that’s been done by the FDA into a suspected link between these medications and heart attacks. Based on that investigation, the FDA said there isn’t a likely connection, which Lord interprets as meaning “the scientific jury is still out,” but I would hardly put this on a list of “medicines to avoid” if no conclusive link has yet been made even after a study has been completed. He goes on to indicate that the medicines are perhaps too effective anyway, because that same sensation of burning in your chest will kill incoming bacteria and germs that could lead to pneumonia.
Visine was next, a surprise when I first read it until I realized he was talking about the original formula. The original formual “gets the red out” of your eyes by constricting the blood vessels causing the redness, and not actually addressing the cause (such as dryness or allergies). Continual use can perpetuate and even worsen the problem. When my eyes get dry, I occasionally use Visine Pure Tears, which do not contain the active ingredient tetrahydrozoline, which causes the constriction seen with use of Visine Original. (I was waiting for the link to heart attacks, but it never came for Visine.)
The final drug on the list was Pseudoephedrine, a decongestant that could cause problems for people with heart disease or hypertension because it not only constricts the blood vessels in your nose and sinuses, but could also raise blood pressure and heart rate, a definite problem if you have a history of heart problems.
For each drug, Lord does an excellent job of giving alternatives to these medications, but I felt like his profile for each of these was a bit alarmist in nature. Are these really 8 drugs that doctors would never take? So many of them seemed to be linked to heart problems, but do they actually cause heart problems or exacerbate existing conditions? What’s his basis for claiming that most doctors wouldn’t pick up the Physicians’ Desk Reference to check for the serious side effects that these drugs may cause? Or, for that matter, not warn their patients of the potentially fatal side effects and risk a serious malpractice suit?
I would have liked to see some kind of indication of a study (e.g., ‘x’ number of doctors were surveyed for this article and ‘y’ picked these 8 drugs as things they would never take) or some other insight as to why he picked these particular drugs. And what does he say to people who are already on these drugs and find they’re helping? In my post, “Heartburn Relief,” there’s evidence that the alternatives he suggests for Prilosec and Nexium aren’t as effective at treating heartburn. And drugs like Celebrex succeeds in spite of its black box warning because, simply, it works for it patient base who should be well aware of the dangers of their medications if their doctors are doing their job in disseminating information appropriately (I explored this more in “Succeeding in Spite of a Black Box“). Is it realistic to think that prescriptions for these medications are haphazardly given, or are the patients taking them better educated than we think?
I’d love to see more of Lord’s work into this area, perhaps a deeper profile into the doctors that *do* prescribe these medications (or suggest them, in the case of over-the-counter drugs) and why they do so. For that matter, I’d be more interested in taking a closer look at over-the-counter drugs that could be dangerous if taken in high doses, or problematic at least if they’re taken at the recommended doses. Claritin, for example, is a godsend for me during allergy season, but I’m always concerned when a drug makes a jump from prescription-only to over-the-counter. What about Zyrtec?
Lord’s article makes for interesting reading. But there is definitely more research that would need to be done before I would be convinced these are the 8 drugs doctors would not prescribe, and certainly a wealth of other information out there from which people would probably benefit. I hope he, or another writer, will explore the possibilities soon.
What do you think?
