Medications Archive

In the journals

Many commonly used drugs have anticholinergic effects, meaning the drugs block the action of acetylcholine. Nerve cells release acetylcholine to transmit impulses to other nerves in the brain and throughout the body. Previous research has shown a link between these drugs and dementia. Now a study has found a similar link with mild cognitive impairment (MCI), especially if you take larger doses. The findings were published online Sept. 2, 2020, by Neurology.

Some medications are designed purposefully to block acetylcholine, such as those used for urinary incontinence. But more often the anticholinergic action is a side effect of drugs taken to treat conditions like allergies, colds, and depression.

In the journals

Men with intermediate-risk prostate cancer may benefit from undergoing androgen-deprivation therapy (ADT) depending on how far the cancer has progressed, says a study published online Sept. 9, 2020, by JAMA Network Open. The results could help men better weigh risk versus reward when choosing their prostate cancer treatment options.

The study looked at men with intermediate-risk prostate cancer. This is the mid-range of prostate cancer in terms of aggressiveness between low-risk (which often doesn't need treatment) and high-risk cancer. There are two categories of intermediate-risk cancer: favorable intermediate-risk (FIR) and the more advanced unfavorable intermediate-risk (UIR).

Certain drugs or treatments may affect the skin, causing side effects like excessive dryness or blue spots.

Having problems with your skin? You may want to look in your medicine cabinet. Numerous prescription drugs and even over-the-counter treatments may bring unexpected skin changes, says Dr. Suzanne Olbricht, an associate professor of dermatology at Harvard Medical School. Medications to look out for include the following.

Blood-thinning medications

Spontaneous bruising that occurs even without bumping into something becomes more common as you get older. Doctors call it senile or actinic purpura and it happens often in people who take medication to prevent blood clots, such as warfarin (Coumadin) or even a baby aspirin. "As you age, the dermis, the thick middle layer of the skin, begins to thin and doesn't support the blood vessels inside as well as it used to," says Dr. Olbricht. This can make the blood vessels more likely to break. Even the tiniest injury can release blood under the skin, leading to the discoloration and dark purple bruises that characterize this condition.

Contrary to conventional wisdom, some blood pressure drugs are linked to a lower risk of depression.

Like all medications, blood pressure drugs sometimes cause unwanted side effects. While many are mild and short-lived, some are more worrisome, including mood changes such as depression. But contrary to what doctors have long assumed, blood pressure drugs may not raise the risk of depression. In fact, some appear to be linked to a lower risk, according to a recent study (see "Depression rates in people taking different blood pressure drugs").

"The traditional view has been that blood pressure drugs that cross the blood-brain barrier are more likely to cause depression," says Dr. Randall -Zusman, a cardiologist at Harvard-affiliated Massachusetts General Hospital. Depression has also been associated with drugs known as beta blockers. But beta blockers (which work in part by slowing the heart rate) can also make you feel tired and listless, which may dampen your mood, Dr. Zusman explains.

On call

Q. I would occasionally get some swelling in my legs. But now I notice it by late afternoon every day. I otherwise feel fine. Should I be worried?

A. It sounds like you have edema, swelling in your legs due to fluid in the soft tissues beneath your skin. This usually occurs when pressure from the fluid inside your veins is high, which forces water out of the blood vessels and into the surrounding tissues.

Research we're watching

A drug made from a highly purified form of EPA (an omega-3 fatty acid found in fish) appears to help reduce plaque in the heart's arteries, according to a study published online Aug. 29, 2020, by the European Heart Journal. The findings may explain why the drug, icosapent ethyl (Vascepa), lowers the risk of heart attack and stroke by 26% in people at high risk for those serious problems.

The study included 80 people with fatty plaque in the arteries of the heart (coronary artery disease). Most of them had diabetes and were taking a statin. Their trigly­cerides were elevated, ranging from 135 to 499 milligrams per deciliter. Half were randomly assigned to take 4 grams of icosapent ethyl daily; the other half received a placebo.

The condition is an all-too-real problem for men, and one of the more difficult to treat.

After age 50, men often have periods of discomfort "down there." It could be a cramping, aching, or throbbing pain in and around your pelvis and genitals. You also may have issues in the bedroom and bathroom. While the problems are real, the cause is often difficult to pinpoint.

It's called chronic pelvic pain syndrome (CPPS) — also known as chronic prostatitis — and it's one of the most puzzling and difficult-to-manage conditions for older men.

Ask the doctors

Q. My partner says I've been snoring lately. Are there any home remedies I can use to help me stop?

A. Snoring occurs when muscles in your airway relax during sleep, narrowing the airway and making your breath sounds louder as the air forces its way through. There are a number of strategies that can help. Try sleeping on your side instead of your back, which pushes your tongue to the back of your mouth. Clear nasal congestion resulting from allergies or a stuffy nose. Avoid alcohol (which may act as a sedative) and sleep medications known as benzodiazepines, which may cause your airway tissues to relax, making snoring worse. Losing weight can also help, because surplus tissue, caused by weight gain, can put pressure on and compress the airway, making snoring worse. However, if your snoring does not improve, your partner notices that you have periods during the night where your breathing ­appears to stop, or you regularly feel drowsy during the day, it may be time to pay a visit to your doctor. You could have a condition called obstructive sleep apnea, which may require treatment.

Research we're watching

Serious heart complications are common in people hospitalized with influenza, according to a study published online Aug. 25, 2020, by Annals of Internal Medicine.

Researchers from the CDC looked at the rates of cardiovascular problems in more than 80,000 adults hospitalized with a confirmed case of influenza (commonly called the flu) from 2010 to 2018. Almost 12% had a serious cardiovascular problem, most commonly heart failure or a lack of adequate blood flow to the heart, known as acute coronary syndrome. The body's immune response against the infection can trigger inflammation and other changes that harm the cardiovascular system.

On call

Q. My blood pressure stays low. Sometimes it drops so low, it causes dizziness and weakness. What causes this?

A. Of the possible causes of low blood pressure, two are at the top of my list. First, I would review your medications. Drugs prescribed to treat high blood pressure and heart disease are the ones that most often cause this side effect. Reducing the dose with your doctor's approval may be all you need.