Medications Archive

Can you do anything about hand and finger joint pain?

Everyone experiences the occasional painful hands and sore fingers, but when osteoarthritis strikes, it can put a hold on many aspects of your life.

"As osteoarthritis progresses, you may lose some hand mobility, like the ability to grasp and hold objects," says Dr. Robert Shmerling, clinical chief of rheumatology at Harvard-affiliated Beth Israel Deaconess Medical Center and senior faculty editor at Harvard Health Publishing. "Over time, osteoarthritis can make the joints deformed, so it's harder to open and close your hands."

Simple organization and communication strategies can help you manage your medications and reduce health risks.

If your pillbox is overflowing, you're not alone. Some 60% of Americans have at least one chronic condition, and 40% have two or more, according to the CDC. Doctors often prescribe multiple drugs to manage them.

"Some studies have found that a large number of people are taking as many as 12 to 15 drugs at a time," says Dr. David Bates, a professor of medicine at Harvard Medical School.

Antidepressants and opioids are common offenders.

It's frustrating when you feel the urge to move your bowels but can't seem to go. Before blaming your diet, consider whether medication side effects are causing your constipation.

Possible suspects

Many medications can contribute to constipation, including the following:

It may be as simple as adjusting the dose, avoiding alcohol, or taking the drug at a different time of day.

Image: iStock

One of the most commonly reported side effects of some medications is drowsiness. "Many people report tiredness or fatigue as a side effect from their medicines. However, there are things you can do to minimize the feelings of daytime sleepiness," says Laura Carr, a pharmacist at Harvard-affiliated Massachusetts General Hospital.

Typical offenders

Common culprits that cause sleepiness include antidepressants; antihistamines, found in sleep aids or medicines that treat allergies; anti-emetics, which are used to control nausea and vomiting; antipsychotics and anticonvulsants, which can be used to treat seizures or depression; drugs to treat high blood pressure, including alpha blockers and beta blockers; benzodiazepines and other sedatives, which are commonly used for anxiety or insomnia; drugs for Parkinson's disease; muscle relaxants; and opioids and other prescription pain medications. Many over-the-counter medicines may also make you drowsy, such as remedies for insomnia, allergies, nausea, vomiting, or diarrhea.

Doctors say three recently approved migraine prevention drugs are helping people have fewer headaches.

For people with frequent, debilitating migraine headaches, 2018 brought encouraging news. The FDA approved three new medications — erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality) — the first drugs designed specifically to prevent migraines and reduce their frequency, intensity, and duration.

It was a big development, since other medications used to stop migraines were created to control other conditions, such as seizures, depression, high blood pressure, or an irregular heartbeat. But their side effects (such as weight gain, dizziness, or fuzzy thinking) often cause people to skip treatment.

But some experts say limitations of the study raise questions about the results.

Could one of your regular pills raise your risk of dementia? A study published online June 24 by JAMA Internal Medicine found that people over age 55 who took a daily dose of certain common drugs for approximately three years had a 50% higher risk of developing dementia.

The medicines in question are in a category known as anticholinergics, which are used to treat conditions as diverse as depression, urinary incontinence, allergies, and Parkinson's disease. The study's authors say the findings should prompt doctors to use caution or potentially even avoid prescribing certain medications to people over age 45 on a long-term basis if there are other options available.

Research we're watching

Rabies infections are extremely rare in the United States, with only approximately one to three cases seen each year. That number has dropped significantly since the 1930s and 40s when there were 30 to 50 cases during the average year. But when they do occur, they're typically transmitted by infected bats. According to a new report by the CDC, the majority of people who have died from rabies in the United States were infected through contact with a bat. This is the case even though bats represent only one-third of the 5,000 rabid animals typically seen in the United States each year. The second most common source for rabies infections in Americans is rabid dogs encountered when people are traveling overseas.

To prevent exposure to rabies, be certain to let your doctor know if you are scratched or bitten by a bat, or if you awaken with one flying around your house or bedroom, says the CDC. If you are exposed to rabies, your doctor can administer a series of shots (known as post-exposure prophylaxis) before you develop symptoms, which can prevent you from developing a rabies infection, which is almost always fatal. If you are traveling outside the United States, be aware that dogs may carry the infection.

There are several things you can do to prevent or minimize the aches and pains that might accompany statin use.

If you're not taking a statin now, you may well be soon. These medications are commonly prescribed to lower "bad" LDL cholesterol and have been shown to reduce the risk of heart attack, stroke, and death. They are routinely recommended for people who have cardiovascular disease and for many people ages 40 to 75 who don't have cardiovascular disease but have at least one risk factor (high blood pressure, high cholesterol, diabetes, or smoking) and a 7.5% or greater risk of a stroke or heart attack in the next decade. Moreover, recent research indicates that they may benefit high risk individuals over age 75 as well.

Muscle pain and other statin side effects

Taking a statin may give you some assurance that you're doing all you can to avoid heart attack and stroke, but you may also experience side effects. Reported side effects include an increased chance of developing diabetes — which is largely restricted to people who are already at risk for diabetes, and who can be monitored with glucose or hemoglobin A1c tests. Statin use has also been associated with difficulties with memory and reasoning, although there is no clear evidence that the drugs were responsible. In very rare cases, statins may cause liver problems or a potentially life-threatening breakdown in muscle cells.

Prescription and over-the-counter medications may affect you differently now.

Despite the beneficial effects of medications, some drugs need to be used with increasing caution as you age. Drugs that caused few if any side effects in your youth can now cause discomfort or even put you at risk for serious problems such as falls or bleeding.

What's different in older age?

Even though you may have taken a medication for decades, your body may react differently to it later in life. One reason for this is that your metabolism has slowed down. Some medicines need to be processed by your liver to benefit your health; slower digestion and liver function mean it may take longer for a drug to get into your bloodstream. Later, remnants of the medicine need to be eliminated from your body by the liver and kidneys. Slowdowns at this stage mean it may take longer for a drug to leave your body, so its effects last longer.

This noninvasive test can predict plaque in the heart's arteries. But it is useful only in certain situations.

Imagine a 57-year-old man (let's call him Bill) who's in pretty good health — a nonsmoker who eats right and exercises regularly. He takes two drugs to treat high blood pressure. Even though his LDL (bad) cholesterol isn't all that high, his primary care doctor suggests that Bill consider taking a statin to lower his risk of a heart attack.

Bill is a little hesitant to add another drug to his daily regimen, so his doctor tells him about a test that may help with the decision: a coronary artery calcium scan. This noninvasive test, which can reveal dangerous plaque in the heart's arteries, has been available for more than a decade. But calcium scans (as they're often called) are now recognized in official guidelines and are being used far more often than in the past, says Dr. Ron Blankstein, a cardiovascular imaging specialist and preventive cardiologist at Harvard-affiliated Brigham and Women's Hospital.