Recommended Diuretic Drug Tied to Harmful Side Effects

Patients taking a common diuretic to help lower blood pressure may be better off with a similarly effective but safer one, a new study suggests.

Current guidelines recommend the drug chlorthalidone (Thalitone) as the first-line diuretic. But it can have serious side effects that can be avoided with another diuretic, hydrochlorothiazide (Hydrodiuril), researchers say.

“Diuretics are recognized as among the best drugs to treat hypertension, but there are no randomized studies to help decide which diuretic is best,” said lead author Dr. George Hripcsak, head of biomedical informatics at Columbia University in New York City.

Hydrochlorothiazide is the world’s most-used diuretic, but chlorthalidone is gaining favor because it is longer acting and, therefore, might be more effective, Hripcsak said.

Guidelines from both the American College of Cardiology and American Heart Association recommend chlorthalidone for that reason.

But the new study found that patients taking chlorthalidone were three times more likely than those taking hydrochlorothiazide to have dangerously low levels of potassium and other electrolyte imbalances, as well as kidney problems.

Six percent of patients taking chlorthalidone had low potassium, compared with 2% of those taking hydrochlorothiazide. The rate remained the same even with lower doses of chlorthalidone, the researchers found.

“If you are taking chlorthalidone, then your physician should be monitoring your electrolytes and kidney function carefully,” Hripcsak said.

For the study, his team reviewed 17 years of data on more than 730,000 patients treated for high blood pressure.

While both drugs were equally effective in preventing heart attack and hospitalization for heart failure and stroke, chlorthalidone had a higher risk of side effects, the study found. Those side effects include low potassium, which can trigger abnormal heart rhythms; low salt, which can cause confusion; kidney failure; and type 2 diabetes.

This is not the first study to point out these side effects of chlorthalidone, the study authors said.

“Until stronger evidence comes out to the contrary, I believe this study tips the scales toward hydrochlorothiazide for people taking a diuretic for high blood pressure,” said study co-author Dr. Harlan Krumholz, a professor of medicine at Yale University in New Haven, Conn.

Krumholz predicted treatment guidelines might shift from a generic endorsement of chlorthalidone to a more specific statement about the drug that seems safer.

He added that both drugs seem equally effective and are both inexpensive. “The good news is that the better choice is the most commonly prescribed diuretic for hypertension,” Krumholz said.

The findings should prompt patients to discuss treatment options with their doctors, he noted.

“The evidence is strong, but it is not a clinical trial, so there remains some uncertainty,” Krumholz said. “But until stronger evidence is out, this study represents some of the best information we have — and it favors hydrochlorothiazide.”

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said that because this study looked back at data, it can’t prove that one drug is better or safer than the other.

Fortunately, Fonarow said, a large randomized trial comparing these drugs is underway with a plan to enroll 13,500 people with high blood pressure. Results are expected in 2022.

In any case, the most important thing that people with high blood pressure can do is to keep their readings in check, Fonarow said.

“It is critical for individuals with high blood pressure to achieve and maintain recommended blood pressure goals with a well-tolerated medication regimen together with lifestyle modification,” he advised.

The report was published online in JAMA Internal Medicine.

Source: HealthDay


Today’s Comic

Caution: Some Over-the-Counter Medicines May Affect Your Driving

Anyone who operates a vehicle of any type—car, bus, train, plane, or boat—needs to know there are over-the-counter medicines that can make you drowsy and can affect your ability to drive and operate machinery safely.

Over-the-counter medicines are also known as OTC or nonprescription medicines. All these terms mean the same thing: medicines that you can buy without a prescription from a healthcare professional. Each OTC medicine has a Drug Facts label to guide you in your choices and to help keep you safe. OTC medicines are serious medicines and their risks can increase if you don’t choose them carefully and use them exactly as directed on the label.

According to Ali Mohamadi, M.D., a medical officer at FDA, “You can feel the effects some OTC medicines can have on your driving for a short time after you take them, or their effects can last for several hours. In some cases, a medicine can cause significant ‘hangover-like’ effects and affect your driving even the next day.” If you have not had enough sleep, taking medicine with a side effect that causes drowsiness can add to the sleepiness and fatigue you may already feel. Being drowsy behind the wheel is dangerous; it can impair your driving skills.

Choosing and Using Safely

You should read all the sections of the Drug Facts label before you use an OTC medicine. But, when you know you have to drive, it’s particularly important to take these simple steps:

First, read the “active ingredients” section and compare it to all the other medicines you are using. Make sure you are not taking more than one medicine with the same active ingredient. Then make sure the “purpose” and “uses” sections of the label match or fit the condition you are trying to treat.

Next, carefully read the entire “Warnings” section. Check whether the medicine should not be used with any condition you have, or whether you should ask a health care professional whether you can use it. See if there’s a warning that says when you shouldn’t use the medicine at all, or when you should stop using it.

The “When using this product” section will tell you how the medicine might make you feel, and will include warnings about drowsiness or impaired driving.

Look for such statements as “you may get drowsy,” “marked drowsiness will occur,” “Be careful when driving a motor vehicle or operating machinery” or “Do not drive a motor vehicle or operate machinery when using this product.”

Other information you might see in the label is how the medicine reacts when taken with other products like alcohol, sedatives or tranquilizers, and other effects the OTC medicine could have on you. When you see any of these statements and you’re going to drive or operate machinery, you may want to consider choosing another medicine for your problem this time. Look for an OTC medicine that treats your condition or problem but has an active ingredient or combination of active ingredients that don’t cause drowsiness or affect your ability to drive or operate machinery.

Talk to your healthcare professional if you need help finding another medicine to treat your condition or problem. Then, check the section on “directions” and follow them carefully.

Here are some of the most common OTC medicines that can cause drowsiness or impaired driving:

  • Antihistamines: These are medicines that are used to treat things like runny nose, sneezing, itching of the nose or throat, and itchy or watery eyes. Some antihistamines are marketed to relieve cough due to the common cold. Some are marketed to relieve occasional sleeplessness. Antihistamines also can be added to other active ingredients that relieve cough, reduce nasal congestion, or reduce pain and fever. Some antihistamines, such as diphenhydramine, the active ingredient in Benadryl, can make you feel drowsy, unfocused and slow to react.
  • Antidiarrheals: Some antidiarrheals, medicines that treat or control symptoms of diarrhea, can cause drowsiness and affect your driving. One of these is loperamide, the active ingredient in Imodium.
  • Anti-emetics: Anti-emetics, medicines that treat nausea, vomiting and dizziness associated with motion sickness, can cause drowsiness and impair driving as well.

“If you don’t read all your medicine labels and choose and use them carefully,” says Dr. Mohamadi, “you can risk your safety. If your driving is impaired, you could risk your safety, and the safety of your passengers and others.”

Source: FDA


Today’s Comic

Taking Several Prescription Drugs May Trigger Serious Side Effects

Many older Americans take a variety of prescription drugs, yet new research suggests that combining various medications is not always wise.

Taking lots of different drugs for different conditions is called “polypharmacy,” and a team of researchers set out to find how doctors take this into account in their prescribing. To address this, providers discuss “deprescribing” — working with patients to cut down on unnecessary or redundant medications.

Drugs to treat high blood pressure, to thin blood and lower cholesterol are some of the most prescribed drugs in the United States, the researchers noted.

Although these medications save lives, they can cause serious reactions when mixed with other drugs.

To look at prescribing habits, researchers led by Dr. Parag Goyal from Weill Cornell Medicine in New York City and Dr. Timothy Anderson from Beth Israel Deaconess Medical Center in Boston, quizzed 750 geriatricians, general internists and cardiologists.

They got responses from 12% to 26% of these doctors.

Over 80% of the doctors who responded said that they recently considered not prescribing a cardiovascular medication and cited adverse side effects as the most common reason.

Often doctors are reluctant to halt a drug another doctor has prescribed for fear of stepping on a colleague’s turf.

Another reason for not stopping a drug is the patient’s desire to keep taking it, the researchers found.

Among geriatricians, 73% said they might discontinue a drug that was not expected to help patients who had a short time to live, compared with 37% of general internists and 14% of cardiologists.

Also, 26% of geriatricians said that they might stop prescribing drugs that affect the ability to think and made decisions, compared with 13% of general internists and 9% of cardiologists.

The report was published in the Journal of the American Geriatrics Society.

“We hope our study will contribute to advancing deprescribing as a patient-centered strategy that can improve the safety of medication prescribing practice and improve the well-being of older adults,” the researchers said in a journal news release.

If you’re one of the many who regularly take several medications and are concerned about how they work together, talk it over with your doctor.

But never stop taking a prescribed drug or make changes to your medications without speaking to a doctor first. If you have serious side effects from any drugs you’re taking, call 911 immediately, the researchers said.

Source: HealthDay


Today’s Comic

Brain Bleed Risk Puts Safety of Low-Dose Aspirin in Doubt

Amy Norton wrote . . . . . . . .

Let’s say you’re one of the millions of older adults who takes a low-dose aspirin religiously, in the belief that it will guard against heart disease and heart attacks.

Now, a new review suggests your risk of a brain bleed outweighs any heart benefit that a daily aspirin might bring you.

Researchers said the findings support a recent change to guidelines on low-dose aspirin: The blood thinner should now be reserved for people at high risk of heart attack or stroke.

Others can skip it.

The change was issued in March by the American College of Cardiology (ACC) and the American Heart Association (AHA). The groups said that while the bleeding risk with aspirin has always been known, it now appears the risk is not worth it for most people.

Instead, the average person should focus on controlling their blood pressure, blood sugar and cholesterol, eating a healthy diet, getting regular exercise and not smoking.

“All of those things are more important than taking low-dose aspirin in preventing future heart attacks and strokes,” said Dr. Meng Lee, one of the authors of the new report.

“Our findings do support the latest change to the ACC/AHA guidelines,” said Lee, of Chang Gung University College of Medicine, in Taiwan.

For the study, the investigators pooled the results from 13 clinical trials testing low-dose aspirin in older adults with no history of heart problems or stroke. On average, aspirin raised the risk of bleeding in or around the brain by 37%, the findings showed.

The risk was still small: The researchers estimate that a daily aspirin would cause an additional two brain bleeds for every 1,000 people.

But for people at lower risk of heart attack or stroke, that’s a chance they probably should not take, according to the new guidelines.

And, based on two trials, people of Asian ethnicity might be at particular risk of brain bleeding. Patients in those studies saw their risk rise by 84%.

It’s not clear why, according to Lee — but other studies have found the same pattern.

The latest finding was published online in JAMA Neurology.

If it has long been known that aspirin carries a bleeding risk, why is the advice changing now?

Research in recent years has shown that the balance of risks versus benefits has changed, explained Dr. Eugene Yang, a member of the ACC’s Prevention Section and Leadership Council.

Earlier studies did suggest that the bleeding risks with aspirin were generally outweighed by its ability to curb the odds of a first-time heart attack and stroke.

But things are different today, Yang explained. People are smoking less and there have been improvements in controlling high blood pressure and cholesterol. That means for lower-risk people, the heart benefit of aspirin has diminished — making the bleeding risk more of a concern.

Yang stressed, however, that the guideline change applies only to people without “overt” cardiovascular disease. For people with a history of heart attack or stroke, or significant narrowing in the arteries supplying the heart, brain or legs, the advice stays the same.

“In those cases, you’re trying to prevent further complications,” said Yang, who is also a clinical associate professor of medicine at the University of Washington, in Seattle.

In addition, he pointed out, aspirin is not an absolute “no” for preventing first-time complications, either.

The guidelines say people over age 70 should avoid aspirin if they do not have overt cardiovascular disease. But it may still be considered for certain people ages 40 to 70 who are at heightened risk of cardiovascular complications.

“It’s not a simple, black-and-white decision,” Yang said.

If you are currently taking aspirin and wondering if you should stop, talk to your doctor first, Yang advised.

“There could be other reasons it was prescribed, such as lowering the risk of colon cancer or to prevent blood clots,” he said.

Source: HealthDay


Today’s Comic

Is Daily Low-Dose Aspirin Really Worth It for Seniors?

Dennis Thompson wrote . . . . . . . . .

There’s disappointing news for seniors: A new trial shows that taking daily low-dose aspirin doesn’t prolong healthy, independent living in otherwise healthy people aged 70 and older.

Aspirin has long been recommended for middle-aged folks with a history of heart disease, to prevent future heart attacks or strokes.

Researchers had hoped that aspirin’s specific effects might help folks ease gracefully into their old age.

“The thinking was the double action of blood thinning and anti-inflammation might decrease the risk of dementia and disability,” explained senior researcher Dr. Anne Murray, director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis.

But a major new clinical trial has concluded that daily aspirin does not prolong disability-free survival in the elderly.

In fact, aspirin could put their health at risk by increasing the risk of bleeding in the brain and the gastrointestinal tract, researchers found.

“We were so hoping that such an inexpensive and accessible medication might be effective in prolonging healthy independent life,” Murray said.

Daily aspirin is recommended for people between 50 and 59 if they are at increased risk of heart disease, according to the U.S. Preventive Services Task Force, a guideline-setting expert panel.

For people ages 60-69 “who have a 10 percent or greater 10-year [heart disease] risk,” the decision to start low-dose daily aspirin “should be an individual one,” the USPSTF said.

However, there’s not been enough medical evidence to say whether aspirin would help elderly folks, the USPSTF says.

“It’s the first of its kind to address this question,” said Dr. Basil Eldadah, chief of the Geriatrics Branch of the U.S. National Institute on Aging. “It’s an important issue because so many older people in the United States take aspirin, and there’s not clear evidence up until now whether that’s indicated.”

To answer the question, researchers recruited just over 19,000 people in Australia and the United States with an average age of 74, and assigned half to take daily aspirin and the other half to receive a placebo.

People were recruited between 2010 and 2014, and had to be free of dementia, physical disability or any medical condition that would require aspirin use. They were followed for an average of close to five years.

Treatment with 100 milligrams of aspirin per day did not affect the chances a person would live longer free from dementia or disability, researchers found.

In fact, the group taking aspirin had a slightly increased risk of death — 5.9 percent died compared with 5.2 percent taking a placebo. However, the higher death rate was due to more cancer deaths in the aspirin group, which could have been due to chance, the researchers said.

More troubling was the fact that people taking daily aspirin suffered clinically significant bleeding.

Hemorrhagic stroke, bleeding in the brain, gastrointestinal bleeding, or bleeding at other sites that required transfusion or hospitalization occurred in 3.8 percent of people on aspirin versus 2.7 percent of people on placebo.

“There’s definitely an increased bleeding risk, and it’s not benign,” said Dr. Vincent Bufalino, a cardiologist and spokesman for the American Heart Association. “The intracranial bleeding risk is obviously a terrible complication.”

The clinical trial’s results suggest that “if seniors don’t have a valid medical need for taking aspirin, you are unlikely to benefit from it and there are some risks,” concluded lead researcher John McNeil, head of epidemiology and preventive health at Monash University in Melbourne, Australia.

However, all of the experts agreed that if you’re now taking aspirin under a doctor’s direction you shouldn’t stop until you discuss it with them, regardless of your age.

“Many people are taking aspirin for important medical reasons,” McNeil said. “It would be unwise to stop without speaking to their doctor about it.”

The clinical trial was published online as three papers in the New England Journal of Medicine.

Source: HealthDay