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News Briefs

New guidelines from the American College of Physicians (ACP) urge doctors to prescribe generic medications whenever possible, rather than more expensive brand-name medications. The guidelines were published online Nov. 24, 2015, in Annals of Internal Medicine. An ACP committee, led by Harvard Medical School's Dr. Niteesh Choudhry, analyzed more than 2,500 studies and found that brand-name prescription medications are more likely to be prescribed, but not filled. The committee also observed that people do a better job of sticking to a medication regimen if they take generics, since the drugs are cheaper and people are more likely to get prescriptions filled. (If you're more likely to take a medication, you're more likely to get better.) Do generics work just as well? The committee found that the vast majority of the evidence showed generic drugs are as effective as brand-name medications when it comes to health outcomes. If your doctor prescribes a brand-name medication, ask if there's a generic that will do the same job and save you money.

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In the Journals

Adding muscle relaxers or narcotic pain relievers to the nonsteroidal anti-inflammatory drug (NSAID) naproxen (Aleve) did not improve pain or function for people who went to emergency rooms seeking help for severe low back pain, according to a study in The Journal of the American Medical Association.

The study followed a group of 320 people who visited the same emergency room in the Bronx, N.Y. None had symptoms that would suggest disk-related back pain, like shooting pain down the back of the legs (sciatica). They were all advised to take naproxen for 10 days and were chosen at random to add one of three additional pills: the muscle relaxer cyclobenzaprine (Flexeril); ox-ycodone (Percocet), a narcotic pain reliever; or a placebo.

In the Journals

Alpha blockers, a type of medication that many men take for urinary difficulties caused by an overgrown prostate, are associated with a dangerous but very small risk of falling, according to a recent study in BMJ. This should reassure men who have heard that the drugs could cause dizziness from a sudden drop in blood pressure.

The Canadian study identified more than 147,000 men in Ontario prescribed one of three drugs: alfuzosin (Uroxatral), silodosin (Rapaflo), and tamsulosin (Flomax). Most of the men (84%) took Flomax, although all three drugs work the same way.

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Several medications can maintain or increase bone density. You can choose one based on your health and preferences.

Most of what we read about hip fracture isn't good. It is a major cause of disability, nursing home admissions, and death in older women. But there is a promising trend: hip fractures in the United States have been on the decline since 1996. Although better nutrition, increased physical activity, and education on fall prevention may have played a role, the drop in fractures has also coincided with the widespread availability of bisphosphonates—a class of drugs first approved in 1995 to increase bone density.

Flu season still has a few months left, and it is not too late to get a flu shot if you have not done so already. 
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They may help reduce symptoms of the flu, but they're not for everyone.

Ask the doctor

Q. I take my blood pressure medication twice a day. Or at least I am supposed to, but I sometimes forget the second dose because my evenings tend to be really busy. What can I do?

A. One idea is to leave a sticky note on your bathroom mirror or near your bed as a reminder. Or try using an alarm (either a traditional alarm clock or one on a smartphone) that rings close to the time when you normally go to bed. You might also consider taking the second dose with dinner, assuming your doctor or pharmacist says it is okay to take your particular medicine with food.

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New guidelines and a novel diabetes drug point to new treatment approaches.

When it comes to the cardiovascular dangers from diabetes, the statistics are pretty disheartening: about two-thirds of people with type 2 diabetes ultimately die from heart disease or a stroke. But there's progress afoot. Recently updated guidelines and a novel diabetes drug with proven heart benefits offer promise for making a dent in that dire statistic. And in a nod to the importance of early detection, the U.S. Preventive Services Task Force recently recommended that adults ages 40 to 70 who are overweight be screened for diabetes (see "Diabetes screening tests").

Research we're watching

For people who take anti-clotting drugs such as dabigatran (Pradaxa), one serious downside has been the rare but dangerous risk of uncontrolled bleeding in the event of an accident or urgently needed surgery. But in October, the FDA approved idarucizumab (Praxbind), a drug that quickly reverses the effects of dabigatran. Given by injection into a vein, the drug binds to dabigatran and neutralizes its effect, allowing the blood to clot normally.

Dabigatran was approved in 2010 to prevent strokes (most of which are caused by blood clots in the brain) in people with atrial fibrillation. It's also prescribed to prevent and treat venous thromboembolism. Because idarucizumab works specifically on dabigatran, it can't be used as an antidote for similar anti-clotting medications, which include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). However, an antidote that works on these drugs is under development, with approval expected within the next year or so.

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News briefs

Initial results of a large national clinical trial suggest that being more aggressive in treating high blood pressure may save lives. Results of the Systolic Blood Pressure Intervention Trial (SPRINT) aren't yet published, so we don't know all of the details. But from information released by the National Institutes of Health (NIH) in September, it appears that aiming for a systolic (top) blood pressure reading of less than 120 mm Hg may reduce the risk of heart attacks, strokes, and heart failure by almost a third, and reduce the overall death rate by 25%. Researchers came to this conclusion after following more than 9,000 middle-aged and older adults with high blood pressure for several years. Half of the participants took an average of two medications and set a target systolic blood pressure of less than 140 mm Hg, the current recommended number. The other half took an average of three medications and aimed for a systolic blood pressure of less than 120 mm Hg. The results in the lower-target group were so impressive that NIH stopped the study early to share the news. Does this mean you should add more pills to your blood pressure treatment? "Not necessarily, because there may be more drug side effects. But if you're aiming for a lower number, I think it will be critical to rely on lifestyle modification, such as stress reduction, diet, salt restriction, and exercise, in addition to medication to lower blood pressure," says Dr. Randall Zusman, a cardiologist and Harvard Medical School associate professor.

Ask the doctor

Q. I've read news reports that the heartburn drug I take may cause heart attacks. Should I worry about this?

A. Several studies have reported an association between proton-pump inhibitors (PPIs) and heart attacks. PPIs are medications for heartburn, such as omeprazole (Prilosec) and pantoprazole (Protonix). Overall, however, the evidence suggests these medications are not risky for your heart.