Hold the heartburn on Thanksgiving

For many people, the Thanksgiving feast means overindulging, which can lead to a bout of indigestion and heartburn. But the easiest way to manage heartburn is to prevent it from happening in the first place. Keep your belly jolly this turkey day by trying these simple steps:

• Cut back on caffeine and alcohol
• Eat smaller meals
• Eat fewer fatty foods
• Go easy on spicy foods
• Give up smoking

If your heartburn is still bothering you, adjusting your bed may help soothe your stomach at night. Raise the head of your bed using wooden blocks, so that your head is higher than your feet. One small study found this helped ease heartburn symptoms.

A longer range strategy is losing weight if you need to, which may give you another reason to hold back on that second helping of stuffing during Thanksgiving.

If the diet changes don’t bring relief, then it may time to try a medicine. Your first and best bet is to try an inexpensive over-the-counter antacid like Maalox, Mylanta, Rolaids, Tums, or acid-reducing drugs called H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). All of those products are available without a prescription as low-cost generics.

If your heartburn persists and you experience it twice a week or more for weeks or months on end, then you should see a doctor because you may have gastroesophageal reflux disease, or GERD. This is a serious condition that can cause damage to your esophagus, if left untreated. The good news is that drugs called proton pump inhibitors, or PPIs, can help keep GERD under control. In our Best Buy Drug report, we recommend two over-the-counter proton pump inhibitors as your best first option if you have been diagnosed with GERD:

•   Prilosec OTC
•   Generic omeprazole OTC

Another option might be the nonprescription version of Prevacid, called Prevacid 24HR, which recently hit store shelves earlier this month.

All of these are just as effective and safe as more expensive PPIs but remember, if you are having an acute bout of heartburn on Thanksgiving day, a PPI should not be what you reach for first.  In most cases, an antacid or an acid-reducing H2 blocker is all you need.

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs

Obesity drug Meridia may raise risk of heart attack, stroke, death

The weight-loss drug Meridia may be another example of the treatment being worse than the disease. Early data from a recent study suggests that people taking Meridia (sibutramine) face a higher risk of heart attack, stroke and death than those on a placebo pill. But the Food and Drug Administration isn’t raising a red flag on Meridia just yet. The agency says it is still analyzing the data before drawing any conclusions, but adds that the findings underscore the recommendations on Meridia’s labeling that people with a history of heart problems or stroke should not take it.

In the meantime, we’ve been concerned about the heart risks posed by Meridia for more than a decade, since it was first approved by the FDA in 1997 for the treatment of obesity. We’ve categorized it as a high-risk drug you should avoid if you have heart disease, high blood pressure or other significant health issues that might make you vulnerable.

Ironically, the study in question, which was conducted by Abbott Pharmaceutical, the manufacturer of Meridia, was designed to show that the drug reduced the risk of cardiovascular problems. Approximately 10,000 people who were 55 or older participated in the study. All were overweight or obese and had a history of heart disease or type 2 diabetes, plus one other factor that upped their cardiovascular risk. A preliminary analysis found that 11.4 percent of those on Meridia suffered a heart attack, stroke, or death, compared with just 10 percent of those on placebo.

The FDA said it is conducting an expedited safety review of Meridia and will announce its conclusion when finished. The agency also urged people taking the drug to report any adverse events they’ve experienced to FDA's MedWatch Adverse Event Reporting program.

So if drugs aren’t the answer to losing weight, what are your options? In general, we advise against the use of diet pills because the benefits are often marginal at best and sometimes come with dangerous side effects. Better and safer ways to shed pounds include healthy exercise and diet changes. For more on safe and effective weight loss strategies, compare treatments to see what works best (subscribers only).

—Steve Mitchell, associate editor, Consumer Reports Best Buy Drugs 

Study adds weight to case against cholesterol drug Zetia

 
Bad news continues to buffet the once-blockbuster cholesterol drug ezetimibe, which is sold under the brand name Zetia. Backing up research released last year, a new study has found that ezetimibe does not reduce fatty build-ups in the arteries, despite lowering levels of "bad" (LDL) cholesterol in the blood. On the other hand, one of the oldest treatments for high cholesterol—the B vitamin niacin—seems to help on both counts, say the researchers.

The study included 363 people with heart disease, or a high risk of the disease, who had been taking drugs called statins for several years to lower their cholesterol. Statins are the usual go-to drug when changes in diet and exercise don't reduce a person's cholesterol enough. But sometimes even statins fall short and people need additional treatment. Ezetimibe was approved by the FDA as a supplemental treatment, and for occasional use on its own, in 2002. Besides Zetia, you can also get a pill called Vytorin that combines ezetimibe with a statin (the earlier research looked at this combined form).

In the new study, half the people took ezetimibe and half took an extended-release version of niacin, in addition to their statin. All had regular ultrasound scans to check the narrowness of the arteries in their necks. The level of build-up in these blood vessels can help predict a person's risk of having a heart attack or stroke.

Simple, cheap remedy for toenail fungus

I used to cringe when my yoga instructor told us to “take off your socks.” The big toenail on my right foot was an ugly flakey brownish gray, a condition I’ve had for years. It may have started when I was taking Tae Kwon Do and kept landing on my big toe while trying to do roundhouse kicking.

I don’t know which is more embarrassing, having a discolored toenail or being the only one in yoga class with socks on. I was also unhappy at the beach and the community pool in the summer. Yeah, I could paint my toenails, but I was hoping that if I let that big toe breathe, it would eventually get better.

The toe was not only discolored but sometimes uncomfortable, so I went to a podiatrist who said he thought I had a nail fungus and gave me a liquid topical with a brush (much like nail polish) to apply daily.  This I did for months and months without any noticeable change. I returned to the podiatrist and he clipped a piece of the nail to be analyzed, and it was confirmed, I had a fungus. He sent me for blood tests because the next form of treatment would be Sporanox (itraconazole), a prescription antifungal pill that carries serious health warnings and precautions. At first, it seemed as though the Sporanox was going to work and then the fungus returned. I was then given another liquid topical and another antifungal medicine.

Buzzword: Teeth bleachorexia

What does it mean? Bleachorexia is the compulsion for ever-whiter teeth.

Why the buzz? Americans have been snapping up at-home tooth whitening kits. We spent $343 million in 2008 on these products, which claim to give you a brighter smile in a week or so. And they can brighten teeth somewhat, our tooth whitener tests show. But how much tooth bleaching is too much? Can a person overdo it by wearing teeth whitening strips or trays too often?

The American Dental Association thinks so. While tooth whiteners may seem as innocuous as toothpaste, the ADA says if they’re applied improperly the chemicals in the products might damage your gums and teeth. And unsupervised use might mask an undiagnosed medical condition or an unknown allergy. 

Moreover, tooth whiteners are not regulated by the Food and Drug Administration. And some important information about the products is often missing from their labels. For example, last year the European Scientific Committee on Consumer Products recommended that home tooth-bleaching products contain no more than 6 percent hydrogen peroxide. But none of the eight tooth whiteners tested and rated (available to subscribers) by Consumer Reports included the peroxide percentage.

Finally, no one seems to know how often you can safely use tooth whiteners. The ADA simply says more studies are needed, especially for products containing a high concentration of hydrogen peroxide.

Q&A: Co-Q10 supplements for statin safety?

I’ve heard that people on cholesterol-lowering statin drugs should take coenzyme Q10 (Co-Q10) pills to prevent muscle damage. Does any evidence support that? —M.R.V., by e-mail 

Not enough to recommend taking the pills for that purpose. Muscle pain or, rarely, muscle damage is a known side effect of statins, and several studies have found that some of those drugs can reduce natural blood levels of Co-Q10. And extreme deficiencies of the compound can cause similar muscle problems, which then respond to Co-Q10 supplements. But no study has determined whether Co-Q10 reductions actually cause the side effect in statin users. And to our knowledge, only one small, unpublished study has indicated that the pills can relieve that adverse effect. More important, people who experience muscle discomfort while on a statin should talk to their doctor about stopping the drug, reducing the dosage, or switching to a different one rather than taking a supplement to try relieving the symptom, which might signal a more serious problem.

Drug prices increase as inflation rate declines

You may want to be extra vigilant buying brand-name prescription drugs these days. Prices for some of the most widely prescribed brands shot up an average 9% this year–the highest rate in over a decade–even as the overall inflation rate actually declined by around 1 percent.

This assessment* comes from Stephen W. Scholdelmeyer, a professor of pharmaceutical economics at the University of Minnesota’s PRIME Institute. The analysis includes drugs such as Nexium for heartburn (up 7.2%), Plavix to prevent blood clots (up 8.2%), Singulair for asthma (up 12.5%), Flomax for enlarged prostate (up 19.7%), and Fosamax and Boniva for osteoporosis (up 6.9% and 18.6%, respectively).

The analysis was done for AARP, which has closely monitored wholesale prices for a group of 219 drugs since 2002. "The pharmaceutical industry should be embarrassed when it sees its own price increases put side-by-side with the general inflation rate," said John Rother, AARP executive Vice President. "Even as the cost of most good and services drops, a person taking just one brand name drug now pays $200 more per year than a year ago."

Q&A: Preventing shingles?

A friend recently had a painful outbreak of shingles. How can I avoid that condition? —F.J.S., Franklin, N.C.

If you’re age 60 or older, you can get the shingles vaccine. About one in four adults who’ve had chicken pox will eventually experience shingles, a painful, blistering rash that occurs when the herpes zoster virus—which lies dormant in the body after a case of the pox—is reactivated by weakened immunity from age, disease, or another factor. The vaccine cuts your risk of a first outbreak in half, and reduces discomfort by about two-thirds in the event you do get shingles. (The odds of a second outbreak are much smaller, only about 1 in 20.) Your doctor should be able to provide the shot, which costs about $150 and is partly covered by most forms of insurance.

FDA cracks down on Web sites illegally selling prescription drugs

It’s buyer beware when it comes to purchasing prescription drugs over the Internet, but the Food and Drug Administration is looking to weed out some of the bad apples. The agency said it sent warning letters to 136 off-shore web sites that are illegally selling drugs to U.S. consumers.

The concern is that drugs sold by these web sites could pose a danger to consumers. "Many U.S. consumers are being misled in the hopes of saving money by purchasing prescription drugs over the Internet from illegal pharmacies," FDA Commissioner Margaret A. Hamburg, M.D., said in a statement. "Unfortunately, these drugs are often counterfeit, contaminated, or unapproved products, or contain an inconsistent amount of the active ingredient."

The agency said it also notified Internet service providers and domain name registrars that the web sites were violating U.S. law. The providers and registrars could terminate the sites or suspend use of the domain names. The FDA did not identify the web sites, but said that they did not represent U.S. or Canadian pharmacies.

FDA says RockHard Weekend may be a dangerous getaway

People who purchased RockHard Weekend, which was marketed as a sexual enhancement supplement, may have gotten much more than they bargained for. The Food and Drug Administration announced a nationwide recall of the herbal supplement because it contains an undeclared compound (sulfoaildenafil) that is similar to the erectile dysfunction drug sildenafil (Viagra), which actually makes RockHard Weekend an unapproved drug. This drug ingredient could pose a threat to unsuspecting consumers because it can lead to dangerously low blood pressure.

The Viagra-like compound, which is not listed as an ingredient in RockHard Weekend, might interact with nitrates that are found in some prescription drugs, such as nitroglycerin. This could result in a risky drop in blood pressure.

If you have experienced any side effects from use of the supplement, consult your doctor. You can also help the FDA monitor the situation by reporting your adverse events to the agency.

Q&A: Viagra and eye problems?

I take sildenafil (Viagra), which temporarily gives a blue tint to my vision. Recently I was also diagnosed with macular degeneration. Will taking sildenafil worsen that? —Name and address withheld

Probably not, but few studies have looked into it. Sildenafil affects vision by blocking an enzyme that helps the eyes process color. But the limited studies available, mostly funded by drug manufacturers, show that effect is transient and appears to have no long-term effect on eye function. A few small studies of patients with macular degeneration or glaucoma taking sildenafil have shown the drug doesn’t worsen either condition within up to five hours of taking it. 

The only eye condition that’s been associated with sildenafil use is a rare blockage of blood flow to the optic nerve that causes a sudden, permanent decrease in vision in one eye—though it’s not clear what role the drug plays, if any, in the condition. If you experience such an impairment, contact your eye doctor right away.

Read more on the side effects of sildenafil, find out if women should take Viagra, and see our Treatment Ratings for macular degeneration (subscribers only).

Avoid dangerous combination: Blood thinner Plavix with some heartburn drugs

The Food and Drug Administration warned today that people who take the blood thinner clopidogrel (Plavix) should not take the heartburn drugs omeprazole (Prilosec, Prilosec OTC, and generics) and esomeprazole (Nexium) because two new studies confirm that the combination could have dangerous consequences. The studies show that omeprazole and esomeprazole—both members of a class of stomach acid-reducing drugs called proton pump inhibitors, or PPIs—can lower the effectiveness of Plavix , putting people at risk of heart attacks or strokes.

Plavix is given to people after a heart attack to help reduce the risk of blood clots that can trigger another attack. The drug can be hard on the stomach and cause gastrointestinal bleeding, so people are often prescribed a PPI treatment, which reduces the amount of acid in the stomach and lowers the risk of stomach bleeding. But previous studies suggested this drug combination may actually increase the risk of having another heart attack. The FDA’s warning is based on two new studies from the makers of Plavix that show that both omeprazole and esomeprazole reduce the drug’s effectiveness because they block an enzyme in the body called CYP 2C19.

The agency said it does not have enough information to draw a conclusion about whether any other PPIs can be safely used with Plavix, but studies into this issue are being conducted. However, a different type of acid-reducing drug called cimetidine (Tagamet, Tagamet HB, and generics) also inhibits the CYP 2C19 enzyme and should not be taken with Plavix.

Q&A: What causes easy bruising?

I’m a 75-year-old woman who bruises easily. What could cause that? —J.B., Irvington, N.Y.

Several things. Bruises form when tiny blood vessels near the surface break, causing bleeding that discolors skin. Anything that affects those vessels or the blood’s ability to clot can lead to increased bleeding and bruising. The most likely cause is the natural thinning of the skin with age, which leaves the vessels less protected. Other causes include various drugs, notably the steroid prednisone; the blood thinners aspirin, clopidogrel (Plavix), and warfarin (Coumadin); and diseases of the blood cells, bone marrow, immune system, or certain organs. So be sure to talk with your doctor if you’ve started to bruise easily.

People with depression get strong painkillers, but do they work?

If you have chronic pain, such as back or neck aches, and also suffer from depression, you may want to think twice about the treatment your doctor has prescribed.

A new study shows that people with chronic aches who are also depressed are more likely than others to get a potent painkiller, such as morphine or codeine, but there’s no evidence these drugs are effective or safe for those who suffer from depression. The medicines also pose a risk of addiction and serious side effects.

In the study, which appears in the November-December issue of General Hospital Psychiatry, researchers examined medical records of more than 14,000 people who were prescribed opioids for three months or longer between 1997 and 2005 for chronic pain. The result: people with a history of depression were three times more likely to have been prescribed the potent painkillers. They were also more likely to receive a higher dose, and to be put on opioids that carry a higher potential for abuse or addiction, such as morphine and oxycodone (OxyContin, Percocet, and others, including generics).

FDA recalls Pai You Guo weight loss supplement

People who bought the weight loss supplement, Pai You Guo, may have gotten some extra ingredients for free, including a prescription drug and a dangerous chemical. The Food and Drug Administration said all lots of the supplement had been recalled because it contained the weight loss drug, sibutramine (Meridia), and phenolphthalein, a chemical that may cause cancer.

Both of these agents could play havoc with your health. Sibutramine may be relatively safe when used under a doctor’s supervision, but it carries some risky side effects that could prove dangerous to unsuspecting consumers. Sibutramine can increase your pulse and blood pressure and could be particularly risky for people with a history of coronary artery disease, heart failure, arrhythmias, or stroke.