Which Drug to Use to Reduce High Blood Pressure

Regardless of your age, much of the time high blood pressure can be controlled with just one drug. The National Institutes of Health’s National Heart, Lung and Blood Institute recommends beginning treatment with a mild water pill (diuretic) at a low dose. The safest and best studied of the diuretics is  hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE). The starting dose should be low: 12.5 to 25 milligrams per day or even every other day. Confirming the advice we have been giving since 1988 is a large definitive study (named ALLHAT) involving more than 33,000 patients aged 55 or older that found “compelling evidence that thiazide diuretics (such as hydrochlorothiazide or chlorthalidone) should be the initial drug of choice for patients with hypertension.” Thus, the widespread prescribing practice—spurred on by massive advertising—of starting people with newly diagnosed hypertension with calcium channel blockers (such as Norvasc, Cardizem, or Procardia), ACE inhibitors (such as Zestril, Accupril, or Vasotec), or other drugs that are not thiazides lacks any scientific rationale.

For older adults, in general, the rule for treating high blood pressure, as with so many other drug treatments, is “start low and go slow.” According to experts in prescribing for older adults, for mild hypertension (or heart failure) start with half the standard starting dose and increase gradually.

If a second drug is needed the National Heart, Lung, and Blood Institute recommends  beta blockers, although they are not as effective in older adults as they are in younger adults. Because of this, beta-blockers should never be used as the first drug in treating high blood pressure in older adults. ACE inhibitors are also effective drugs to use as a second agent. It is rarely necessary to take more than two drugs to treat high blood pressure. If you are taking more than two, a reassessment is indicated.

Cholesterol-lowering Drugs

Mevacor (Lovastatin), Pravachol (Pravastatin Sodium), Zocor (Simvastatin) and Lipitor (Atorvastatin) are members of the statin family of cholesterol-lowering drugs. The statin drugs work by inhibiting an enzyme that is responsible for the production of cholesterol in the body. Like all cholesterol-lowering drugs, these drugs should be used in addition to a diet restricted in saturated fat and cholesterol only when the response to diet and other non-drug treatment measures, including exercise, has been inadequate.

Mevacor, Pravachol, and Zocor are sometimes referred to as “natural statins” because they are similar to chemicals produced naturally by fungi.

The major FDA-approved uses for Mevacor are to reduce the risk in individuals without symptomatic cardiovascular disease, and with moderately elevated cholesterol levels, of heart attack, unstable angina (chest pain), and the need for coronary revascularization procedures such as angioplasty or heart bypass surgery.

Pravachol was approved by the FDA as the primary drug for individuals without clinically evident coronary heart disease to reduce the risks of heart attack, revascularization procedures such as angioplasty and heart bypass surgery, and cardiovascular mortality, without increasing the risk of death from noncardiovascular causes.

Pravachol is also approved for the secondary prevention of cardiovascular events. Secondary prevention refers to reducing the risk of a serious outcome in individuals who already have clinically evident coronary heart disease. Pravachol is approved to reduce the risk of coronary death, heart attack, coronary revascularization procedures, stroke and stroke/transient ischemic attack (TIA), and to slow the progression of coronary atherosclerosis.

The FDA has approved Zocor for use in individuals at high risk of coronary events because of existing coronary heart disease, diabetes, peripheral vessel disease, history of stroke, or other cerebrovascular disease. In this group of patients this statin is approved to reduce the risk of coronary heart disease death, nonfatal heart attack and stroke, coronary and noncoronary revascularization procedures.

Lipitor has been approved for use in adult patients who either have clinically evident coronary heart disease or multiple risk factors for coronary heart disease, to reduce the risk of heart attack (myocardial infarction), stroke, angina, and to reduce the need for certain surgical procedures such as angioplasty or bypass surgery that restore blood flow to the heart or other organs (revascularization). In addition, for patients who have coronary heart disease, the drug is approved to reduce the risk of hospitalization for congestive heart failure.

A Patient Package Insert was added to the Lipitor product label to provide patients with information about taking this drug.

In early 2003, a highly publicized study comparing a high dose of Lipitor to a standard dose of Pravachol (PRAVACHOL) found that Lipitor was better in reducing a combination of adverse cardiovascular events in people who had recently been hospitalized with a heart attack or angina. Although this combination of subsequent events was reduced by Lipitor (compared with Pravachol), there was no significant reduction in the incidence of heart attacks alone or strokes alone.

In 2006, the FDA revised the professional product label of Lipitor to include information from a large study that examined the effects of statin drugs on patients who had a recent stroke. The study showed that patients taking Lipitor who had a hemorrhagic stroke within the six months preceding the study appeared to be at an increased risk for hemorrhagic stroke compared to patients who taking a dummy pill with no medicinal value, known as a placebo.

The consumer’s “gold standard” for knowing the health benefits, if any, of a prescription drug is the FDA-approved professional product labeling for that drug. It is clear from the FDA-approved labeling for the statins that Mevacor, Pravachol, Zocor, and Lipitor should be used in preference to rosuvastatin (CRESTOR) or fluvastatin (LESCOL) because of acceptable scientific evidence of a health benefit, rather than just the ability to lower cholesterol.

The statin drugs appear to share psychiatric risks with other cholesterol-lowering drugs. Aggressive behavior; memory impairment; mood changes; and cognitive, sleep and perception disorders, such as nightmares, have been reported with the use of many drugs used to treat high cholesterol: the statins, fenofibrate (TRICOR), gemfibrozil (LOPID), ezetimibe (ZETIA) , and clofibrate, Though researchers have not yet established a direct link between these reports and the use of the cholesterol-lowering drugs listed, patients should be alert to this possibility and report unexpected changes to their doctor. Potentially, statin-induced memory impairment could be mistaken for other conditions such as early Alzheimer’s disease. This could result in the prescribing of a drug to treat Alzheimer’s when it is not needed.

In the October 2005 issue of the Canadian Adverse Reaction Newsletter, 19 case reports of memory loss or impairment associated with the use of a cholesterol-lowering statin drug were analyzed. Potentially, statin-induced memory impairment could be mistaken for other conditions such as early Alzheimer’s disease. This could result in the prescribing of a drug to treat Alzheimer’s when it is not needed.

Video joke about Abilify

Seriously:

Call your doctor immediately if you experience:

• anxiety or nervousness
• blood pressure increases or decreases
• difficult breathing
• increased sweating
• loss of bladder control
• chest pain
• confusion
• convulsions
• sudden loss of consciousness
• tiredness
• unusually pale skin
• lip smacking
• puffing of cheeks
• uncontrolled chewing movements
• uncontrolled movements of arms and legs
• dizziness, fainting, lightheadedness
• facial grimace
• feelings of depression, euphoria, or suicide
• fever
• flulike symptoms
• faster or slower heartbeats
• hostility
• involuntary movements of all extremities, twisting, snakelike movements
• twitching muscles
• severe muscle stiffness
• pneumonia
• restlessness that is extreme, urgent need of movement
• blue-black, greenish-brown, or yellow patches on skin
• difficulty swallowing
• swelling of ankles or feet
• thirst
• tremor
• blurred vision
• difficulty walking

Call your doctor if you continue to experience:

• appetite decrease
• constipation
• fear
• inability to sit still
• lack of or loss of strength
• lightheadedness
• nervousness
• rash
• trouble sleeping
• blurred vision
• coughing
• fever
• runny nose
• prolonged drowsiness
• inflamed or irritated eyes
• headache
• muscle cramps
• nausea or vomiting
• dry or itchy skin
• profuse sweating
• undesired weight gain

Other adverse effects are possible. Check with your doctor about any concerns.

Signs of overdose:

• sleepiness or unusual drowsiness
• vomiting

Abilify. FDA Approved

Abilify was approved by the FDA for the treatment of schizophrenia in November 2002. On March 1, 2005, it was approved as a maintenance therapy for Bipolar disorder.

The Food and Drug Administration (FDA) issued a public health advisory on April 11, 2005, to warn that the drugs known as the atypical antipsychotics are associated with an increased risk of death when used to treat dementia in elderly patients.

The atypical antipsychotics affected by the FDA advisory are Aripiprazole (ABILIFY), olanzapine (ZYPREXA), quetiapine (SEROQUEL), risperidone (RISPERDAL), clozapine (CLOZARIL) and ziprasidone (GEODON). None of these drugs, however, are approved for the treatment of behavioral disorders in patients with dementia.

Abilify is a member of a relatively new family of drugs known as atypical antipsychotics. These drugs are also being referred to as second-generation antipsychotics. All antipsychotic drugs usually improve symptoms such as agitation, delusions, hallucinations, and suspiciousness. Atypical antipsychotics additionally tend, more than the older antipsychotics, to improve negative symptoms such as apathy, disorientation, emotional withdrawal, and lack of pleasure. However, there is no clear evidence that atypical antipsychotics are more effective or are better tolerated than the older conventional antipsychotics such as haloperidol (HALDOL).

Three of the five short-term trials submitted to the FDA for Abilify’s approval showed the efficacy of the drug in doses ranging from 10 milligrams to 30 milligrams per day. There appeared to be no therapeutic advantage of the 30 milligram dose over the lower doses. The FDA-approved dose for the drug ranges from 10 milligrams to 15 milligrams per day. Of the two remaining studies, Abilify could not be differentiated from placebo in one, and the other trial failed.One of our reviewers suggests starting with the new 5 milligram dose to minimize the risk of adverse effects.

These trials were not conducted in a way to make direct comparisons between Abilify and haloperidol or risperidone, which were used as comparator drugs. And nothing in these five trials can lead one to believe that Abilify is a meaningful advancement in the treatment of schizophrenia.

The editors of the highly respected Medical Letter on Drugs and Therapeutics concluded in their evaluation of Abilify that “published comparisons with other atypical antipsychotics are needed to determine its relative efficacy and safety.”

We are concerned about the possibility of eye toxicity with the use of Abilify. The studies done in rats before the drug was approved clearly showed degeneration of the retina in animals receiving Abilify. The studies done in mice and monkeys found no retinal degeneration, but they were invalid studies. The company committed to doing additional postmarketing research on retinal degeneration in animals as a condition for the approval of Abilify. These are studies that clearly should have been completed before the drug was approved.

There are additional findings from the FDA’s safety review of Abilify that are important. An alteration in the electrical conduction of the heart known as QT prolongation is an important safety issue with both old and new antipsychotic drugs. QT prolongation can lead to life-threatening heart rhythm disturbance.

There was no evidence of QT prolongation with Abilify at doses up to 30 milligrams per day. However, in a special study that explored doses of the drug up to 90 milligrams per day, there was substantial prolongation of the QT interval at doses of 75 milligrams and 90 milligrams per day.

In February 2005, the French regulatory agency warned of a risk of stroke associated with the use of Abilify. In three 10-week placebo controlled trials of Abilify, strokes and transient ischemic attacks (small strokes caused by a temporary blockage of blood flow to part of the brain) were twice as frequent among patients taking arpiprazole. Two of the patients who had strokes died.

In March 2005, the FDA revised the product package label of apiprazole regarding an increased incidence of cerebrovascular adverse events (stroke and transient ischemic attacks), including fatalities in Abilify-treated patients. Abilify is not approved for the treatment of patients with dementia related psychosis.

Weight gain has also been a problem with the antipsychotic drugs, particularly with the atypical antipsychotics. In the short-term trials, there was a small difference in average weight gain between Abilify and placebo patients. The patients given Abilify gained on average 1.5 pounds, while the placebo patients lost 0.1 pounds on average. The number of patients gaining more than 7% of their body weight who were taking Abilify was equal to 8%, compared to 3% of the placebo patients.

Mizoprostol Cytotec

Misoprostol Cytotec is used to prevent ulcers, especially, stomach, by the action of aspirin, ibuprofen and other analgesics commonly used in arthritis. Analgesics may cause serious harm, even lead to death from bleeding in the stomach or intestine. Misoprostol Cytotec is a synthetic prostaglandin, which can protect the gastric mucosal shell and moderately reduce the formulation of hydrochloric acid in the stomach.

The group of high-risk ulcerous diseases as a result of analgesics side effects includes older patients, whose body weakened by disease and patients suffered particularly from ulcerous diseases. Misoprostol Cytotec should apply only to patients who have previously been observed ulcerous disease. In any case, the appointment of such patients at the same time acting analgesics and Misoprostol Cytotec can be justified only in the event of severe arthritis. Treatment ulcerous illness in smokers has been slower.

For older patients, which represent a group at high risk of complications ulcerous development of the disease, there is also a high risk of developing complications from accepting Misoprostol Cytotec. It was shown that Misoprostol Cytotec affects the metabolism of bone tissue in animals and in the chemical markers of bone metabolism in tissues in humans. Although the drug is intended for implementation of the older patients suffering from arthritis, which form a group of the risk of osteoporosis (bone weakening and depletion), from the manufacturer, there is little information on the effects of Misoprostol Cytotec on the human skeleton, with a lengthy admission of the drug.

Diarrhea is a common side effect of Misoprostol Cytotec and has varying degrees of severity from mild to severe, poses a threat to life. Do the elderly loss of fluids and minerals with diarrhea can lead to the fall of blood pressure or lead to a breach of heart, kidney and impair mental condition. Misoprostol Cytotec causes diarrhea among a significant number of patients are not carrying the drug. In clinical studies diarrhea observed in the 14-40% of cases.

Medical Parasitology - Neurocysticercosis, Pinworms, Etc.

ALBENDAZOL. New opportunities of the worms infections cure

People familiar with the diseases caused by parasitic worms (de-worming) from the times of great antiquity.Now we have high protivogelmintnye synthesized drugs. Their feature is the low toxicity. Many of these drugs are very important property-polivalentnost action, that is acting on several parasites. One of the most interesting and effective deworming drugs is Albendazole.

Albendazole, marketed as Albenza is a member of the benzimidazole compounds. One of this group of compounds synthesized such a drug, commonly known as Mebendazole issued also called vermoks (vormin). But Albendazole far exceeded Mebendazole both efficiency and breadth spectrum.

Albendazole is effective against most threadworms (pinworms), roundworms, whipworms, tapeworms and hookworms. Perhaps today it is a single deworming drug with such a wide range of actions.