With 3,480 pages of fine print, the Physicians' Desk Reference (a.k.a. PDR) is not a quick read. That's because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication — a humongous sleeping pill.
Doctors count on this compendium to help them make smart prescribing decisions — in other words, to choose drugs that will solve their patients' medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don't stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body.
Of course, plenty of M.D.'s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it
Advair
It's asthma
medicine ... that could make your asthma deadly. Advair contains the
long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19
trials, published in the Annals of Internal Medicine, found that
regular use of LABAs can increase the severity of an asthma attack.
Because salmeterol is more widely prescribed than other LABAs, the
danger is greater — the researchers estimate that salmeterol may
contribute to as many as 5,000 asthma-related deaths in the United
States each year. In 2006, similarly disturbing findings from an
earlier salmeterol study prompted the FDA to tag Advair with a "black
box" warning — the agency's highest caution level.
Your
new strategy: No matter what you may have heard, a LABA, such as the
one in Advair, is not the only option, says Philip Rodgers, Pharm.D., a
clinical associate professor at the University of North Carolina school
of pharmacy. For instance, if you have mild asthma, an inhaled
corticosteroid such as Flovent is often all you need. Still wheezing?
"Patients can also consider an inhaled corticosteroid paired with a
leukotriene modifier," says Dr. Rodgers. This combo won't create
dangerous inflammation, and according to a Scottish review, it's as
effective as a corticosteroid-and-LABA combo.
Avandia
Diabetes
is destructive enough on its own, but if you try to control it with
rosiglitazone — better known by the brand name Avandia — you could be
headed for a heart attack. Last September, a Journal of the American
Medical Association (JAMA) study found that people who took
rosiglitazone for at least a year increased their risk of heart failure
or a heart attack by 109 percent and 42 percent, respectively, compared
with those who took other oral diabetes medications or a placebo.
The
reason? While there have been some reports that Avandia use may cause
dangerous fluid retention or raise artery-clogging LDL cholesterol, no
one is sure if these are the culprits. That's because the results of
similar large studies have been mixed. So the FDA has asked
GlaxoSmithKline, the maker of Avandia, to conduct a new long-term study
assessing users' heart risks. There's only one problem: The study isn't
expected to start until later this year.
Your
new strategy: Stick with a proven performer. "I prefer metformin, an
older, cheaper, more dependable medication," says Sonal Singh, M.D.,
the lead author of the JAMA study. "Avandia is now a last resort." Dr.
Singh recommends that you talk to your doctor about
cholesterol-lowering medicines, such as statins or the B vitamin
niacin. Swallowing high doses (1,000 milligrams) of niacin daily may
raise your HDL (good) cholesterol by as much as 24 percent, while at
the same time lowering your LDL and triglyceride levels.
Celebrex
Once
nicknamed "super aspirin," Celebrex is now better known for its side
effects than for its pain-relieving prowess. The drug has been linked
to increased risks of stomach bleeding, kidney trouble, and liver
damage. But according to a 2005 New England Journal of Medicine study,
the biggest threat is to your heart: People taking 200 mg of Celebrex
twice a day more than doubled their risk of dying of cardiovascular
disease. Those on 400 mg twice a day more than tripled their risk,
compared with people taking a placebo.
And
yet Celebrex, a COX-2 inhibitor, is still available, even though two
other drugs of that class, Bextra and Vioxx, were pulled off the market
due to a similar risk of heart damage. The caveat to the consumer? In
2004, the FDA advised doctors to consider alternatives to Celebrex.
Your
new strategy: What you don't want to do is stop swallowing Celebrex and
begin knocking back ibuprofen, because regular use of high doses of
nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to
gastrointestinal bleeding. A safer swap is acupuncture. A German study
found that for people suffering from chronic lower-back pain,
twice-weekly acupuncture sessions were twice as effective as
conventional treatments with drugs, physical therapy, and exercise. The
strategic needling may stimulate central-nervous-system pathways to
release the body's own painkillers, including endorphins and
enkephalins, says Duke University anesthesiologist Tong-Joo Gan, M.D.
You can find a certified acupuncturist in your area at medicalacupuncture.org/findadoc/index.html.
Ketek
Most
bacteria in the lungs and sinuses don't stand a chance against Ketek,
but you might not either. This antibiotic, which has traditionally been
prescribed for respiratory-tract infections, carries a higher risk of
severe liver side effects than similar antibiotics do. "Ketek can cause
heart-rhythm problems, can lead to liver disease, and could interact
poorly with other medications you may be taking," says Dr. Rodgers.
"Unfortunately, it's still available, and although many doctors are
aware of the risks, some may still prescribe it without caution." In
February 2007, the FDA limited the usage of Ketek to the treatment of
pneumonia.
Your
new strategy: Can't imagine catching pneumonia? The last time the
Centers for Disease Control and Prevention calculated the top 10
killers of men, this deadly lung infection (along with the flu) came in
seventh. Avoid backing yourself into a corner where you might need
Ketek by always signing up for your annual flu shot — if you have
pneumonia, it'll reduce your risk of dying of the infection by 40
percent. And if you still end up staring at a scrip for Ketek, Dr.
Rodgers recommends asking to be treated with one of several safer
alternatives, such as Augmentin or the antibiotics doxycycline or
Zithromax.
Prilosec and Nexium
Heartburn
can be uncomfortable, but heart attacks can be fatal, which is why the
FDA has investigated a suspected link between cardiac trouble and the
acid-reflux remedies Prilosec and Nexium. In December 2007, the agency
concluded that there was no "likely" connection. Translation: The
scientific jury is still out. In the meantime, there are other reasons
to be concerned. Because Prilosec and Nexium are proton-pump
inhibitors, they are both incredibly effective at stopping acid
production in the stomach — perhaps too effective.
A
lack of acid may raise your risk of pneumonia, because the same stuff
that makes your chest feel as if it's burning also kills incoming
bacteria and viruses. You may also have an elevated risk of bone loss —
in the less acidic environment, certain forms of calcium may not be
absorbed effectively during digestion. "The risk of a fracture has been
estimated to be over 40 percent higher in patients who use these drugs
long-term, and the risk clearly increases with duration of therapy,"
says Dr. Rodgers.
Your
new strategy: When you feel the fire, first try to extinguish it with
Zantac 150 or Pepcid AC. Both of these OTC products work by blocking
histamine from stimulating the stomach cells that produce acid. Just
know that neither drug is a long-term fix.
"To really cure the problem, lose weight,"
says Michael Roizen, M.D., chief wellness officer at the Cleveland
Clinic and co-author of "YOU: The Owner's Manual." That's because when
you're overweight, excess belly fat puts pressure on and changes the
angle of your esophagus, pulling open the valve that's supposed to
prevent stomach-acid leaks. This in turn makes it easier for that
burning sensation to travel up into your chest.
Visine Original
What
possible harm to your peepers could come from these seemingly innocuous
eyedrops? "Visine gets the red out, but it does so by shrinking blood
vessels, just like Afrin shrinks the vessels in your nose," says Thomas
Steinemann, M.D., a spokesman for the American Academy of
Ophthalmology. Overuse of the active ingredient tetrahydrozoline can
perpetuate the vessel dilating-and-constricting cycle and may cause
even more redness.
Your new
strategy: If you still want to rely on Visine, at least make sure you
don't use too many drops per dose and you don't use the stuff for more
than 3 or 4 days. But you'd really be better off figuring out the
underlying cause of the redness and treating that instead. If it's
dryness, use preservative-free artificial tears, recommends Dr.
Steinemann. Visine Pure Tears Portables is a good choice for moisture
minus side effects. On the other hand, if your eyes are itchy and red
because of allergies, pick up OTC antiallergy drops, such as Zaditor.
It contains an antihistamine to interrupt the allergic response but no
vasoconstrictor to cause rebound redness.
Pseudoephedrine
Forget
that this decongestant can be turned into methamphetamine. People with
heart disease or hypertension should watch out for any legitimate drug
that contains pseudoephedrine. See, pseudoephedrine doesn't just
constrict the blood vessels in your nose and sinuses; it can also raise
blood pressure and heart rate, setting the stage for vascular
catastrophe. Over the years, pseudoephedrine has been linked to heart
attacks and strokes. "Pseudoephedrine can also worsen symptoms of
benign prostate disease and glaucoma," says Dr. Rodgers.
Your
new strategy: Other OTC oral nasal decongestants can contain
phenylephrine, which has a safety profile similar to pseudoephedrine's.
A 2007 review didn't find enough evidence that phenylephrine was
effective. Our advice: Avoid meds altogether and clear your nasal
passages with a neti pot, the strangely named system that allows you to
flush your sinuses with saline ($15, sinucleanse.com).
University of Wisconsin researchers found that people who used a neti
pot felt their congestion and head pain improve by as much as 57
percent. Granted, the flushing sensation is odd at first, but give it a
chance. Dr. Roizen did: "I do it every day after I brush my teeth," he
says.
A morbidly obese man with a large abdominal pannus (image at right)
came in exhibiting red, irritated skin around the abdomen. It looked
like a routine skin infection. But what was the cause? During the exam,
I lifted the pannus and a turkey sandwich fell from between his folds.
The man said it was about a month old, which the smell confirmed.
A woman living alone with multiple medical problems came in complaining
of odor and itching of her feet. In what was left of both of her feet 
An older gentleman man came in with many complications from his
diabetes. I went to take off his socks and as I began to examine him,
the tip of his second toe broke off into my hand like a piece of turkey
bacon. It was dry gangrene.
Periodically, men have arrived in the ER with the same complaint:
"Doctor, my junk is purple." The culprit is always a metal cock ring
that got stuck. I've learned that regular ring cutters available in the
ER don’t work. The time it takes to get more powerful (and cringe
inducing) wire cutters does not help calm the patient’s nerves.
An elderly woman from a nursing home was brought in and complained of a
"large ball” between her legs. It was her uterus, which had come out of
her vagina. When one gets older everything starts to sag, and in some
cases hang out, including the uterus and rectum.
A man came in complaining of pain and bleeding from down below. He was
trying to quit smoking and had replaced cigarettes with sunflower
seeds, eating them shell and all whenever he got the urge.
A woman came in complaining of pain in her pelvis, so the doctor put
her in the stirrups and performed a pelvic exam. He immediately removed
the problem -- a set of car keys. The woman explained she didn’t want
her boyfriend taking the car, so she hid the keys in a place where “he
never goes”.
A patient came in with a very simple case: a toilet bowl scrubber had
become lodged in his rectum. Curiously, he wasn’t sure how it got there.
