Hi Dr. Lakin–
As always, the balance of benefits and risks need to be considered on a case-by-case basis and individualized to the particular person.
Hi Dr. Lakin–
In the New York Times this Sunday there was an Editorial on the topic of chemicals in our environment, organic chemicals found in many common objects and bottles, that we use every day, and the potential unknown risks they may pose. Most interesting was the connection between these chemicals and obesity.
Yes….it’s possible that your bottled water is making you fat. How? Well, there are a new category of chemicals known as ‘endocrine disrupters’. These organic chemicals are found in all sorts of plastic items, in water bottles, and in cosmetics. They can act to interfere with normal hormone action in the body, creating a change in the metabolism that can lead to many illnesses, including obesity.
Just look at the picture accompanying his article. Sobering information….about a topic that is just beginning to be uncovered.
ACTOS (Pioglitizone) is a medication for Type 2 Diabetes that works by making your own insulin work more effectively in muscle, fat, and liver tissues. It is a very effective and tolerable medication, but there are some controversies.
It has been available for over a decade and is now going generic. Since this medication is very pricey, a generic alternative is a great savings.
Recently, a patient told me that his pharmacist said ACTOS would be taken off the market due to dangerous side effects…..but this is not the case. There have been some issues with this class of medication and with ACTOS in particular, but none have been severe enough to warrant removal of this medication from use. The controversies and issues are:
1. Liver inflammation–This has rarely been a concern. Simple blood test monitoring when you begin the medication can monitor this issue.
2. Heart Failure–Another medication in this class, AVANDIA, has been known to cause issues with fluid retention in patients with congestive heart failure and is not to be used in such patients. ACTOS has not been criticized as much as AVANDIA, for this issue, but it is still a consideration with ACTOS and if you have heart failure, ACTOS is not advisable.
3. Bladder Cancer–Recent studies show a potential increased risk of bladder cancer in patients specifically on ACTOS. In fact, I have seen advertisements on TV, from lawyer groups, looking for patients who want to sue the drug manufacturer if they have bladder cancer and are on ACTOS. Whether this association is enough to warrant more caution in the future, it is unknown and the issue is under further investigation. At this time, ACTOS has a warning noted on it’s package warnings about this potential, but the severity of the association will need further data.
Controlling blood sugar is critical for the health of diabetic patients and ACTOS can be an effective medication in assisting in treatment. There are consequences of poor sugar control, just as there are side effects from medications. The balance of pro’s and con’s need to be considered for each individual patient in deciding on the need and use of ACTOS….but for now, as Mark Twain said about his premature obituary: “The reports of my death are greatly exagerated!”
Read more at:
Statin medications (LIPITOR, MEVACOR, PRAVACHOL, ZOCOR, CRESTOR) have been around for 25 years and have a proven track record of effectiveness and safety. No drug is perfect and these drugs are no exception, but the recent concerns that are raised for use of these medications are important, but should not disuade patients of using them when properly prescribed.
What are the concerns?
1. Diabetes: There is a very small risk of diabetes of these medications. It is very small and statistical. This risk does not outweigh the benefits to heart and brain from prevention of strokes and heart attacks.
2. Muscle pains: True…this is the most common side effect of these medications and if it is a real bother, the medication should be stopped or the dose lowered to prevent bothersome symptoms.
3. Memory loss: There have been some reports of transient memory loss from these medications, but I must say that I have not seen a case of this that I am certain of. Memory benefits of these medications include a presumed lowered risk of dementia by prevention of strokes and microstrokes, thus resulting in less cases of dementia is patients with associated brain damage from plaque and brain injury from underlying degenerative conditions. Although speculative, I feel this potential benefit outweighs the risks of these medications on this account.
In summary, these medications are not for ‘all people’. That is why in my patients I have selected those who will have a statistical and real benefit from treatment. We have chosen wisely….do not undo these benefits by stopping medication based on vague concerns that are not highly likely to cause you significant harm. Do discuss the issue with me directly before considering stopping the medications. I am certain you will benefit from these medications in the long run.