“New” pill for obesity?

Gelesis 100 has  been in development  for the past 15 years and if approved by the FDA would be classified as a medical device and not as a medication. It contains hydrogel which expands in the stomach. This stretches the stomach walls and tricks the brain into thinking you are full. It has been studied for 15 years and has been shown to be safe and effective (11% weight loss on average). If this concept sounds familiar, it was originally called “ATTIVA”. The reason it is probably taking so long to get FDA approval probably is due to the many side effects and heart and lung complications that prior weight loss medications have caused in the past. What is interesting is that this may render surgical weight loss  procedures obsolete!

Best medical treatment to quit smoking

Am J Psychiatry, June 17, 2014

Many patients try nicotine replacement products in an attempt to quit smoking, but are rarely successful. E-cigarettes have not only been proven to be ineffective, but they are probably also not safe. Currently, the FDA bans the sale of these products to minors. Behavior therapy, hypnosis and acupuncture may help some people but the results are variable. The reason most people cannot quit smoking is that they are psychologically addicted as opposed to being physically addicted. The best success I have seen over the years involves the antidepressant buproprion (Wellbutrin, Zyban). Several years ago, the FDA approved CHANTIX for patients who could not quit smoking using other methods. Once again, the benefits vary from patient to patient. Now, the results of several intuitional studies have shown that by combining Chantix and Bupropion MALE SMOKERS had success rates much higher than when these medications were used alone. Nicotine patches were not even close. What is interesting is that these findings were not seen in women.

Bupropion is well tolerated but many patients have a fear of using CHANTIX due to behavior changes and suicidal thoughts. Just because a medication may have serious side effects, it doesn’t mean that it occurs in everyone. All medications should be taken under strict physician supervision and side effects reported immediately.

As always, we have to weigh risks vs benefits and I’m still trying to find any benefits in smoking!

Risks of heart attacks in older patients using testosterone

There has been a lot of controversy over the use of testosterone in older males because of recent studies showing a 25% higher risk of getting heart attacks. What’s interesting is that most studies prior to last year actually showed a decrease in heart disease. Yes, there are side effects to using testosterone-the latest being thrombophlebitis (blood clots in the legs-no know reason at this time) Here is a retrospective study from the University of Texas which looked at 6355 men over 65 who got at least one testosterone injection between 1997 and 2005 and compared them to 19,000 men who have never used any testosterone products. Not only did they not see an increase in heart attacks, but actually saw fewer! The researchers did not study topical testosterone products and there are no testosterone pills available. Research is not a perfect science and many bad outcomes in the past and have been changed.

(Anyone remember how dangerous coffee was and the subsequent cancer scare in the 1980’s? Now it’s considered to be very healthy-especially in women who drink 3-4 cups daily!))

Low testosterone is very common and may have serious adverse effects on quality of life issues. Once again, we always weigh the benefits vs risks, but hopefully this study and more like these will help both physician and patient make better decisions about their medical care.

Great app to help with medication costs

Recently I wrote about a phone app called GOOD Rx which allows you to compare prescription prices at local pharmacies.

I have also discovered another app that tells you how to get help buying mediations that you may have trouble affording. This app is called “NEEDYMEDS” and is also free. If you don’t have a smart phone, you can also find this on your computer under www.needymeds.org.

On this site, you type in the prescription that you need and it will take you directly to the pharmaceutical company’s assistance program.

The nice thing about this program is that help for both uninsured and insured (including Medicare donut hole) patients may qualify.

What’s in your pill box?

Many patients who take multiple medications will use pillboxes or other pill organizers to improve compliance with taking their medications.

This can be especially helpful for the elderly or during travel.

Many pills can be placed in a pillbox, however some must be kept in their original vials to maintain potency.

Orally disintegrating tablets are sensitive to moisture and others may be sensitive to light.

Some medications simply lose their potency when taken out of the original containers.

If you have any questions, ask your pharmacist.  They can even recommend the proper pillbox for you.

Diabetes and Pancreatitis

BMJ 2014;348:g2780
This blog is for my diabetic patients who are worried about one the best types of drugs to treat diabetes

Many patients are afraid to take INCRETIN based medications for their diabetes because of their (unfounded) concerns over the risks of getting pancreatitis (this is an incredibly painful condition that will require hospitalization). Insurance LOVE these fears because they do not want you to use the best medications available-just the cheapest!

Examples of INCRETIN drugs would be JANUVIA, ONGLYZA, BYETTA and VICTOZA. A 5 year study evaluating patients in the United Kingdom for 2007 to 2012 showed absolutely no increased risk of pancreatitis when compared to sulfonylureas (glipizide, glimepiride). Their studies revealed 1.45 cases per 1000 patients for both drugs. What’s interesting about this is that just having diabetes itself carries the same risks!

Incretin drugs cause no weight gain and no risk of hypoglycemia. Sulfonylureas are cheap but are associated with weight gain, low sugar reactions and an increase in the risk of getting heart disease.

Which treatment would you prefer?

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