Ask the doctor - drugs and medication

Should I change tablets?

I have high blood pressure and have been prescribed the drug ramipril, but it has given me a dry cough. My GP suggested I change to a tablet that he says won’t have the same problems, but I’m worried whether it will be as effective.

New drugs are often developed not because existing ones don’t work, but because they have too many side effects. Ramipril is from a ‘family’ of drugs called the ACE inhibitors – it has been found to cut blood pressure and the risk of cardiovascular disease. The drug your doctor has suggested is probably an ARB (the drugs in this group have names that end in ‘sartan’ and include telmisartan, losartan and candesartan). These are well tolerated and don’t cause the cough that can affect people taking ACE inhibitors. A study using the ARB telmisartan has shown it has all the benefits of the ACE inhibitor you’ve been taking.

Dr Sarah Jarvis, Good Housekeeping 

 

Problems with aspirin

I recently had some chest pain, and was told that although I hadn’t had a heart attack, the pain was related. I’ve been taking aspirin anyway for a couple of years to prevent heart attacks – but now my GP wants me to change to something called clopidogrel. What’s wrong with taking aspirin?

The answer is nothing - for most people. Aspirin is amazingly effective at cutting your risk of heart attack or stroke. We recommend it for the majority of  people who are at risk of these conditions - and since they account for one in three premature deaths in men and one in four in women, that's a lot of aspirin. However, it seems that quite a lot of people (as many as one in five) find aspirin hard to tolerate. For them, clopidogrel is an effective alternative. And now studies have also shown that if you're at particularly high risk of having a heart attack or a stroke, taking clopidogrel may be more effective, and safer, than taking aspirin.
Dr Sarah Jarvis, Good Housekeeping
 

Isotretinoin and depression

My 17-year-old son has terrible acne, which has made his life miserable. Three months ago, however, he started taking isotretinoin, and it’s worked wonders. Now I’ve heard this drug can cause depression – even suicide – so should I be concerned?

I'm afraid I can't give you a definitive answer about the side effects of this drug, better known by its brand name Roaccutane. The trouble is that although there are reports of depression and suicide among young people taking Roaccutane, it's hard to work out if it's the medicine or the acne that caused it. Severe acne, as you know, can wreck lives. Likewise, Roaccutane can control acne that's so severe nothing else can touch it. As your son has been on the drug for three months already, you may have nothing to worry about, but look out for symptoms of depression or mood changes. If you are worried, talk to his doctor at once to see if your son should stop the medicine.
Dr Sarah Jarvis, Good Housekeeping

 

Drug monitoring and warfarin

I take the blood thinning drug warfarin and have always attended the local hospital to be monitored. Now I’ve been told I’ll have to go to a local GP’s surgery instead. Is this just a way of saving money?

I can reassure you that you'll get just as good a service at your local surgery as in hospital and it should be more convenient as well. You do have to be monitored regularly if you're on warfarin - as nearly a million people in this country are - and more GPs are setting up local clinics. These are required to undergo checks to make sure that all their equipment and measurements are accurate. It means you won't have to trek to the hospital every four to six weeks. These days, many people have home machines to monitor their warfarin dose - they obtain the strips to do the tests on NHS prescription and can ring the clinic to discuss any changes in their dosage. Ask your GP if this might be an option for you.
Dr Sarah Jarvis, Good Housekeeping

My malaria dilemma

Are there any alternatives to taking malaria tablets? I’m going to Africa and am worried about side effects.

Malaria is a disease that can cause serious complications and be fatal. Prevention is vital – you must strongly consider taking recommended anti-malaria drugs, using mosquito nets, insect repellents and covering up as much flesh as possible, especially at dusk. Complementary approaches should only be used as well as, not instead of, anti-malaria drugs to reduce the risk of being bitten. Garlic powder tablets taken daily work well – mosquitoes do not like the garlic scent in your sweat that results. You can get information on medicines, vaccinations and disease prevention from the Medical Advisory Services For Travellers Abroad (www.masta.org).
Dr Sarah Brewer, Prima

My twin dilemma

I have twin eight-year-old boys who do everything together – and whenever one needs medicine, the other wants it, too. What can I do?

I also have twins, so I know what you’re up against! While you try to treat them equally, there are times when a different approach is needed. When ours were younger, we kept a bottle of sugar-free tonic as a ‘placebo’ to give when one needed paracetamol and the other felt left out. They are now seven and old enough to understand medicines must be treated with respect – if only one needs medicine, the other must go without but is made to feel special by helping to look after the poorly one. You need to be firm and give a reason they can understand.
Dr Sarah Brewer, Prima
 

Am I taking too  much aspirin?

My family has a history of heart problems so for the last year, since I turned 40, I’ve been taking aspirin regularly, which I know can help prevent heart disease. However, I read recently that too much aspirin can be dangerous so now I’m worried – is one pill a day too much?

Aspirin is an extremely useful drug – far more than just an effective painkiller. It is well known that it can help to cut your risk of a heart attack or stroke by reducing the thickness of the blood, thereby lowering the risk of a blood clot forming in the arteries. But what you may not know is that you don’t need to take a full adult painkilling dose every day to make a real difference. A recent US study has confirmed that a low daily aspirin intake of just 75mg to 81mg – the amount found in a child’s dose – is best for the long-term prevention of both cardiovascular disease and strokes, without causing serious side effects. Higher doses of aspirin don’t offer any more protection and are associated with increased risks of gastrointestinal bleeding, according to the authors of the study.
However, it is very important that you don’t self-medicate. Visit your GP who will assess your risk and advise you on the best course of action. Taking aspirin regularly is only one way of helping to keep your heart healthy – you need to lead a healthy lifestyle too. That means 30 minutes of exercise daily and a healthy low-fat diet with five portions of fruit and veg a day. It’s also best if you don’t smoke and keep your alcohol intake to no more than a couple of units a day. Make sure that you have your cholesterol checked regularly too, and aim to maintain a suitable weight for your height.
Dr Louise Selby, SHE

 

Are there any good alternatives to statins?

I have a high cholesterol level but had to stop the treatment my doctor prescribed because of side effects. What alternatives are there?

 Several different cholesterol-lowering drugs are available, and it’s likely that your doctor can prescribe another statin that may suit you better. Taking co-enzyme Q10 supplements helps to reduce some statin side effects such as muscle aches. Garlic tablets can reduce cholesterol levels by an average of 11 per cent. Antioxidants (such as vitamins A, C and E, and the plant extract Pycnogenol) are also beneficial. Omega-3 fish oil supplements also have a positive effect on blood fat balance and help to reduce furring up of the arteries.
Dr Sarah Brewer, Prima

Are these drugs dangerous? 

I’ve always sworn by nasal decongestants when I’ve had a cold. Now I’ve been told that they are being labelled as dangerous because addictive drugs can be manufactured from them. Should I be worried?

The MHRA (the official body that regulates medicines in this country) has looked at whether medicines containing pseudoephedrine and ephedrine – ingredients in some decongestant medicines – should be available only on prescription rather than over the counter. In fact, what the MHRA has suggested is that the size of the pack you can buy from a chemist should be limited. Large quantities of these medicines are needed to make small amounts of the highly addictive drug methylamphetamine, also known as crystal meth. The move to restrict their use is aimed at stopping illegal drug makers from buying up the huge amounts they need by shopping at lots of pharmacies. However, these decongestant medications are completely safe – as well as effective at reducing the misery of colds – in the doses recommended by your pharmacist.
Dr Sarah Jarvis, Good Housekeeping

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk