Pills That Pack On Pounds

If you are one of those people who are overweight  and would love to blame something other than too much food or lack of exercise, this blog is for you.

According to the Harris County Hospital District’s Drug Information Center, weight gain or loss may not always be attributed to lifestyle. For some, it’s due to the medicines they’re taking.

Certain meds can cause significant weight changes. For example, weight-related side-effects are common in medicines taken by patients with diabetes, high-blood pressure and mental health conditions.

Those likely to experience weight increase include people taking steroids and women on birth control, while those taking antidepressants such as Prozac® and Wellbutrin® are likely to lose weight.

However, this does not mean you should immediately start making changes to your medication regimen. Drugs are weird. They do different things to different people and it’s often impossible to predict which people will have which side effects from which drugs.

Because of the stigma of weight gain, patients may tend to stop taking their medicines or decrease their dosage without talking to their physician,” says Ryan Roux, PharmD, chief pharmacy officer, Harris County Hospital District. “Doing this is a bad thing. It can affect your health in a number of negative ways.”

Instead, it’s important that you tell your physician about any weight changes and then reassess the drugs or dosages taken. The more you can become actively involved in your treatment and be informed about long-term medication use, the better.

Not sure if the meds you’re taking could be to blame?

SRxA’s Word on Health brings you a list of some common medications and their weight side effects listed both by brand and generic name:

Diabetes

Weight promoting

  • Actos® (pioglitazone)
  • Amaryl® (glimepiride)
  • Insulins

Weight loss or weight neutral

  • Byetta® (exenatide)
  • Januvia® (sitagliptin)
  • Symlin® (pramlintide)
  • Metformin
  • Precose® (acarbose)

Hypertension

Weight promoting

  • Lopressor ® (metoprolol)
  • Tenormin® (atenolol)
  • Inderal® (propranolol)
  • Norvasc® (amlodipine)
  • Clonidine

Antidepressants

Weight promoting

  • Paxil® (paroxetine)
  • Zoloft® (sertraline)
  • Amitripyline
  • Remeron® (mirtazapine)

Weight loss or weight neutral

  • Wellbutrin® (bupropion)
  • Prozac® (fluoxetine)

Antipsychotic

Weight promoting

  • Clozaril® (clozapine)
  • Zyprexa® (olanzapine)
  • Risperdal® (risperidone
  • Seroquel® (quetiapine)
  • Lithium
  • Valproic Acid
  • Carbamazepine

Antiepileptic Drugs

Weight promoting

  • Carbamazapine
  • Neurontin® (gabapentin)

Weight loss or weight neutral

  • Lamictal® (lamotrigine)
  • Topamax® (topiramate)
  • Zonegran® (zonisamide)

As always, we advise – for more information about the effects of medicines, consult your physician or pharmacist.

Do DIY “spit kits” stress you out?

One of the fastest growing health care trends in “individualized medicine” is home genetic testing. The over-the-counter mail-in kits, with price tags as high as $2,500, use a saliva specimen to identify small variations in the human genome  associated with heightened risk for diseases such as diabetes and prostate cancer.

The U.S. Food and Drug Administration (FDA) has raised concerns about whether the tests are clinically beneficial and has advocated they be conducted under medical supervision, but few studies, to date, have investigated the emotional effects that direct-to-consumer genetic screens have on patients.

Now that’s all changed.  A group of Mayo Clinic physicians and bioethicists have analyzed whether these genetic tests cause patients to experience excessive worry about developing diseases. “We looked for evidence of increased concern about disease based solely on genetic risk, and then whether the concern resulted in changes in health habits,” said co-author Clayton Cowl, M.D.

The randomized study found patients’ worry tended to be modestly elevated one week after the genetic testing, and that people worried more about unfamiliar diseases, for instance the thyroid condition Graves’ disease than those commonly known, such as diabetes.

One year later, however, patients who had undergone testing were no more stressed than those who hadn’t. One surprising result was that men whose genetic risk for prostate cancer was found to be lower than that of the general population, and who also had normal laboratory and physical screening results for the disease, were significantly less stressed about the disease than the control group.

The researchers concluded that the tests may be useful if they prompt patients to make health-conscious changes, such as losing weight or being vigilant about cancer screening.

However, some doctors are concerned that patients who learn they have less-than-average genetic risk for a disease might skip steps to promote good health. Others just think it’s a bad idea – period.  “Genetic testing is a complex, difficult and emotionally laden medical process which requires extensive counseling, contextualization and interpretation,” says Dr. Michael Grodin, professor of bioethics, human rights, family medicine and psychiatry at Boston University.

It’s also worth noting that the current study only assessed the emotional effects of do-it-yourself genetic testing. Nobody yet knows whether a calculation of genetic risk accurately predicts disease.

Have you bought one of these kits?  How did you feel while you waited for the results. SRxA’s Word on Health would love to know.

Is prescription drug spending sky-rocketing out of control?

Are prescription costs raising your blood pressure?

According to the latest news and numbers from the Agency for Healthcare Research and Quality (AHRQ) they may well be.  Figures, just released, show that insurers and consumers spent $52.2 billion on prescription drugs for outpatient treatment of metabolic conditions such as diabeteshypertensionhigh-cholesterolobesity and thyroid disease.

The four remaining top therapeutic classes of outpatient prescription drugs were:

In 2008, purchases of metabolic drugs by adults age 18 and older accounted for 22% of the total $233 billion spent to buy prescription drugs.

To put this number in perspective, $223 billion would buy you either 1,000 brand new 747 jumbo jets; 137 new space shuttles or 495 space shuttle missions!

Hard Facts on Hard Drives & Heart Health

If you’re like us and spend much of your day in front of a computer screen, rather than rockin’ it like Lady Gaga or kickin’ it like David Beckham, today’s story may just kick your butt!

How many of us sit in front of a computer for an entire work day, and then go home and park it night after night on the couch watching television or surfing the Web?  But no, we don’t  feel guilty because we religiously squeeze in an hour of cardio at the gym before or after work.  That mitigates all that motionless  sitting, right?  Well, apparently not.  According to  a new study that just makes us “active couch potatoes”.

According to a report published this week in The Journal of the American College of Cardiology,  the amount of leisure time spent sitting in front of  a screen can have an such an overwhelming  impact on our health that the exercise we take doesn’t produce much benefit.

What!?!  All our lives we’ve been told that 30 minutes a of brisk physical activity day will improve our health! Unfortunately, it now seems that the concern isn’t how much exercise we get, but how much of our time is spent in sedentary activity and the harm this does to our body.

Uh-oh.

This particular study followed 4,512 middle-aged Scottish Health Survey respondents from 2003 to 2007. It found that those who admitted to spending two or more leisure hours a day sitting in front of a screen had double the risk of a heart attack and other cardiac events compared with those who watched less.

Those who spent four or more hours of recreational time in front of a screen were 50% more likely to die of any cause. The study noted it didn’t matter whether subjects were physically active for several hours a week. Exercise it seems, doesn’t mitigate the risks associated with the high amount of sedentary screen time.

During the study’s follow-up period, 325 individuals died of various causes, and 215 suffered a heart attack or other cardiac event. Even after adjusting for differences in lifestyle, weight, smoking, occupational physical activity and risk factors such as diabetes, high blood pressure and other longstanding illnesses,  those who spent four hours or more of their leisure time in front of a screen each day were 50% more likely to die.

Recreational screen time has an “independent, deleterious relationship” with cardiovascular events and death of all causes, the paper concluded, possibly because it induces metabolic changes.

The study focused on recreational screen time because it’s the easiest to curtail, said lead author Dr. Emmanuel Stamatakis. However, he encouraged employees who work at computers all day to get up and take breaks and short walks periodically.

That said, SRxA’s Word on Health bloggers will always be here to assist you….when we’re not taking a brisk run around the courtyard!

Unlocking the Mystery of Autoimmune Disease

A key feature of the immune system is its ability to discriminate between self and non-self.

When the mechanisms that prevent the immune system from attacking itself break down, it can result in autoimmune disorders such as multiple sclerosis, rheumatoid arthritis, Crohn’s disease and diabetes.

Now researchers at Columbia University Medical Center claim they have not only found out why people with autoimmune diseases attack their own tissues and organs, but also how to correct the problem.

According to a study just published in The Journal of Clinical Investigation scientists have identified a defect in the T cell regulatory pathway which normally controls autoreactive T cells.  The majority of people with Type 1 diabetes who were tested were found to have a defect in CD8+ T cells that impacted their recognition of a common target structure known as HLA-E/Hsp60sp. More importantly, researchers were able to successfully correct the defect in-vitro.

For decades, autoimmune diseases have been treated by reducing overall immune response. That’s been effective in extending life spans, but has been hard on the quality of life for many of those patients,” said lead researcher Hong Jiang, M.D. Ph.D.

Current therapies for treating autoimmune disease include steroids, which systemically suppress the immune system, resulting in multiple side effects, including weight gain and increased susceptibility to infections.  Therapies based on this new research are designed to selectively suppress immune responses to self-antigens without damaging the body’s normal anti-infection and anti-tumor responses.

This research is significant. The Columbia University scientists believe that this greater understanding of the defect could eventually lead to prevention of autoimmune diseases altogether.

SRxA’s Word on Health is keeping everything crossed.

Inhaled Insulin as effective as Injected Insulin

Diabetes, affects 26.8 million people in the U.S. It is characterized by the body’s inability to properly regulate  blood sugar levels. Insulin, a hormone produced by the pancreas, normally regulates the body’s glucose levels, but in people with diabetes insufficient levels of insulin are produced or the body fails to respond adequately to the insulin it produces.

Current mealtime insulin therapy has a number of limitations, including the risk of severe hypoglycemia (low blood sugar), weight gain, inadequate post-meal glucose control, the need for complex titration of insulin doses in connection with meals and, of course, the need for injections.

So Word on Health was excited to hear that needles may soon become a thing of the past.  According to the manufacturer, investigational inhaled insulin works at least as well in patients with Type 1 diabetes as standard injection therapy.

MannKind Corporation announced yesterday that a new Phase III clinical trial showed that the ultra fast-acting inhaled insulin AFREZZA (insulin human [rDNA origin]) combined with basal insulin worked at least as well as injectable Humalog (insulin lispro [rDNA origin]).  Additionally, patients receiving the inhaled insulin showed lower rates of hypoglycemia, lower fasting and post-prandial blood glucose levels than those receiving subcutaneous injections

Effectively controlling blood sugar levels and managing hypoglycemic events go hand in hand as key to successfully treating patients with Type 1 diabetes,” said Satish K. Garg, M.D., Professor, Departments of Pediatrics and Medicine, University of Colorado School of Medicine; Head, Young Adult Diabetes Clinic, Barbara Davis Center for Childhood Diabetes, and lead study investigator.   “Our findings demonstrate that AFREZZA may offer a significant advance from current mealtime insulin delivery methods, as it is comparable to the standard of care in glycemic control and provides the additional benefit of lower hypoglycemia rates.”

AFREZZATM is a drug-device combination product, consisting of Inhalation Powder and a small, easy- to-use inhaler. Administered at the start of a meal, AFREZZA dissolves immediately upon inhalation and delivers insulin quickly to the blood stream. Peak insulin levels are achieved within 12 to 14 minutes of administration, mimicking the release of meal-time insulin observed in healthy individuals. To date, the AFREZZA clinical program has involved more than 50 different studies and over 5,000 adult patients with both Type 1 and Type 2 diabetes.

MannKind is currently preparing its FDA resubmission of the AFREZZA new drug application and is hoping to gain approval for the treatment of adults with Type 1 or Type 2 diabetes.