Category Archives: Rx

Heart Disease: The Best Ways To Lower High LDL Cholesterol Levels

November 1, 2022

What is a healthy target for LDL cholesterol?

Target LDL depends on many factors, including your age, family history, and personal history of cardiovascular disease. For people at intermediate risk, LDL should be lowered by 30% to 50%. For those who have already had a heart attack, target LDL is no more than 70 mg/dl (note: automatic download).

Which non-statin therapies are recommended first?

Five non-statin therapies described in this post aim to help people achieve target LDL goals while minimizing side effects. They may be combined with a statin or given instead of statins.

Each helps lower LDL cholesterol when diet and statins are not sufficient, such as when there is a family history of high cholesterol (familial hypercholesterolemia). But so far, only two options are proven to reduce cardiovascular risk — the risk for heart attack, stroke, heart failure, and other issues affecting the heart and blood vessels.

Ezetimibe (Zetia)

What it does: Lowers LDL and cardiovascular risk by reducing cholesterol absorption.

How it’s given: A daily pill

Relatively inexpensive and often given with statins.

PCSK9 inhibitors, alirocumab (Praluent) and evolocumab (Repatha)

What it does: A protein called PCSK9 controls the number of LDL receptors on cells. These medicines are monoclonal antibodies against PCSK9 that increase LDL receptors on the liver, helping to clear circulating LDL from the bloodstream.

How it’s given: A shot every two to four weeks

Highly effective for lowering LDL, but expensive and may not be covered by insurance.

Read more

Dr. C’s Journal: Expired Medications – What To Do

Not too long ago, US government required pharmaceutical manufacturers to place an expiration date on their medications. The drug manufacturers embraced this requirement, since it added to their bottom line.

There are three cogent questions that should be asked:

  1. Can outdated medications cause direct harm?
  2. Do medications become ineffective after their expiration date?
  3. How do you dispose of unwanted medication?

Most sites mention only two medications that can become dangerous as they age, tetracycline, and diclofenac. Neither finding is for certain, but its best not to take these medication‘s if outdated.

Everything degrades with time, and medications are no exception. Those that are compressed into tablets and kept in the dark and dry tend retain potency longer than those in liquid form. Certain medications, such as nitroglycerin and epinephrine are quite prone to oxidation; epiPen, In ready-to-inject needles, in particular should be fresh; Biologics in general should be current. Drugs that are exposed to water, warm or humid conditions, or that are crumbly or have an odor should obviously be discarded. Liquid medication’s of all types, such as eyedrops, should be carefully stored and within their expiration date. One of my eye medications, latanoprost, requires refrigeration, a sure sign of instability.

That being said, the US Army found that 90% of 100 medication‘s were still effective 5 to 20 years after their expiration date. Another study found that some retain their efficacy even after 10 to 40 years.

Another factor to consider is the danger of the disease that is being treated. If you have such things as heart disease, or a severe infection, You should exert greater care.

If you plan to get rid of medication, look around for an organization willing to accept them; Developing countries are looking for such medication.

Avoid flushing medication down the toilet, since it may enter the environment and  be harmful to the ecosystem. Ideally it should be packaged in a container that is difficult to get into, so that children and other individuals may not have access; almost all medications are dangerous if taken in large amounts.

A lot of information is available on the Internet, with a variable amount of suggested precautions, depending upon the site.

I am a physician, and have taken many outdated medications In a pinch, but if I plan taking them for an extended time I usually get a new prescription.

—Dr. C.

Supplements: Melatonin For Sleep Is Non-Addictive

Melatonin is a hormone that is naturally made by your brain in response to darkness,” says sleep specialist Marri Horvat, MD. “When someone takes melatonin, they are either trying to increase the amount of this hormone overall or increase the amount they have in their body at a certain time to help them fall asleep.”

While there are some possible setbacks to taking melatonin (depending on how your body reacts), it isn’t addictive. Turns out, even if you depend on melatonin to make you fall asleep, it won’t cause your body to become dependent on it.

“As we age, we have a natural decrease in the amount of melatonin we produce, so supplementation can often be helpful,” Dr. Horvat explains.

Read more at Cleveland Clinic

Insights: The Lucrative Business Of Diabetes (2022)

In our modern consumer society, Type 2 diabetes has become a widespread disease. Companies are developing drugs that are increasingly expensive, but not necessarily more effective. Health authorities are powerless. Diabetes is spreading rapidly, all over the world.

The disease destroys lives and puts a strain on public budgets. The UN is calling on governments to take action. Diabetes is proof that modern societies are incapable of adequately treating chronic disease. It affects around 430 million people worldwide, with two main metabolic disorders falling under the name diabetes.

Type 1 is an autoimmune disease that must be treated with lifelong doses of insulin, while type 2 can develop when a person’s diet is too high in fat and sugar and they do not engage in enough physical activity. With turnover of $46 billion, diabetes is a massive and extremely lucrative market. Constantly promised miracle cures have not led to satisfactory treatment, with patients either taking too many drugs or no longer being able to afford them.

It’s a desperate situation, and the only ones benefiting seem to be pharmaceutical companies. A medical focus on blood glucose levels has led to an overreliance on medication, sometimes without due concern for dangerous side effects. Patients become trapped in a cycle of treatment, which in many cases still does not halt the disease’s progression. This can lead to amputations, blindness and heart attacks.

And yet there are alternatives that could flatten the curve of the type 2 diabetes epidemic, while reducing health care spending. Improved diet can be a preventative measure, and a strict adherence to diet can also bring about remission in the case of Type 2 diabetes. But these solutions require effort, as well as a complete rethinking of chronic disease management. Filmed on three continents, this documentary features industry whistleblowers, patients, researchers and medical professionals. It also confronts pharmaceutical companies about their responsibility for the situation.

Covid-19: Review Of Latest Treatments & Medicines

DR. C’S MEDICINE CABINET: ‘CELEBREX’ (NSAID)

NSAIDs are a  common pain medication. Younger people with no underlying diseases take them all the time for headaches, sprained ankles, and other injuries.

I have an underlying stomach problem that makes me want to minimize the gastrointestinal side effects when I need an NSAID medication, and for that reason I have 100 mg Celebrex, or celecoxib in my medicine cabinet.

I am fortunate not to have much severe pain, although I do have osteoarthritis in my hand, and infrequent abdominal pain from a small bowel surgery.

Celebrex is my magic bullet whenever I have pain from diverse causes such as in my legs; I do have a very active exercise program of an hour a day in the morning and a half an hour in the evening.

The Cox 2 inhibitor‘s were initially touted as being able to avoid the stomach problems caused by the non-selective  NSAIDs. Unfortunately, several of them, such as vioxx, were associated with more heart attacks, a 45% increase, and they were removed from the market . Celebrex was a survivor from this group, but it still tends to cause an increase in blood pressure.

Whenever you take any medication, it’s always a trade-off;  relief from the problem at hand, traded for the inevitable side effects. There is no powerful medication that has only the desired activity, and  most people are better off with a healthy lifestyle than taking medication.

Another advantage with medication avoidance is that when you take the medication, it tends to work a whole lot better. At least I have found that to be true, and celecoxib is my magic pain medication, which has salvaged countless nights of sleep.

—Dr. C.

COVID-19: MOLNUPIRAVIR – MERCK’S ANTIVIRAL DRUG

Molnupiravir (MK-4482, EIDD-2801) is an investigational oral antiviral medicine that significantly reduced the risk of hospitalization or death at a planned interim analysis of the Phase 3 MOVe-OUT trial in at risk, non-hospitalized adult patients with mild-to-moderate COVID-19. At the interim analysis, molnupiravir reduced the risk of hospitalization or death by approximately 50%; 7.3% of patients who received molnupiravir were either hospitalized or died through Day 29 following randomization (28/385), compared with 14.1% of placebo-treated patients (53/377); p=0.0012. Through Day 29, no deaths were reported in patients who received molnupiravir, as compared to 8 deaths in patients who received placebo.

Medicine: Is Metformin A Wonder Drug? (Harvard)

DR. C’S MEDICINE CABINET: LITHIUM OROTATE

Lithium’s big claim to medical fame is it’s beneficial effect on manic depressive disorders in approximately 1/3 of the cases. It seems to benefit the manic phase more than the depressive phase, and its effect  on isolated depression is uncertain.

A recent report states that lithium works by increasing CRMP 2, which has an effect on tubulin in nerve cells. This report has not yet been confirmed.

When lithium is effective, it must be given in a dose that is almost toxic. People taking this drug should have lithium levels on a regular basis, and be alert to its numerous side effects, diarrhea, lethargy, and the like. It may also have an adverse effect on thyroid function.

I started taking low doses of lithium orotate a while back because of the touted effects on memory, mitochondrial function, and the like. I thought that our hunter gatherer ancestors probably had some exposure to lithium from the Hot Springs present in many areas, and that maybe lithium was a physiologic necessity.  Sodium and potassium are highly regulated ions in the cell membrane of all cells, I thought, so why should not lithium, a kindred element, have some effect there.

Lithium carbonate is the form that is used for treatment of manic depressive disease, and lithium orotate has not been well studied.
When one starts taking a dietary supplement, it is hard to tell whether or not it has any effect. Our bodies are complicated, and even if something does have an effect, the bodies corrective mechanisms can nullify that effect, or even cause  a reverse effect,

After further thought, I plan to start phasing out my lithium orotate. Maybe once a week would be a reasonable dosage, if at all. With irregular dosages, if I notice that I feel better on a day when I take lithium orotate, I might change my mind.

—Dr. C.