Q: Without a doctor's instruction and unbeknownst to his family, my father was popping one regular-strength aspirin a day for years. When he was rushed to the hospital, they found a heart valve leaking, and they implied the aspirin my father admitted to taking was probably the cause.
A: We hate it when doctors blame the patient for a condition they have no control over. A leaky heart valve is not your father's fault.
Your father probably was trying to protect his heart with aspirin, based on information that this inexpensive drug can prevent repeat heart attacks. The latest research shows, however, that for people at low risk, the increased danger of bleeding may outweigh any benefit (The Lancet, Aug. 26, 2018). In addition, your father was taking a higher dose than would be recommended even for those at great risk of a recurrent heart attack.
Before taking any medication on a regular basis, people should discuss the pros and cons of it with their doctors.
Q: I have been taking atenolol to control my blood pressure for some years now. Perhaps as a result, I feel very foggy and tired.
When I mentioned this, my doctor suggested I change to Cozaar. I have read a number of patient reviews about the serious side effects of Cozaar, and I am concerned. Is there any data about the relative safety of the two drugs?
A: You have asked an excellent question. Both atenolol and losartan (Cozaar) have been used for decades, so you might imagine that comparing their safety would be relatively simple. However, head-to-head trials, particularly those focusing on adverse effects, are not common.
Both drugs lower blood pressure, but atenolol is no longer considered a first-line treatment for high blood pressure (Cochrane Database of Systematic Reviews, Jan. 20, 2017). That is primarily because it is not as effective in preventing stroke and coronary heart disease as other types of blood pressure medicine.
At least one study comparing the two drugs found that people had fewer side effects on losartan than on atenolol (Journal of Hypertension, September 2002). The most common side effects from atenolol include fatigue, dizziness, depression, slow heart rate, cold hands and feet, and breathing difficulties. Losartan also can cause fatigue or weakness, dizziness, digestive distress and cough.
We recommend that you discuss your qualms further with your doctor. To help you prepare for that conversation, we are sending you our “Guide to Blood Pressure Treatment,” which discusses side effects of the main types of blood pressure pills. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (71 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. B-67, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q: I have been using NasalCrom for years, usually two times a day in allergy season and once per day as a preventive the rest of the time. Is there any harm in taking it every day over a long term?
A: Cromolyn (the active ingredient in NasalCrom) is considered safe and effective as a long-term maintenance treatment for asthma (Sleep & Breathing, December 2012). We got a bit nervous when we spotted a study linking it to amyloid beta in the brain. However, the research shows that rather than exacerbating the risk of Alzheimer's disease, it appears to reduce it in mice designed to develop this condition (Journal of Biological Chemistry, Jan. 23, 2015). There's a big leap from mice to humans, but the results suggest there might not be a problem long term.
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