7 underused medications

Here are 7 medications we should use more often

This week I discuss 7 groups of medications that are underused. ( A previous post discussed 7 that are overused. ) Both of these posts contain a lot of information and several links; you may want to bookmark to review later. (This post also has affiliate links, which when used to make a purchase, help fund this blog. )

I call these drugs underused.  However, I do not mean

  • That you should always take them
  • That you should start using them
  • That your doctor should prescribe them
  • That you should take them even  if your doctor recommends against them
  • That they are good or perfect drugs

We should think more about when, why and how to use these drugs.

By drugs and medications, I consider any substance we put into our bodies to treat or prevent a disease or symptom, whether prescribed or over-the-counter (OTC), synthetic or “natural”. I’m not considering foods nor any substance that is illegal or mostly recreational in this discussion.

I picked classes of drugs that I am familiar with as a family physician, excluding highly specialized medications like cancer chemotherapy, cardiovascular drugs, anti-rheumatics and neurological drugs.

I based my assessment on my experience as well as medical literature and the opinions of other physicians. As always, your best source of information about the right drugs for your conditions is your personal physician.

I easily came up with the list of 7 overused drugs but this list was harder. I tend to be a minimalist in using drugs, both in prescribing them for patients and in using medication myself. But once I started considering the issue, I realized there are helpful meds that can be better utilized.

No smoking sign
Smoking cessation meds are available and effective.

Smoking cessation medications

I suggest  reviewing 7 surprising reasons to be smoke free 

Many people use e-cigarettes as a way to stop smoking cigarettes. But other smoking cessation aids are available and effective. There are several types of nicotine replacement products as well as non-nicotine pills which help with the craving for cigarettes. Patients sometimes complain about the cost of these products but if you are already paying for cigarettes, what’s the difference? And you may qualify to get them free through the smoking hot line www.quit.com.

Allergy medication

Many people suffer from seasonal or year round allergy symptoms-sneezing, itching, runny nose, itchy/watery eyes. Once you get the diagnosis confirmed, effective medications available without a prescription  can manage the symptoms.  The key is using them soon enough and consistently enough. Sometimes finding the right ones is trial and error. I see people give up too quickly.

Asthma control medications

In the last post I talked about the overuse of rescue inhalers. Persistent wheezing and shortness of breath indicate uncontrolled asthma that will not be completely controlled by using a rescue inhaler over and over.  You should check with your doctor as to if and  when it is wise to  start or stop an asthma maintenance medication.

The human respiratory system
Respiratory allergies and asthma involve the breathing tract from the nose all the way down to the lungs. (photo complimentary from Pixabay)

Migraine medication

Most people with “sinus headaches” have migraine, a complex disorder that involves more than a headache. While many sufferers get relief with OTC pain relievers, many do not. Opioid pain medication does not work well for migraine but there are other prescription options, mainly the triptan drugs. I find that many patients with migraine have never tried these, or the various preventive drugs available. It’s worth talking to your doctor about these options.

Psychotropic medications

While milder forms of depression and anxiety can be managed without drugs, the more severe forms often require medication to achieve remission. In cases where one’s personal life and work suffer due to a mental illness such as severe depression, mania, panic disorder, PTSD, and alcoholism,  medication may restore control and function. Unfortunately, many of these people quit medication once they feel better, and ultimately relapse.

Anti-viral medications

In my last post I told you we use too many antibiotics, drugs used for bacterial infections. We mistakenly use them for viral infections like colds and bronchitis even though they don’t help. We don’t have anti-viral drugs for colds, but we do have some for other viruses. You may already be familiar with the use of oseltamivir, Tamiflu, used both for prevention and treatment of influenza (flu). 

Here are 6 things you need to know to get through the flu season

Antiviral meds  are available for these infections- 

  • HIV-human immunodeficiency virus
  • HBV, HCV- hepatitis B and hepatitis C 
  • HSV, HZ – herpes simplex virus and herpes zoster (shingles).

For many of these, treatment needs to be started very soon after onset of symptoms, within a few days, for maximum effectiveness.

Supplements

This class made both lists. While there is little evidence that supplements in general are helpful, medical studies suggest some specific ones may be effective.  

Folic Acid, also known as folate a B vitamin (B9) . The USPSTF recommends folate intake for women who may become pregnant. Medical studies suggest that taking folic acid during pregnancy decreases the risk of neural tube defects such as anencephaly-impaired brain formation and spina bifida- spinal cord malformation. All women with childbearing potential should take 400 to 800 micrograms daily. Learn more at this link 

Fish oil lowers blood triglyceride (fats) levels. Triglycerides contribute to heart attack risk but we don’t know if lowering them with fish oil  decreases the risk. It is available as both OTC and prescription versions.

The herb ginkgo biloba improves mental and behavioral function in people with dementia, including Alzheimer’s patients. Results were similar to those for the prescription Alzheimer drugs.

Probiotics, such as Lactobacillus, Bifidobacterium and Saccharomyces can prevent or limit diarrhea from antibiotics. They should be started within three days of starting  the antibiotics and continued for one week after.

St. John’s  Wort (Hypericum perforatum) shows effectiveness for treating mild to moderate depression.

This information is presented for your information only and should not be considered a recommendation for treatment or prevention of any condition.

Discuss the use of these medications with your personal physician if you think they may be helpful for you. 

Please follow this blog for future discussion of non-drug treatments for several common conditions, including allergies, colds, migraine, insomnia, pain, depression, and anxiety.

7 overused medications

What 7 drugs are overused? Find out here.

This week I discuss  7 groups of medications that are overused. This, and the next post about drugs which are underused, has many links; you may want to bookmark for future review.

medication capsules
Sometimes we need medication, but sometimes we don’t.

 

I call these drugs overused.  However, I do not mean

 

  • That you should never take  them
  • That you should quit using them
  • That your doctor should not prescribe them
  • That you should quit taking them if your doctor prescribed them
  • That they are bad or dangerous drugs

 

We should think more about when, why and how to use these drugs.

 

By drugs and medications, I consider any substance we put into our bodies to treat or prevent a disease or symptom, whether prescribed or over-the-counter (OTC), synthetic or “natural”. I’m not considering foods,nor any substance that is illegal or mostly recreational in this discussion.

I picked classes of drugs that I am most familiar with as a family physician so excluded highly specialized medications like cancer chemotherapy, cardiovascular drugs, anti-rheumatics and neurological drugs.  

I based my assessment on my professional experience as well as medical literature and the opinions of other physicians. As always, your best source of information about the right drugs for your conditions is your personal physician.

 

Antibiotics

Every infectious disease expert says we use  too many antibiotics unnecessarily-but we keep doing it. Doctors and patients share the responsibility of using antibiotics appropriately.

Reasons to avoid antibiotics

They don’t help most of the things we use them for, namely respiratory infections which are usually caused by viruses.

They add to the cost of medical care.

They frequently cause side effects; they are one of the top four causes of adverse drug reactions that lead to ER visits and hospital admission.

They can change the balance of the good bacteria that live in our bodies, the microbiome.

6 smart facts about antibiotic use

 

Here is a previous post about the use and misuse of antibiotics for respiratory infections, the most common culprit in the inappropriate antibiotic battle.

How to navigate the antibiotic highway

 

Opioid pain medication

These are the drugs that comprise the current opiate epidemic. Like antibiotics, they are a frequent cause for ER visits and admissions for adverse reactions.  Unlike antibiotics, they can create physical and mental dependency and addiction, and can be fatal in overdose which is happening more often. The New York Times reports 

 

Opioid poisonings increase in toddlers and teenagers

 

Some of the overdose deaths are accidental, especially in children, but in adolescents and adults are too often intentional.

Used properly, opiates relieve severe pain due to cancer, trauma,and  surgery, but doctors and patients should consider other alternatives for less severe pain first, especially if it is a long term condition.

Dr. Sanjay Gupta, CNN medical correspondent, suggests doctors and patients work together to achieve pain relief without the risk of addiction.

“But most simply, we as doctors need to engage our patients and discuss treatment with them, whether its short term opioids or alternatives like physical and occupational therapy. We need to help set realistic expectations for our patients: Living entirely pain free is not always possible. As doctors, we need to have follow-up conversations with our patients to see how treatment is going. If we better understand our patients, we can provide better treatment and help develop pain strategies that are effective and safe.”

 

Talk to your doctor if you believe your use of opiate pain medication has become a problem.

Doctors must lead us out of our opioid abuse epidemic

 

lying woman with palm full of pills
Deaths from accidental and intentional opioid overdoses are skyrocketing.

 

Anti-inflammatory drugs

These are the  non-steroid anti-inflammatory drugs, referred to as NSAIDs. This includes generic ibuprofen and naproxen, available in both otc and prescription strengths. ( Brand names include Motrin, Advil and Aleve.) There are other NSAIDs but these are most frequently used.

 

When these drugs first hit the market, we were excited to have effective drugs for people with joint pain from  arthritis. Then we recognized they also worked well for headaches, menstrual pain, and other  forms of muscle and joint pain.

 

Now they seem to have become the go-to drugs for almost any discomfort or symptom, with people taking multiple doses daily (often exceeding the recommended dose) without medical supervision. 

 

Although usually well tolerated, they do pose risk to the kidney, heart and liver, especially in people who already have disorders of those organs. And they can cause stomach ulcers with bleeding in anyone.

 

Acetaminophen

 

The name Tylenol has become synonymous with the drug acetaminophen, although there are other brands and generic versions. Sometimes abbreviated APAP, this drug relieves pain and reduces fever, and is used frequently by adults who also give it to their children. It does not carry the risk of stomach ulcers as do the NSAIDs. However, it also can cause harm to the liver and kidney.

 

At this link you can

understand your OTC pain reliever options better 

 

 

Sleeping medications

Many people have trouble falling asleep, staying asleep, or getting a restful sleep and turn to medications, both prescription and non-prescription for help.

Sleep specialists avoid the routine use of sleeping medications, due to lack of effectiveness long term and potential side effects and risks. They recommend altering conditions related to sleep such as bedtime, sleeping arrangements, temperature and activities, often called sleep hygiene, or mind-body interventions like meditation, hypnosis, yoga, tai chi and music.

Here is a Consumer Reports review of

Sleeping pills for insomnia 

person sleeping on a couch
Sometimes getting a good night’s sleep can be a challenge.

 

 

 

 

Rescue inhalers for asthma

 

People use quick acting or rescue inhalers for asthma or COPD symptoms. The inhalers usually relieve symptoms promptly and if they aren’t, people may believe the inhaler “isn’t working”.

 

Instead, it may mean that the lungs aren’t “working” to full capacity  and need more aggressive treatment. Continuing to use the inhaler repeatedly with little or no relief can be dangerous and lead to respiratory failure. Instead, you need to seek medical attention at a  clinic or hospital emergency room.

This article explains

Inhaled asthma medications 

 

 

Vitamins,  minerals and other supplements

 

People spend $37 billion annually on vitamins,  minerals  and other supplements with little to no  proof that they prevent or treat anything. Most nutrition scientists teach that appropriate eating will supply our requirements for vitamins and minerals.

 

Vitamins and/or minerals are recommended in some medical situations, including-

  • Pregnancy and nursing
  • People with intestinal disorders who absorb nutrients poorly
  • People with restricted diets for any reason
  • People with or at high risk of macular degeneration, a cause of blindness

 

Find out why

most adults don’t need dietary supplements 

In a future post I will discuss non-drug alternatives to these drugs and others.

 

Listen to a podcast by two physicians at 2 Docs Talk

Are supplements good medicine?

 

Come back in 2 weeks to find out what 7 medications I call underused.

 

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