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.
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.
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.
watercress words by Dr Aletha 
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