Using double duty drugs-COVID-19, migraine, and shingles

In 2020 SARS-CoV-2 caused a worldwide pandemic of infection. To treat this novel, or new, virus, infectious disease experts turned to old drugs while developing new unique drugs to treat it.

In this post I’m reviewing some drugs that treat multiple conditions. This post was updated August 5, 2020.

Many drugs originally developed to prevent or treat one condition can be “repurposed” to treat another.

This information is current as of the publication date; it is general medical information that helps a doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to coordinate with the World Health Organization (WHO), federal, state and local public health partners, and clinicians in response to the coronavirus disease 2019 (COVID-19) outbreak. CDC is closely monitoring the situation and working 24/7 to provide updates.
Centers for Disease Control and Prevention (CDC) activated its Emergency Operations Center (EOC) to coordinate with the World Health Organization (WHO), federal, state and local public health partners, and clinicians in response to the coronavirus disease 2019 (COVID-19) outbreak. CDC is closely monitoring the situation and working 24/7 to provide updates credit James Gathany, public domain

Treatment options for COVID-19

In 2020 SARS-CoV-2 caused a worldwide pandemic of infection. To treat this novel, or new, virus, infectious disease experts turned to old drugs while developing new unique drugs to treat it.

Chloroquine, an old malaria drug and its cousin hydroxychloroquine, used for rheumatoid arthritis and lupus received EUA, Emergency Use Authorization, from the FDA for use against COVID-19. At first it looked promising; President Trump even took it for prevention. But analysis of treatment results did not show fewer deaths but did find adverse heart effects so the EUA was withdrawn. However clinical trials using the drug can be continued.

In early July a hospital in Michigan released statistics showing more patients treated with hydroxychloroquine lived that those who weren’t, surprising other medical centers who did not find the same results in their patients.

As of August 2, 2020, the White House coronavirus task force member charged with coordinating the U.S. testing effort said that the nation needs to “move on” from the debate over hydroxychloroquine.  

Adm. Brett Giroir, assistant secretary of health and human services, said on NBC News’ “Meet the Press” that “from a public health standpoint, at first, hydroxychloroquine looked very promising” but at “this point in time, there’s been five randomized control, placebo-controlled trials that do not show any benefit to hydroxychloroquine.” 

“So, at this point in time, we don’t recommend that (hydroxychloroquine) as a treatment. There’s no evidence to show that it is,”

Adm. Brett Giroir

Another old drug however did reduce deaths in severely ill COVID-19 patients. Dexamethasone, a steroid, reduced mortality in patients who needed oxygen, either alone or by a ventilator and is now recommended for use in all such patients. Steroids treat a variety of conditions including severe asthma, rheumatoid arthritis, gout, lupus, autoimmune diseases, and multiple other inflammatory conditions.

illustration showing the coronavirus which causes COVID-19

 

Avoiding surgery for ectopic pregnancy

Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. As the fertilized egg begins developing into an embryo, it will eventually outgrow size of the Fallopian tube, and rupture, causing hemorrhage (bleeding) in the pregnant woman.

Ruptured ectopic pregnancies cause about 2.7% of pregnancy-related deaths. Ectopic pregnancy is a true medical emergency and usually requires surgery to prevent death. But another old medicine can in some cases spare a woman from losing her tube to either rupture or surgery.

Methotrexate is an old drug used to treat several forms of cancer as well as several inflammatory and autoimmune diseases, including psoriasis, multiple sclerosis, and Crohn’s Disease. Now, some patients can avoid surgery for an ectopic pregnancy by receiving one or two doses of methotrexate by the IM (intra-muscle) injection route.

The treatment is not 100% effective; patients must follow their doctor’s instructions for follow up carefully, as surgery may still be necessary.

https://medlineplus.gov/images/femalereproductivesystem.png

Prevention of migraine pain and disability

Migraine, although not exclusive to women,occurs much more frequently in them than men. For infrequent headaches,non opiate pain relievers are effective and recommended. But for severe, frequent, or persistent symptoms prevention is recommended to improve quality of life.

Botox, onabotulinumtoxin A, has been FDA approved for treating chronic migraine, meaning patients with frequent headaches and other migraine symptoms for at least 3 months.

Yes the same drug used to treat wrinkles,Botox, can prevent migraine.

Manufactured by Allergan, a vial containing 200 units costs $1452, per goodrx.com. For migraine, the drug is injected in the upper facial muscles by a physician specifically trained in its use.

 

Preventing cancers with the HPV vaccine

Infection with the HPV, human papillomavirus, causes genital warts, an uncomfortable condition but not life threatening. However it can also cause changes in the cervix called CIN which can lead to cervical cancer.

According to a review of clinical trials by Cochran, vaccination against this virus effectively prevents infection and thus fewer cases of CIN. Since a significant percentage of CIN progresses to cancer, we can expect fewer women will develop invasive cervical cancer, the 4th most common cancer in women worldwide.

The vaccine, Gardasail 9, originally approved for use in females ages 9 to 26 years,received FDA approval for use up to ages 17 to 45 years in both males and females.

The vaccine is intended to prevent cancers of the anus, vulva, vagina, and cervix.

The American Cancer Society, ACS, recommends routine vaccination from ages 9-12 years, to prevent the greatest number of cancers, since the vaccine is less effective at older ages. The ACS encourages physicians to offer “catch-up” vaccination to people through age 26 years. For persons older than 26 years, the vaccine offers much less cancer prevention so the society does not recommend it.

HPV-16 E5 Oncoprotein
Description:
A koilocyte is a squamous epithelial cell that has undergone structural changes as a result of infection by human papillomavirus (HPV). This image of a koilocyte shows human ectocervical cells (HEC) expressing HPV-16 E5 oncoprotein, and immortalized with HPV-16 E6 and E7 oncoproteins. Formation of koilocytes requires cooperation between HPV E5 and E6 oncoproteins. The cell culture is stained with hematoxylin and eosin (H&E).

This image was originally submitted as part of the 2016 NCI Cancer Close Up project.

This image is part of the NCI Cancer Close Up 2016 collection.


Source:
National Cancer Institute \ Georgetown Lombardi Comprehensive Cancer Center
Creator:
Ewa Krawczyk
Date Created:
2006
Date Added:
April 11, 2016
Reuse Restrictions:
None – This image is in the public domain and can be freely reused. Please credit the source and, where possible, the creator listed above.

Stopping shingles-and strokes- with the zoster vaccine

Zoster is a reactivation of the varicella/zoster virus that causes chickenpox. It causes a painful rash known as shingles;the pain may continue after the rash is gone. It can happen at any age, but symptoms tend to be worst in older persons.

The new zoster (shingles) vaccine, Shingrix, prevents the painful rash much more effectively than the original vaccine Zostavax. It ranges in effectiveness from 91% to 97% at preventing shingles, depending on age. The first vaccine was 51% effective.

However, the original shingles vaccine may not prevent shingles as well, but it may prevent strokes due to inhibiting inflammation causes by the shingles virus.

Researchers at the CDC reviewed the Medicare health records of more than 1 million people age 66 or older who received Zostavax between 2008 and 2014, and 1 million people of the same age who had not received the vaccination. Researchers took into account age, gender, race, medications and existing health conditions.

Based on these records, the Zostavax reduced stroke risk by 18% for the most common type of stroke. During the years they reviewed, the Shingrix was not in use, so they couldn’t say if it would also show a protective effect.

Signs of Stroke
Signs of Stroke

Stroke is the fifth leading cause of death in the U.S. and causes more serious long-term disabilities than any other disease. Every minute counts, especially during the COVID-19 crisis. The best way to help someone having a stroke is to recognize the symptoms and call 9-1-1. www.stroke.nih.gov/index.htm
before you leave, here’s another post you might enjoy

exploring the HEART of health

Thanks for joining me to review some old drugs with new tricks.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

This blog may earn a commission if you use these affiliate links

Women’s health update-relieving migraine and other pain

In this post I review some new drugs that treat conditions exclusive to or common in women.

I illustrated this post with covers of books written by women; I have reviewed all of these books on my blog, so I’ll include those links also. Please note these are affiliate links, so if you do happen to use them for a purchase you will help me fund this blog.

This information is current as of the publication date; it is general medical information that helps a doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

Photo by rawpixel.com on Pexels.com

Relieving the pain of endometriosis

Women with endometriosis can suffer infertility, heavy menstrual bleeding, painful periods, and pelvic pain unrelated to their periods. In endometriosis, uterine tissue grows outside the uterus; laparoscopy, an invasive procedure us used to diagnose it. Treatment depends on the goal, whether pregnancy, pain relief, or both. Short of surgery, hormonal therapy has been the mainstay of treatment.

A new hormonal drug released in 2018, elagolix, brand name Orilissa, is the first of its kind specifically developed and approved to treat “moderate to severe” endometriosis pain, but not infertility. AbbVie, the pharmaceutical company which developed the drug,priced it at $844 per month, or about $10000 per year, retail.( per Reuters report) Patients may pay less depending on insurance.

 

Easing dyspareunia

After menopause many women develop atrophy of the vagina, making it thin, dry, and easily irritated, leading to painful sex, or dyspareunia. A new intravaginal medication, prasterone,brand name Intrarosa, can help relieve the discomfort. Studies show it may also help improve sexual desire and arousal, but it is not labeled for this.

Manufactured by AMAG Pharmaceuticals, it is for “moderate to severe” symptoms. Also known as DHEA, a steroid, it transforms into estrogen in the vagina; administered as a once daily vaginal insert at bedtime, applied with an applicator. According to goodrx.com, a 30 day supply costs about $213.

DHEA can be purchased as an over-the-counter, non-regulated product, whose effectiveness and safety are unknown. A one-month supply of 50 mg tablets may cost $5.

Other options for treating vaginal atrophy symptoms are oral or vaginal estrogen and/or vaginal lubricants.

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Prevention of migraine pain and disability

Migraine, although not exclusive to women,occurs more frequently in them than men. For infrequent headaches,doctors recommend non-prescription pain relievers since they are effective, safe, and have few side effects. For more severe and disabling headaches, prescription meds designed specifically for migraine are tried next, usually those in the triptan class of drugs.

But when headaches are severe, frequent, or persistent, patients should also consider preventive medication to improve quality of life. In addition to several effective oral meds there are two injectable drugs which work differently

The Food and Drug Administration has approved several new drugs in the past two years.

a new use for Botox

Yes the same drug used to treat wrinkles,Botox, can prevent migraine

Botox, onabotulinumtoxin A, treats chronic migraine, meaning patients with frequent headaches and other migraine symptoms for at least 3 months.

Manufactured by Allergan, a vial containing 200 units costs $1452, per goodrx.com. For migraine, the drug is injected in the upper facial muscles by a physician specifically trained in its use.

It’s in the genes

Another novel therapy uses the immune system to fight migraine.

Monoclonal antibodies bind to a calcitonin gene-related peptide receptor which transmits migraine pain. The antibodies are produced in a laboratory but work like antibodies naturally produced by the body. They are used to treat cancers and some forms of arthritis. They are called calcitonin gene-related peptide (CGRP) receptor antagonists.

These drugs are used to prevent migraine . (generic name-brand name)

  • Erenumab-Aimovig
  • Fremanezumab-Ajoovy
  • Galcanezumab-Emgality
  • Eptinezumab-Vyepti

 

Administered as subcutaneous injections (under the skin) monthly, according to Medscape, the average cost is $600 per month.

Two similar drugs, rimegepant (Nurtec ODT)and ubrogepant (Ubrelvy) treat migraine pain and are taken by mouth (orally).

You may want to review my previous post about non-drug ways to manage migraine.

Simple and effective ways to manage chronic pain

exploring the HEART of health through books

Thanks for joining me to review new steps in women’s health and review some fine women authors. I hope you will follow the links to my reviews and read some or all of these books. When you do, I would love to know your reaction. I might use your comments in an update.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn .

                              Dr. Aletha 

This blog may earn a commission if you use these affiliate links.