The Essential Guide to Prescription Drugs 12 Top Meds for 2012

Weight loss drug decreases heart attacks? Contrave and early data


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fireworks A study of 4,500 patients using a new weight loss drug called Contrave (bupriprion and naltrexone) had the expected effect of a weight loss benefit, and the drug was FDA approved. A study of 8,910 people in a follow up study had the weight loss benefit, however; the patients taking Contrave had fewer heart attacks than the people who didn't take it.

There is controversy over this trial and apparent early leaks of data, but the information that patients taking the drug had fewer heart attacks is stunning. Importantly, the researchers doing the study thought the benefit on heart attacks may be a direct effect of the drug combination!

More to follow as always.

Contrave and cardiology--could this newer weight loss drug help your heart too?


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food Contrave (bupropion and naltrexone) is apparently unique. The SEC disclosed that the US patent office gave the 371 patent to Orexigen Therapeutics based on an interim look at the LIGHT study. What this means is that Contrave has a claim for having a POSITIVE IMPACT on cardiovascular results (outcomes) beyond (unrelated to) weight loss.

More to come and most probably from the American College of Cardiology meeting in San Diego this month. Regardless, having strength in weight loss AND HEART disease is a true breakthrough in medicines.

Can weight loss help atrial fibrillation (Afib) ? Mandrola and Krumholtz say yes and support Abed et al.

lean food on plate  Can weight loss help atrial fibrillation (Afib) ?

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lean food on plate  Can weight loss help atrial fibrillation (Afib) ?

A fascinating study in JAMA was the center of a Commentary by Mandrola and Krumholtz January 22, 2015. The original study in the Journal of the American Medical Association (JAMA 2013;19:2050-60) was the Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. This study asked if weight reduction and aggressive treatment of heart and metabolic risk (cardiometabolic) factors could lower the burden and severity of symptoms in atrial fibrillation. The answer is yes.

Losing weight and intensive risk factor management decreased in symptoms of atrial fibrillation AND burden of AFib as well as beneficial cardiac remodeling. The reviewers called the study disruptive in the sense that it changes the established thinking about atrial fibrillation treatment. Mandrola and Krumholtz point out that most AFib patients get care late in the disease and care is directed at preventing symptoms and controlling complications. They astutely note that existing strategies do not address root causes of atrial fibrillation-LIFESTYLE factors and the resultant structural changes in the heart.

I heartily concur with their conclusion that weight reduction and aggressive targeting of cardiometabolic risk factors should be a new standard of care in the treatment of patients with atrial fibrillation.  This again points to exercise as a medicine for the family and lowering of heart risk wherever possible! I’ll be mentioning this in my authors note for the 25th edition of The Essential Guide to Prescription Drugs. Perhaps building weight/overweight and risk into every physician and pharmacist office visit is a paradigm we can all live longer with!

New flu test may help your doctor decide if it's the flu in 15 mnutes


older woman Flu season this year has seen a lot of controversy erupt over what the flu vaccine covers, if it actually causes the flu and many wonder if it still helps your immune system even if it doesn't prevent the flu.

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older woman Flu season this year has seen a lot of controversy erupt over what the flu vaccine covers, if it actually causes the flu and many wonder if it still helps your immune system even if it doesn't prevent the flu.

Yes, it covers about 23% (effectiveness) of the flu (viruses that are around). No, it doesn’t cause the flu. Yes, you can still get the shot or the spray and it will challenge your immune system (boost immunity) and it will lessen the severity of the flu symptoms if you get the flu. Benefits in immunity may work in strange ways in some years and the “guess” (based on science) of the 3 or 4 viruses that will cause the flu in a given flu season isn’t always correct. Bottom line is that getting a spray or shot with even the wrong virus still boosts your immune system and offers some coverage.

As in past years, if you or a family member do get the flu, it is important to go to the doctor quickly if you plan to try to get Tamiflu. Oseltamivir (Tamiflu) is best started immediately on flu symptoms. The longer you delay, the less the benefit will be and it must be started within 48 hours. There are great symptom checkers on the CDC web site to help you tell the difference between some breathing (respiratory) infections and the flu (visit them at Your doctor may face the treat or not to treat dilemma. This is important if you have diabetes or a heart condition or cancer as the flu can be devastating. The interesting new development is an easier/more prevalent potential use of a lab test to diagnose the flu.

Enter Alere i. Yes, Alere i. The company received a CLIA waver (Clinical Laboratory Improvement Ammendments) for their test. What this means is that the test and technology is simple enough to be used by personnel in a doctor’s office or free-standing Emergency Department. Their test is very fast (about 15 minutes) and uses the latest desirable technology (nucleic acid based) approach. This is the first CLIA waiver for such a flu (influenza A or B) test and means that you and your family could have the convenience of an accurate quick test in a non-traditional laboratory site. This will also help your doctor make treatment decisions sooner and help you get a handle on the flu or appropriate treatment if it isn’t the flu.   

Technology plus medicines, improved population health and targeted treatments for 2015. I will make mention of this test in the upcoming Essential Guide to Prescription Drugs!


MADD Report to the nation on drunk driving

two women drinking The MADD Report to the nation on Drunk Driving is out. This sobering report shows that progress has been made, yet we still have 6 people a day die from alcohol poisoning. This is why I put alcohol (ethanol) into the Essential Guide to Prescription Drugs, 12 top meds for 2012.

This website is not intended as medical advice, and you should consult your doctor before changing or adding any medicines or vitamins to those you may now be taking and about applying any strategies BEFORE you adopt any approach in this report. While diligent care has been taken to ensure the accuracy of the information provided during the preparation of this edition, no claim is made that all known actions, uses or side effects, strategies for cost containment, targets or cholesterol pathways are included in this report. The accuracy and currentness of information are ever subject to change relative to new guidelines, new information derived from drug research, development and general usage.