Q: I am very concerned about all the recalls of blood pressure pills. When valsartan was first recalled, my doctor put me on losartan. Before long, that was also recalled. In the meantime, my blood pressure was not well-controlled.
I’m back on valsartan now, but I have no confidence that it is safe to take it. I can’t afford the brand name, Diovan, because it is so expensive. I guess I have an unacceptable choice: Do I die from cancer or from a heart attack or stroke?
A: Since July, millions of blood pressure pills have been recalled because of nitrosamine impurities. The drugs include irbesartan, losartan and valsartan.
According to the Food and Drug Administration, the risk of cancer is very low, even though the recalled medicines have been contaminated with suspected carcinogens for four years or longer. That said, most people would prefer to avoid potential cancer-causing chemicals in their medicines.
A perspective published in the New England Journal of Medicine (March 13, 2019) points out that doctors may find it challenging to switch patients from one medication, such as valsartan, to another, such as losartan. There aren’t good studies to guide them on how to adjust the dosages.
The average retail price for a month’s supply of brand name Diovan (160 mg) is $320, according to GoodRx.com. That organization offers coupons that can lower the price to $260.
Canadian online pharmacies offer Diovan at around $45 for a four-week supply. There have been no reports of contamination with this brand. You can learn more about Canadian online pharmacies in our eGuide to Saving Money on Medicines, available at www.PeoplesPharmacy.com.
Q: I have been hearing about the importance of intestinal microbiota for our health. How do drugs such as Nexium affect these microbes that live in our digestive tracts over the long term?
A: Investigators have found that acid-suppressing drugs such as esomeprazole (Nexium) can alter the balance of bacteria in our digestive tracts (Journal of Clinical Biochemistry and Nutrition, January 2018). Such changes may predispose people taking these PPI medications (including lansoprazole, omeprazole and others) to intestinal infections with C. difficile. Some researchers believe that "the effects of PPI are more prominent than the effects of antibiotics or other commonly used drugs" (Gut, May 2016).
Q: My wife has Sjogren's syndrome and some other autoimmune problems. She is currently taking Plaquenil, which worries us because it can cause serious vision problems.
I found a reference to using low-dose naltrexone as an alternative treatment with few side effects. Can you comment on the efficacy of this drug for autoimmune problems? I didn’t find any solid studies, just anecdotal information.
A: Naltrexone is an oral form of the opioid antagonist naloxone. At the standard 50-mg dose, it is approved for treating alcoholism and other substance abuse disorders.
Off-label, low-dose naltrexone (1 to 4.5 mg) is being considered for use against chronic pain (Senior Care Pharmacist, Jan. 1, 2019), fibromyalgia (Current Rheumatology Reviews, 2018) and certain autoimmune conditions (International Immunopharmacology, August 2018).
We haven’t found any studies of low-dose naltrexone for Sjogren’s syndrome, which causes dry mouth, dry eyes and complications affecting other organs. Researchers need to conduct well-controlled trials to determine if this drug would be helpful.
