Q: Please settle a family dispute. My husband insists on using high-potency DEET mosquito repellent when we go hiking. I prefer a natural approach like lemon eucalyptus, which he says is worthless. Who’s right?
A: You’re both right. Consumer Reports rates 15 to 30 percent DEET as highly effective (Ben’s, Off Deepwoods VIII and Repel Scented Family). Of the natural repellents, Repel Lemon Eucalyptus (30 percent) was roughly comparable to DEET, keeping mosquitoes away for up to seven hours.
Another effective option is picaridin 20 percent, which is a synthetic version of a chemical in the black pepper plant. Brands include Sawyer Picaridin and Natrapel 8 Hour.
Q: My husband’s doctor prescribed niacin for cholesterol control. His HDL was too low, and the doctor said niacin would improve that.
After taking the niacin, he had terrible tingling, itching and flushing. On his doctor’s advice, he started taking an Alka-Seltzer a half-hour before taking the niacin (Niaspan). He has had no symptoms since.
A: Niacin can raise HDL as well as lower total cholesterol, but many people can’t tolerate the uncomfortable symptoms you describe. Using an extended-release formulation such as Niaspan helps a little. Doctors have long known that taking aspirin (an ingredient in Alka-Seltzer) with niacin or half an hour earlier cuts down on the flushing (International Journal of Clinical Pharmacology and Therapeutics, February 2007).
We are cautious about recommending use of Alka-Seltzer or other aspirin-containing antacids on a regular basis for older people. The Food and Drug Administration has just issued a warning about a “serious bleeding risk with over-the-counter antacid products containing aspirin.”
Another option to control the niacin flush is apple pectin. One placebo-controlled trial found that 2,000 mg of apple pectin taken half an hour before niacin reduced the duration of flushing about as well as aspirin (Journal of Clinical Lipidology, March-April 2013). You can buy apple-pectin supplements or eat an apple.
Q: I was recently diagnosed with asthma. After six weeks of steroids that didn’t help much, I went to the emergency room and found out I had a lung infection. This misdiagnosis was by a well-known pulmonologist who should have ordered an X-ray.
A: Many people (including doctors) are not aware that adult-onset asthma can sometimes be triggered by a lung infection that may be difficult to diagnose (Journal of the American Board of Family Medicine, July-August 2012). David Hahn, M.D., M.S., has written about diagnosis and treatment in such situations in his book “A Cure for Asthma? What Your Doctor Isn’t Telling You — and Why.” (People’s Pharmacy Press published it, and it is available at www.PeoplesPharmacy.com.)
Q: I’ve been on tamsulosin for a year to reduce urinary symptoms from an enlarged prostate. I am experiencing sinus swelling, eye discomfort, no interest in sex and poor ejaculation. I am still getting up three times a night to pee.
I will soon be seeing my urologist. Are there other drugs for benign prostate enlargement?
A: Ask your doctor about tadalafil (Cialis). Most men think of this as an alternative to Viagra for treating erectile dysfunction, but the FDA has approved it to ease symptoms of prostate enlargement. Another prescription option is either dutasteride (Avodart) or finasteride (Proscar), though these drugs also may have sexual side effects.
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