Q: I heard your radio show in which you talked about ibuprofen being associated with an increased risk of atrial fibrillation. I have been practicing medicine for more than 20 years, and I’ve never seen anything about a connection between NSAIDs like ibuprofen and a-fib.
I have seen huge numbers of people with stomach ulcers related to these drugs. I’ve heard of heart attacks associated with Vioxx, which was taken off the market. But not a-fib.
I think you should not be misleading people with incorrect statements. A lot of people see TV commercials about a-fib, and after listening to you they may be afraid to take ibuprofen. Please get your facts straight.
A: NSAIDs like diclofenac, ibuprofen, meloxicam and naproxen have been on the market for decades. It took a long time before the Food and Drug Administration realized such drugs might increase the risk of heart attacks.
The connection between NSAIDs and the irregular heart rhythm called a-fib was first reported in the Archives of Internal Medicine (Sept. 13, 2010). Then a Danish study of more than 32,000 patients found that people taking NSAIDs were about 40 percent more likely to develop this arrhythmia (BMJ, July 4, 2011).
People with hypertension, heart disease or a-fib might benefit from other ways to control pain. Our newly revised and expanded Guide to Alternatives for Arthritis provides many nondrug options and is available for purchase at www. PeoplesPharmacy.com.
Q: If a medication is supposed to be taken before meals, how much time before meals does that mean?
A: “Before meals” is much too ambiguous to be useful. If your doctor meant for you to take the medicine on an empty stomach, that would be at least one hour before eating or two hours after finishing a meal. If your doctor meant “take with food,” that would be at mealtime. Have your doctor or pharmacist specify exactly what was intended.
Q: I have been taking omeprazole for several years. With all the recent information about nasty side effects of PPIs, I have decided to wean myself off it.
Ranitidine is giving me good results, but I am wondering if this product also is a PPI. When I tried to look it up on the internet, I could not find the answer to this question. Is ranitidine any safer than a doctor-prescribed PPI?
A: Ranitidine (Zantac) is not a proton-pump inhibitor (PPI). Like cimetidine (Tagamet) and famotidine (Pepcid), it blocks stomach-acid production though a different mechanism.
Because these H2 antagonists are less potent, they generally are less likely to cause complications like chronic kidney disease (JAMA Internal Medicine, February 2016).
Q: Bactrim is the only antibiotic that works well for me. Would it interact with the quinapril I take for my blood pressure?
A: Please contact your physician and pharmacist immediately. The combination of an ACE inhibitor like quinapril or lisinopril with an antibiotic such as co-trimoxazole (Bactrim or Septra) could be life-threatening (BMJ, Oct. 30, 2014). Potassium can rise quickly and lead to cardiac arrest. Symptoms of this condition (hyperkalemia) include heart palpitations, nausea, tingling or numbness in the lips, feet or fingers, trouble breathing, fatigue, weakness, slow pulse and confusion.
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