Friday, June 09, 2006

Avoid Stimulant Drugs

Avoid Stimulant Drugs

Stimulant drugs increase the risk of stroke and sudden death. They must be used with caution or avoided. The drugs of concern are epinephrine, norepinephrine, ephedrine, pseudoephedrine, phenylpropanolamine, methyphenidate, ampthetamine, and methamphetamine

Cocaine decreases brain perfusion and increases the risk of ischemic stroke. The intake of caffeine will increase the effect of sympathetic amines that are found in weight loss products, cold remedies, cough syrups, energy drinks, and prescription drugs. Sympathetic amines increase blood pressure, heart rate and decrease brain perfusion. Haller and Benowitz warned that: “Dietary supplements that contain ephedra alkaloids (also known as ma huang) and guarana-derived caffeine are widely consumed in the United States for purposes of weight reduction and energy enhancement. A number of reports of adverse reactions to dietary supplements that contain ephedra alkaloids, some of which resulted in permanent injury or death, have appeared in the medical literature. In response to growing concern about the safety of ephedra alkaloids in dietary supplements, the Food and Drug Administration (FDA) requested an independent review of reports of adverse events related to the use of ephedra alkaloids to assess causation and determine the level of risk these products pose to consumers.”

In the US, a FDA advisory committee heard testimony indicating that 2.5 million children take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States. The use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. The popularity of the diagnosis, Adult ADHD is relatively recent leading to at least 1.5 million adults who take stimulants on a daily basis, with 10 percent of users older than 50 years of age. Drug-related events reviewed by the committee included 25 cases of sudden death in children or adults that included myocardial infarction, stroke, and serious heart arrhythmias. The committee concluded: “We rejected the notion that the administration of potent sympathomimetic agents to millions of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon and decisively. “

May 26 2006 Canada's health ministry warned individuals with hypertension, heart disease or abnormalities, arthrosclerosis or hyperthyroidism not to take drugs used to manage attention deficit hyperactivity disorder (ADHD). All ADHD drugs stimulate the heart and blood vessels... in some patients this stimulation may result in cardiac arrests, strokes or death.

The drugs of concern mentioned by Health Canada include:

* Adderall XR
* Concerta
* Ritalin and Ritalin SR
* Dexedrine
* Strattera

For updates on drug warnings see our new page Brain Drug Warnings

Also, read the Book of Brain by Stephen Gislason MD

Brain Prescription Drug Warnings

I have progressed from being an enthusiastic supporter of psychotropic drug research and the therapeutic use of mind drugs 30 years ago, to a disenchanted skeptic who is convinced that drug prescriptions to change mood, attitude, thinking and memory are mostly ill-advised and may often be harmful.

I argue that responsible adults need to become better informed about prescription drugs and exercise constraint when seeking and accepting prescriptions that alter their brain function. I will also argue that prescriptions for psychotropic drugs for children and the elderly are increasing unreasonably and need to be voluntarily constrained by physicians, resisted by family members and controlled by government regulators.

Many, if not most, humans alter their consciousness and behavior by deliberately consuming chemicals to alter they way their brain works. The general principal is that materials that enter human noses and mouths play a role in determining the nature and operation of their mind. We could think of this as the local molecular flow through the brain that alters, expands or contracts the contents of the mind. The brain, as the organ of mind, is the receiving set for the wisdom of the universe. If the receiver is out of tune, not working properly, the wisdom of the universe is either not received at all or the message is garbled.

For updates on drug warnings see our new page Brain Drug Warnings

Also, read the Book of Brain by Stephen Gislason MD

Heart Attacks, Strokes and ASA

The use of drugs in cardiovascular medicine is like fashion in clothes design - always changing. The use of Acetylsalicylic Acid (ASA or Aspirin) taken in a small dose daily, has been advocated for many years to reduce the risk heart attacks and strokes. ASA is a platelet inhibitory drug, effective in doses as low as 50 mg per day.

One major shift in 2006 recommendations is based on noticing differences among men and women of different ages. Ridket and Beller pointed out that 95,000 men and women participated in aspirin prevention trials with a net 24% reduction in myocardial infarction and no benefit on stroke; however if you stratify men and women separately, you get 44,000 men with 32% reduction in heart attack. In contrast the 51,000 women had little or no reductions in myocardial infarction, but a significant 19% reduction in the risk of stroke.

A further study looked at the experience of women over the age of 45 more closely. A total of 39,876 women participated in the trial to receive aspirin 100 mg very other day or placebo. The mean follow-up period was 10.1 years. The primary endpoint was first major cardiovascular event, which included nonfatal MI, nonfatal stroke, or cardiovascular death. Secondary endpoints were the individual endpoints of fatal or nonfatal MI, fatal or nonfatal stroke, ischemic stroke, hemorrhagic stroke, and death from cardiovascular causes. Additional analyses included the incidence of death from any cause, transient ischemic attack (TIA), and the need for coronary revascularization.

The characteristics for the groups were similar; participants were 54.6 years of age and more than half were postmenopausal; slightly more than one-quarter were hypertensive and nearly 85% had a 10-year Framingham risk score < 5%. Ridket stated: “Women over the age of 65, have a benefit of stroke reduction associated with low-dose aspirin. In women under age 65, my feelings are go to the gym, lose weight, eat a healthy diet, and maybe the benefit of aspirin is just smaller than we had hoped.”

The 2006 conclusion? ASA has benefits in the primary and secondary prevention of heart attacks in men with little or no benefit in women. Aspirin has a benefit in women over the age of 65 in the  prevention of stroke or transient ischemic attacks. What next?

See the Book of Heart and Arterial Disease