Pharmacy News Online: People’s Pharmacy: An unexpected side effect of simvastatin

People’s Pharmacy: An unexpected side effect of simvastatin

Q: After my doctor prescribed simvastatin, I gradually began to lose my libido. I didn’t realize that this medication was responsible, but after I dumped the drug because of severe muscle pain, my sex drive came back. Do doctors know about this side effect?

A: We suspect that relatively few physicians are aware of this potential complication. The official prescribing information for simvastatin (Zocor) does not mention lowered libido.

There is a surprising lack of research regarding sexual function and statin-type medications like atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin. Because cholesterol is a building block for testosterone, drugs that interfere with cholesterol production can lower levels of this hormone (Journal of Sexual Medicine, April 2010). Niacin, a different kind of cholesterol-lowering drug, does not appear to have this side effect. In fact, a recent study found that niacin might actually improve erectile function (Journal of Sexual Medicine online, Aug. 2, 2011).

Q: As a nurse, I’m concerned about the widespread use of acid-suppressing drugs such as omeprazole. I’ve heard many patients talk about how bad their reflux is when they stop these drugs. Until recently, I was not aware that there is a rebound effect. Do you have any suggestions about how people can discontinue such medicine?

A: Rebound hyperacidity is now recognized as a potential complication of stopping many powerful acid-suppressing drugs. Proton pump inhibitors (PPIs) such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex) can trigger severe heartburn symptoms when people stop them suddenly (American Journal of Gastroenterology, July 2010). Gradual tapering might be beneficial. Less potent acid-reducing approaches including antacids or natural compounds also may help get someone past the most difficult stage.

Visitors to our website report that deglycyrrhizinated licorice (DGL) may help, along with ginger and persimmon tea.

Google Girds for a Grilling

Google Inc. is taking no chances as its executive chairman, Eric Schmidt, prepares to face a Senate hearing Wednesday on whether the company is abusing its dominance in Internet search.

Hoping to fend off any antitrust action, Google has hired at least 13 lobbying and communications firms since May, when the Federal Trade Commission ramped up its probe of the Internet giant. Firms led by figures from both parties—including former House Democratic leader Richard Gephardt and the son of Indiana Republican Sen. Richard Lugar—are going to bat for the company.

Looming over this week’s proceedings will be rival Microsoft Corp., whose former chief executive, Bill Gates, faced his own congressional grilling on March 3, 1998.

Just two months after Mr. Gates’s shaky performance, the U.S. government hit Microsoft with an antitrust suit accusing it of abusing its dominance in the market for PC operating software. Though Microsoft, which often chose confrontation with the government, ultimately avoided being broken up, the suit weighed it down for years.

At the time, Mr. Schmidt was a software executive who criticized Microsoft’s operating-system dominance; Google had yet to be founded. Now, Mr. Schmidt represents a company whose situation strikingly resembles that of Microsoft 13 years ago.

Like Microsoft then, Google relies overwhelmingly on its core product, Internet search, and dominates the market for that product. It handles around two-thirds of U.S. Internet searches and more than 80% in many European countries, according to comScore Inc.

Microsoft now leads the critics who say that Google uses its dominance in search to gain an edge in other services, such as business listings, maps and product-comparison websites.

Google says it has users’ interests in mind and adds that if people don’t like its offerings, competitors are just a click away.

One lesson Google has learned from Mr. Gates’s experience: Don’t appear arrogant. “We understand with success comes scrutiny, and we’re looking forward to the hearing and answering any questions senators may have about our business,” a Google spokeswoman said.

Mr. Schmidt has made three rounds of visits to senators on the Judiciary Committee in recent weeks to address their concerns, a Google spokesman said. One of its top search engineers, Matt Cutts, also has visited Capitol Hill to rebut accusations that Google changes its search formula to bump down competitors.

And Google co-founders Larry Page and Sergey Brin have met some policy makers in Washington over the past year, according to a person familiar with the matter. Mr. Page replaced Mr. Schmidt as CEO in April.

With its new hires, Google has at least 25 lobbying and communications firms, many with Republican ties, working for it on issues including antitrust and online privacy. That helps blunt any perception that the company, which welcomed then-presidential candidate Barack Obama to its headquarters in 2007, leans Democratic. Several Google employees went on to work at the White House after Mr. Obama was elected, and he has appointed Mr. Schmidt to his Council of Advisers on Science and Technology.

Among Google’s recent additions is the lobbying firm First Group, which includes a former chief of staff to Senate Republican leader Mitch McConnell. Google also hired Rob Saliterman, a former spokesman for President George W. Bush, to direct its political-advertising team in Washington.

“We have a strong story to tell about our business, and we’ve sought out the best talent we can find to help tell it,” a Google spokeswoman said.

After long trailing Microsoft in its lobbying spending, Google caught up in the first half of this year. Filings show that both companies spent around $3.5 million in that period.

So far, Google doesn’t face the breadth of opposition in Silicon Valley that dogged Microsoft in the late 1990s. To play down monopoly concerns, it also can point to powerful rivals, such as Facebook Inc., who have grabbed the attention of Internet users.

Still, Wednesday’s hearing could focus attention on its recent stumbles. Last month Google paid $500 million to settle a criminal probe involving illegal online pharmacy ads on its search engine. Mr. Schmidt also will look to avoid gaffes such as his comment last year that Google’s policy “is to get right up to the creepy line and not cross it.”

Google has launched an advertising campaign aimed at connecting it to politically important issues, such as job creation and helping small businesses. Some of the ads, which have appeared on TV and in Washington publications, have featured businesses located in the states of senators on the panel holding Wednesday’s hearing, including Wisconsin, New York, Connecticut and Utah.

“Michael’s [Green Bay Packers merchandise] store is in Menomonee Falls, Wis., but he uses Google AdWords to reach Cheeseheads around the U.S.,” read one ad this month in Politico, which is widely read on Capitol Hill. The chairman of the Senate antitrust panel, Democratic Sen. Herb Kohl, hails from Wisconsin.

Google also has given thought to the staging of the event. According to people familiar with the matter, it successfully sought to have Mr. Schmidt appear alone at the hearing, instead of having to share the spotlight with other witnesses.

At the 1998 hearing, Mr. Gates shared a table with two bitter rivals, Scott McNealy of Sun Microsystems and Jim Barksdale of Netscape Communications, and looked on awkwardly as they denounced his company.

At one point, Mr. Barksdale took an instant poll in the hearing room, asking people to raise their hands if they used a computer based on an Intel chip, rather than an Apple Macintosh. Of those, he asked how many used an operating system other than Microsoft Windows. All hands went down.

“Gentlemen,” he told the senators, “that is a monopoly.”

This time, witnesses critical of Google will appear separately in a second panel. They include the chief executive of business-listings service Yelp Inc. and a representative of travel site Expedia Inc. Both complain that Google favors its own services in search results and demotes their competing sites, an issue that people familiar with the matter have said is at the center of the FTC’s antitrust investigation.

Under Sen. Kohl’s leadership, the Senate antitrust panel hasn’t been overtly hostile to Google. But the panel’s newly elected top Republican, Sen. Mike Lee of Utah, has repeatedly raised concerns about Google’s market power and had called for the hearing.

Before his Senate victory last year, Mr. Lee, a tea-party favorite, was an attorney for 1-800 Contacts, an online contact-lens retailer in Utah that clashed with Google in court. He also helped push for a state law that critics said would have effectively outlawed keyword advertising, Google’s largest revenue source.

Rite Aid and OptumHealth introduce NowClinic Online Care services

Rite Aid Corporation, a drugstore chain, and OptumHealth have introduced NowClinic Online Care services in the greater Detroit area.

NowClinic offers Rite Aid customers real-time access to convenient medical care, information and resources from doctors and OptumHealth nurses. Through private, face-to-face consultations using the Internet, Rite Aid customers can see and speak directly to doctors who are able to discuss symptoms, provide guidance, diagnose and prescribe certain medications when appropriate.

Customers can also interact with OptumHealth nurses, who are able to address a range of health care needs such as basic health care education, information on common acute issues and assistance in identifying appropriate provider options for care. A customer record is automatically captured at the end of each interaction and is available for immediate sharing with a customer’s primary care provider, maintaining continuity of care.

Customers can have consultations with doctors and interact with OptumHealth nurses via NowClinic Online Care inside private consultation rooms inside the following Rite Aid pharmacies in the Detroit area during regular pharmacy hours.