Pharmacy News Online: Simvastatin sapped libido

People’s Pharmacy: Simvastatin sapped libido

Q: After my doctor prescribed simvastatin, I gradually began to lose my libido. I didn’t realize 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 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). French and Dutch researchers have reported that decreased libido and erectile dysfunction may be associated with statin-type drugs (British Journal of Clinical Pharmacology, September 2004; Drug Safety, July 2009).

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 like 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). One reader noted: “I have been taking Nexium for about three years. I tried to get off it and got the rebound effect. Now what do I do?”

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.

Q: Thank you for your recent column suggesting taking prescription pills with water instead of juice. I asked my doctor about this, and he agreed with the idea. Since I switched to water, I’ve noticed a definite lowering of my blood-pressure numbers.

A: Certain fruit juices can reduce the blood levels of a variety of drugs, including levothyroxine for thyroid, ciprofloxacin for infections and atenolol for high blood pressure (British Journal of Clinical Pharmacology, November 2010). To avoid this problem, take your pills with water.

Mail pharmacy bill will hurt consumers

I urge Gov. Andrew Cuomo to veto the “Anti-Mandatory Mail Order Pharmacy Bill” (A5502-B).

It represents the latest effort by a small group of businesses to shield themselves from online competition. In the end, the legislation will raise health care costs for employers and consumers and undermine consumer choice.

The National Community Pharmacists Association has convinced state lawmakers that the legislation would merely ensure that consumers could fill prescriptions at any retail pharmacy and benefit from one-on-one interaction with their pharmacists.

What NCPA has not addressed, however, is the bill’s likely effects on prices — higher drug costs, higher insurance premiums and co-pays and lower deductibles — which would result from undermining price-cutting arrangements that insurers now commonly negotiate with online pharmacies.

What’s more, the bill will not prevent job losses. If anything, it could stifle economic development efforts by raising costs for employers in the state who provide health coverage for their employees.

Online retailing, with its centralized warehousing, service, efficiency and convenience, has many advantages over bricks-and-mortar retailing.

Consumers should be able to enjoy these advantages and have access to the lowest prices.

This bill provides none of these advantages for consumers but merely a measure of protection for retail pharmacists from competition.

Online doctors are just a click away

Michiganians who have an urgent medical question, lack insurance or just want access to a doctor and prescription after hours can increasingly reach for their phones or computers for an instant chat or webcam conversation with a physician or nurse.

Telemedicine and telehealth — the practice of medicine using electronic communication between a physician in one location and a patient in another — is growing in popularity in the state and across the country.

But the trend is drawing attention from some physician groups and state medical boards, including Michigan’s, that are uneasy about the quality of online physician diagnoses and prescriptions.

Companies such as MDLiveCare and Consult A Doctor offer consumers the convenience of online health care 24 hours a day, and employers are showing more interest in offering the service to employees to rein in health care costs.

At health fairs today, nine Southeast Michigan Rite Aid stores will debut OptumHealth’s NowClinic, which allows consumers to talk to a nurse for free or use a credit card and pay $45 for a private appointment with a doctor licensed to practice in Michigan — anytime the store is open and online 24 hours a day.

Doctors can diagnose patients and, when appropriate, write them a prescription, which can be filled at Rite Aid stores.

NowClinic gives Rite Aid a similar service to rival CVS’s MinuteClinic, a walk-in clinic inside select stores, including several in Metro Detroit.

“Our main goal is to provide access to the patient, to give them options for their total health care needs,” said Shawn C. Wilt, Rite Aid regional vice president of pharmacy in Michigan and northwest Ohio.

While the use of online health care grows, some physician groups, the state of Michigan’s Bureau of Health Professions and the Federation of State Medical Boards are concerned about doctors who prescribe medications this way.

While telemedicine is legal in Michigan, the Bureau of Health Professions, or the state’s medical board, does not support physicians prescribing medication after using an Internet questionnaire or without having an existing doctor-patient relationship, said Steve Creamer, manager of the professional practice section for the state bureau. Doctors doing so are providing substandard care, which would lead to an investigation that would likely lead to a fine and/or license suspension or revocation, Creamer said, adding the state is considering changes to its laws to clearly define what is improper.

“The physicians on NowClinic would not be solely relying on a questionnaire to prescribe,” said Chuck Grothaus, spokesman for OptumHealth. “Through chat, through webcam, through phone conversation, they’re able to actually talk with patients, see them in most cases.”

Grothaus said doctors also use discretion when prescribing, and only after diagnosing common illnesses.
‘The 411, not the 911′

Online health companies say their services are perfect for people who have a health question or an illness such as a sinus infection or may need a short-term replacement of a blood pressure medication.

“It’s only … since about 2009 that consumers and employers have accepted this as part of the health care solution, not in replacement of going to the doctor,” said Randy Parker, chairman and CEO of MDLiveCare, a Florida-based online health care service available nationwide that is seeing the use of its service almost double each month. “We say we are the 411, not the 911.”

The local Rite Aids with NowClinics, such as one on South Canton Center Road in Canton, have private consultation rooms equipped with a computer with webcam and telephone for phone consultations. They are equipped with a scale, ear thermometer and blood pressure monitor for patients to take vitals for a doctor.

“I’ve seen a physician for my personal poison ivy and was given a prescription, and it cleared it up quickly,” Rite Aid’s Wilt said of using NowClinic service. “What was amazing was the doctor followed up with me three days later just to see if I was healing, which is a very nice personal touch.”

Wilt said during his online doctor’s appointment, he showed the physician poison ivy on his skin via the webcam before the doctor made his diagnosis and prescribed a medication.

MDLiveCare requires patients first fill out a medical intake assessment, which is reviewed by physicians before they talk to patients, Parker said. If appropriate, the doctor will electronically prescribe a medication or antibiotic, he said. NowClinic, Consult A Doctor and MDLiveCare don’t prescribe controlled substances.

Consult A Doctor’s CEO Wolf Shlagman said its physicians review a patient’s medical history and can look up prior prescription information through a pharmacy service.

The Federation of State Medical Boards, which advises but leaves it to state boards to regulate doctors, supports telemedicine as a way to deliver care more efficiently and conveniently. But it doesn’t condone skipping steps, such as a physician taking a patient’s medical history or conducting an in-person exam before prescribing medication. Doctors who cut corners could make mistakes, said Dr. Humayun Chaudhry, president and CEO of the Texas-based federation.

“There’s no substitute to actually looking into a patient’s mouth or ears with actual medical equipment,” he said.

OptumHealth said it chose Michigan for the NowClinic pilot with Rite Aid for its telehealth laws, the strength of Rite Aid in Metro Detroit and the ability to help increase access to care, said Chris Stidman, senior vice president of OptumHealth Care Solutions, part of Minnesota-based OptumHealth. NowClinic is available in 10 states, including Michigan.

“We’ll be evaluating additional rollouts as we evaluate the pilot,” Rite Aid’s Wilt said.
Acceptance growing

As acceptance of telemedicine grows, other companies such as California-based RingADoc, offering telephone doctor appointments to residents in 18 states, plan to expand into Michigan early next year, said Jordan Michaels, RingADoc, co-founder and chief operating officer.

Several online health companies such as MDLiveCare and Consult A Doctor are growing by forming partnerships with health insurers and employers as a way to lower health care costs.

Through its wellness program, Taylor-based Masco Corp. provides its about 500 headquarters’ employees and dependents free access to MDLiveCare, which has board-certified, Michigan-licensed physicians available 24/7.

“We really wanted to see how it works and to have an alternative to seeing your primary care doctor, running to the urgent care for things that were minor in nature,” said Julie Forrester, director of benefits for Masco, which makes several brand-name home products.

During the past six months, Masco has recorded about 40 different doctor visits for non-emergencies, Forrester said. The service can save employees time and money, as co-pays for an office visit run $20 to $25 and up to $100 for a trip to urgent care, Forrester said. If successful, Masco is considering putting a kiosk — which includes MDLiveCare and other wellness tools for employees — into some of its manufacturing locations, where access to health care may be more difficult, Forrester said.