· Generic Name
DIAZEPAM

· Drug Class
Benzodiazepine long acting medication
Sedative medication

· How It Works
Medication binds to GABA receptor in brain, slowing brain activity

· Serious Side Effects
bone marrow damage
dependency
depression
hallucinations
liver damage
low blood pressure
potential for abuse
respiratory depression
slow heart rate
withdrawal
psychosis

· Common Side Effects
blurred vision
changes in libido
confusion
constipation
depression
difficulty speaking
dizziness
double vision
drowsiness
dry mouth
fatigue
forgetfulness
headache
incontinence
liver damage
low blood pressure
muscle weakness
nausea
rash
slurred speech
tremor
urinary retention

· Generic Name
Vardenafil

· Drug Class
Erectile Dysfunction Medication

· How It Works
Medication inhibits enzyme, increasing blood circulation to certain tissues

· Serious Side Effects
allergic reaction
chest pain
fast heart rate
glaucoma
hearing loss
heart attack
high blood pressure
light sensitivity
low blood pressure
priapism
vision loss

· Common Side Effects
back pain
dizziness
flu-like symptoms
flushing
headache
joint pain
liver damage
muscle damage
muscle pain
nausea
runny nose
sinus infection
stomach upset

Essential tremor is the uncontrolled rhythmic movement of an extremity such as your hand or arm that is not from Parkinson’s Disease.  Essential tremor affects about 5 million people in the United States older than 60 years.  The cause of essential tremor is likely the result of a certain type of brain damage.

·This study was a prospective observation analysis of 3,300 people who were 65 years and older.  Over half of the study participants reported drinking routinely.

· The study authors report that participants who drank more alcohol and for longer periods of time were more likely to developed tremor.  The risk of developing tremor increased by 23% for every year of routine alcohol use.
· The authors also report that concomitant cigarette smoking or depression more than doubled the risk of developing tremor.

· Alcohol is known to cause brain damage, especially to the cerebellum, the area of the brain responsible for coordinated muscle movement.

· This observation study was based on a survey filled out by the participants and there are many variables that could not be controlled, making it difficult to draw strong conclusions.  More studies are needed to confirm these findings.

Reference
J Neurol Neurosurg Psychiatry. 2009;80:423-425. Abstract

· Generic Name
VARENICLINE

· Drug Class
Smoking Cessation Medication

· How It Works
Medication stimulates nicotinic acetylcholine receptors in the brain

· Serious Side Effects
allergic reactions
agitation
anemia
depression
hallucinations
heart arrhythmias
kidney failure
kidney stones
light sensitivity
seizures
syncope
thinking of suicide
visual changes
pancreatitis

· Common Side Effects
abnormal dreams
change in taste
constipation
diarrhea
dry mouth
fatigue
emotional disturbances
gas
headache
insomnia
malaise
nausea
rash
somnolence
stomachache
vomiting

· Generic Name
Varenicline

· Drug Class
Smoking Cessation Medication

· How It Works
Medication stimulates nicotinic acetylcholine receptors in the brain

· Serious Side Effects
allergic reactions
agitation
anemia
depression
hallucinations
heart arrhythmias
kidney failure
kidney stones
light sensitivity
seizures
syncope
thinking of suicide
visual changes
pancreatitis

· Common Side Effects
abnormal dreams
change in taste
constipation
diarrhea
dry mouth
fatigue
emotional disturbances
gas
headache
insomnia
malaise
nausea
rash
somnolence
stomachache
vomiting

· Generic Name
VASOPRESSIN

· Drug Class
Endocrine medication
Advanced Cardiac Life Support medication

· How It Works
Medication mimics activity of anti-diuretic hormone.

· Serious Side Effects
allergic reactions
chest pain
heart arrhythmias
heart attack
high blood pressure
slow heart rate
water intoxication

· Common Side Effects
diarrhea
dizziness
fever
headache
gas
nausea
rash
stomachache
sweating
tremor
vomiting

· A recent study in the journal The Lancet reports that patients with HIV would benefit from starting anti-viral HIV medication earlier.

· The study analyzed data from 18 studies of patients with HIV which included 45,000 individuals.

· The study reported that waiting to start medication until a CD4 cell count dropped to 251-350 cells was associated with higher rates of the development AIDS and death when compared with starting medications earlier, when CD4 cells counts were higher, between 351-450 cells.

· The study authors concluded that their data indicates that medications should be started earlier in the course of the disease, when patients have CD4 cells that have dropped to 350 cells.

· This study is a retrospective observational analysis of previous clinical trials. The authors present a convincing argument to start treatment earlier, possibly at CD4 cell count as high as 450.

Reference
The Lancet, Early Online Publication, 9 April 2009

April 9 2009

· The authors of this review article report on multiple previous studies showing protection against certain forms of cancer and aspirin use. Due to ethical constraints, there are no long-term randomized placebo-controlled clinical trials on aspirin use and prevention of cancer.

· The current evidence of a reduction in cancer with aspirin use comes from studies of aspirin that were designed to test vascular protection, heart disease and stroke.

· The authors of this article summarized the evidence from previous published studies supporting the potential benefit of aspirin in cancer prevention.

These trials include:
· The Physicians’ Health Study, which showed a relative risk reduction for developing colorectal cancer in the aspirin group, compared with the placebo group.

· A British study of 5,000 male doctors showed that after six years, cancer deaths were 18% lower in the aspirin-treated group.

· The Nurses’ Health Study of almost 80,000 American women, showing a 12% reduction in cancer deaths with aspirin use.

· Cancer Prevention Study II showed a significant reduction in overall cancer for men only, a reduction in colon and prostate cancer, and a nonsignificant reduction in breast cancer.

· There are 20 other observational studies that have found that NSAIDs appear to offer a degree of protection against breast cancer and might be of benefit to women with cancer. Some benefit has also been observed for both gastric and esophageal cancers.

· The dose and duration of aspirin needed for a protective effect against cancer is not known.

· The information from these studies is observational and many variables cannot be analyzed, which complicates conclusions made by the authors.

· The authors also point out that there are differing viewpoints within the medical community as to whether or not patients at a high risk for cancer should be advised to use prophylactic aspirin.

Reference
The Lancet, Early Online Publication, 27 March 2009

· Dr. Turner, lead investigator of the study comments “many patients who have been labeled with fibromyalgia are, in fact, suffering from symptomatic vitamin-D inadequacy.”

· The study found that patients who had inadequate vitamin-D levels and required narcotic pain medication were taking much higher doses; almost twice as much medication as those with adequate vitamin-D levels. Subjects with low vitamin-D levels also reported worse physical function and worse overall health perception.

· This was a retrospective study of 267 patients who were admitted to the Mayo Comprehensive Pain Rehabilitation Center.

· The study’s authors compared vitamin-D levels at the time of admission along with the duration of pain, the medication patients were taking, self-reported levels of pain, emotional distress, health perception, physical functioning, and demographic information such as sex, age and body-mass index.

· Patients with low vitamin-D levels, below 20 ng/mL, were considered to have inadequate amounts of vitamin-D. The prevalence of low vitamin-D was 26%.

· Researchers report that the patients with low vitamin-D levels required 48% more pain medication to control pain. The patients with low vitamin-D levels also needed narcotic pain medication for 38% longer than the patients with normal vitamin-D levels.

· The researchers also observed a link between increasing body-mass index and decreasing levels of vitamin-D.

· The authors conclude that low vitamin-D levels may create or sustain pain.

· One of the study authors suggested that patients with inadequate vitamin-D levels may benefit from vitamin-D supplementation. But he urged caution for patients with calcium or phosphate-processing disorders. Dr. Turner comments, “Increasing vitamin-D levels could be problematic in patients with kidney failure or stones, or primary hyperparathyroidism, or sarcoidosis. ” For patients with adequate vitamin-D looking to maintain levels, he recommends 10 to 15 minutes of sun exposure with no sunscreen on the trunk and arms and legs 3 times a week.

· The importance of adequate vitamin-D is just recently being recognized by the medical field. Vitamin-D may help reduce some forms of cancer and heart disease. Deficiencies may be important in the development of Multiple Sclerosis and now researchers are seeing an association with chronic pain.
Our society is likely at a higher risk of vitamin D deficiency today with the current avoidance of sun exposure, one of the sources of vitamin-D.
Vitamin D levels can be easily checked with a simple laboratory test and reviewed with your doctor.

References
Pain Med. 2008;9:979-984.

· Readers should keep in mind, however, that the “Women’s Health Initiative” is not the best type of study for medical research. There are too many variables that cannot be controlled, which affect the results of the study.

· Other recent studies have shown benefits from vitamin supplements. Vitamin D supplements have been shown to offer some protection from certain types of cancer and heart disease. Folic acid(another vitamin) can control homocysteine blood levels which in excess can increase heart attack risk.

· Vitamin supplements are likely beneficial to good health and we should not conclude otherwise based on the Woman’s Health Initiative.

Reference
Arch Intern Med. 2009;169(3):294-304.

February 11, 2009