Brief Pearls About Hormone Replacement, Chantix for Smoking Cessation, and Tylenol

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March 17, 2015

1. Hormone Replacement Therapy: a New Review from the Mayo Clinic

Among the most controversial issues in Gynecology is the use of hormone replacement therapy (HRT) after menopause. In 2002, the famous WHI study found a potential link to breast cancer in those who were on estrogen and progesterone after menopause. The result of this study had caused a drastic drop in the use of estrogen replacement therapy. Since then, several more studies were done on this topic.

A new review from Mayo Clinic in Minnesota of 43 randomized, controlled clinical trials of more than 52,000 women 50 or older showed how HRT did not increase risk of dying from stroke, heart disease, or cancer. The treatment was either with estrogen alone, or estrogen and progesterone combined. The report was presented in the annual meeting of the Endocrine society.

2. Varenicline (Chantix; Pfizer) for smoking cessation – there’s good news and bad news

The good news is that varenicline was shown to help smokers who are not ready to quit in the next month but may be in the next 3 months. In a year-long study of 1500 smokers, the varenicline group was able to decrease the number of cigarettes by 50% at 24 weeks. At one year, the quit rate was 27% in the Chantix group and only 10% in the placebo group.

The bad news is that the FDA issued a safety announcement following a study published in JAMA. The study showed that people who take varenicline can become more susceptible to the effects of alcohol, including more aggressive behavior, and memory loss for the time they were under the influence. They may also have new onset seizures. After concerns in 2009 and 2011 about possible mental status changes and suicidal ideation, studies were initiated which should provide results in late 2015. Meanwhile, the FDA has advised patients to reduce their alcohol consumption while taking varenicline, and immediately stop the medication if they have a seizure, develop agitation or depression or suicidal thoughts. At this time, they are not recommending avoiding varenicline, just to weigh the risks and benefits as we do with any medication.

JAMA. 2015; 313(7): 687-694.

3. Acetaminophen (Tylenol) Potential Toxicity with Long Term Use

Long-term use of acetaminophen, commonly known at “Tylenol,” might lead to many dangerous health problems, reported in an observational study in the Annals of Rheumatic Diseases by the Leeds Institutes of Rheumatic and Musculoskeletal Medicine in the United Kingdom.

A review of 1,888 studies of more than 665,000 people in the United States, Britain, Denmark and Sweden showed a potential link to kidney disease, intestinal bleeding, and increase risks in myocardial infarction, stroke and high blood pressure in those who use heavy dose of acetaminophen. The authors, however, could not establish a “safe” dose for acetaminophen use.

Because it was an observational study and not a clinical trial, the study authors recommended a new review of the safety and effectiveness of acetaminophen, as they were concerned that the risks associated with this medication might be higher than we consumers think.