People’s Pharmacy: How good is Nexletol against heart attacks?
Q. I’ve been reading about bempedoic acid as an alternative to statins to prevent heart attacks. It is marketed under the brand name Nexletol. I hope you can interpret the results of the recent study for your readers.
The authors report a 23% lower risk. I believe that is a relative risk number, which is most useful for marketing expensive drugs. I would like to know the absolute risk reduction. Can you enlighten us?
A. Thank you for this very sophisticated question about the recent study (New England Journal of Medicine, March 4, 2023). Most of the news reports about bempedoic acid have emphasized the 23% relative risk reduction in heart attacks. That certainly sounds impressive.
Drilling down on the data, however, reveals that 3.7% of people taking Nexletol had heart attacks during the more than three years of the study. In comparison, 4.8% of those on placebo had heart attacks. That absolute difference is 1.1%.
When it came to survival, the two groups cannot be told apart. Of those on the medication, 6.2% died from any cause. That is almost identical to the 6.0% who died while taking placebo.
According to GoodRx, a month’s supply of Nexletol could cost over $460. That makes it substantially pricier than statins unless insurance covers it.
Q. I have taken diphenhydramine at bedtime for many years. Is there a way to stop this medication? When I don’t take it, I have problems falling asleep.
A. Diphenhydramine (DPH) is the antihistamine in Benadryl. It causes drowsiness. DPH is found in most nighttime (“PM”) pain relievers such as Advil PM, Aleve PM and Tylenol PM.
Drug companies suggest that their pills are for “occasional” sleeplessness rather than nightly. They describe DPH as a non-habit-forming sleep aid.
Sleep experts we have consulted do not recommend regular use of this antihistamine for insomnia. DPH has strong anticholinergic activity. That means that it interferes with the action of the brain neurotransmitter acetylcholine. Anticholinergic drug use has been associated with mild cognitive impairment (Alzheimer Disease and Associated Disorders, January-March 2023).
We searched the medical literature for an answer to your important question without much success. Gradual tapering might be helpful. You may also find our “eGuide to Getting a Good Night’s Sleep” helpful. This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com. We offer many nondrug options for overcoming insomnia.
Q. I have been taking Alli in an attempt to lose weight and reduce my cholesterol. I have taken it continuously for six months and plan to keep on until my next cholesterol testing. I typically do not suffer the stated side effects from this medication. Is it safe to use this medication long term?
A. Orlistat was first approved by the Food and Drug Administration in 1999 as the prescription drug Xenical. An over-the-counter form called Alli got the greenlight in 2007. It works by blocking the absorption of fat from the intestinal tract.
This drug does lower both total cholesterol and LDL cholesterol. It may also reduce the absorption of fat-soluble vitamins such as E, D and K as well as beta-carotene. A daily multiple vitamin might be a good idea to reduce this potential complication. The FDA has warned that, in rare cases, orlistat may affect the liver.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”