People’s Pharmacy: The FDA issues update on breast implant illness

Q. Allergan ran a long-term study on silicone breast implants in 2009. I always wanted a more feminine body like the girls in the magazines, so I joined and got implants. They never followed up with me, other than to send me annual surveys to fill out.

Within a year, I ended up with mystery illnesses, including full-body itchy rashes and sores that didn’t heal, memory loss, major weight loss, constant diarrhea, abdominal pain and blurry vision. None of the many doctors I saw could tell me what was causing this.

The implants were removed in 2020. My symptoms have improved, but I am still not completely healthy. It makes me sad and angry that doctors I trusted did not inform me about the risks.

A. The safety of breast implants has been controversial for decades. On Feb. 6, the Food and Drug Administration issued an update on “breast implant illness.” Although the diagnosis is not official, the agency notes that many women experience fatigue, brain fog, hair loss, joint or muscle pain, rash, weight changes, anxiety and depression associated with implants.

About 40% of the reports note that the implant was removed, with many patients experiencing some improvement of symptoms after that. Some, however, “noted either no improvement or worsening of symptoms.”

Q. I took statins for decades, until I started having severe chronic pain in my upper thigh. After reading one of your articles, I told my doctor I wanted to try stopping statins.

She prescribed Repatha injections instead. They control my cholesterol without causing extreme pain. I am grateful.

A. Almost a decade ago, the FDA approved two drugs to lower LDL cholesterol. These PCSK9 inhibitors were perceived as an adjunct to statins to lower bad cholesterol more effectively.

Evolucumab (Repatha) and alirocumab (Praluent) are injectable monoclonal antibodies. They have been joined by inclisiran (Leqvio). For people who cannot tolerate a statin these medications offer a different way of managing blood lipids.

You can learn more about these medications in our “eGuide to Cholesterol Control and Heart Health.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Another option is bempedoic acid (Nexletol). It is an oral cholesterol-lowering medication that has been shown to lower the risk of a heart attack without some of the classic statin side effects.

Q. Milnacipran (Savella) is used to treat fibromyalgia. It is a serotonin-norepinephrine reuptake inhibitor (SNRI). When I took it for two years, my gut motility eventually shut down to almost zero. Four gastroenterologists told me that my symptoms could not be caused by the drug.

After they proposed surgery to remove my intestines, I decided to stop the drug. My motility returned in two days. That kind of surgery could have ruined my life.

A. Researchers don’t understand exactly how milnacipran eases the pain of fibromyalgia. Like some antidepressants that have also been approved for this kind of pain, Savella affects neurotransmitters .

Gastroenterologists may not be as well informed about the side effects of a drug that they may not prescribe very often. The official prescribing information makes it clear that milnacipran could cause nausea or constipation. We are glad you realized this before undergoing unnecessary surgery.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”