N- acetylcysteine

I read with interest a recent article discussing the potential benefits of N- acetylcysteine, an amino acid that has been used in treatment primarily of tylenol toxicity. The effects are based on its ability to act as a potent antioxidant which may support the body’s ability to fight infections or stress. It appears to protect cells from toxins by detoxification of various toxic substances.
The most interesting clinical application is in the treatment and prevention of influenza. With more and more threat of the pandemic H1/N1 swine flu, N-acetylcysteine may be a useful adjunct to current therapy. Compared to placebo pills, N-acetylcysteine users were less likely to have clinical influenza (or at least symptoms of it). Secondly, when those patients actually did develop influenza, it was a much less severe case. It appeared that immunity at a cellular level improved significantly. Though not part of any official CDC recommendations, it may be an option for those who are at higher risk of developing the H1/N1 strain, or any influenza strain for that matter.
A second use of N-acetylcysteine is for patients with chronic lung disease (COPD or emphysema). A study of over 1300 patients found there was a reduction in cough severity and amount of phlegm produced. Those same patients had less likelihood of developing shortness of breath and associated heart failure. Furthermore, based on actual lung testing, they had improvement in their overall lung function. It was shown that in the N-acetylcysteine group, there was nearly 50% less loss of lung function when compared to those not on the supplement. This may be exciting news for patients with chronic lung disease. Many of the available inhaled treatments do not provide total relief. Addition of N-acetylcysteine may be useful in preventing future attacks of acute bronchitis.
Dosing is generally 1200 mg twice per day. Generally at lower doses, the drug is well-tolerated. Side effects may include nausea, vomiting, diarrhea, skin rash, flushing and abdominal pain. Larger doses are used to treat acetaminophen toxicity (tylenol poisoning). At these doses, side effects may include headache, itching, fever and severe allergic reactions. Any patient on nitroglycerin for heart disease should use caution as this combination may result in significant drops in blood pressure. N-acetylcysteine is available over the counter in doses of 600 mg. As noted, standard dosing is two capsules twice per day.
In short, N-acetylcysteine, by acting as a potent antioxidant, may improve symptoms of chronic lung disease and may also be a useful adjunctive medication in the prevention and treatment of viral influenza. It may also protect against kidney damage when given prior to certain imaging procedures (i.e. CT scans that use intravenous contrast). I did not expand on this fact in a deliberate attempt to not bore my readers to tears. There you have it.

Polypill on the Horizon?

At the recent American College of Cardiology meeting, phase 2 results of the Indian Polycap Study (TIPS) were presented. Within this landmark trial, investigators have been evaluating the positive effects of a polypill that contains three blood pressure lowering agents, a cholesterol reducer (statin) and an aspirin. It has been estimated that use of the polypill could reduce coronary heart disease by 62% and stroke by 48%. The polypill represents one of three strategies in development by the World Health Organization to reduce cardiovascular disease, the other two being weight loss and smoking cessation.
TIPS took 2053 patients and placed them in one of eight study groups and evaluated them over the course of 12 weeks. The other groups included aspirin alone, aspirin plus statin, and combinations with all blood pressure agents. All were Indian patients with an average blood pressure of 134/85 and bad cholesterol (LDL) of 117, both of which are quite good by most standards. Results were impressive with most patients having substantial blood pressure drops and cholesterol lowering. The big question is whether high-risk individuals should be on this combination as a preventative measure. One also wonders if all patients should consider medications like this for health maintenance. It may be years before all the data is back, but it is certainly thought provoking.

Honey for Cough?

Controversy surrounds the use of over the counter cough and cold medications, especially in children. There is no convincing evidence that any of them provide benefit, and, in fact, they may be harmful secondary to side effects and the potential for overdose. It has been estimated that more than 7000 emergency room visits occur annually due to adverse drug events related to the use of children’s cough and cold medications. One third of these are associated with simple dosing errors. Once again, the World Health Organization has stepped in and recommended the use of honey to soothe cough in children older than one year. No formal study has evaluated honey versus standard medicines like dextromethorphan, though it appears better than no treatment. Given the relative safety of honey consumption, its potential use in treating upper respiratory infections is certainly intriguing. I would certainly recommend giving it a try before resorting to OTC purchases. At a minimum, parents should be educated on these issues. We all believe that there medicine can cure anything, but the reality is that they all have the potential to do more harm than good.
Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.

Insomnia Part 2

Dear Dr. Spence,
Why can’t I seem to get a good night sleep? What can I do other than pop pills every night?
Signed,
Sleepless in Marianna

In my last writing I had been discussing some of the causes and implications of insomnia. The solution to improving sleep hygiene, however, is more complex. There are many options available to patients. Some are by prescription, some are over the counter remedies and some are just plain common sense. First and foremost, of course, is fixing any problem that may have led to the insomnia originally. If a patient is depressed for example, proper therapy may be an antidepressant as opposed to a sleep aide.
Changing sleep habits is a simple and occasionally effective way of combating the problem. Maintaining regular sleep and wake times are crucial at helping regulate the body’s natural circadian rhythms. Many people incorporate behavioral therapy into the mix. Techniques include muscle relaxation, breathing exercises and cognitive therapies that try to replace worry about sleep with more positive thoughts.
There are of course some basics when it comes to sleep hygiene. You should keep the same sleep schedule regardless of whether it is a weekend or not. Try to avoid the temptation of sleeping in once Saturday and Sunday roll around. You should sleep as much as you need to in order to feel rested. If you cannot sleep for fifteen minutes, it is recommended that you engage in another activity for a while (i.e. reading a book or watching T.V.) Do not read, eat, watch T.V. or work in bed. The bedroom should be a place of comfort; cool with minimal distractions like noise or light. Get rid of the computers and T.V. Those who engage in regular exercise generally report better sleep. Lastly, limiting alcohol and/or caffeine at bedtime can also help prevent insomnia.
Finally, medications can be used if all else fails. Over the counter medications like valerian and melatonin have been used for years with varying degrees of success. Most studies do not support their efficacy. Your physician can prescribe a host of agents that may help induce sleep. Popular agents like lunesta and ambien can be beneficial but may be potentially addictive and may be problematic in older adults due to their sedative properties. Rozerem claims to work by helping maintain the natural sleep architecture through sleep-wake cycles and does not appear to have the adverse effects or dependence that is seen with other agents. Your physician can assist you in finding the right medication for you.
Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.