Friday, 25 November 2016

Wonder drug

Last week I posted on my own experience of statin therapy. It was the second time my GP had arm twisted me into taking statins, and the second time I stopped them because of unpleasant side effects.

At least my GP has not yet brought up the subject of the dreaded polypill. I had thought things had gone quiet on this therapy but a google search shows that it's still out there and still has lots of proponents. Apart from the statin the polypill contains aspirin, and  2, or even 3 antihypertensive drugs. DZ has also been on an antihypertensive for a while. Frequent hypotensive episodes put an end to that. (I don't think DZ is his GP's favorite patient) Some of these episodes occurred whilst driving, and necessitated pulling over to ensure not passing out at the wheel. Bearing in mind the polypill is proposed for all over 55 year old men, regardless of whether they are actually hypertensive or not, how do you feel about sharing the roads with lots of middle aged drivers with their BP in their boots?

And aspirin of course has it's own list of side effects.

Those who would have us all on this therapy claim a number of benefits.

1. Efficacy. Various studies show a reduction in cardiovascular events, but are often dismissive of side effects. Perhaps if we knew the benefit/risk ratio there would be less enthusiasm.
2. It's cheap, since all the components are off patent.
3. Patient compliance is much better, since it's far easier to take one tablet once a day than various preparations at variable frequencies. However this has the downside that many patients will require one drug more than another, and dose adjustment of a single component is just not possible.

DZ has a better idea. There is a drug out there, a single pharmaceutical preparation which has multiple beneficial effects.

1. Cardiovascular benefits especially in congestive cardiac failure and left ventricular hypertrophy. There is also significant reduction in extent of damage in the event of an infarct. CRP is lowered and plaque formation inhibited.
2. This drug drops the blood pressure, not as potently as specific antihypertensives, but  for those who are normotensive this is no bad thing.
3. It's licensed for treatment of symptoms of benign prostatic hypertrophy prevalent in 40% of men over 50, and 75% of men over 75.
4. Early studies indicate possible benefit in type 2 Diabetes
5. It has been used to treat depression.
6. Early studies indicate possible benefits in some cancers, particularly of the throat

So what is this wonder drug? And why aren't doctors insisting it be given to all men over 55? Well cost is a factor, though it comes off patent in Autumn 2017 and should then be available generically, and much cheaper. As for compliance, it has a long half life and only has to be taken once a day. Also, it has one more effect I've not yet mentioned. It's primary licensed indication in fact. An effect which, entirely by itself would guarantee a very high patient compliance.
The drug is Tadalafil (Cialis). It's a phosphodiesterase inhibitor.

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