Benzodiazepines - Zopiclone and Zolpidem
Drug Alert - A recent article in the medical press highlights the potential problems with the benzodiazepine “Z” drugs (Zopiclone and Zolpidem) prescribed for insomnia. I would like to take this opportunity to remind our patients about these dangers.
Benzodiazepines are approved only for short-term use, in part because of the demonstrated loss of therapeutic effect as early as 4 weeks, and because of the risks for cognitive impairment, falls, fractures, and car accidents, as well as the abuse and dependence liability associated with the drugs, especially in the elderly. Benzodiazepines have also been implicated in the development of dementia, infections, pancreatitis, cancer, and exacerbation of respiratory disease. Nonetheless, long-term use of benzodiazepines is common and markedly increases with age.
If anyone reading this has concerns I would be delighted to hear from you. Gradually tapering the dose of medication with the aim to discontinue completely is invariably successful.
Travel Vaccinations for your trips abroad
If you are planning to travel abroad don't forget to check out what vaccinations are required remembering to allow a lead time of approximately 2 weeks for vaccines to become effective. Some vaccines are in short supply so be organised in advance as they need to be ordered.
Should we screen for Vitamin D Deficiency?
Vitamin D is a trendy health subject. Much airtime and many column inches have been devoted to the subject but is there any real value in measuring Vitamin D levels?
The first problem is to decide whether there are natural variations to be taken into account. Most Vitamin D – 80% - is made by the action of sunlight on melanocytes in the skin. Obviously, if you don’t feel the sun you don’t make Vitamin D. People who come from communities where exposing your skin is not recommended (especially women) will never be sufficiently exposed to sunlight to make enough Vitamin D. People who live in the northern hemisphere will have lots of exposure in the summer and very little in the winter.
So, where you live, your community ethics and the time of year all combine to make a Vitamin D reading very variable and of dubious validity.
This is compounded by the uncertainty of what “normal” means in Vitamin D terms even after taking account of other variables. It would seem that the range of Vitamin D is very large. Consensus has now been reached that if the blood level of 25(OH)D is less than 50 nmol/l bone health is compromised and less than 75 nmol/l is possibly injurious to health. The challenge is to make accurate measurements which requires standardization of methodology in all laboratories everywhere.
So we know that as much of 33% the US population have very low Vitamin D and maybe as much as 77% of the population may have less than 75 nmol/l Vit D3 levels. Does this mean that three quarters of the population need Vitamin D supplements and what would the benefit be? The answer is that we do not know and therefore there is no basis on which to recommend routine screening for Vitamin D or routine supplementation.
What does Dr Jack recommend?
- Adding Vit D measurement to routine screening is not advised
- Measuring Vit D in special circumstances is still valid. If bone health and metabolism are compromised then bone screening and Vit D measurements are essential and replacement of D3 and minerals must be prescribed.
- There is poor level evidence that low Vit D is associated with muscle fatigue and even poorer evidence that deficiency is associated with mental tiredness and poor intellectual performance. Nevertheless, people presenting with TATT (“tired all the time”) should have Vit D measurement and supplements prescribed if levels are low.
- 15 minutes of sunshine a day is good for you and boosts Vit D levels. You do not have to strip off completely – exposing your arms and legs is sufficient. Everyone will still need sunblock and hats and avoid sunburn as before – skin cancer is lethal. We don’t know enough about low Vitamin D levels but we can certainly say it is not life threatening. Have a good summer!!
Dementia – Worried about someone?
The Alzheimer’s Society has a free “Staying Connected Kit” designed to help someone with dementia live a more connected life. It provides a better understanding of the condition and information about all the support services the Alzheimer’s Society is able to give people with dementia and their carers.
Request your FREE Staying Connected Kit and help someone with dementia live a more connected life.
Diabetes – Oral Health
People with Diabetes are 2-3 times more likely to develop Periodontal Disease. If you have Diabetes, you may have been told about the importance of looking after your diet, your eyes and your feet, but what about your oral health? Periodontal disease (gum disease) is another common complication of Diabetes Mellitus. Other manifestations include dry mouth, fungus and caries. Management of these conditions is very important so make sure you discuss your condition with your dentist to improve your quality of life.
VACCINATIONS - Are you prepared?
Going on holiday? Remember to check out what vaccinations you may require and get vaccinated 2-3 weeks before you go travelling for full protection.
Meningitis B Vaccine
Supplies of Meningitis B vaccine are only available through the NHS of which there are very limited supplies. More supplies expected summer 2016.
Meningitis B Vaccine (Bexsero) – There has been an unprecedented request for this vaccination in the last week We have attempted to obtain supplies directly from GSK unsuccessfully. The NHS is also short of supplies. Apparently the situation should improve in the summer of 2016 and apparently should be better in 2017. Meanwhile please remember that in an average year there are probably only 160 cases of Meningitis B in a population of 300 million in the US (a rate of 5 cases in 10 million population – a rare illness) and that most cases respond to antibiotics. The risk to your children from Men B is extremely low.
25 February 2016
First reversal agent for non-coumarin oral anticoagulant
First reversal agent available for non-coumarin oral anticoagulant and
New heart failure combination tablet 'could replace ACE inhibitors as mainstay of treatment'. To read the full article click here.
Travel vaccinations - sun protection
Are you up to date with all your travel vaccinations? Vaccinations best given 2-3 weeks prior to departure for full protection. Sun screen is very important not forgetting your head too with a hat and also sunglasses with a good UV filter to protect your eyes.
Meningitis ACWY - Booster vaccinations new guidelines recently published - see Vaccinations
New guidelines on booster vaccinations.
Shingles Vaccine - Zostavax
Shingles vaccine now available by prior arrangement. Please contact the practice for further details.