Q. I saw a physician’s assistant the other day for depression, insomnia and anxiety. Several years ago, a doctor prescribed Ativan and Ambien (and later Lunesta). At the time, he also had me on an antidepressant medication that I later weaned off. I may take an Ativan once during the week and a Lunesta one weekend night, just to help me catch up on sleep. This PA refused to prescribe zolpidem (Ambien) or eszopiclone (Lunesta) because studies have linked those drugs to Alzheimer’s. She said that even the few pills I take could put me at risk. Instead, she gave me a prescription for suvorexant (Belsomra). My doctor gave me a sample when it first came out, and I didn’t find it helpful. I’ve also read that it hasn’t been shown to help people get to sleep much faster. In addition, it’s brand-new and outrageously expensive. Would you be able to provide some insight on this drug?
A. People with insomnia are caught in a terrible bind. They are told that insufficient sleep may increase their risk for problems with memory and concentration. On the other hand, some studies have linked sleeping pills to dementia (BMJ online, Sept. 27, 2012; Medicine, May 2015), though this connection is controversial (BMJ online, Feb. 2, 2016).
Belsomra is a pricey new prescription sleeping pill. According to Consumer Reports, people taking this drug fell asleep about six minutes faster, on average, than those taking placebo. They slept about 16 minutes longer, but were more likely to feel drowsy the next day.
A review of consumer complaints about Belsomra submitted to the Food and Drug Administration shows that they include ineffectiveness, disrupted sleep, agitation and next-day confusion.
Narcotics and constipation
Q. I am bothered by constipation because I take hydrocodone (Vicodin). To counteract this problem, I eat five or 10 prunes a day and take 1 tablespoon of psyllium husks (at a different time from the prunes). The only problem with my regimen is that prunes add calories, and the psyllium container warns against taking the fiber within an hour or two of other medications.
A. Narcotics like hydrocodone are notorious for causing constipation. If natural approaches like yours don’t do the job, there are two prescription drugs to overcome this complication. One is an injection, methylnaltrexone (Relistor). The other, naloxegol (Movantik), is a pill. Side effects may include abdominal pain and diarrhea.
Costs of immunotherapy
Q. I could only gasp when I saw the Medicare summary after I took Opdivo for metastatic melanoma. For each infusion, the charge from the hospital pharmacy was more than $13,000, plus $800 for administration. To make matters worse, it did not work. Now I am scheduled to get Keytruda, if my insurance will cover it.
A. New immunotherapy for cancer is unbelievably expensive. Both nivolumab (Opdivo) and pembrolizumab (Keytruda) are considered important advances in the treatment of metastatic melanoma. They also are approved for treating certain lung cancers.
The original estimate on both these drugs was that they would cost in the range of $12,500 a month. A leading oncologist has called such prices unsustainable.
Joe and Teresa Graedon: www.peoplespharmacy.com