When it comes to prognosis and prescription, doctors have to be on point. Keeping in mind the effects of all the medicines that the patient takes, the combination has to suit the individual. This article speaks on an important study of 5 drugs that are frequently prescribed to patients and also throws light on their noteworthy effects.

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The following are five recent studies that throw light on the unseen effects of five frequently given medications:

1. Statins

Numerous individuals infected with COVID-19 also used statins. However, what effect do statins have on those who have COVID-19? Korean researchers examined the association between statin usage and COVID-19 mortality in a prospective study published in Arteriosclerosis, Thrombosis, and Vascular Biology.

After adjusting for age, gender, and comorbidities, the researchers discovered a statistically significant reduction in mortality associated with statin usage. According to the scientists, “this protective effect was supported by the possibility of an inhibitory impact on the SARS-CoV-2 major protease, a critical coronavirus enzyme.”

Despite statins' protective benefits against COVID-19 in the current investigation, criticism surrounds the co-prescribing of statins and antivirals. The authors expressed worry that the usage of statins in patients with COVID-19 may be further lowered as a result of probable medication interactions with antiviral/antibacterial medicines and decreased cholesterol levels in the acute stress situation. “However, our data indicated that statins do not need to be stopped during COVID-19 treatment.”

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2. Gabapentin

Postherpetic neuralgia in adults, supplementary therapy for partial-onset seizures, and epilepsy are all FDA-approved uses for this medication. Additionally, it has a slew of off-label applications, including treatment of some mental problems. Researchers mined the National Ambulatory Care Medical Survey to learn more about "gabapentin" visits in a population-based study published in Psychiatric Services.

Between 2011 and 2016, they discovered that gabapentin was prescribed in 2.8 per cent of psychiatric visits; fewer than 1% of prescriptions were for the aforementioned purposes. Off-label users were found to have a depressive condition in 5.3 per cent, an anxiety disorder in 3.5 per cent, and bipolar disorder in 1.8 per cent. Gabapentin was most commonly used in combination with antidepressants (24.3 per cent), opioids (22.9 per cent), and benzodiazepines (22.9 per cent) (17.3 per cent).

The authors concluded, "In this nationally representative sample, 1% of outpatient gabapentin usage was for authorised reasons. The high rate of concurrent use of CNS-D [CNS depressive] medications and off-label gabapentin for mental disorders underscores the importance of increased safety communication.” Gabapentin may cause dizziness, double/blurred vision, and anxiety. Additionally, gabapentinoids are frequently abused.

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3. ACE inhibitors vs ARBs

When both angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are needed, there is frequently disagreement about which medication to use. Both medications work by inhibiting the renin-angiotensin-aldosterone pathway and are used to treat hypertension, heart failure, coronary artery disease with left ventricular dysfunction, and chronic renal failure, respectively.

According to an early study, ACE inhibitors were more successful than ARBs at reducing the incidence of myocardial infarction, cardiovascular death, and all-cause mortality in individuals with hypertension, diabetes, and elevated cardiovascular risk. Additionally, ACE drugs were thought to be more effective at reducing overall mortality in individuals with heart failure and a decreased ejection fraction (HFrEF).

According to the Cleveland Clinic, "this supposed advantage of ACE inhibitors over ARBs was attributed to a higher vasodilatory impact generated by inhibition of bradykinin breakdown, resulting in higher levels of nitric oxide and vasoactive prostaglandins." Another hypothesis was that because ARBs inhibit angiotensin II AT1 receptors but not AT2 receptors, the enhanced activation of significantly upregulated AT2 receptors in atheromatous plaques in response to higher blood angiotensin II levels was detrimental.”

ACE inhibitors have been chosen as first-line treatment in light of this knowledge. ARBs are used in patients who are unable to tolerate ACE inhibitors. According to experts, this calculus is erroneous. According to the Cleveland Clinic, the results of early clinical studies that revealed ACE inhibitors outperformed ARBs may have been skewed by a 'generational gap in the studies', negating the superior efficacy of ACE inhibitors over ARBs.

However, one advantage of ARBs over ACE inhibitors is that ARBs have fewer side effects and are hence more well-tolerated. When compared to the general population, ACE inhibitors cause major side effects such as an increased risk of angioedema in Black folks and an increased risk of cough in Chinese Americans.

In a recent clinical experiment, researchers discovered that the usage of ACE inhibitors was related to impaired respiratory performance as determined by lung function tests in individuals with hypertension. These adverse effects were not detected in either the experimental or control groups taking ARBs.

The authors concluded, "Unlike ACE [inhibitors], ARBs are not linked with adverse effects on respiratory function in hypertension individuals. As such, they may be a first-line therapeutic option for hypertensive individuals at high risk of developing respiratory side effects.”

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4. Amlodipine

Calcium channel blockers (CCBs), such as amlodipine, are frequently recommended to treat hypertension, arrhythmias, and coronary artery disease. However, new evidence indicates that what is beneficial to the heart may also be beneficial to the bones. CCBs improved fracture healing in animal models, according to a study published in European Cellular Materials. They did so by activating bone production, callus remodelling, and osteoclast activity.

The scientists reported, “At two and five weeks, histomorphometric examination indicated considerably more bone tissue within the callus of amlodipine low- and high-dose treated mice compared to controls. This was coupled with a decrease in cartilaginous and fibrous tissue, indicating that fracture healing was accelerated. Biomechanics revealed a slightly, but not considerably, increased bending stiffness in amlodipine low- and high-dose treated animals. Western blot examination demonstrated considerably enhanced bone morphogenetic protein (BMP)-2 and vascular endothelial growth factor (VEGF) expression (VEGF). Additionally, the research revealed a fivefold rise in osteoprotegerin (OPG) expression and a tenfold rise in receptor activator of NF-B ligand (RANKL) expression, indicating accelerated bone turnover.”

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5. Metformin

At first glance, it may appear counterintuitive that the anti-diabetic drug metformin may protect against emphysema. However, this may be the case, according to the findings of the research published in the American Journal of Respiratory and Critical Care Medicine. Metformin was reported to protect against pulmonary inflammation, airspace expansion, and small-airway remodelling caused by cigarette smoke exposure in mice models. The AMPK signalling pathway was most likely responsible for the drug's protective effects. The researchers discovered that patients who took metformin had a slower development of emphysema.

According to scientists, “Cigarette smoke (CS) inhalation induces oxidative stress and inflammation, resulting in accelerated lung ageing, apoptosis, emphysema, and systemic pathologies because metformin is useful for ageing-related disorders, we predicted that it would improve the pathology of emphysematous COPD caused by CS.”

They stated, "Our findings establish a basis for clinical trials examining the effectiveness of metformin in slowing the course of emphysema and its systemic effects."

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Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.