The People's Pharmacy

Joe Graedon, M.S.,and Teresa Graedon, Ph.D.

Q. My libido had dropped to zero after menopause. A new doctor prescribed testosterone cream specially formulated by a compounding pharmacy.

I was like a teenage boy until I found the right dose. It doesn’t take much. My bone density is excellent, and I now have an active sex life.

A. TRT (testosterone replacement therapy) is quite controversial. The Food and Drug Administration cautions that “prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions.”

A review in the journal U.S. Pharmacist (Aug. 19, 2019) reports that “TRT has been shown to be effective for improving libido, sexual desire, arousal, sexual frequency and sexual satisfaction in women.” The long-term effects of this off-label use have not been well-studied, though, and safe dosing guidelines are not well-established.

Q. I want to thank you for your story about whether to take blood pressure medications in the morning or at bedtime. I’ve been taking BP meds for about 20 years.

In January I visited my doctor about another problem, and he became concerned about my blood pressure. He wanted me to monitor it every day for a month and check back in.

During that month, I read your article. I’d been taking my meds with breakfast, and I decided to change that.

The effect was quite remarkable. My systolic pressure dropped from about 145 to 135. (Those are averages of about 70 readings before the switch and 21 readings after the switch, measured both before breakfast and before supper.)

I’ve had serious side effects from BP meds in the past and I was apprehensive that my doctor would change my meds. Lately, I’ve been on amlodipine and HCTZ, and the side effects seem minimal. Yesterday, my doctor decided not to make any changes and I want to thank you for that.

A. We are glad to hear that this is working for you. Research shows that people taking their blood pressure pills in the evening had better BP control and were less likely to have heart attacks or strokes (Sleep Medicine Reviews, Jan. 23, 2021).

An important exception: People with glaucoma should not follow this schedule. In addition, people taking diuretics may find that bedtime pills result in more frequent overnight bathroom trips.

Q. I have osteoporosis and just picked up a new prescription of risedronate sodium delayed release tablets. The label on the bottle has my doctor’s instructions to take the pill 30 minutes before my first food or drink. That’s the traditional method for the instant-release risedronate I used to take.

The pharmacy included an instruction sheet telling me to take one tablet on the same morning each week immediately following breakfast. Please tell me which method is more effective, or if it makes a difference.

A. Your doctor may have confused the delayed-release with the immediate-release formulation. The official prescribing information for delayed-release risedronate tablets advises taking the pills “immediately following breakfast.” If you take the drug before breakfast, on an empty stomach, you run a higher risk of a serious stomachache.

Be sure to swallow the tablet with a full glass of water to make sure it doesn’t get stuck. The ingredients can irritate the esophagus.

(In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: www.PeoplesPharmacy.com.)

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