Alcoholism drugs can lend valuable support

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Q. Now that Mel Gibson's alcohol problem is out in the open, perhaps there will be more discussion about treating alcoholism. Why don't rehab centers use naltrexone or acamprosate for this disease?

One of my family members is being treated at such a center. I asked the counselor why they don't use these medications, and he said they make people very sick if they drink. That suggests to me that he hasn't kept up with the field.

Please tell your readers that the new medications can be helpful. I say this because another family member uses the medication and it is working, we hope forever.

A. Thank you for highlighting the new treatments for alcohol dependence. In the old days, doctors prescribed Antabuse (disulfiram), which did indeed make people extremely ill if they consumed alcohol.

Naltrexone (ReVia) works by blocking pleasurable effects associated with alcohol. Eliminating the high removes the reward for drinking.

When acamprosate (Campral) is combined with counseling or social support, it can help people who have stopped drinking avoid alcohol. There is no magic bullet, but these relatively new drugs can be useful for motivated individuals.

Q. I was on prednisone for supposedly "short-term, low-dose" treatment that turned out to be neither.

I developed avascular necrosis two years after I stopped taking it, and as a result lost my hip at age 58. The package insert warns that prednisone can cause this horrible condition.

I was in excruciating pain in a wheelchair for two years before I finally gave in and had a hip replacement.

Doctors prescribe this medication far too freely for nonlife-threatening problems.

A. Prednisone is a valuable drug, but it may also cause serious side effects. Avascular necrosis is tissue death, especially bone, from lack of blood supply.

Prednisone can also cause adverse psychological reactions. Another reader reports: "About two months ago I had shoulder problems, and the doc assured me that 5 mg of prednisone couldn't hurt. After three days I had to stop taking it. I was increasingly wired, couldn't sit still, and couldn't even rest, much less sleep."

We are sending you our Guide to Alternatives for Arthritis with more information about the hazards of prednisone and NSAIDs and suggestions on other ways to ease joint pain.

Q. You have suggested that tonic water with quinine can help prevent leg cramps in people who are not susceptible to certain blood conditions. You also should warn against quinine for pregnant women.

My wife suffered from leg cramps when she was pregnant, and her internist recommended quinine.

I checked with her OB-GYN about this advice. He said it might put the developing fetus at grave risk.

P.S. Fifteen years later, we have a beautiful daughter.

A. Quinine comes from the bark of a South American tree, the cinchona.

It was used to treat fevers and was widely used against malaria in the 19th century. High doses of quinine have caused birth defects, though.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or e-mail them via their Web site: www.PeoplesPharmacy.com.

Sunday, August 13, 2006