GRAEDONS | The People's Pharmacy Bone strengtheners are not all the same

Q. I have always been afraid to take estrogen because of a family history of breast cancer. When I read that Evista could reduce the risk of osteoporosis and might protect against breast cancer, I asked my doctor about it. He agreed that it was a good option.
After I took it for several months, my HMO would no longer pay for Evista and required me to switch to Fosamax. When I asked about it, the nurse said it was the same as Evista. Is that true?
A. Evista is a SERM (selective estrogen receptor modulator). That means it works like estrogen to strengthen bones, but it has anti-estrogenic action on the breast. A recent study demonstrated that long-term use of Evista cut the risk of breast cancer by more than half.
Fosamax is quite different from Evista. Although it is effective against osteoporosis, there are no data to suggest Fosamax can protect against breast cancer.
Q. I just put one of my 81 mg enteric-coated aspirins in a glass vase of fresh flowers.
It's now 24 hours later, and the tablet has not disintegrated. Does it need stomach juices to disintegrate, or is my aspirin no good?
A. Most pills are absorbed through the wall of the stomach into the bloodstream, but enteric coatings are designed to resist acid. That way, the pill goes through the stomach intact and instead dissolves in the small intestine. This is supposed to prevent stomach irritation.
If the tap water in your vase is slightly acidic, the enteric coating will not dissolve. To test your aspirin, try adding a little baking soda and a pinch of salt to the water. If the pill doesn't disintegrate, there might be a problem with the coating. Another brand might work better.
By the way, we have been unable to find proof that aspirin helps cut flowers last longer.
Q. My older sister is taking a lot of medications. She is on fluoxetine and Zoloft for depression, Ambien for insomnia and Tegretol for bipolar disorder. In addition, she is on atenolol, Zestril, verapamil and hydrochlorothiazide for blood pressure. She also takes Lipitor for high cholesterol, Actos for diabetes, Prevacid for acid reflux and aspirin for heart protection.
She complains about drowsiness, dry mouth, frequent sore throats, weakness, sweating, unsteadiness and breathing problems. Could these symptoms be related to her medications?
A. Your sister is taking 12 different drugs, many of which might be interacting in dangerous ways. She needs immediate medical attention to sort out which drugs are causing some of her symptoms.
Tegretol (carbamazepine) can cause blood disorders that might be responsible for frequent sore throats. She needs a blood test to rule this out right away.
Taking two similar antidepressants (fluoxetine [Prozac] and Zoloft) is unorthodox and might lead to dry mouth and sweating. In addition, such drugs might raise blood levels of Tegretol. At toxic doses, this drug can cause unsteadiness.
To help your sister protect herself from drug side effects and interactions, we offer our Guide to Drugs and Older People along with a Drug Safety Questionnaire and Medical History form. Anyone who would like copies, please send $2 in check or money order with a long (No. 10), stamped (60 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. OQH-883, P.O. Box 52027, Durham, N.C. 27717-2027.
XIn their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features Syndicate, 888 Seventh Ave., New York, N.Y. 10019, or e-mail them at pharmacy@mindspring.com or via their Web site: www.peoplespharmacy.org.
& copy; 2004, King Features Syndicate Inc.