Symptoms and new meds align, but are drugs the culprit?

DEAR DR. ROACH

>> Following placement of two stents in my arteries (not my heart), my cardiac physician has me on an 81-mg aspirin and 75 mg of clopidogrel daily. I am much weaker during my exercise class, fall asleep in the late morning and am utterly unable to have sex. My primary physician is adamant that aspirin does not cause loss of strength. He did not comment on my sexual problem, except to refer me to my urologist, who simply ascribed it to my age (84). I take self-injected Praluent with no side effects. I am fairly certain the blood thinner is the cause of my problem, but my cardiologist insists I take it until “my last breath.”

My questions are whether a full aspirin is as effective as baby aspirin plus clopidogrel, and whether the clopidogrel could be the cause of the erectile dysfunction. DEAR READER >> It’s impossible to say with certainty that any of your medications — aspirin, Praluent or clopidogrel — are NOT causing your symptoms. However, none of them are well known for doing so. For example, less than 0.2 percent of reported side effects with clopidogrel (among the minority of people who reported a side effect) were about sexual dysfunction. It sounds like the timing of your symptoms coincides with starting the medicine, which is good evidence that there may be a connection. However, there are at least two other possibilities.

The first is that the procedure itself, or the underlying condition, caused the symptoms. Stents are placed in arteries to relieve blockages, which cause poor blood flow. Poor blood flow is certainly a cause of erectile dysfunction. I don’t know what arteries you had stented, but it is certainly possible that the blood flow to the penis is inadequate for sexual function. Your urologist could test that (I hate to secondguess your doctor, but every time I hear that a physician has ascribed symptoms to a patient’s age, I worry that something might be missed).

The second possibility is that when people expect a side effect from a medication, it can come on. This is called the “nocebo effect,” and it shows how powerfully the mind and body are linked.

The question about switching to aspirin only is for your cardiologist. It depends on the type of stent (a drug-eluting stent will require a longer period on clopidogrel), and the optimum treatment is not clear from medical studies. There may be other options besides clopidogrel. Aries (March 21-April 19): When people mean well but don’t make the impact they hope to, it’s usually a function of misreading the situation or simply not knowing enough about it. The best move you can make now is to sit tight and learn all you can.

Taurus (April 20-May 20): In nature, the bull goes with the herd; it suits the bull and it suits the herd. But if it doesn’t suit the bull, the bull leaves. Be the same. Only stick with the herd if it is what’s in your heart.

Gemini (May 21-June 21): There you go again, moving forward as if unafraid. What the onlookers don’t know is your internal dialogue and how you quiver inside your boots. And that’s what makes you truly brave. You feel the fear and do it anyway.

Cancer (June 22-July 22): Public speaking is easier for some than others. There will be shy ones who aren’t sure if it’s worth the trouble to stand and be counted. You’ve felt like that in the past, which is why you’ll be a most encouraging presence.

Leo (July 23-Aug. 22): There are some decisions you’ll make that you’ll never really know the consequences of. That’s why today it will be most satisfying to get evidence that a choice you made long ago was the right one.

Virgo (Aug. 23-Sept. 22): Bringing people together will be your specialty today, though you may not be consciously aware that it’s what you’re doing. Your inclusiveness starts a ripple of happy effects.

Libra (Sept. 23-Oct. 23): What you see is not only what you get; it’s what you’ll keep getting. So if you don’t like it, make a quick change. It will be way easier to set things on track in the early stages of an arrangement.

Scorpio (Oct. 24-Nov. 21):

The best ones to spend time with today will fall into one of two categories. Either they are people you’re sure to have fun with, or they are people who genuinely need you.

Sagittarius (Nov. 22-Dec. 21): For some, loneliness is a palpable problem, an actual chill that your fire sign energy can thaw with the stretch of a smile. Don’t underestimate the good a little warmth and kindness can do.

Capricorn (Dec. 22-Jan. 19): They’re better because of you, and this much they’ll tell you. Nothing could be more soul-fortifying than knowing you improved the lives of those closest to you.

Aquarius (Jan. 20-Feb. 18): People make mistakes, but people are not their mistakes. For learning purposes, separate the

This solar return, you ride in on a bubble of freedom and then bounce along for months working your advantages. The hard work begins in February. But don’t worry; this will actually be your favorite part of the year. You’ll see what you’re made of and be ionically bonded to colleagues in the process. Capricorn and Cancer adore you. Your lucky numbers are: 9, 33, 31, 29 and 16.