Naltrexone helps overcome compulsion to pull out hair
Q: I use naltrexone off-label to help me control trichotillomania “hair pulling.” It has been a godsend and helped me more than I ever thought possible. I’ve struggled with the disorder for almost 40 years, and naltrexone has been most helpful.
A:
Trichotillomania involves compulsively pulling out hair from the scalp, eyebrows or other parts of the body. It can be quite challenging to treat. The Food and Drug Administration has not approved any medications for this condition. Cognitive behavioral therapy may be effective. Dietary supplements such as NAC (N-acetylcysteine) and Inositol also may be helpful (Archives of General Psychiatry, July 2009; International Clinical Psychopharmacology, March 2017). Naltrexone is approved for treating addictions such as alcoholism. Some research supports the use of naltrexone to treat conditions like compulsive hair pulling, shoplifting and other behavioral addictions (European Addiction Research, online, Sept. 7, 2017).
Q: I have been plagued with high cholesterol most of my life. Doctors put me on statins, and the result was terrible pain and loss of shortterm memory. The statins lowered my cholesterol from the 300s down into the 200s, but the side effects were totally unacceptable. Switching statins and lowering the dosage didn’t help. My new doctor prescribed Repatha, and within six weeks, my cholesterol dropped to 107 with no side effects. I have been on Repatha for six months now and can’t say enough about the new treatment.
A:
Evolocumab (Repatha) is a relatively new injectable cholesterol-lowering medicine. It is approved for people with heart disease or those who have familial (inherited) super-high cholesterol. Repatha usually is prescribed together with a statin. However, some doctors are prescribing it for patients who can’t tolerate statin side effects. A study published in the New England Journal of Medicine (May 4, 2017) showed that Repatha plus a statin reduced heart attacks, strokes and the need for stents more than placebo plus statin. Side effects are relatively uncommon. Some people experience serious allergic reactions, flu-like symptoms such as sore throat and cough, back pain, headache, muscle pain, dizziness and digestive distress. If insurance covers the cost of Repatha, you are fortunate. Otherwise the drug is very expensive.
Q: When my husband and I were traveling in Mexico, we relied on activated charcoal for all our intestinal woes, including flatulence. Capsules take a little longer, or you can mix loose powder into water and drink it down. That is messier, but you can feel it working from the time it hits your tongue. Be prepared to brush your teeth immediately to clear the charcoal residue. Don’t be surprised if your doctor pooh-poohs it, but charcoal has been a staple of our medicine
cabinet for 30 years.
A: Activated charcoal is a time-honored remedy for flatulence. Supposedly, it absorbs smelly gases. However, there is little research to support this approach (American Journal of Gastroenterology, January 1999). Another option is Beano (containing the enzyme alpha-galactosidase). One study concluded that “Alpha-galactosidase reduced gas production following a meal rich in fermentable carbohydrates and may be helpful in patients with gas-related symptoms” (Digestive Diseases and Sciences, online, January 2007). You can learn more about controlling flatulence in our Guide to Digestive Disorders, available at PeoplesPharmacy.com in the health guide section.