To Your Good Health
DEAR DR. ROACH: I take 20 mg of famotidine and have for years. Is this safe to take daily? I’ve tried looking up the answer online and get a lot of conflicting results. — G. S.
ANSWER: In an ideal world, it would be great if you didn’t have to take any medications. However, reflux disease is very common; about 20% of the North American population has this symptomatic disease, with an even higher prevalence in older ages.
Lifestyle changes are the first line of treatment. Avoidance of food triggers, weight loss if appropriate, elevation of the head of your bed, and avoiding eating at least 2 hours before bed are among the most effective. Smoking and excess alcohol use should be stopped.
When lifestyle changes aren’t enough, a histamine-2 blocker like famotidine is a reasonable option, especially for someone with intermittent symptoms. Side effects are rare, and if you haven’t had them yet, you aren’t likely to get them. Proton pump inhibitors like omeprazole have more clearly defined risks with long- term use, so these should be reserved for when they are truly necessary. Famotidine starts working quickly, while omeprazole and similar drugs take days to work.
DEAR DR. ROACH: I have a friend who has had an extremely bad cough, especially when she gets a cold. (It sounds like she is coughing up a lung.) She is a breast cancer survivor and has had this cough for a number of years. She has only had a chest X-ray done and was informed that she has asthma. She was given an inhaler.
I suggested that she request a CT scan of her chest to rule out anything else that could be going on, as this kind of cough is not normal and needs further investigation. What are your thoughts please? — R. L. Z.
ANSWER: There’s so much I don’t know that it’s harder than usual for me to comment. A cough that lasts for years could be due to several possibilities, but asthma is one of the most common causes. So, whoever considered asthma was wise. However, you can’t make a diagnosis of asthma with a chest Xray (or by a CT scan either). The diagnosis is made by clinical criteria (a cough or wheeze are cardinal symptoms) and confirmed by pulmonary function testing. She may have had this done.
I suspect that you are also worried about a recurrence of breast cancer. Chest X-rays will pick up large lesions, but you are quite right that a CT scan is much more sensitive. A cough is a symptom that sometimes occurs if breast cancer comes back in the lungs. Unfortunately, breast cancer can recur, even after many years and decades.
If her symptoms get much better with the treatment of asthma, this would be considered strong evidence that it was actually caused by asthma. If not, then a further evaluation is called for, including a CT scan. But her doctors will also consider reflux disease and sinus problems with postnasal drip. There are many rare causes.
Medical treatments can sometimes lead to cough. Some chemotherapy drugs used in breast cancer can cause lung disease, as can radiation treatment.
Finally, I can’t tell you how many times I have seen a clinician forget to check if their patient is taking a blood pressure medicine in the angiotensin- converting enzyme class (whose names all end in - pril, such as lisinopril). These medicines frequently cause cough.
DEAR DR. ROACH: Every so often, I break out in hives. I went to an allergist who told me to try Allegra in its generic form. I did, and it works great. My question is, what is the difference between Allegra and Allegra Hives, since they both have the same active and inactive ingredients? — P. L.
ANSWER: To the best of my knowledge, the answers are marketing and cost. In my opinion, you are best off staying with 180 mg of the generic fexofenadine, as it is working well and should be a much lower cost than the brand name.
When I checked one store online, 180 mg of generic fexofenadine is 13 cents a pill, while the brand name, Allegra, is 39 cents a pill. Allegra Hives is 67 cents a pill, but they are all the same medicine. Like most physicians, I personally use the generic versions whenever I can, with very few exceptions.