Nal­trex­one for use on hair-pulling prob­lem?

The News & Observer - - Weather - BY JOE GRAEDON, M.S., and TERESA GRAEDON, PH.D. King Fea­tures Joe and Teresa Graedon an­swer let­ters from read­ers. Write them at King Fea­tures, 628 Virginia Drive, Or­lando, FL 32803, or email peo­ple­sphar­macy.com. Their new­est book is “Top Screwups Doc­tors

Q: I use nal­trex­one of­fla­bel 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 short-term 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 choles­terol­low­er­ing 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.

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