Greetings, Dr. Roach My niece uses gabapentin for anxiety, but I, at eighty-two, take it for arthritis. What is the purpose of gabapentin? — J.M.
ANSWER: Gabapentin was first licensed as a medication to treat epilepsy, but it quickly became apparent that it was also effective in treating chronic pain, particularly pain resulting from nerve damage. However, it also helps with other types of pain. (The Food and Drug Administration expressly recommends it to relieve shingles-related discomfort.)
Off-label, it is also used to treat anxiety and a number of other ailments, such as restless legs syndrome and menopausal hot flashes. Because gabapentin can have adverse effects including sedation and mood changes, it takes knowledge and discretion to determine when to use it.
Greetings, Dr. Roach I was lucky to survive a saddle pulmonary embolism (PE) in 2016. I was given a prescription for Eliquis when I was discharged from the hospital. Despite doing a number of blood tests, my doctors were unable to determine what caused the PE. The cardiologist advised me to continue taking Eliquis for a year due to the severity of the clot. My cardiologist and pulmonologist agreed to let me quit it after 18 months.
I had three severe PEs in September 2021—two in one lung and one in the other. Several deep vein thromboses (DVTs) were also discovered. At one of the hospitals in our area, I was taken to the emergency room and told that I was near death. The staff and attending physician put me on a clot-busting intravenous line. After that, I was evacuated to the teaching hospital, where I was only required to remain for a day and a half. My situation considerably improved during the flight.
I was placed back on Eliquis, of course, and I will remain on it for the rest of my life. I was compelled to tell you of the dangers of stopping the man’s medication after reading his latest letter expressing his desire to do so. — S.C.
ANSWER: I appreciate your letter. An enormous blood clot known as a saddle PE forms in the major pulmonary artery and divides into the blood arteries that supply the left and right lungs. (Any substance that enters the lung, whether a clot, air, or cholesterol, is called a pulmonary embolism.) You were fortunate to survive this uncommon and usually potentially fatal incident.
The majority of specialists advise lifetime anticoagulation with a medication like Eliquis for patients who have a potentially fatal clot and no known reason or if the cause is something that cannot be corrected (such as a genetic propensity to blood clots).
In retrospect, lifetime treatment was the right decision because you were even more fortunate to survive the blood clots that entered your lungs from your legs the second time. Although administering thrombolytic (literally, clot-busting) drugs is risky since it may result in a stroke, it is necessary for such a serious illness.
Many people are concerned about the adverse effects of anticoagulant medications, such as warfarin or Eliquis, yet when taken as directed, they prevent much more issues than they cause. Not providing these medications or terminating them too soon results in many more strokes. They prevent major bleeding events significantly more often than they prevent clots. In particular, the new medications are safer than warfarin, whose levels in the body can get too high or low even with careful monitoring.
Although he regrets not being able to respond to each letter individually, Dr. Roach will try to include them in the column. Questions can be sent by mail to 628 Virginia Dr., Orlando, FL 32803 or by email to [email protected].
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