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People’s Pharmacy: Brisdelle to treat hot flashes?

Q: I saw a commercial for Brisdelle and wanted to know more since I have struggled with hot flashes and night sweats for way too long. Then I learned it has the same ingredient as Paxil.

I took Paxil some years ago for depression, and when I stopped, the withdrawal symptoms were horrific. I suffered “brain zaps” – the worst thing I’ve ever been through.

As a result, I won’t go near Brisdelle. The commercial says it’s the only nonhormonal option. Is that true?

A: Brisdelle is the only nonhormonal drug that the Food and Drug Administration has approved for hot flashes. The maker might be emphasizing the nonhormonal angle because many women worry about hormone-replacement therapy. Estrogen and progestin may raise the risk of breast and ovarian cancer, heart attacks, strokes and dementia.

The ad doesn’t mention that the active ingredient in Brisdelle, paroxetine, was originally used as an antidepressant. Nor does it say that stopping paroxetine suddenly can be hard, as you discovered.

Most important, the commercial does not tell how well it works. The difference between Brisdelle and placebo was two fewer hot flashes per day. While that is statistically significant, it is hardly impressive, especially since women had to experience at least seven flushes a day to be included in the study.

Side effects of Brisdelle include headache, nausea, vomiting and fatigue. Suicidal thoughts also may occur on occasion.

There may be a side effect on the wallet, as well. One woman said her Brisdelle bill was $178 for a month’s supply. A low dose of generic paroxetine, though not approved for hot flashes, runs about $4.

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Q: I have been taking 5,000 IUs of vitamin D-3, and my psoriasis has seriously improved as a result. If only I had known about this 15 years ago, it would have saved me so much anguish. I can’t understand why doctors don’t recommend vitamin D along with their creams.

A: Both oral and topical vitamin D can be effective against psoriasis (International Journal of Dermatology online, Jan. 20). People with eczema may also benefit from vitamin D supplementation (Journal of Drugs in Dermatology, March 2012).

A surprising number of people have inadequate levels of vitamin D, especially during the winter. Read more about this crucial nutrient and its role in helping control blood pressure, easing arthritis pain and preventing fractures in the “Guide to Vitamin D Deficiency” that we are sending you.

Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. D-23, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

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Q: My doctor prescribed Celebrex several years ago to help ease the arthritis pain in my knee. Three days ago, my pharmacy substituted with generic celecoxib.

I was pleased with the savings, but my pain has grown worse daily. Have other people found that generic celecoxib is not as effective as Celebrex?

A: The FDA approved generic celecoxib in May 2014, so it has been available for less than a year. Although we get complaints about other generic drugs, we’ve not heard from readers regarding generic Celebrex. If we hear from others who have been disappointed with celecoxib, we will let you know.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: PeoplesPharmacy.com.