Busting Common Medication Myths: Pharmacists Empowering Patients with Accurate Information

Medical misinformation is widespread, particularly now in the digital age, in which information travels rapidly. Approximately 70% of individuals have been exposed to health-related misinformation, and almost 50% question their ability to distinguish between facts and falsehoods.

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The most common sources of medical misinformation have been identified as social media, family or friends, news channels, and the internet.¹ This often leads to misconceptions surrounding medications, including widely prescribed drug classes such as HMG-CoA reductase inhibitors (statins) or proton pump inhibitors (PPIs).

As one of the most trusted health care professionals, pharmacists play a vital role in debunking these myths by providing patients with accurate information to make positive decisions regarding their health.

Statins are a class of medications that are widely prescribed to manage cholesterol levels and reduce cardiovascular risk. Despite their proven efficacy and safety profile, several myths persist, often resulting in hesitation among patients.

One of the most common myths surrounding this class of medications is the prevalence of muscle-related effects, including myalgias, myopathy, and rhabdomyolysis. The fact is that some patients may experience muscle-related effects with clinical trials showing a prevalence of about 10%.

What is important to note is that many patients in the placebo groups, who were not receiving a statin, also reported experiencing theses effects. Clinical data have shown the difference in incidence of muscle-related symptoms in statin-treated patients versus placebo is less than 1%.^2,3

Considering pain is subjective, it is important to discuss the patients’ symptoms to understand where the pain is coming from and obtain appropriate lab work to truly determine whether symptoms are statin-induced. Furthermore, there are statins available, particularly those that are hydrophilic such as rosuvastatin or pravastatin, that have a lower risk of myalgias.

Hydrophilic statins do not penetrate the muscle tissue as easily as lipophilic statins, meaning there is a lower risk of muscle-related adverse effects (AEs). Hydrophilic statins may be a better option for patients who have previously experienced muscle-related effects or those with risk factors for myopathy, such as age 65 or greater, primary muscle disease, and hypothyroidism.⁴

Another misconception is the belief that statins are harmful to the liver. This largely stems from early reports of liver enzyme elevation in some patients taking statins. Extensive research and clinical data demonstrate that statin-induced liver injury is exceptionally rare, with the estimated risk being about 1%.^5,6 Nonetheless, caution should be taken with statin therapy in patients who consume large amounts of alcohol or have a history of liver disease.

Although pharmacists are an excellent resource for dispelling misinformation regarding statins, they can also explain the benefits. Depending on the intensity, statins may provide greater than a 50% reduction in low-density lipoprotein (LDL-C), or “bad” cholesterol.

It is estimated that each 18 mg/dL (1 mmol/L) reduction in LDL-C decreases the rate of major vascular events by 22%, vascular mortality by 14%, and all-cause mortality per year by 10%.⁷ As the most accessible health care professionals, pharmacists play a pivotal role in guiding patients toward informed decisions regarding statin therapy and promoting better cardiovascular outcomes.

PPIs, commonly prescribed for the treatment of gastrointestinal conditions such as gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD), also face their fair share of misconceptions. Because PPIs are readily available OTC, it is often assumed that they are harmless and can be taken long-term without risk of complications.

While PPIs are generally safe and effective for short-term use of 2 weeks at a time when used OTC, long-term therapy (greater than 1 year) has been associated with gastrointestinal AEs, such as Clostridioides difficile-associated diarrhea (CDAD).

As PPIs function to reduce the production of gastric acid, which acts as a natural barrier to ingested bacteria, the concern for bacterial overgrowth arises.⁸ Another concern is the potential for nutrient deficiencies.

Stomach acid plays a crucial role in absorbing nutrients such as vitamin B12, calcium, iron, zinc, and magnesium. Extensive suppression of stomach acid may decrease the level of absorption, causing a lack of those nutrients.

This may require further supplementation of vitamins and minerals, which may increase patient pill burden.^9-11 Additionally, there has been an association between long-term PPI use and an increased risk of bone fractures, particularly in older adults.

Some studies suggest decreased calcium absorption and increased bone metabolism occur with PPIs, leading to weakened bones over time; however, the evidence is inconclusive and further research is required to better understand this relationship.^12,13

PPIs also face the myth that they are addictive or difficult to stop taking. Long-term PPI use has been associated with possible rebound effects upon discontinuation. When stopped abruptly, there may be an initial increase in acid production, leading to symptoms such as heartburn and acid reflux.

Patients may misinterpret rebound symptoms as a return of their original ailment, and believe that they still require the medication, which may lead to unnecessary long-term use. In patients who have received continuous therapy for at least 6 months, some experts gradually taper therapy until discontinuation to avoid worsening or rebound symptoms.¹⁴

Health care professionals, including pharmacists, can help educate patients about the appropriate use of PPIs, potential risks, and strategies to mitigate those risks. Thorough patient education will allow patients to make informed decisions about the long-term use of PPIs based on their specific medical needs and minimize potential harm.

One of the easiest ways to combat medical misinformation is providing patients with the tools to find accurate and reliable sources. Generally, websites created by federal government agencies provide accurate sources of information, such as the National Institutes of Health and the Centers for Disease Control and Prevention.

When utilizing other online resources, it is important to analyze who is sponsoring the website. Websites ending in .gov, .org, and .edu are typically owned by government agencies, educational institutions, or nonprofit medical research societies.

Additionally, evaluating the author’s credentials and selecting sources with the most recent date of publication may be beneficial in choosing reliable sources. Health care organizations, hospitals, academic medical institutions, and health care professionals can also serve as trustworthy sources of health information.¹⁵  

Dispelling medical misinformation is a crucial task, and pharmacists stand at the forefront of this mission. With specialized knowledge of medications, pharmacists possess the expertise to educate patients, debunk myths, and provide evidence-based information.

By taking the time to engage in patient counseling, pharmacists can address patient concerns, correct misconceptions, and bridge the gap between medical literature and patients' understanding. With commitment to evidence-based medicine, patient education, and personalized care, pharmacists have the unique ability to empower patients with the knowledge necessary to make informed decisions about their medications and overall health care.

References

1. Pola, S. Medical Misinformation Runs Rampant, and Many Americans Have Trouble Identifying It. GoodRx Health. Published: March 14, 2022.
2. Selva-O'Callaghan A, Alvarado-Cardenas M, Pinal-Fernández I, et al. Statin-induced myalgia and myositis: an update on pathogenesis and clinical recommendations. Expert Rev Clin Immunol. 2018;14(3):215-224. doi:10.1080/1744666X.2018.1440206
3. Newman CB, Preiss D, Tobert JA, et al. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019;39(2):e38-e81. doi:10.1161/ATV.0000000000000073
4. Climent E, Benaiges D, Pedro-Botet J. Hydrophilic or Lipophilic Statins?. Front Cardiovasc Med. 2021;8:687585. Published 2021 May 20. doi:10.3389/fcvm.2021.687585
5. Averbukh LD, Turshudzhyan A, Wu DC, Wu GY. Statin-induced Liver Injury Patterns: A Clinical Review. J Clin Transl Hepatol. 2022;10(3):543-552. doi:10.14218/JCTH.2021.00271
6. Meurer L, Cohen SM. Drug-Induced Liver Injury from Statins. Clin Liver Dis. 2020;24(1):107-119. doi:10.1016/j.cld.2019.09.007
7. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomized trials. Lancet. 2010;376(9753):1670-1681. doi:10.1016/S0140-6736(10)61350-5
8. Trifan A, Stanciu C, Girleanu I, et al. Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis. World J Gastroenterol. 2017;23(35):6500-6515. doi:10.3748/wjg.v23.i35.6500
9. Kinoshita Y, Ishimura N, Ishihara S. Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use. J Neurogastroenterol Motil. 2018;24(2):182-196. doi:10.5056/jnm18001
10. William JH, Danziger J. Proton-pump inhibitor-induced hypomagnesemia: Current research and proposed mechanisms. World J Nephrol. 2016;5(2):152-157. doi:10.5527/wjn.v5.i2.152
11. Hirschowitz BI, Worthington J, Mohnen J. Vitamin B12 deficiency in hypersecretors during long-term acid suppression with proton pump inhibitors. Aliment Pharmacol Ther. 2008;27(11):1110-1121. doi:10.1111/j.1365-2036.2008.03658.x
12. Ngamruengphong S, Leontiadis GI, Radhi S, Dentino A, Nugent K. Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am J Gastroenterol. 2011;106(7):1209-1219. doi:10.1038/ajg.2011.113
13. Hansen KE, Jones AN, Lindstrom MJ, et al. Do proton pump inhibitors decrease calcium absorption? [published correction appears in J Bone Miner Res. 2011 Feb;26(2):439]. J Bone Miner Res. 2010;25(12):2786-2795. doi:10.1002/jbmr.166
14. Rochoy M, Dubois S, Glantenet R, Gautier S, Lambert M. Gastric acid rebound after a proton pump inhibitor: Narrative review of literature. Therapie. 2018;73(3):237-246. doi:10.1016/j.therap.2017.08.005
15. How To Find Reliable Health Information Online. NIH. Published: January 12, 2023. Accessed June 14, 2023. https://www.nia.nih.gov/health/how-find-reliable-health-information-online