Q: I have painful osteoarthritis throughout my body. Because I am on the blood thinner Pradaxa for life, I am not able to take aspirin or NSAIDs for the pain.
I have been taking low-dose naltrexone for a couple of years. I didn’t quite realize how well it relieved my pain until I went on vacation and forgot to bring it along. I couldn’t wait to get home and get back to my LDN!
My doctor doesn’t really like to prescribe it, but she does because my former doctor, her colleague, did. I’m grateful.
A: Naltrexone was first approved by the Food and Drug Administration in 1984 under the brand name Trexan. The drug was developed to treat opioid dependence but currently is used primarily for people with alcohol use disorder at a dose of 50 milligrams.
The FDA has not approved the use of low-dose naltrexone (1.5 to 4.5 mg), but many practitioners prescribe it for a variety of painful conditions. These include fibromyalgia, multiple sclerosis, inflammatory bowel disorders and diabetic neuropathy (Journal of Pain Research, June 14, 2023).
Researchers have not studied low-dose naltrexone for osteoarthritis, although some believe it might be helpful (Biomedicines, June 2023). One intriguing study suggests that LDN might also help people with symptoms of long COVID (Clinical Therapeutics, March 2024). Most clinicians will want to see well-conducted randomized clinical trials before prescribing LDN for either long COVID or arthritis, however.
Q: I have been taking lisinopril for years to control high blood pressure. It seems obvious that you should reduce salt. After all, salt can raise blood pressure.
I have learned from your column NOT to use salt substitutes. I am very surprised that I needed to learn this from you because neither my pharmacy nor my doctor warned me about it.
A: Lisinopril is known as an ACE (angiotensin converting enzyme) inhibitor. Many blood pressure pills such as thiazide diuretics deplete the body of potassium. ACE inhibitors, on the other hand, help the body preserve potassium.
As a result, using a potassium-based salt substitute could lead to an excess of this mineral. Too much potassium (hyperkalemia) is just as dangerous as too little. Symptoms may include weakness, slow pulse, heart palpitations, tingling or numbness in hands, feet or lips and confusion. When potassium levels get too high, they can cause fatal heart rhythm abnormalities.
Another class of drugs that pose similar risks are ARBs (angiotensin receptor blockers) such as losartan. To learn more about the pros and cons of such drugs and other approaches for controlling high blood pressure, you may find our “eGuide to Blood Pressure Solutions” helpful. This online resource can be found under the Health eGuide tab at PeoplesPharmacy.com.
Q: I use Pepto Bismol occasionally for stomach cramps. It turns my stools black within a day.
Recently, I used a generic product. To my surprise, it turned my tongue black. Thank goodness that went away in about 24 hours.
A: Bismuth subsalicylate, the active ingredient in Pepto Bismol, can react with the sulfur in your mouth to form bismuth sulfide. This black compound may coat your tongue (making it black) or turn up in your stool (also black).
As a side effect of taking bismuth, it is harmless. The black color should disappear within a few days of stopping the medicine.