Experts say you shouldn’t stop taking your medications. There are alternatives to consider as well as lifestyle choices that can help.
We trust drug companies to provide us with safe medicines. Now, we’re finding out what happens when things go wrong.
Since last July, we’ve seen medications for high blood pressure pulled from pharmacy shelves because of potential contamination from a cancer-causing agent.
Now, there are shortages of certain blood pressure drugs due to the series of recalls.
It started when the Food and Drug Administration (FDA) learned that the generic versions of blood pressure drugs called angiotensin II receptor blockers (ARBs) contained nitrosamine impurities that don’t meet the agency’s safety standards.
Nitrosamine impurities include N-nitrosodimethylamine (NDMA) and N-nitrosodiethylamine (NDEA), which have been identified as probable human carcinogens.
“This contamination was noted in factories in China and India. The contaminated active ingredient can also be combined with other agents like hydrochlorothiazide or amlodipine. It is unclear if the impurity was from a new manufacturing process or other source,” Dr. Guy L. Mintz, director of cardiovascular health and lipidology at Northwell Health’s Sandra Atlas Bass Heart Hospital in New York, told Healthline.
The FDA warned in a statement this week that there’s now a nationwide shortage of the ARB drugs typically prescribed to treat high blood pressure.
The agency adds that other blood pressure drugs may soon be in short supply due to the ongoing recalls.
The agency is currently investigating and testing all ARB drugs for contamination.
However, according to the FDA, not all ARB medications are contaminated with NDMA or NDEA.
Alternative drugs may be available that aren’t affected by the recalls.
“The medications that were recalled include losartan, valsartan, and irbesartan,” said Dr. Cara East, FACP, executive director at the Soltero Cardiology Research Center at Baylor University Medical Center in Texas.
“Not all lots were recalled, but it is probably best to stop using any of these medications and use alternative medications,” she told Healthline.
NDMA and NDEA are nitrosamines, the substances that caused a scare some years ago among people who enjoy . They’re also found in some cheeses, certain fish, and even groundwater.
Animal research has shown that nitrosamines are associated with an increased risk of gastric cancer, although the researchers used large doses to get this result.
“They have a chance of causing cancer in 1 in 100,000 people after 70 years of exposure,” said East. “Thus, the risk over the short term is extremely low. However, there is no reason for anyone to be exposed to cancer-causing chemicals when it can be avoided.”
Research in September in the BMJ medical journal looked at the cancer risk associated with exposure to NDMA through using contaminated valsartan products.
The study involved 5,150 Danish patients in their 40s with no history of cancer. They obtained information about cancer outcomes from the Danish Cancer Registry.
The researchers estimated that about half of the valsartan products used by the study participants were probably contaminated with NDMA.
“In this nationwide cohort study of Danish valsartan users, we did not see an increased short-term overall risk of cancer associated with the use of valsartan products potentially contaminated with N-nitrosodimethylamine (NDMA),” the study authors wrote.
However, Mintz thinks it’s still best to be cautious.
“It’s in every person’s best interest to decrease risk factors for cancer,” he said. “Knowing that something is carcinogenic is reason enough to remove that risk factor by stopping ingestion of that substance.”
The manufacturers affected include Major Pharmaceuticals, Solco Healthcare, Torrent Pharmaceuticals, and Teva Pharmaceuticals Industries.
Late last year, India-based pharmaceutical company Torrent Pharmaceuticals expanded its recall of losartan medication to include six additional lots of losartan potassium and hydrochlorothiazide tablets containing trace amounts of NDEA, according to a notice shared last week by the FDA.
The most recent recalls are from Prinston Pharmaceuticals.
The company announced in a press release that they’re voluntarily recalling one lot of irbesartan and seven lots of irbesartan HCTZ due to contamination with trace amounts of NDEA.
For people who rely on these recalled drugs, the threat of heart attack is much more immediate than the risk of cancer.
The FDA is advising that patients continue taking these medications for now but recommends that they consult with a doctor or pharmacist to discuss alternative treatment options.
“There is no need for hysteria,” Mintz said. “Patients who are currently taking the recalled drugs should continue on the medication and make an appointment with their prescribing physicians to discuss alternate treatment options based upon their individual clinical situations.”
Medication isn’t the only way to prevent high blood pressure.
The lists five lifestyle choices you can make that’ll help keep your blood pressure in a healthy range.
- Reduce your sodium intake. Eating too much salt and too little potassium will increase the risk of developing high blood pressure. Foods that contain potassium include bananas, beans, and yogurt.
- Get more exercise to prevent unhealthy weight gain.
- Obesity increases the risk of heart disease and high blood pressure. Keep your weight under control to stay heart-healthy.
- Alcohol consumption can raise blood pressure, so drink in moderation.
- Quit smoking. Besides the increased cancer risk, nicotine and carbon monoxide from cigarettes raise blood pressure while reducing the oxygen levels in your blood.
Potentially cancer-causing chemicals have been found in a certain type of medication used to treat high blood pressure. Many drug companies are recalling these drugs, causing shortages.
The FDA has made it clear that the short-term risk of cancer is low, especially compared to the risk of heart attack from not using the drugs.
If you rely on these recalled drugs, you should speak with a doctor or pharmacist to find out what alternatives are available to you.
Consider making healthy changes to your lifestyle that help control and prevent high blood pressure.