Are calcium pills safe for women?

Q. Almost all women over 50 are told to take calcium supplements to prevent bone loss. Hip fractures, spine fractures and other bone problems can cause a lot of pain and misery, not to mention early death. But now I am reading that calcium pills themselves may lead to heart disease, stroke and premature death. This is very confusing.

A. Earlier research has shown that men who take calcium supplements (1,500 mg) are more likely to suffer a heart attack or stroke (JAMA Internal Medicine online, Feb. 4, 2013). A new study has shown that this danger haunts women, too (BMJ online, Feb. 13, 2013).

The study included more than 60,000 Swedish women followed up for almost 20 years. The researchers found that those who ate a high-calcium diet (at least 1,400 mg/day) and also took calcium tablets (500 mg each) were more than twice as likely to die during the study as those whose diets contained between 600 and 999 mg of calcium daily. Overall, it appears that relying on dietary sources of calcium is safer and more likely to provide additional nutrients needed for bone strength, such as magnesium, vitamin K and vitamin D.

We discuss the confusion surrounding calcium supplements, offer a list of calcium-rich foods and advise on nondrug approaches in our Guide to Osteoporosis. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. U-92, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.>

Q. I take Frova for migraines. It works great and doesn’t cause a rebound migraine.

My only complaint is that it takes a long time to work, sometimes as long as two hours. That’s an eternity with a migraine.

I wondered if it would work faster if I placed it under my tongue, so I tried it. It tasted terrible, but my migraine was gone in about 15 minutes!

Is there some reason I should not take Frova sublingually? I read the pamphlet that came with it, and didn’t see anything about taking it sublingually. What do you think?

A. We suspect the nasty taste you noted would be enough to discourage most people from repeating this experiment. The drug companies usually are happy if their migraine products relieve pain within two hours.

We looked to see if frovatriptan (Frova) is available as a sublingual tablet. It is not, but researchers in India have had success with a related medication, sumatriptan (International Journal of Pharmaceutical Investigation, July 2012). They found that they could mask the bitter taste and speed drug dispersion with this approach. Ask your doctor and pharmacist if your under-the-tongue trick is OK.

Q. Taking Chantix was the worst thing I ever did in my life. I wish I could undo the damage it has caused in my life. It triggered a manic episode that lasted six months, then a spiraling depression that ended with my relationship crumbling and me losing friendships, my family and my house.

A. The stop-smoking drug Chantix can be useful for some people. For others like yourself, however, the psychological side effects of Chantix can be devastating.

The manufacturer offers this caution: “Some people have had changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions while using CHANTIX to help them quit smoking.”

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or email them via their Web site: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”

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