People’s Pharmacy: How harmful is nicotine-gum addiction?

Q. I quit smoking six years ago by using nicotine gum. The trouble is, I haven’t quit the gum.

Since I quit smoking, I chew about 10 pieces of 4 mg gum per day. What health risks are there from long-term use?

A. Nicotine is by all accounts a highly addictive substance. Some people have called cigarettes nicotine-delivery devices because it is this drug that makes it so hard to quit smoking.

Nicotine-containing gum has been around for more than three decades. It has helped many people give up cigarettes. And there is no doubt that the gum is safer. That’s because cigarette smoke contains carcinogenic chemicals.

You are not the only person to find yourself dependent on nicotine gum. Side effects may include digestive upset, hiccups, sore throat, headache and heart palpitations. Even after all this time, though, experts are not sure whether long-term use of nicotine gum poses serious health risks. You may find that switching to a nicotine patch makes it easier to gradually wean yourself from nicotine.

Q. I have been treated for prostate cancer. My oncologist has recommended that I take the diabetes drug metformin and the cholesterol medication rosuvastatin to reduce my risk of recurrence.

When I saw my family doctor and said I am taking these drugs, he was surprised. He had never heard of this use and said it was off-label. Is there any evidence that these drugs would be helpful against cancer?

A. There are studies to suggest that the diabetes drug metformin could have anti-cancer activity. An overview published in Investigative and Clinical Urology (May 2016) noted that “Use of metformin has been shown to be associated with decreased incidence and improved outcomes of prostate, bladder, and kidney cancer.”

There are biological reasons to expect statins also might block prostate cancer, but the research so far has been inconclusive (Nutrition and Metabolic Insights online, July 14, 2016). An Australian study is underway to determine if metformin and atorvastatin together can affect the course of localized but aggressive prostate cancer (Contemporary Clinical Trials online, June 28, 2016). The answer won’t be apparent for a few more years.

Q. I have taken Cymbalta for depression and pain. The generic I have been given just doesn’t help me, so I’ve been looking for an “authorized generic” that would be identical to the brand name.

One pharmacy refused to order it because they said they would lose money. Another looked at me like I was asking for a unicorn.

My insurance company didn’t have a clue what I was talking about. Cymbalta as a brand name isn’t covered, and I cannot afford the $250 a month it would cost out of pocket. Can you help me?

A. Authorized generic drugs are identical to the brand-name products, sometimes manufactured in the same facility. Prasco initially sold an authorized generic version of Cymbalta (duloxetine) but no longer does so. A spokesperson told us that there is currently no authorized generic for Cymbalta.

If you purchase brand-name Cymbalta from a legitimate Canadian pharmacy, the cost could be about one-third as much as in the U.S. To learn more about authorized generics and reliable Canadian pharmacies, you may want to read the newly revised Guide to Saving Money on Medicines we are sending you. This 20-page guide is available for download at www.PeoplesPharmacy.com for $2.99.

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