People’s Pharmacy: Did heart drug make man’s breasts bigger?

Q. I was recently diagnosed with gynecomastia. Could that be a side effect of taking amiodarone for heart-rhythm problems?

I know that amiodarone has many serious side effects, but neither my cardiologist nor my endocrinologist knows of any definitive connection between that drug and gynecomastia.

A. Gynecomastia is the development of large breasts on men. It may be a side effect of hormone imbalance or medications.

We searched high and low for a link between the heart-rhythm drug amiodarone and gynecomastia. There is nothing in the prescribing information, but doctors in Israel reported a case decades ago (New England Journal of Medicine, Dec. 11, 1986). Because the patient’s breasts diminished in size when the drug was discontinued and reappeared when it was restarted, the physicians concluded that the breast enlargement was the result of the medication.

Hundreds of drugs can cause gynecomastia, but it is not a side effect that gets much attention. Prostate cancer medications and certain drugs prescribed for high blood pressure, heartburn, fungal infections and mental illness also can trigger breast enlargement in men.

Q. My doctor prescribed Keppra and Tegretol for my epilepsy. I do not want to take the generic forms, so I buy the brand-name products from a Canadian pharmacy. Three months of Keppra is about $900 there, and Tegretol about $200.

In the U.S., they would be $4,176 and $1,567 for three months, respectively, so I save about $4,600 over that time.

I have had no problems with the Canadian pharmacy, and they usually source these brand-name drugs from the U.K. I do have to plan ahead, though, to allow for shipping time. I thought others could benefit from my experience.

A. We have heard from many readers that switching from brand-name Keppra to the generic anticonvulsant levetiracetam may lead to breakthrough seizures, so we understand why you have chosen to stick with the brand name.

Because it is so expensive in the U.S., a more affordable Canadian pharmacy makes sense. Not all online pharmacies that claim to be Canadian are legitimate, though. To verify, look for the provincial pharmacy license number on the website. There also must be a physical address in Canada. A certification seal from CIPA (Canadian International Pharmacy Association) is also reassuring.

We summarize this and much more information about ordering from legitimate Canadian pharmacies in our “eGuide to Saving Money on Medicines.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. My doctor requests a vitamin D level every time I get a blood test. A few years ago, it was lower than he wanted, so he suggested I take D3.

I am not spending as much time working outside, so my body doesn’t seem to produce as much vitamin D. I really appreciate his caution, as I haven’t even had a cold since I started on the supplement.

A. We think it makes sense to have vitamin D levels tested periodically. Millions of Americans are low or deficient in this crucial nutrient.

Many studies show that when people do not have adequate vitamin D, they are more susceptible to infection. A placebo-controlled trial of 5,000 IU vitamin D3 daily found that volunteers on D3 were less likely to contract influenza-like illness than those on placebo (Nutrients, Dec. 30, 2022).

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla. 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”