Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.
AA is a 55-year-old Hispanic woman who comes to the pharmacy counseling area and hands the pharmacist a new prescription for Glucotrol XL 10 mg once daily and a bottle of cinnamon cassia 500-mg capsules. She explains to the pharmacist how she went to see her family physician, and he told her that her diabetes was not as well controlled as it should be. The pharmacist looks in her prescription profile and sees that AA is currently taking metformin 1000 mg twice daily for her type 2 diabetes. AA is concerned about having to take another prescription medication and states she would feel more comfortable taking a natural product to control her sugar. AA also explains that she has a friend with diabetes who swears that taking 2 cinnamon capsules 3 times a day helped her get her sugar under control.
What advice should the pharmacist give AA?
BP is a 61-year-old man who comes to the pharmacy appearing outwardly distressed as he hands the pharmacist a new prescription for finasteride 5 mg once daily. He proceeds to tell the pharmacist that he just returned from reviewing the results of his prostate-specific antigen (PSA) test with his urologist. During the visit, he was told to begin taking this new prescription to �prevent prostate cancer.� BP remarks that he was surprised that his physician wanted him to take a medication to prevent prostate cancer because his PSA levels have always been in the normal range for his age and he is not experiencing any urinary symptoms. BP notes he is unsure why he should spend his hard-earned money on finasteride, especially because his physician told him that it might cause sexual side effects.
How should the pharmacist respond to BP?
Cinnamon Cassia for Diabetes
Whereas an early trial of cinnamon cassia (common table cinnamon) demonstrated that it might help lower fasting blood sugars in type 2 diabetes patients numerous additional studies since have failed to confirm this finding. Thus, the preponderance of current evidence does not support its efficacy for this purpose (Diabetes Care. 2008;31(1):41-43). The pharmacist should counsel AA that cinnamon cassia will likely not help to control her diabetes and remind her about the importance of good diabetes control (decreased risk of heart attacks, blindness, nerve damage, kidney failure). Finally, the pharmacist should reassure AA that the best way to control her diabetes is to take the medications prescribed by her physician (Glucophage and Glucotrol XL), exercise, and eat a proper diet.
The pharmacist should tell BP that recently the American Urological Association and the American Society of Clinical Oncology published guidelines for prostate cancer chemoprevention (J Urol. 2009;181(4):1642-1657). These guidelines suggest that men like BP, who are regularly screened for prostate cancer (often because they are thought to have a higher than average risk) using PSA testing and have normal levels (<3.0 ng/mL), are likely to have a 26% lower risk of prostate cancer if they take a 5-alpha-reductase inhibitor such as finasteride or dutasteride. Therefore, for every 1000 men treated over 7 years, 15 fewer patients will develop prostate cancer. It is important, however, to remind BP that finasteride will not reduce his risk of prostate cancer to zero, nor has it been shown to decrease the number of deaths due to prostate cancer. Finally, the pharmacist also should reassure BP that any sexual side effects from finasteride (such as decreased libido) are reversible and often diminish over time.