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DRUGS THAT RAISE HOMOCYSTEINE

Gabe Mirkin, M.D.

A study from Tulane shows that several drugs used to prevent heart attacks raise blood levels of homocysteine and therefore may actually increase risk for heart attacks if this is not recognized.

High blood levels of homocysteine increase your risk for a heart attack. The vitamin, Folic acid, is necessary to lower blood levels of homocysteine. Anything that lowers blood levels of folic acid increases your risk for a heart attack. Glucophage, used to treat diabetes, and cholestyramine, used to treat high triglycerides, block the absorption of folic acid from the intestines to raise blood levels of homocysteine. Niacin, used to treat high cholesterol, and methotrexate, used to treat rheumatoid arthritis, block metabolism of folic acid in the body to lower blood levels of folic acid. To prevent heart attacks, doctors should prescribe folic acid along with any of these drugs: methotrexate for rheumatoid arthritis, Glucophage (metformin) for diabetes, cholestyramine for high blood triglycerides, or niacin for high cholesterol. People on these drugs should have homocysteine levels followed. If homocysteine is above 100, take folic acid, pyridoxine and B12 (readily available in combination pills such as Foltex or Fol-B.)

Treatment with folate or vitamins B6 and B 12 lowers plasma homocysteine levels effectively. Drugs affecting homocysteine metabolism - Impact on cardiovascular risk. Drugs, 2002, Vol 62, Iss 4, pp 605-616. C Desouza, M Keebler, DB McNamara, V Fonseca. Fonseca V, Tulane Univ, Sch Med, 1430 Tulane Ave SL-53, New Orleans,LA 70112 USA

Checked 9/3/05