Salt in medicines ‘a health risk’


Effervescent tablet

Soluble painkillers used by millions of people in Britain could pose a health risk because they are high in salt, UK researchers are warning.

Some formulations taken at maximum dose tip users over the recommended daily sodium intake for an adult, with potentially dangerous consequences, the study authors say.

Their work in the BMJ looks at the outcomes for 1.2 million UK patients.

It found a link between effervescent tablets and heart attacks and stroke.

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Without clear labelling on these products, it is impossible to know how much additional sodium you would be eating”

Prof Gareth Beevers Blood Pressure UK

All medicines that contain at least 1mmol (or 23mg) of sodium – a component of salt – in each dose are required to declare on their labelling that the product contains sodium.

The accompanying patient information leaflet provides information on the quantity of sodium and includes a warning to patients on a low-sodium diet to take the amount of sodium in the medicine into account.

Compared with patients taking the same drugs without salt, those who regularly took effervescent or soluble medications increased their risk of having a heart attack, stroke or dying from a vascular cause by a fifth

They were also seven times more likely to develop high blood pressure or hypertension, which the researchers say is at the root of the problem.

Lead researcher Dr Jacob George, from Dundee University, said: “We know that high salt causes hypertension and that hypertension leads to stroke.”

The British Heart Foundation said it was important to remember that the research applied to people who were taking these medicines every day – it did not mean that occasional use could damage your heart health.

Hidden salt

Effervescent medicines contain a substance called bicarbonate, which helps them fizz and dissolve, and this is often combined with sodium.

The study looked at 24 different prescribed effervescent medicines, including common painkillers such as paracetamol and aspirin, as well as supplements.

But Dr George said many more people bought these types of treatment from chemists, without a prescription.

He said that people needed to be aware of the risks and drug manufacturers should look at cutting the salt content of their products.

In the study, sodium levels in tablets ranged from as low as 3mmol to as high as 18mmol – approximately a fifth of a teaspoon.

The recommended sodium intake for an adult in the UK is 104mmol per day.

A person who takes the maximum daily dose of eight tablets of soluble paracetamol, for example, would ingest 148.8mmol of sodium, which exceeds their daily salt allowance.

If you then took in to account the dietary salt a person was likely to get from the food that they ate, their overall salt intake could be dangerously high, said Dr George.

The Medicines and Healthcare products Regulatory Agency (MHRA) said it kept a close check on the safety of all licensed medicines.

“We will carefully review the findings of this new research,” said a spokeswoman.

“We recommend that people with questions about their salt intake should read the patient information leaflet and speak to their GP,” the MHRA said.

But Prof Gareth Beevers, of Blood Pressure UK, said many consumers would be unaware of the risks.

“It is extraordinary to think that sodium has been hiding in our medicines all this time.

“Without clear labelling on these products, it is impossible to know how much additional sodium you would be eating, so it is shocking to find you could be having more than your daily maximum from medicines alone.

“Eating too much sodium – in any form – puts up our blood pressure, which puts you at increased risk of strokes and heart attacks, the biggest killers in the world.”

Child bone-marrow transplant ‘first’


First human trial of new bone-marrow transplant method.

Mohammed Ahmed
Mohammed started going to school in September

Doctors at London’s Great Ormond Street Hospital have carried out a pioneering bone-marrow transplant technique.

They say the method should help with donor shortages since it does not require a perfect cell match.

Mohammed Ahmed, who is nearly five years old, was among the first three children in the world to try out the new treatment.

He has severe combined immunodeficiency syndrome and had been waiting for a suitable donor for years.

Mohammed, who lives in Milton Keynes, was referred to Great Ormond Street Hospital when he was a year old.

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We waited for a full match but it did not come. By the grace of God, we took the decision to have the treatment”

Jamil Ahmed, Mohammed’s dad

His condition – a weak immune system – makes him more susceptible to infections than most, and a bone marrow transplant is the only known treatment.

While Mohammed was on the transplant waiting list, he became extremely sick with swine flu.

At that time, his doctors decided Mohammed’s only real hope was to have a mismatched bone-marrow transplant, with his father acting as the donor.

Mohammed’s dad, Jamil, agreed to give the experimental therapy a go.

Before giving his donation, Jamil was first vaccinated against swine flu so that his own bone-marrow cells would know how to fight the infection.

Mohammed’s doctors then modified these donated immune cells, called “T-cells”, in the lab to engineer a safety switch – a self-destruct message that could be activated if Mohammed’s body should start to reject them once transplanted.

Safety net

Rejection or graft-v-host disease is a serious complication of bone-marrow transplants, particularly where tissue matching between donor and recipient is not perfect, and is one of the most difficult challenges faced by patients and their doctors.

Mismatched transplants in children – where the donor is not a close match for the child – are usually depleted of T-cells to prevent graft-v-host disease, but this causes problems in terms of virus infections and leukaemia relapse.

Blood cells
White blood cells protect the body against infections

The safety switch gets round this – plenty of T-cells to be transfused and later killed off if problems do arise.

Thankfully, the transplant carried out in 2011 was a success – Mohammed’s doctors did not need to use the safety switch.

Although Mohammed still has to take a number of medicines to ward off future infections, his immune system is now in better shape.

Jamil said: “We waited for a full match but it did not come. By the grace of God, we took the decision to have the treatment.

“Now he is all right. Sometimes we forget what he has been through. We are just so grateful.”

He said Mohammed would still need close monitoring and regular health checks over the coming years, but his outlook was good.

Dr Waseem Qasim, ‎consultant in paediatric immunology at Great Ormond Street Hospital and lead author for the study, said the new approach should hopefully mean children who received a mismatched transplant could enjoy the same chance of success as those given a fully matched transplant.

“We think Mohammed is cured of his disorder. He should be able to lead a fairly normal life now.”

A full report about Mohammed’s therapy and the research by Great Ormond Street Hospital, King’s College London and the Institute of Child Health has just been published in PLoS One journal.

There are currently about 1,600 people in the UK waiting for a bone-marrow transplant and 37,000 worldwide.

Just 30% of people will find a matching donor from within their families.

Donations involve collecting blood from a vein or aspirating bone marrow from the pelvis using a needle and syringe.

Blood pressure drug ‘fights cancer’


Losartan pill
Losartan has been prescribed as a blood pressure drug for decades

A commonly used blood pressure drug could help fight cancer by opening up blood vessels in solid tumours.

Used beside conventional cancer-fighting drugs, it could improve life expectancy, experts believe.

Following successful testing in mice, doctors plan to give losartan to patients with pancreatic cancer to see if it can tackle this hard-to-treat disease, Nature Communications reports.

Currently, only 5% of pancreatic cancer patients survive for at least 5 years.

This is partly because only one in 10 people with the disease has a tumour that is operable.

Future hope

Investigators at the Massachusetts General Hospital in the US are currently recruiting volunteer patients with inoperable pancreatic cancer to test out the new drug combination of chemotherapy plus losartan.

Although the treatment will not cure them, the researchers hope it will give the patients more months or years of life than they might otherwise get.

Losartan has been used for more than a decade as a safe blood pressure medication.

It works by making the blood vessels relax or dilate so that they can carry more blood, easing pressure.

The Massachusetts team found that the drug was beneficial in mice with breast and pancreatic cancer.

It improved blood flow in and around the tumours allowing more of the chemotherapy drugs to be delivered to their target.

Mice given this treatment, rather than standard chemotherapy alone, survived for longer.

Dr Emma Smith of Cancer Research UK said: “This interesting study in mice sheds light on why drugs for hypertension might improve the effectiveness of chemotherapy, but we don’t yet know if they work exactly the same way in people.

“The fact that these drugs are already widely used to treat high blood pressure will hopefully cut down the amount of time it will take to test their potential in treating cancer but they may not be safe for all patients or when combined with other cancer treatments, so we need to wait for the answers from clinical trials which are already under way.”