Dear Dr. Roach: In all the warnings you see for prescription drugs on TV and in print, it seems like a disproportionally high number of them have some tie-in to tuberculosis. They say to get tested for it and dont take the medicine if youve had it or if you know someone who had it. Regular over-the-counter drugs dont seem to have this connection to tuberculosis, at least from the labels. Why is it true for prescription drugs? C.W.
Answer: Despite the feeling you are getting from television ads, only a handful of prescription drugs increase risk for tuberculosis, but among those that do are some of the best-selling drugs (by total amount of money, not by number of prescriptions) and thus they are advertised heavily. These include adalimumab (Humira) and other tumor necrosis factor inhibitors (Remicade, Cimzia, Simponi and Enbrel). These drugs increase risk of developing tuberculosis by between 50 and 100 percent, but that is still only about 1 person in 200 who takes these medications. Steroid medications like prednisone also increase risk for tuberculosis, but you wont see those advertised on television.
I hear the ads as well, and am puzzled when they say if you live in an area where certain fungal infections are common. I bet that even people who do live in those areas may not realize it. They are referring (mostly) to histoplasmosis, which occurs in the Ohio and Mississippi River Valleys. Other fungal infections are possible, including coccidioidomycosis in the Southeastern states and blastomycosis, which in addition to the Ohio and Mississippi Valleys occurs in the St. Lawrence River area and the Great Lakes. Only the Northwest and Northeast are really at low risk for any fungal infections.
Symptoms of fungal infection with histoplasmosis are similar to a mild pneumonia: Fever and chills, cough and chest discomfort are common, but some people have more vague symptoms, such as weight loss and just not feeling well. People on these drugs with these symptoms should discuss them with the prescriber.
