Pills for a healthy old age

Drugs that improve the quality of life in old age

Normal aging is not a disease, but an increasing number of people resort to so-called "medicines that improve the quality of life", including nootropic and psychotropic drugs, hormones and drugs of natural origin. Life-improving drugs are used to achieve a certain ideal of health or beauty, formed by public opinion, and not to combat diseases known to medicine.

Drugs that improve the quality of life have become a new, economically, socially and medically important group of medicines. The craze for such drugs is influenced by fashion trends and lifestyle features, as well as, more generally, a variety of socio-economic factors. The amount of information about drugs that improve the quality of life provided by the media and available on the Internet is rapidly increasing. At the same time, the number of people who require therapy with such drugs in order to strengthen their sense of well-being is also growing.

In the past, patients turned to doctors for advice and help about getting rid of the symptoms of the disease; today, specialists in certain areas (for example, aesthetic surgery) are under pressure from patients who require prescribing medications or performing surgical interventions that are not medically necessary. On the other hand, it is impossible not to admit that doctors and pharmacists themselves create new commercial markets for the purpose of enrichment. In addition, now, for the first time in the history of mankind, medicine has partially moved away from the desire for restitutio ad integrum (Lat. "full recovery") and turned her attention to the improvement of the human body.

Drugs that improve the quality of life can be divided into 2 groups:

• drugs approved for use for certain indications in order to improve the quality of life (for example, finasteride for the treatment of androgenic allopecia, which is not considered a disease in the medical sense), and
• drugs approved for use for certain indications, but taken for other purposes (undocumented use).

For example, phosphodiesterase inhibitors are prescribed for the treatment of erectile dysfunction, but healthy men use them to improve their sexual capabilities. Men's dreams of a fully controlled erection lead to the fact that normal, from time to time, "failures" can develop into a far-fetched somatoform disorder that turns phosphodiesterase inhibitors into drugs that improve the quality of life.

Nootropic drugs are approved for the treatment of certain diseases, such as mental or neurological symptoms of cerebral circulatory disorders of various etiologies (post–stroke, post-traumatic or sclerotic), and selective serotonin reuptake inhibitors - for the treatment of depressive disorders. However, these drugs can be used without a doctor's prescription to improve well-being. Thus, when used for certain purposes, the drug can turn into a drug that improves the quality of life.

Similarly, the use of doping, especially anabolic androgenic steroids, the use of which is fraught with side effects and long-term consequences, has grown from a problem of the sports community into a public health problem.

Moreover, recently, drugs that "slow down aging" have become increasingly popular, the effectiveness and safety of which has little or no scientific evidence. The group of the highest risk associated with the use of such drugs includes elderly people who often take many medications for medical reasons, which increases the likelihood of developing dangerous drug interactions.

Currently available drugs that improve the quality of life can be divided into 5 groups:

1. Nootropic agents: dimethylaminoethanol, gidergin, piracetam, pramiracetam, acetyl-L-carnitine, oxiracetam, aniracetam, vinpocetine, idebinone, vincamine, cyprodenate, yohimbine.
2. Psychotropic drugs: 7-hydroxybutyrate, ketamine, fluoxetine, selegiline, S-adenosyl methionine, adrafinyl/modifinyl, sibutramine, L-tryptophan, serotonin, dexfenfluramine, ecstasy, ondansetron parlodel.
3. Hormonal drugs: dehydroepiandrosterone, pregnenolone, melatonin, desmopressin, norethisterone, contraceptives, growth hormones, anabolic steroids, bremelanotide.
4. Preparations of natural origin: absinthe, echinacea, kava-kava, vegetable ecstasy, guarana, Chinese herbs, rose of Sharon, vitamins, minerals, amino acids, Gingko biloba.
5. Other: dextromethorphan, metformin, propranolol, coenzyme Q, orlistat, nimodipine, centrophenoxine, clenbuterol, NADH (nicotinamide adenine dinucleotide, reduced), phenytoin, deprenyl, bupropion.

The most popular drugs are described below, the use of most of which requires a medical appointment.

• Vitamin E and selenium are currently undergoing a large-scale randomized clinical trial as a means to prevent prostate cancer. However, taking regular doses of vitamin E for 10 years is not associated with a reduced risk of developing this disease.
• The amino acid L-arginine, which is a substrate of the enzyme nitric oxide synthase, is increasingly being used as a dietary supplement to reduce vascular stiffness. However, in a randomized, double-blind, placebo-controlled clinical trial, the addition of L-arginine to the standard protocol of post-infarction therapy not only did not improve vascular stiffness, but may have been associated with higher post-infarction mortality.
• Overweight is a serious medical problem of modern society. The drugs orlistat and sibutramine used to treat obesity, which are inhibitors of digestive enzymes that break down fats, are increasingly being taken by people with normal body weight who are striving to achieve the ideal. Possible side effects of such "treatment" may be pigmentation disorders, flatulence, incontinence of intestinal contents and pain in the rectum.
• Antidiabetic medications such as metformin and blood lipid lowering drugs (statins) are taken by healthy people to reduce body weight or to prevent the effects of eating fatty foods. People who believe in the advertised safety of such drugs arrange "food orgies", which takes the metabolism out of balance and leads to undesirable side effects.
• Psychotropic drugs, especially selective serotonin reuptake inhibitors such as fluoxetine (prozac), are also taken as drugs that improve the quality of life by improving the psychological state, facilitating social contacts, as well as reducing body weight. Recently, paroxetine has become fashionable, positioned "as a pill for the modest" in the context of social phobia. Ritalin or atomoxetine (strattera), intended for the treatment of attention deficit, are often misused as stimulants to increase mindfulness and improve mental abilities. Benzodiazepines are also widely used in the absence of significant indications.
• Modafinil (vigil), registered as a drug for the treatment of narcolepsy, is taken to increase attention and the duration of periods of wakefulness. In Germany, the prescription and use of this drug is regulated by the drug law.
• Donepezil is used to treat Alzheimer's disease, but currently students take it to stimulate cognitive function, improve learning outcomes, general body condition and memory. However, the actual effectiveness of the drug is questionable, and possible long-term side effects observed in elderly people can lead to serious problems.
• Sildenafil (Viagra), a drug whose appearance on the market in 1998 caused the most active discussion of sexual behavior around the world, is a phosphodiesterase inhibitor and is used to treat erectile dysfunction. After it, new drugs were developed, such as tadalafil and vardenafil, which have a longer effect. In some cases, sildenafil is also prescribed to women, as its positive dose-dependent effect is shown in violation of sexual arousal in women. The main undesirable side effect of phosphodiesterase inhibitors, which people taking them should remember, are complications from the cardiovascular system, fraught with death.
• Testosterone preparations are usually used as replacement therapy in the form of patches, transdermal delivery systems and injections. Currently, experts are discussing the so-called "male menopause syndrome", while a decrease in testosterone levels is considered responsible for a decrease in libido and other complaints, such as a deterioration in general well-being, a decrease in muscle strength, sleep disorders, depression and nervousness. However, studies have not confirmed the existence of such a relationship. A new dosage form – testosterone undecanoate, which has a long-term kinetics, is enough to use only 4 times a year, which ensures the maintenance of normal levels of testosterone in the blood serum without periods of their abnormal decrease or increase. In 2003, a testesterone gel appeared on the market, which is often abused by men with normal hormone levels. A randomized, double-blind, placebo-controlled clinical trial has shown that testosterone patches Intrinsa improve sexual function and reduce the severity of unpleasant manifestations in menopausal women who developed as a result of surgical interventions. However, the U.S. Food and Drug Administration (FDA) has not approved the use of this drug for these indications to date. In this context, it is appropriate to mention the recent study of bremelanotide nasal spray (PT-141) containing a synthetic hormone–like peptide analog of alpha-melanocyte-stimulating hormone acting as an agonist of melanocortin receptors. Its effect on the libido of both men and women is currently being studied, and the intermediate results obtained indicate a positive effect in women with disorders of sexual arousal. The erectogenic potential of bremelanotide and its effectiveness when used by patients who do not respond to phosphodiesterase inhibitors makes it a promising alternative treatment for erectile dysfunction, but it has not yet appeared on the market.
• Somatotropin – growth hormone – is currently produced using genetically modified bacteria, which ensures their low cost. Athletes abuse somatotropin because of its supposed pronounced anabolic effect, and elderly people consider it as a "source of youth". As a drug that improves the quality of life, somatotropin is taken to increase muscle strength, reduce fat, smooth wrinkles, increase energy and improve sexual life. However, a number of side effects should not be neglected, especially the launch of processes leading to the development of diabetes mellitus and malignant neoplasms, or aggravating existing pathologies.

Cosmetic preparations that improve the quality of life are generally safe and non-invasive compared to surgical procedures, but their side effects should also not be neglected.

• Vitamins, dietary supplements, minerals and skin creams are aggressively advertised as effective means to slow down aging and increase life expectancy. Vitamins A, E and C are used for the prevention and therapy of skin aging. The results of studies conducted in the laboratory indicate that these compounds, known for their antioxidant properties, are able to stimulate synthesis. However, among people who consumed very large doses of vitamin E (11,000 IU per day), increased mortality was detected.
• Small doses of isotretinoin (one of the isoforms of vitamin A) are used to reduce physiological seborrhea and facial skin gloss. At the same time, the side effects of isotretinoin, such as teratogenicity and metabolic disorders, are much more serious than the desired effect of its use as a drug that improves the quality of life.
• Finasteride (propecia), a popular drug for the treatment of androgenic alopecia, which is not a disease in the literal sense, inhibits the enzyme type 5a-reductase II in hair follicles and blocks the peripheral conversion of testosterone into the active form – dihydrotestosterone. Reported side effects include decreased libido, decreased ejaculate volume and erectile dysfunction, as well as breast enlargement. In the near future, new drugs for the treatment of androgenic baldness (dutasteride – 5a-reductase type I and II, latanoprost) are expected to appear on the market.
• Botulinum toxin, a neurotoxin of the anaerobic bacterium Clostridium botulinum, is widely used in cosmetic medicine to treat wrinkles and excessive sweating. It binds to the presynaptic terminals of cholinergic neurons and blocks the transmission of nerve impulses in the endings of motor and autonomic nerves. Botulinum toxin is the strongest known poison that causes clinical symptoms of botulism, a type of food poisoning. In cosmetology medicine, it is used mainly as a drug that improves the quality of life.

Medicines are intended only for use for certain indications, therefore, when they are used as drugs that improve the quality of life, the risk / benefit ratio can shift very much in favor of risk. However, people, in spite of everything, often ignore the information provided to them by doctors and contained in the instructions for the use of drugs.

Today, almost all drugs marketed as "medicines" for healthy people can be purchased without a prescription on the black market, especially via the Internet. The result of this was the appearance of a huge gap between real and official figures. For example, global sales of human growth hormone reach several billion US dollars per year, which is many times higher than the actual cost of the drug needed to treat people with dwarfism, as well as patients with cachexia and/or old age.

The group of fans of drugs that improve the quality of life includes a significant number of people suffering from emotional disorders. Therefore, the attending physician, faced with the requirement to prescribe a drug that improves the quality of life, should take into account the psychological context of this requirement. Issues of improving the quality of life in medicine can be associated with somatoform disorders – somatization of norm variants and the desire to undergo somatic treatment for psychosomatic pathologies. A good example is the history of the appearance on the market in January 1999 of finasteride (propecia), a drug for the treatment of androgenic alopecia. At the same time, the number of men contacting a dermatologist about prescribing this drug for the treatment of hair loss (often imaginary) or its prevention has increased dramatically. A significant part of them were patients with dysmorphic phobia – anxiety about a non-existent or overly exaggerated defect in appearance, accompanied by clinically significant anxiety or the impossibility of normal social contacts.

A special form of dysmorphic phobia is the so–called "Dorian Gray syndrome" - the desire to stay young forever. This diagnosis is associated with narcissistic personality regression, social phobia and a strong desire to preserve youth.

Other diagnoses often found in patients of cosmetology clinics include primary mental disorders (dysmorphic disorder, affective/bipolar disorder), personality change, acute stress reaction, secondary mental disorders and combined diseases.

Attending physicians should be prepared for the fact that a patient with a psychosocial disorder may require the appointment of a drug that improves the quality of life. Thoughtless satisfaction of such requests can lead to the chronization of undiagnosed emotional disorders. The decision on the appointment of psychotherapy in such cases depends on the concomitant diseases and abnormalities, as well as the motivation of the patient himself. Patients with psychological abnormalities sometimes consciously ignore possible risks and complications or deny the fact of side effects. Therefore, when prescribing any drugs that improve the quality of life, it is necessary to exclude psychosomatic disorders in all patients without exception.

Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on the article by W. Harth, K. Seikowski and B. Hermes
Lifestyle Drugs in Old Age – A Mini-Review (Gerontology 2009;55:13–20).

27.09.2012