The U.S. Food and Drug Administration announced (April 1, 2020) it is requesting manufacturers to withdraw all prescription and over-the-counter (OTC) ranitidine drugs from the market immediately. This is the latest step in an ongoing investigation of a contaminant known as N-Nitrosodimethylamine (NDMA) in ranitidine medications (commonly known by the brand name Zantac). The agency has determined that the impurity in some ranitidine products increases over time and when stored at higher than room temperatures and may result in consumer exposure to unacceptable levels of this impurity. As a result of this immediate market withdrawal request, ranitidine products will not be available for new or existing prescriptions or OTC use in the U.S.

“The FDA is committed to ensuring that the medicines Americans take are safe and effective. We make every effort to investigate potential health risks and provide our recommendations to the public based on the best available science. We didn’t observe unacceptable levels of NDMA in many of the samples that we tested. However, since we don’t know how or for how long the product might have been stored, we decided that it should not be available to consumers and patients unless its quality can be assured,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “The FDA will continue our efforts to ensure impurities in other drugs do not exceed acceptable limits so that patients can continue taking medicines without concern.”

NDMA is a probable human carcinogen (a substance that could cause cancer). In the summer of 2019, the FDA became aware of independent laboratory testing that found NDMA in ranitidine. Low levels of NDMA are commonly ingested in the diet, for example, NDMA is present in foods and in water. These low levels would not be expected to lead to an increase in the risk of cancer. However, sustained higher levels of exposure may increase the risk of cancer in humans. The FDA conducted thorough laboratory tests and found NDMA in ranitidine at low levels. At the time, the agency did not have enough scientific evidence to recommend whether individuals should continue or stop taking ranitidine medicines, and continued its investigation and warned the public in September 2019 of the potential risks and to consider alternative OTC and prescription treatments.

New FDA testing and evaluation prompted by information from third-party laboratories confirmed that NDMA levels increase in ranitidine even under normal storage conditions, and NDMA has been found to increase significantly in samples stored at higher temperatures, including temperatures the product may be exposed to during distribution and handling by consumers. The testing also showed that the older a ranitidine product is, or the longer the length of time since it was manufactured, the greater the level of NDMA. These conditions may raise the level of NDMA in the ranitidine product above the acceptable daily intake limit.

With today’s announcement, the FDA is sending letters to all manufacturers of ranitidine requesting they withdraw their products from the market. The FDA is also advising consumers taking OTC ranitidine to stop taking any tablets or liquid they currently have, dispose of them properly and not buy more; for those who wish to continue treating their condition, they should consider using other approved OTC products. Patients taking prescription ranitidine should speak with their health care professional about other treatment options before stopping the medicine, as there are multiple drugs approved for the same or similar uses as ranitidine that do not carry the same risks from NDMA. To date, the FDA’s testing has not found NDMA in famotidine (Pepcid), cimetidine (Tagamet), esomeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec).

In light of the current COVID-19 pandemic, the FDA recommends patients and consumers not take their medicines to a drug take-back location but follow the specific disposal instructions in the medication guide or package insert or follow the agency’s recommended steps, which include ways to safely dispose of these medications at home.

The FDA continues its ongoing review, surveillance, compliance, and pharmaceutical quality efforts across every product area, and will continue to work with drug manufacturers to ensure safe, effective and high-quality drugs for the American public.

The FDA encourages health care professionals and patients to report adverse reactions or quality problems with any human drugs to the agency’s MedWatch Adverse Event Reporting program:

Complete and submit the report online at www.fda.gov/medwatch/report.htm; or

Download and complete the form, then submit it via fax at 1-800-FDA-0178.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

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April is foot health awareness month, and a great opportunity to take care of your feet. But if you’re experiencing an issue, it may be time to visit a podiatrist. Here are seven foot-related conditions you shouldn’t ignore.

1. Pain, numbness or swelling. A bit of discomfort after being on your feet all day or running a race is normal. However, sudden pain, swelling, and numbness in your feet with no apparent cause should prompt a call to the podiatrist.

2. Persistent heel pain. Heel pain that’s worse in the morning or after long periods of inactivity is a symptom of plantar fasciitis. It can also indicate other conditions, but in any case, it needs to be assessed by a podiatrist.

3. Injuries. If you think you may have broken or sprained your ankle, you’re better off seeing a podiatrist than an orthopedist. They have more expertise in treating these kinds of injuries.

4. Athlete’s foot. If over the counter products haven’t been able to rid you of this common fungal infection, consult a podiatrist. They can prescribe more effective treatments.

5. Diabetes. Type 1 and type 2 diabetes significantly increases the risk of developing foot problems. Diabetics should see a podiatrist at least once a year to monitor the health of their feet.

6. Bunions. These growths can get extremely painful if not treated. There’s a wide range of available treatments, but only a podiatrist can recommend the best one and implement it.

7. Joint pain. If you notice persistent pain in the joints of your feet or ankles, you should consult a professional. Even if the pain goes away with over-the-counter painkillers, identifying the cause is important to ensure that the problem doesn’t get worse.

Left untreated, these issues can make it harder to stay active and lead to a decline in your overall health. If you have one or more of these conditions, visiting a podiatrist is the best way to manage it.

Seventy-five percent of Americans will experience foot issues within their lifetime.

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Did you know that lifestyle choices have significantly more influence on longevity than genetics? Often, the habits you need to implement to live a longer, more satisfying life are easy to adopt.

1. Don’t smoke. Smoking contributes to numerous severe and potentially fatal health problems.

2. Stay active. Older adults should engage in at least 150 minutes of aerobic activity every week. In addition, regularly stretching helps maintain mobility and prevent falls.

3. Keep learning. Challenge your mind with problem-solving activities and puzzles. This will reduce the risk of dementia and improve cognition.

4. Eat healthy. Your diet should be rich in whole grains, fruits and vegetables. Avoid overeating, opt for plant proteins and eliminate saturated and trans fats.

5. Get outside. Sunshine is good for your mood and your health. Being outdoors also encourages you to be more active.

6. Sleep well. Seven to eight hours of quality sleep every night is crucial for regulating cell function and healing your body.

7. Build friendships. A strong social network helps prevent depression, loneliness and cognitive decline.

8. Be proactive. Regular screenings and preventive care will help your doctor diagnose and manage or treat diseases early.

9. Brush and floss. Poor oral hygiene can lead to mouth cancer, heart disease and diabetes. Brush your teeth twice a day, floss daily and visit your dentist regularly.

10. Mitigate stress. Stress and anxiety increase the likelihood of heart disease and stroke. Counter these risks with optimism and laughter.

Many of these habits have multiple payoffs, meaning a few healthy choices allow you to reap substantial benefits and enhance the quality and length of your life.

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Cancer Control Month takes place every year in April, and the occasion serves as an opportunity to take note of the fact that cancer screening saves lives. To help you advocate for your health and that of your friends and family members, here’s a timeline of when various types of cancer should first be screened for.

Cervical cancer: age 21
Women aged 21 to 65 should get a Pap smear every three years. Starting when they turn 30, they should also get an HPV test every five years. Women over 65 who had normal results over the last 10 years can forgo further testing.

Cervical cancer is highly treatable when caught early, making screening for it extremely important.

Breast cancer: age 50
According to the American College of Physicians, women with no increased risk for breast cancer should get a screening mammogram every two years starting at age 50 until age 75. However, women between the ages of 40 and 49 may elect to undergo screening after discussing the pros and cons with their doctor.

Breast cancer is by far the most commonly diagnosed cancer in women. While survival rates are improving for all stages, the earlier it’s caught, the easier it is to treat.

Colorectal cancer: age 50
While people with early-stage colorectal cancer have a survival rate of 90 percent, the prognosis isn’t as good for symptomatic cancers, which are usually quite advanced.

For people with average risk, a first colonoscopy at 50 years old is recommended, with follow-up exams depending on the results. Earlier screening is recommended for people with increased risk, such as those who are of African-American descent, those with a family history or those with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.

Prostate cancer: age 50
Prostate cancer is the most common cancer among American men. Detected early, the survival rate is nearly 100 percent.

However, research suggests there may be more downsides than upsides to getting tested regularly. For this reason, it’s recommended that men who are about to turn 50 have a discussion about prostate cancer screening with their doctor to determine whether they’re at high risk and whether screening would be beneficial.

Lung cancer: age 55
Lung cancer is the leading cause of cancer death in the United States. Contrary to popular belief, it’s very treatable if caught early. The problem is that over 80 percent of lung cancers are diagnosed at an advanced stage.

Current smokers, as well as former heavy smokers, aged 55 to 80, should be screened with a low-dose computed tomography (CT) scan.

Cancer screening saves lives, so don’t hesitate to remind friends and relatives to get tested.

Skin cancer
People of all ages can develop skin cancer. Talk to your doctor to determine your risk factors and to schedule regular skin exams.

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Dental crowns are used to restore the shape, appearance and function of damaged teeth. They can be made of one of several different materials, and each has its own pros and cons. Here’s what you should know about the various options.

• Metal alloy. These dental crowns last the longest and rarely chip or break. However, because of their color, they’re not considered suitable for teeth that are visible when talking or smiling. The type of metals in the alloy can include gold, platinum, chromium, nickel or others.

• Porcelain. These are ideal for front teeth because they can be tinted to precisely match the color of your existing teeth. On the other hand, they’re less durable than other types of dental crowns and are more likely to chip or crack.

• Composite. These also look very natural, and while they won’t chip as easily as porcelain, they tend to get worn down by chewing and brushing. They’re also more likely to stain.

• Porcelain fused to metal. These crowns combine the strength of metal and the look of porcelain. However, the porcelain can chip and consequently expose the metal. Additionally, if the gums are thin or recede the metal will show along the gum line.

When properly taken care of, dental crowns can last for up to 10 years. Be sure to brush twice a day, floss regularly and visit your dentist twice a year.

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If you think you’re making a healthier choice by sprinkling sea salt on your food instead of regular old table salt, think again.

Any type of salt, be it kosher salt, celery salt, garlic salt, table salt or pink Himalayan salt, contains the same amount of sodium, which is to blame for an increased risk of hypertension, cardiovascular events and kidney disease.

The only healthier choice when it comes to salt is to avoid consuming it in excess.

North Americans eat nearly 3,400 milligrams of salt a day, more than twice the recommended amount. Using more herbs and spices to season food is a good way to cut down on sodium.

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