Topamax can diminish sex drive

Q: Does Topamax cause complete lack of sexual desire? And I do mean complete!

A: Topamax (topiramate) is prescribed for epilepsy, but it also is used to prevent migraines. Your short question implies a lot of frustration and sent us hunting for an answer.

"Decreased libido" has been reported as a side effect of Topamax in the prescribing information provided for doctors. It seems not to be very common, though, affecting just a few patients in a hundred.

Doctors also have described cases in which Topamax completely blocked women's ability to achieve orgasm (Neurology, Oct. 25, 2005). About five days after discontinuing the Topamax under medical supervision, the women were once again able to climax. Never stop an epilepsy drug suddenly without your doctor's approval. An unexpected seizure could be devastating.

Q: I have been hearing that something called CRP may be more important than cholesterol when it comes to heart disease. I don't know much about it. What are normal CRP values? There was an opportunity to have blood work done at my college recently, and my CRP was 6.7 mg/L. Isn't that high? Is there any way to lower CRP other than taking Crestor?

A: Recent research showed that the statin-type cholesterol-lowering drug Crestor lowered CRP and reduced cardiovascular events even in people who started with normal cholesterol (New England Journal of Medicine, Nov. 20, 2008). Before this hit the headlines, many people had never heard of CRP, or C-reactive protein. This marker of inflammation should ideally be at or below 1, so yours is elevated. Many cardiologists think that CRP above 2 calls for treatment.

Crestor can lower CRP, but it is expensive, and some people experience side effects. You may be able to fight inflammation with exercise and weight loss. Supplements such as fish oil and Coenzyme Q10 also may help. We are sending you our new Guide to Cholesterol Control and Heart Health, in which we discuss CRP and offer a list of anti-inflammatory foods and nondrug approaches for heart health.

Q: A reader recently reported using zinc oxide to treat hemorrhoid symptoms. I just wanted you to know that I have been using zinc oxide for this purpose for years. I thought no one else knew about it.

It's something I just tried on my own after little or no relief from such ointments as Preparation H. Zinc oxide provides almost instant relief. I told my doctor years ago, but she had never heard of using zinc oxide for hemorrhoids.

A: Zinc oxide appears to be a safe, inexpensive alternative to other external hemorrhoid creams. When we looked for it at the drugstore, we found it sold as a diaper-rash cream.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 888 Seventh Ave., New York, NY 10019, or via their Web site: www.peoplespharmacy.org