Dear Dr. Roach: I have a serious problem with my fingernails splitting and coming off at the edges. I have tried biotin and keratin for almost a year without results. I am an 89-year-old man who takes ibrutinib, Valtrex, allopurinol, cetirizine, and recently Eliquis and metoprolol succinate. Is there a solution for this sore, uncomfortable situation?
P.M.L.
Oncholysis is when the nail separates from the nail bed, while onychorrhexis is the splitting of the nails. There are a surprisingly large number of skin and general medical conditions that can cause these problems. Constantly working with wet hands and some chemical exposures (including nail polish, acrylic gels and polish remover) can all cause nail problems. Up to 20% of older people will have some kind of brittle nail condition. High levels of thyroid hormone, especially with Grave’s disease, cause oncholysis and should be checked.
However, ibrutinib, a tyrosine kinase inhibitor used for B-cell leukemias and lymphomas, is well-known to cause this problem. In one study, 67% of patients treated with ibrutinib developed brittle nails, while 25% developed hair issues.
Biotin is a good choice to try, even though it’s only effective in about 25% of people with this condition, because it is safe and inexpensive. It does interfere with laboratory tests for hormones, especially the thyroid hormone, making test results seem abnormal when everything is OK. (You should be off biotin for two days before getting your thyroid tested.) There are prescription nail lacquers that might be helpful if your oncologist has no alternative to ibrutinib.
Dear Dr. Roach: In a recent column, you noted that some common medicines can cause weight gain. Which types of medicines can do this?
B.B.
Probably the largest group of medications that can cause weight gain are psychiatric medicines. Antidepression medicines of the tricyclic class (amitriptyline, mirtazapine and many others) and SSRIs can frequently cause weight gain. Antipsychotics (especially clozapine, but many others) routinely cause weight gain, sometimes a very great amount of weight. Some antiseizure medicines, like carbamazepine and gabapentin, can as well.
In some people, many diabetes drugs can cause weight gain, such as insulin and those that increase insulin in the body like glyburide, glipizide and sitagliptin. Oral contraceptives that contain progestins can cause weight gain; this means all combination birth control pills and “minipills.”
Some blood pressure medicines, especially the beta blockers (whose names all end in “-olol”) may cause weight gain, and many prescribers underestimate this effect. The HIV medicines of the protease inhibitor class cause weight gain, and all corticosteroids like prednisone and hydrocortisone almost universally cause weight gain.
There are usually alternatives to these medications that can be tried before attempting to use other medications to counteract this side effect.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
