Risks of Cigar Smoking Detailed

In yet another warning about the dangers of one of the hottest trends of the '90s, a new study has found that cigar smokers are twice as likely as nonsmokers to get cancer of the mouth, throat and lungs. They also run about 1 1/2 times the risk of all smoking-related cancers together and are more likely to develop heart disease or chronic obstructive pulmonary disease.

The study, published in the New England Journal of Medicine today, was conducted by Carlos Iribarren, an epidemiologist at the Kaiser Permanente Medical Care Program in Oakland, Calif., who examined the medical records of 1,546 regular cigar smokers and 16,228 nonsmokers from 1971 through 1995. Most of the cigar smokers smoked fewer than five a day.

The risks aren't as high as they are for cigarette smokers because cigar smokers usually don't inhale the smoke and hold it in their lungs. Cigarette smokers have about three times as high a risk of coronary heart disease as nonsmokers, 10 times the risk of lung cancer and 20 to 25 times the risk of cardiac lung disease, Iribarren said.

`Sleep Attack' Side Effect Reported

Two new drugs for Parkinson's disease may suddenly put patients to sleep, a dangerous narcolepsy-like side effect termed "sleep attack" that has caused at least eight people to have car wrecks, a doctor warned yesterday.

The Food and Drug Administration is talking with the manufacturers about whether the drugs need additional warning labels.

Steven Frucht of Columbia-Presbyterian Medical Center in New York, who reported the eight cases in the journal Neurology, said Parkinson's patients should not overreact to the warning and stop taking the drugs, which can be very helpful in treating Parkinson's symptoms. Patients should tell their doctors whether they feel sedated or ever have suffered a sleep attack, he said.

Eight men taking the drug Mirapex, known chemically as pramipexole, suffered sleep attacks while driving that resulted in accidents, although none of the patients was injured, Frucht said. Four also experienced sleep attacks during business meetings and phone calls. Six stopped taking Mirapex while two others reduced the dose, and the sleep attacks stopped.

But one former Mirapex patient then switched to a second Parkinson's drug called Requip, known chemically as ropinirole, and suffered another sleep attack while driving.

The effect appears rare: More than 100,000 Americans take these drugs, and the FDA said it knew of no other cases.

When the FDA approved Mirapex and Requip in 1997, it noted on the drugs' labels that they occasionally cause somnolence, and thus driving would not be a good idea until the patients have taken the medicines long enough to tell if they are susceptible. But somnolence -- that drowsy feeling that even over-the-counter drugs such as antihistamines often cause -- is very different from a sleep attack, said Frucht, describing the attacks as overwhelming and irresistible sleepiness that comes without warning.