- Patients with congenital long QT syndrome are at particular risk of torsades de pointes, ventricular tachycardia and sudden death when given drugs that prolong the QT interval. Nevertheless, the labeling recommendation for patients with congenital long QT syndrome has been changed from “contraindicated” to “not recommended,” because it is recognized that there may be some patients with this condition who could benefit from a low dose of citalopram and who lack viable alternatives. Similarly, the drug is not recommended for those who have bradycardia, hypokalemia or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure.
- Although citalopram use should be avoided, if possible, in patients with certain conditions because of the risk of QT prolongation, ECG monitoring and electrolyte monitoring should be performed if citalopram must be used in these patients.
- The maximum recommended dose of citalopram is 20 mg per day for patients with hepatic impairment, adults older than 60, patients who are CYP2C19 poor metabolizers, and those who are taking cimetidine or another CYP2C19 inhibitor concurrently.
- Citalopram should be discontinued in patients who are found to have persistent QT measurements (corrected for heart rate) greater than 500 milliseconds.
Pharma
Minor Trauma Led to Death in Pradaxa Patient
Dabigatran etexilate is an oral anticoagulant that acts as a direct, competitive thrombin inhibitor. It does not require routine monitoring and has been approved by the FDA for the prevention of stroke and systemic embolism in patients with atrial fibrillation. Note, however, that no effective reversal agent for dabigatran in the event of catastrophic hemorrhage has been identified.
On the article’s webpage you’ll find a link to download a PDF copy of the source article.
Antidepressant Use Soaring – MayoClinic.com
One in 10 people over age 12 in the United States is taking an antidepressant, according to the National Health and Nutrition Examination Survey, which is conducted by the Center for Disease Control. Women between the ages of 40 and 59 are the most likely group to take antidepressants. In this age range, 23 percent of U.S. women are taking one.
via Antidepressant use soaring among Americans 12 and over – MayoClinic.com.
Effect of Two Intensive Statin Regimens on Progression of Coronary Disease — NEJM
Acetaminophen OD More Deadly if Taken in Stages
Those who ingested more than 4,000 mg of acetaminophen in a single day spread out over more than one time point had a significantly higher mortality rate compared with those who overdosed at a single time point (37.3% versus 27.8%, P=0.025), according to Kenneth Simpson, MD, of the University of Edinburgh in Scotland, and colleagues.
The cohort analysis included 663 patients admitted with acetaminophen-induced severe liver injury from November 1992 through October 2008. About one-quarter (24.3%) overdosed in a staggered fashion, defined as taking at least two excessive doses separated by more than eight hours and adding up to more than 4,000 milligrams in one day. The rest of the patients ingested that much at a single time point.
Most of the patients who had a staggered overdose (58.2%) said that pain relief was the reason they repeatedly took an excessive dose. Another 34.3% said it was a suicide attempt.
Learn more at Acetaminophen Toxicity.
Personally I rarely take the stuff. It’s pure poison for the liver.
Intermezzo – Think Low-Dose Zolpidem (Ambien)
Say Farewell to Lipitor but Don’t Forget Its Lessons – Harvard Business Review
The strategic deals that secure a company’s future are the ones that diversify risk, not double down on it.
via Say Farewell to Lipitor but Don’t Forget Its Lessons – Christopher Bowe – Harvard Business Review.
I couldn’t have said it better myself. Read the post. It’s worth your time.
Pradaxa Bleeding Deaths
Medical News: Pradaxa Bleeding Deaths Raise Concern – in Cardiovascular, Strokes from MedPage Today
Dabigatran Etexilate: A Novel Oral Direct Thrombin Inhibitor: Abstract and Introduction
We are talking about a direct thrombin inhibitor, yes? Then this news should not be surprising.
ADHD Drugs and CV Events
ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults — NEJM
In conclusion, in our study involving children and young adults with 2.5 million person-years of follow-up, there were 3.1 serious cardiovascular events per 100,000 person-years. Although the point estimates of the relative risks for ADHD drugs did not indicate increased risk, the upper limit of the 95% confidence interval suggested that a doubling in the risk could not be ruled out. However, the absolute magnitude of any increased risk would be low.
The entire article is worth reading given the potential serious side effects of the drugs in question.
FME’s – 2011
CDC Features – Prescription Painkiller Overdoses in the U.S.
Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs—more than those who die from heroin and cocaine combined.
Thinking About Heath..Just Another FME | Underwriting Solutions LLC
It’s been over three years since I posted about Heath Ledger and his unfortunate FME (Fatal Medication Error). Fresh research from the CDC indicates the problem is getting worse. The current state of the US economy virtually guarantees the staggering increase in prescription painkiller abuse and overdose will get worse before it gets better.
lifeunderwriter.net 
You must be logged in to post a comment.