pharmaceutical

My Statin Comes From India

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According to the USP, the bulk of the APIs come from India. That country is responsible for 50% of the active pharmaceutic ingredients. China is not far behind at 32%. The European Union supplies 10%. That’s a big change since 2000. Back then, European countries like France, Germany, Switzerland and Denmark supplied 42% of the APIs. Drug Recalls From India – Can You Trust Foreign-Made Generics? – https://www.peoplespharmacy.com/articles/more-drug-recalls-from-india-do-you-trust-foreign-made-generics

Dozens of companies received approval from the FDA over the years to sell metoprolol and bupropion in the U.S. Yet from 2018 to 2024, the agency reported running only 2 tests on metoprolol and 7 on bupropion through its quality surveillance program — in each case, by pulling a sample from a single drug maker. In many of those years, the drugs weren’t tested at all, FDA records show. Those that were assessed received passing results. The FDA Often Doesn’t Test Generic Drugs for Quality Concerns, So ProPublica Did – https://www.propublica.org/article/fda-generic-drug-testing

ClinCalc DrugStats Database – https://clincalc.com/DrugStats/

Both articles are long reads but worth your time.

Yikes.

Antidepressant Prescriptions Increase 130% for Teenage Girls

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The increasing rate of mental health disorders among children and adolescents is a concerning trend that has been observed for several decades, with survey studies revealing dramatic increases in anxiety, depression, and suicidal ideation.1 In the United States, suicide ranks as the second leading cause of death for those aged 10 to 19 years and the third leading cause of death for those aged 15 to 24 years.2 Antidepressant Prescriptions and Mental Health – https://publications.aap.org/pediatrics/article/153/3/e2023064677/196661/Antidepressant-Prescriptions-and-Mental-Health

Between January 2016 and December 2022, the monthly antidepressant dispensing rate increased 66.3%, from 2575.9 to 4284.8. Before March 2020, this rate increased by 17.0 per month (95% confidence interval: 15.2 to 18.8). The COVID-19 outbreak was not associated with a level change but was associated with a slope increase of 10.8 per month (95% confidence interval: 4.9 to 16.7). The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand. In subgroup analyses, this rate increased 129.6% and 56.5% faster from March 2020 onwards compared with beforehand among females aged 12 to 17 years and 18 to 25 years, respectively. In contrast, the outbreak was associated with a level decrease among males aged 12 to 17 years and was not associated with a level or slope change among males aged 18 to 25 years. Antidepressant Dispensing to US Adolescents and Young Adults: 2016–2022 – https://publications.aap.org/pediatrics/article/153/3/e2023064245/196655/Antidepressant-Dispensing-to-US-Adolescents-and?autologincheck=redirected

Between 2020 and 2022, antidepressant prescriptions for girls aged 12-17 skyrocketed by 130%. Antidepressants Increase 130% for Teen Girls, Drop 7% For Boys – https://brownstone.org/articles/antidepressants-increase-130-for-teen-girls-drop-7-for-boys/

Yikes.

Not Just For Allergic Rhinitis Anymore

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A common hay fever nasal spray was found to cut COVID-19 infections by two-thirds in a clinical trial, while also reducing rhinovirus cases. Researchers believe it could serve as an easy, low-cost preventive measure, pending further studies. Saarland University. “Common allergy spray slashes COVID-19 risk in surprising trial.” ScienceDaily. http://www.sciencedaily.com/releases/2025/09/250907024535.htm (accessed September 7, 2025).

For Robert Bals, the results suggest practical applications: ‘Azelastine nasal spray could provide an additional easily accessible prophylactic to complement existing protective measures, especially for vulnerable groups, during periods of high infection rates, or before travelling.’ But Professor Bals also stressed the importance of further research: ‘Our results highlight the need for larger, multicentre trials to continue exploring the use of azelastine nasal sprays as an on-demand preventive treatment, and to examine its potential effectiveness against other respiratory pathogens.’

Link to the Jama article – https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2838335 Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections

Prozac is Better Than Viagra (for clams)

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Fluoxetine, the drug commonly known as Prozac, isn’t known to increase sexual prowess in humans. In fact, it often does the very opposite. But when these clams were exposed to the same drug, they instantly jumped to sexual activity. Now, this wasn’t a complete surprise. Research conducted in the 1980s found that if serotonin is injected into the muscles or gonad of clams, they may begin to spawn after just 15 minutes.

How Prozac Might Give Clams a Boost https://undark.org/2025/08/14/excerpt-prozac-clams/

Ketamine in the UK

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Acute harms of ketamine use relate to vulnerability and injuries. Long term use can seriously harm both physical and mental health, diminishing quality of life, affecting personal relationships, and impairing academic or professional performance.9 Ketamine induced uropathy from ulceration and thickening of the bladder is a common and serious complication. In the UK, 27% of regular ketamine users report at least one urological symptom—dysuria, frequency, incontinence, haematuria, or retention—with severity correlated with dose and frequency of use.10 Treatment requires abstinence.11 If abstinence is not achieved, irreversible bladder and kidney damage can occur, requiring urinary tract reconstruction. Long term ketamine use is also associated with “K cramps”—severe abdominal pain. This may be related to liver disease that is similar to primary sclerosing cholangitis but less inflammatory and progressive.12 Acute harms of ketamine use relate to vulnerability and injuries. Long term use can seriously harm both physical and mental health, diminishing quality of life, affecting personal relationships, and impairing academic or professional performance.9 Ketamine induced uropathy from ulceration and thickening of the bladder is a common and serious complication. In the UK, 27% of regular ketamine users report at least one urological symptom—dysuria, frequency, incontinence, haematuria, or retention—with severity correlated with dose and frequency of use.10 Treatment requires abstinence.11 If abstinence is not achieved, irreversible bladder and kidney damage can occur, requiring urinary tract reconstruction. Long term ketamine use is also associated with “K cramps”—severe abdominal pain. This may be related to liver disease that is similar to primary sclerosing cholangitis but less inflammatory and progressive.12 — Non-prescribed ketamine use is rising in the UK – https://doi.org/10.1136/bmj.r1167

Yikes.

Update 07.05.25 – https://www.bbc.com/news/articles/c70r1xdyy59o

Glenmark Pharmaceuticals Recall (check your prescription bottles)

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In February, the FDA found problems with cleaning and testing at the plant in Madhya Pradesh, India, which was the subject of a ProPublica investigation last year. The current recalls, listed in an FDA enforcement report last week, cover a wide range of commonly prescribed medicines, including ones that treat epilepsy, diabetes, multiple sclerosis, heart disease and high blood pressure, among other ailments. ​​A full list of the recalled medications is available here. An Indian Drugmaker, Investigated by ProPublica Last Year, Has Recalled Two Dozen Medications Sold to U.S. Patients https://www.propublica.org/article/glenmark-recalls-two-dozen-drugs

Time to bring the pharma supply chain back onshore.

Controlled Substance Prescribing Patterns – Pennsylvania

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Rates of psychostimulant (stimulant)-related overdose deaths in the United States have increased substantially since 2010; in 2022, 32% of all overdose deaths involved stimulants. Citation: Hayden S, Murzynski SM, Bolton A, Goetz CT. Controlled Substance Prescribing Patterns Among Fatal Overdose Decedents with an Opioid, Stimulant, or Both Contributing to Death — Pennsylvania, 2017–2022. MMWR Morb Mortal Wkly Rep 2025;74:205–209. DOI: http://dx.doi.org/10.15585/mmwr.mm7412a2

Prescribed stimulants. Read more here – https://www.dea.gov/factsheets/stimulants

Happy Friday!

ASCOT-Legacy 20-year follow-up – Long-term Benefits of Atorvastatin

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Patients allocated to atorvastatin had a significant reduction in non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD) events (HR (95% CI) 0.81 (0.69 to 0.94, p=0.006)), total coronary events (0.88 (0.80 to 0.98, p=0.017)) and CV deaths (0.86 (0.74 to 0.99, p=0.048)). No significant reduction in heart failure (HF), strokes, total CV events and all-cause mortality was observed. Long-term benefits of atorvastatin on the incidence of cardiovascular events: the ASCOT-Legacy 20-year follow-up – https://heart.bmj.com/content/early/2025/03/25/heartjnl-2024-325104

Dr. M. Zann McMahan, thank you.

Antidepressant Use Associated With Cognitive decline in Patients with Dementia

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In this cohort study, use of antidepressants was associated with faster cognitive decline in patients with dementia, in particular SSRIs (i.e., citalopram, sertraline and escitalopram) and mirtazapine. These effects appeared to be more pronounced in patients with more severe dementia. Compared with sertraline, escitalopram presented faster cognitive decline, while citalopram was linked to a slower cognitive decline. Additionally, higher dispensed doses of SSRIs were associated with greater cognitive decline, as well as increased risks of severe dementia, all-cause mortality, and fracture. Our study cannot distinguish whether these findings are due to the antidepressants or the underlying psychiatric indication. Mo, M., Abzhandadze, T., Hoang, M.T. et al. Antidepressant use and cognitive decline in patients with dementia: a national cohort study. BMC Med 23, 82 (2025). https://doi.org/10.1186/s12916-025-03851-3

If I develop dementia no SSRI’s for me please.