The current investigators analyzed national healthcare claims from the US Medicaid program from 2001 to 2010 for 39,582 Medicaid beneficiaries (mean age, 44.5 years; 78.5% women) diagnosed with depression. Patients with alternative indications for anti-psychotic therapy, such as schizophrenia, psychotic depression or bipolar disorder, were excluded.
After a period of at least 3 months of treatment with a single antidepressant, more than half of the patients (56.6%) augmented their treatment with one of these atypical anti-psychotics: quetiapine, risperidone, aripiprazole or olanzapine. The remaining patients (43.4%) added a second antidepressant. The average chlorpromazine-equivalent starting dose for all atypical anti-psychotics was 68 mg/day, which increased to 100 mg/day during follow-up.
A total of 153 patients died during 13,328 person-years of follow-up, including 105 who augmented with an atypical anti-psychotic and 48 who augmented with a second antidepressant.
Compared with those who added a second antidepressant, those who added an anti-psychotic had a 45% increased risk of dying during follow up (adjusted hazard ratio,1.45; 95% CI, 1.02 – 2.06).
Antipsychotic Added to Antidepressant Linked to Higher Mortality – Medscape – Oct 07, 2020. https://www.medscape.com/viewarticle/938707?src=rss#vp_1
pharmaceutical
PPI Use Linked to Elevated Mortality Risk
PPI Use Linked to Elevated Mortality Risk
During a median 10 years’ follow-up, 37% of participants died. There were 46 excess deaths per 1000 PPI users in that time. PPIs were associated with excess mortality from cardiovascular disease (CVD) and chronic kidney disease (CKD). Patients without indications for PPI use had higher mortality risk from CVD, CKD, and also upper gastrointestinal cancer. Longer duration of use was associated with greater risk.
The NEJM Journal Watch summary has a link to the full study from BMJ.
Americans Cross Border Into Mexico To Buy Insulin At A Fraction Of U.S. Cost — Kaiser Health News
When Michelle Fenner signed up to run this year’s Los Angeles Marathon, it got her thinking: Tijuana, Mexico, is only a 2½-hour drive from L.A. Why not take a trip across the border and buy some insulin for her son? “It’s so easy to just go across the border,” mused Fenner. This idea had been…
via Americans Cross Border Into Mexico To Buy Insulin At A Fraction Of U.S. Cost — Kaiser Health News
Fifteen percent of osteoporosis patients who take ‘drug holidays’ suffer bone fractures
A Loyola Medicine study has found that 15.4 percent of patients who take so-called “drug holidays” from osteoporosis drugs called bisphosphonates experienced bone fractures. During a six-year follow-up period, the yearly incidence of fractures ranged from 3.7 percent to 9.9 percent, with the most fractures occurring during the fourth and fifth years.
The study by senior author Pauline Camacho, MD, and colleagues was published in the journal Endocrine Practice.
Benzo Update 02.25.18
Between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67 percent, from 8.1 million to 13.5 million. Unlike opioid prescribing, which peaked in 2012 and has decreased nearly 20 percent since then, benzodiazepine prescribing continues to rise. The risk of overdose death goes up nearly fourfold when benzodiazepines are combined with opioids, yet rates of co-prescribing benzodiazepines and opioids nearly doubled between 2001 and 2013. Overdose deaths involving benzodiazepines increased more than sevenfold between 1999 and 2015.
Anna Lembke, M.D., is associate professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and author of “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop” (Johns Hopkins University Press, 2016).
You can read the full article here.
Gabapentin Misuse and Abuse
Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state.
A literature review published in 2016 in the journal Addiction found about a fifth of those who abuse opiates misuse gabapentin. A separate 2015 study of adults in Appalachian Kentucky who abused opiates found 15 percent of participants also misused gabapentin in the past six months “to get high.”
In the same year, the drug was involved in 109 overdose deaths in West Virginia, the Charleston Gazette-Mail reported.
Now slowly focus on the following sentences:
Gabapentin can enhance the euphoria caused by an opioid and stave off drug withdrawals. In addition, it can bypass the blocking effects of medications used for addiction treatment, enabling patients to get high while in recovery.
Guanfacine
If you want to know what this is you’ll have to read this article.
Ten Drugs Make New FDA Watch List
Source: Ten Drugs Make New FDA Watch List
Side effects under investigation.
Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease — NEJM
Conclusions: Treatment with rosuvastatin at a dose of 10 mg per day resulted in a significantly lower risk of cardiovascular events than placebo in an intermediate-risk, ethnically diverse population without cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; HOPE-3 ClinicalTrials.gov number, NCT00468923.)
Source: Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease — NEJM
Source: Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease — NEJM
Source: Blood-Pressure and Cholesterol Lowering in Persons without Cardiovascular Disease — NEJM
What is Meldonium? – The Guardian
Meldonium is also known as mildronate, it increases exercise capacity in athletes and the Olympic figure skater Ekaterina Bobrova admitted to testing positive to the drug on Monday
Source: What is meldonium and why did Maria Sharapova use it? | Sport | The Guardian
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