Medications

Physicians writing on KevinMD about the drugs they prescribe and the ones they cannot get: prior authorization and step therapy, opioid prescribing and the tapers that followed the CDC guideline, the GLP-1 drugs from Ozempic to oral Wegovy and what happens when patients stop them, shortages, compounded versions, and what a prescription costs the patient. Three maintained records draw on this archive: Opioids: what physicians and pain patients say, in their own words, Prior authorization: what physicians say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

Requiring a prescription for pseudoephedrine: How effective is that?

David P. Smith, MD

Medications

August 2, 2014

The State of Mississippi passed a law in 2010 which banned sales of pseudoephedrine without a prescription. The law has resulted in a dramatic improvement in which 698 total methamphetamine (meth) incidents with 314 operational labs were identified in 2010 while there were 119 incidents with only 8 labs in 2013. Other states such as Tennessee are considering similar laws and Oregon already has a law in place as restrictive …

The execution in Arizona: There’s no mystery why it took so long

Karen S. Sibert, MD

Medications

August 2, 2014

There’s no mystery about why the July 23 execution of Joseph Wood in Arizona took so long. From the anesthesiologist’s point of view, it doesn’t seem surprising that the combination of drugs used — midazolam and hydromorphone — might take nearly two hours to cause death.

Here’s why.

The convicted murderer didn’t receive one component of the usual mixture of drugs used in lethal injection: a muscle relaxant. The traditional cocktail includes …

The unintended consequences of well-meaning FDA regulations

Brian C. Joondeph, MD

Medications

July 29, 2014

We rely on the FDA to protect public health “by assuring the safety, efficacy, and security” of medical drugs and devices. The FDA takes its marching orders from Congress via the legislative process. One such law is the Compounding Quality Act of 2013, passed in response to a series of fatal infections due to improper compounding pharmacy processes. While such oversight is important and well meaning, the unintended consequences may be …

Contrave: A promising new approach in the fight against obesity?

David Macklin, MD

Medications

July 27, 2014

As a family physician whose practice deals exclusively in the treatment of obesity, it strikes me as remarkable how little we understand about the disease, which is Canada’s second-leading cause of preventable death.

In every region of the developed world, obesity doubled in the twenty years between 1988 and 2008, according to World Health Organization, which now count more than a half-billion of Earth’s population as obese. The Public Health Agency …

Streamlining the process to approve new drugs can save lives

Nathan Fountain, MD

Medications

July 14, 2014

My heart sinks each time I see the subject line in this too common email I receive in my medical practice: “Sad news: Matthew was fine when he went to bed last night but his mother found him dead in bed this morning.” Matthew (not his real name) had epilepsy with seizures that persisted despite use of currently available antiseizure medications.

We started Matthew’s evaluation when the latest antiseizure medication had been …

Treating hepatitis C: Is sofosbuvir worth it?

Ashish Advani, PharmD

Medications

July 14, 2014

In 2011, Food and Drug Administration Commissioner Margaret Hamburg remarked upon a “new direction in the treatment of hepatitis C,” as a success rate of approximately 70% marked a significant improvement over the previous rate of approximately 50%, and suggested a cure was in sight.

Today, that cure has been realized as Sovaldi (sofosbuvir), a novel agent, has shown a success rate of 95% in clinical trials. Sofosbuvir comes without the …

Why we’re not ready to embrace Eastern medicine

Armaan Rowther

Medications

July 12, 2014

“The Eastern medicine revolution?”

These were the words emblazoned across the screen behind Dr. David L. Katz, founding director of the Yale-Griffin Prevention Research Center, as he discussed the growing popularity of holistic integrative medicine on a recent edition of the Katie Couric Show.

The conversation centered on the opening of Cleveland Clinic’s Chinese herb therapy ward in January of this year, the first of its kind at a major U.S. hospital. Dr. …

MKSAP: 64-year-old man with knee osteoarthritis

mksap

Medications

July 12, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old man is evaluated for a 2-year history of knee osteoarthritis. He has bilateral knee pain that worsens with walking. He has tried topical therapies, physical therapy, and acetaminophen, none of which has provided relief. The patient also has peripheral vascular disease, hyperlipidemia, and hypertension. Medications are hydrochlorothiazide, pravastatin, and a …

Why are doctors still prescribing Zetia?

Janice Boughton, MD

Medications

July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

Ailments are big business

Hans Duvefelt, MD

Medications

July 8, 2014

Back when Prozac (fluoxetine) and Zoloft (sertraline) were new, I remember the mental acrobatics doctors made to justify giving these drugs to anxious patients. The drugs were approved for treating depression, but we knew they often seemed to help anxiety. The reason, we were told, was that some anxious patients were actually depressed, deep down, and we had just failed to recognize their depression.

Now, with studies to support their use …

Read more…

Ailments are big business

Guessing if medications are covered by a patient’s insurance company

Michael Kirsch, MD

Medications

July 7, 2014

One of the frustrating aspects of medical practice is trying to decide if the medication I am prescribing is covered by the patient’s insurance company. Even with the advent of electronic medical records, which should be able to determine this, we are often left to hope and pray.

Here’s how it works. Individual insurance companies have formularies — lists of approved drugs — that they encourage patients and their physicians to use. …

Navigating the prescription drug abuse epidemic

Chiduzie Madubata, MD

Medications

July 2, 2014

Over the past few months, more attention has been paid to the prescription drug epidemic, with increasing rates of accidental deaths noted across the country. Legislatures in different states are currently considering laws to provide first responders access to reversal agents, such as naloxone, to treat people found on the scene who have likely overdosed on these medications. With increasing media coverage, the public is becoming more aware about the …

The case of Makena: Speaking out against unfair drug pricing

Rekha Murthy

Medications

June 29, 2014

I’m 34 weeks pregnant and working hard to keep this baby inside me for as long as possible. As with my last pregnancy, there’s a real risk that the baby could come too early. But we’re both holding on so far, thanks to a combination of luck, modified bed rest and medical science.

The science is my biggest concern right now. I will spare you much of it because, man or …

E-cigarettes are an emerging threat to children

Afshine Ash Emrani, MD

Medications

June 29, 2014

There is a new emerging health threat to our children: nicotine poisoning.

The number of nicotine exposures in children reported to the National Poison Data System has more than tripled in the last year.

Here’s the fact every parent should know: 1 tablespoon of nicotine oil can be lethal to a 60-pound child!

When doctors were campaigning against tobacco companies through public health legislation, we did not foresee a resultant new market for …

A prostate cancer breakthrough: The good and not-so-good news

J. Leonard Lichtenfeld, MD

Medications

June 18, 2014

The annual meeting of the American Society of Clinical Oncology is a place where many commercial interests jostle for attention to make their latest promising therapy the star of the show. But a standard widely available generic drug stole the show by producing incredible results in improving survival for men with advanced prostate cancer. And that has some of us …

Dr. Bob Sears deserves blame for declining vaccination rates

Jennifer Gunter, MD

Medications

June 9, 2014

Measles is on its way to an all time high.

In 2000, measles was eliminated (meaning some travelers from areas with low vaccine penetration might arrive in the U.S. with the disease, but no case came from U.S.), but has been slowly creeping back. Since 2008, this has been more than a trickle.

Let’s put the important goal of measles elimination in perspective. Before …

Applying the anti-vaccine mentality to car seats

Lucy Hornstein, MD

Medications

June 9, 2014

What if a big TV station came out with a blockbuster story claiming that infant car seats were implicated in cerebral palsy (CP)? After all, something like 99.7% of babies diagnosed with cerebral palsy had been brought home from the hospital in a car seat. In fact, every single time they went anywhere in a car, they were strapped into them. That’s …

The problem with an anti-medication bias

Albert Fuchs, MD

Medications

June 6, 2014

“I don’t like taking medicines.”

All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans.

When I was new to practice such an utterance would shock and confuse me.

“I don’t want to take any medicines,” a patient would declare.

“That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going …

Find yourself a physician who is stingy with prescriptions

Roy Benaroch, MD

Medications

June 5, 2014

Antibiotic use is the direct cause of the rise of untreatable superbugs that are killing people.

Antibiotic use is also the cause of most cases of C. diff colitis in kids, a potentially life-threatening, difficult-to-treat gut disorder. Antibiotics have also been linked with recurrent wheezing in infants and inflammatory bowel disease. They can also trigger allergic reactions that can be …

Medical cannabis: Be informed and challenge the myths

Arielle Gerard, MD, MPH

Medications

June 1, 2014

Medical cannabis is a treatment option with a low risk of dependence, minimal side effects, and few detrimental health effects, that has the potential to help hundreds of thousands of people suffering from various debilitating symptoms. Medical cannabis has gotten a bad rap over the past several decades in the United States due to laws put into place in the early-mid …

Medications

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